Personality Disorder Patients’ Perspectives on the Introduction of Imagery Within Schema Therapy: A Qualitative Study of Patients’ Experiences

• Published in: Cognitive and behavioral practice Vol. 18; no. 4; pp. 482 - 490
• Main Authors: ten Napel-Schutz, Marieke C., Abma, Tineke A., Bamelis, Lotte, Arntz, Arnoud
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.11.2011; Elsevier
• Subjects: Counseling Effectiveness; Counseling Techniques; Imagery; imagery rescripting; Interviews; Patients; Personality; personality disorders; Personality Problems; Psychotherapy; Qualitative Research; schema therapy; Schemata (Cognition); schema therapy; qualitative research; imagery rescripting; personality disorders; imagery
• ISSN: 1077-7229; 1878-187X
• DOI: 10.1016/j.cbpra.2011.04.005

A qualitative study was done on patients’ perspectives on the first phases of imagery work in the context of schema therapy (ST) for personality disorders. Patients participated in a multi-center randomized controlled study of the effectiveness of ST. Patients’ experiences and opinions were collected with semistructured in-depth interviews at the time when they were still in the early phases of treatment. The interviews were analyzed using a thematic analysis. For validation, a so-called member check was completed, in which participants could indicate whether they agreed or could correct the transcripts and the conclusions we drew from their interviews. We concentrated on the first imagery techniques that are used as preparation for imagery rescripting; that is, diagnostic imagery and imagery of a safe place. We compared the experiences reported by the patients with Young, Klosko, and Weishaar's (2003) ST manual. The results show that early imagery techniques in ST are considered a valuable method. However, patients emphasize that more attention should be paid to the emotional impact of this specific technique. They report lacking information, communication, and support during the initial phases of imagery work. Furthermore, patients mention that the duration of the imagery exercises is unpredictable; this creates feelings of uncertainty and fear. These results give essential information for protocol adjustments for the use of early imagery techniques and for the implementation of ST. ► In this qualitative study we asked patients about their experiences with early imagery techniques in ST. ► It is considered as a valuable method but more attention should be paid to the emotional impact of these techniques. ► Introduction and evaluation of the technique should be done regularly and in an open dialogue. ► Therapists have to see their patients more as full conversation partners from whom they can learn. ► The experiences and opinions of patients should have a prominent place in the implementation of ST for PD.