What Works in Therapy? Patients' Views on Effective Elements of Schema Therapy Versus Treatment as Usual for Cluster‐C Personality Disorders

Although Schema Therapy (ST) shows promise as an intervention for cluster-C personality disorders (PD), little is known about how patients experience ST. This study explored patients' experiences with Individual ST (IST) and Group ST (GST), and exploratively compared these with specialized Treatment As Usual (sTAU). Specifically, we explored patients' experiences with regard to the format (group vs. individual), the therapeutic relationship, specific ST techniques, patients' ability to participate and practical aspects of the protocols. Thirty participants from a multicenter randomized controlled trial (RCT), comparing IST, GST, and sTAU, were interviewed after completing treatment. The data were analyzed using thematic analysis guidelines. Patients reported both facilitating and hindering factors: Patients described the group format as providing unique learning opportunities, recognition, and support, yet many patients preferred additional individual sessions for more personalized attention to treatment goals. GST participants also suggested implementing screening procedures for group therapy suitability and extending the number of sessions. Across both IST and GST, patients perceived the therapeutic relationship and specific ST techniques, such as the mode model and Imagery Rescripting, as important contributors to their recovery process. Within the therapeutic relationship, a directive yet empathic approach was appreciated, and continuity of care was considered essential for building trust and rapport. Interviewed patients suggested that ST protocols could be further improved by simplifying and tailoring the mode model, offering diverse forms of ImRs, and enhancing personalization to patients' individual needs.