Schematic mismatch in the therapeutic relationship: A social-cognitive model

Cognitive-behavioural therapists recognise the therapeutic relationship as an important component of the process of change. The therapeutic relationship is a co-construction shaped via interactional sequences that occur when the therapist and patient are reacting moment-to-moment with each other. Robert Leahy reviews common dimensions of confusion, disappointment, conflict and resistance in the therapeutic relationship that emerge from these sequences. Of specific focus are the personal schemas and emotional schemas that both patient and therapist bring to the relationship, and how these individual schemas can create mismatches and thus disrupt interactions that can interfere with treatment. Seven common patterns of resistance that interfere with progress are identified, as well as interventions that may be useful in overcoming these potential roadblocks in treatment.