Closing the suitcase: forensic service users’ experiences of imagery in schema therapy

摘要

Schema therapy was developed as a treatment for chronic and entrenched psychological difficulties, and has progressed to be used as an offence focused intervention that addresses dynamic risk factors. This thesis investigated the lived experiences of people with diagnoses of personality disorder who had offended and who had used the technique of imagery in schema therapy. This was explored because although the literature around schema therapy demonstrates some support for the effectiveness of schema therapy holistically, the individual components of this therapy have not been explored. Interpretative Phenomenological Analysis is felt to be an appropriate methodology to address this gap in the literature as it explored imagery from the perspective of those who had experienced it and also acknowledged the researcher‟s influence in co-constructing the understanding of the experience. This methodology allowed for a starting point of knowledge by beginning to develop an understanding of this area which could potentially inform future research. Semistructured interviews were conducted with six people diagnosed with Personality Disorder, who had offended and who had used imagery in schema therapy. Their experiences were explored using Interpretative Phenomenological Analysis. Throughout analysis a metaphor of life as a journey on which one carries carry emotional baggage resonated and themes were named accordingly. An overarching theme of the life journey (as temporal) enveloped three super-ordinate themes of opening the suitcase (revisiting trauma), unpacking and ordering the contents (therapeutic processes), and closing the suitcase (therapeutic outcomes). The super-ordinate theme of opening the suitcase incorporated a subordinate theme of reconnecting with the childhood self which overlapped with the super-ordinate theme of unpacking and ordering the contents. The super-ordinate theme of unpacking and ordering the contents included three subordinate themes, 1) emotional control (i.e. attempts to control emotions isolate people from others, but losing control of emotions during imagery leads to interpersonal connectedness with the therapist), 2) moving on versus being stuck in the past and 3) the therapeutic relationship as characterized by trust, and meeting needs. The second of these subordinate themes was felt to overlap with the super-ordinate theme of closing the suitcase. The super-ordinate theme of closing the suitcase was felt to contain two subordinate themes of healing the fractured self and applying what has been learned. All three super-ordinate themes were penetrated by another theme; distancing from the trauma (protection from emotional pain). This theme was felt to be embedded within descriptions of revisiting the trauma, re-connecting with the childhood self, emotional control, the therapeutic relationship, healing the fractured self and applying what has been learned. Two other minor themes were also identified relating to use of professional language and avoidance. It was concluded that for the six participants in this study, imagery was described as a process that enabled them to close the suitcase and put it away without fear that its contents would be unintentionally disgorged. These results represent the first qualitative exploration of people's lived experiences of imagery in schema therapy. The results add to the literature around both schema therapy and imagery separately. Although these results are not generalisable, they may be transferable to other groups that have topographically similar experiences and therefore they offer a new way to understand imagery in schema therapy.