SCHEMA THERAPY: THE NEXT GENERATION, BUT SHOULD IT CARRY A HEALTH WARNING?

Abstract

Cognitive behaviour therapists working in the field over the last 10 years will have witnessed a shift to more schema focused forms of therapy. While these approaches have been introduced to treat people with personality disorders, they have also had a strong influence on the treatment given to people suffering from Axis I disorders. Indeed, it is my impression that many therapists are now of the opinion that they are not doing proper cognitive behaviour therapy (CBT) unless they have undertaken a detailed history of a patient's early childhood and, along the way, unearthed a couple of core beliefs. This paper outlines some of the pitfalls concerning the shift of emphasis towards schema focused techniques. While it is acknowledged that schema work is a development of “traditional” CBT, it is proposed that schema therapy is being employed without adequate assessment of its appropriateness, especially when used in primary care settings with people with no prior history of psychiatric problems. This paper provides some anecdotal details about therapists' difficulties in using schema techniques. These examples stress the need for good supervision, highlighting the responsibility of therapists to ensure that the patient receives the most appropriate form of therapy. This work recognizes the importance of schema focused approaches, but suggests that they are being used too pervasively, and too often by people with neither sufficient training, nor adequate grounding, in the empirically validated “traditional” CBT approaches.