Imagery

The right hemisphere of the brain is the dominant hemisphere during early childhood and, consequently, the hemisphere through which a young child experiences her formative relationships. For this reason, most early maladaptive schemas are believed to be experienced and stored within the patient’s right hemisphere. The right hemisphere has the strongest links with the limbic part of the brain (the seat of our emotions) and, consequently, is directly connected to our deepest and most powerful feelings. Imagery is a primary means by which the right hemisphere organizes and processes information about self, others and affect and, therefore, is often an important means of gaining direct access to the “vulnerable child part” of the patient in relation to significant others and the associated “gut level” feelings that make up schemas. Guided imagery is often used early in schema therapy to more clearly and deeply understand schemas and modes. This is accomplished by:

1. Eliciting upsetting childhood memories in the form of images of experiences with mother, father and other significant people.
2. Asking the patient to carry on dialogues with these people.
3. Asking the patient what she needs from significant others and understanding these needs in terms of the associated schemas.
4. Asking the patient to identify what current situations have the same emotions as the images from early childhood and, thus, clarifying the links between early memories and current triggers of schemas and modes.

Through this process a resonance is established between the therapist’s right hemisphere as she imagines the imagery the patient is describing by way of her vulnerable child mode and the patient’s right hemisphere. This right hemisphere to right hemisphere resonance is believed to deepen and intensify the emotional connection between therapist and patient.

Imagery is also often an important element of the change phase. This involves a process called “imagery rescripting” through which painful memories are revised in ways that allow for the patient to get their needs met. In instances where parents or significant others were, and remain, unable to meet the patient’s needs, this involves the therapist entering into an image and serving as a transitional source of healthy parenting. This leads to a secure attachment developing between the patient and therapist; a form of attachment that is known to lead growth and integration. Imagery during the change phase also involves the patient being encouraged to express anger towards the individuals that have hurt them and helped to assert her rights. This will occur within an image or role-play during a session and not necessarily with significant others.

Imagery is also used to help patients grieve for the losses in their life and to overcome trauma. In the case of trauma, imagery rescripting involves a reworking of the traumatic memories in the direction of needs such as safety and protection being met rather than primarily a process of exposure and desensitization. Later in therapy, as the patient’s healthy adult mode becomes stronger, she will enter images that include the vulnerable child mode and take the lead in meeting needs.

(by George Lockwood Posted on 22 February, 2009)

Flash Cards

Flash cards are written statements referred to by the patient in-between sessions. They are developed by the therapist or a co-creation of therapist and patient and are statements that would similar to those made by a parent to a young child at the developmental age that the patient currently experiences their Vulnerable Child mode. They serve as links to the therapist and, as such, as transitional objects; especially in the early phases of treatment of work on problems rooted in early attachment. The messages and sentiments expressed in the cards are gradually internalized and, thus, are very helpful in developing the Healthy Adult mode. Patients who suffer from problems such as BPD often find flash cards to be especially powerful. Flash cards are often developed for each type of challenging situation and phase of treatment. They can take various forms such notes or poems, depending of the creativity of the therapist and the developmental level of the Vulnerable Child mode, and may be carefully thought out or spontaneous gestures.

(by George Lockwood. Posted April 5, 2009)

Chair Work

Chair work involves the patient moving between two chairs as she dialogues between different parts of herself such as a schema side and the healthy side or a Detached Protector Mode and the Healthy Adult Mode. Dialogues can also take place between the patient and imagined significant others for such purposes as reaching closure or practicing assertiveness. Imagery work and chair work are frequently blended with one another.

(by George Lockwood, Posted on April 26, 2009) 

Schema Therapy Diaries

A Schema Therapy Diary is a form filled out in-between sessions that provides a guide for the patient to organize their experience when schemas or modes are triggered in terms of what they have been learning in the therapy. Schema driven reactions are sorted out in terms of thoughts, feelings, behaviors, underlying schemas, healthy perspectives and realistic concerns, overreactions, and healthy behavior. It is a summary of all the major elements and stages of the therapy process and, as such, provides an important template. For some patients and therapists the Schema Diary in internalized and not used explicitly, especially at later stages in the therapy. For other therapist-patient pairs it becomes an important tool to further the internalization of healthy adult processes.

(by George Lockwood. Posted on 12, July 2009)