Interpreting the YSQ: ditch the overwhelm and keep it simple instead
- Tena Davies, Clinical Psychologist, Certified Schema Therapist
- 1 day ago
- 4 min read
Can you relate to this? You look down at the YSQ results and think, what does it all really mean? Do you give the client all of this information? And most important of all, where to from here? How does this help with treatment?
Before you share the YSQ results with the client
Hypothesise - hold in mind the client's presenting problem(s), how/what they have presented with, and the client's history. Based on this, predict what schemas they may have. For example, a client that presents with burnout may have a self-sacrifice schema. If you look at their history you should be able to tell where this came from and also gain a sense about what schema is under the self-sacrifice (e.g. defectiveness, abandonment, social isolation, emotional deprivation etc.). These hypotheses will help you to interpret the YSQ results and see through the noise of all the data.
As a general principle, the YSQ should inform your formulation, not replace it.
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Look for patterns in scores - look at their scores overall, are the scores particularly low? Are the scores all very high? Low scores suggest the client was in an avoidant or an overcompensating mode when completing the questionnaire. This gives you great information about their maladaptive coping modes. If they have high scores on many schemas they may have experienced a lot of trauma.
If the scores are generally low, especially for predicted schemas, they may have been in an avoidant mode when completing the questionnaire. In these circumstances, I might consider scores of 3s and 4s, not just 5 and 6s.
Presenting the results to the client
Keep it relevant and synthesise the data- while it can be tempting to go into every single schema that comes up on the YSQ, in the name of being transparent, this usually has the effect of information overload and can overwhelm both the client and the therapist. Clients can feel they came in with one problem (e.g. burnout) and now have 10 other problems in the form of the identified schemas. It can also be unclear to the client how knowing how these schemas will help with treatment.
Instead, offer your hypothesis (e.g. formulation) about what schemas are contributing to the presenting problem (e.g. your formulation) more broadly. Then reference the questionnaire. For example:
"Jane, I know you are here to address your burnout. It makes sense to me that you are so burnt out. I can see how much you sacrifice for other people both at work and at home. My sense is that you do this to avoid abandonment, sacrificing is a survival strategy you used growing up to keep dad from leaving, is that right? Does that resonate with you? . . .Also, thank you for completing the questionnaire. One of your highest scores was defectiveness. Can you tell me more about that? I wonder how that is related to the burnout?
Where clients have many schemas, it can be useful to present the results in terms of core unmet needs to make sense of them and give a coherent message. For example, if a client has significant items on all five domain 1 schemas (e.g. social isolation, defectiveness, abandonment, emotional deprivation and mistrust abuse), you could say, "I could see on your questionnaire that you had high scores for schemas related to attachment and that suggests that your normal need for connection, belonging stability, and safety were not met. Does that resonate? . . .Yes, that makes sense to me as well given your upbringing.
Be curious and collaborative - If there are other schemas that you feel are significant but you're unclear if and how they are related to presenting problem, explore these with the client. They may be related to the presenting problem or to another problem entirely. Either way it's a rich and useful discussion.
The devil is in the detail - when you review the results, have a look at the individual items. They can reveal important information about the client's schemas, even if the subscale overall is not particularly high. Looking at a few individual items related to the presenting problem can be great discussion points with clients. For example, if a client endorses the item: "I sometimes feel as if I'm an alien" on the social isolation sub-scale of the YSQ, ask them to give you an example of when that feeling has come up for them growing up but also more recently. Childhood examples could prove useful imagery rescripting targets.
Instill hope and connect to a treatment plan - Administering questionnaires and providing feedback is all well and good, but don't forget to let the client know where this is all going. Say something like, "Ok, thank you for completing that questionnaire, it's hopefully given both of us a greater understanding of the factors driving the burnout. Given that the main schemas driving the problem appear to be self-sacrifice, emotional deprivation and defectiveness at the core, I think we should start there. What do you think?
Connect to modes
I can see that these schemas fuel your critic and your survival mechanisms like people pleasing and ultimately leave your little vulnerable part feeling so unseen. Do you think we should start working with the critic that tells you that you are worthless or the people pleaser part that makes little you feel invisible?
Want to learn more about schema therapy assessment and formulation? Check out my webinar here.
Tena Davies is a Clinical Psychologist, Advanced Certified Schema Therapist, Supervisor and Trainer. She works with adults in Melbourne, Australia in private practice. In addition to her client work, Tena enjoys supervising and training fellow schema therapists. See www.tenadavies.com/webinars for more info.
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