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Schema Therapy is intended for use when patients fail to respond or improve after having been through other therapies, for example, Dialectical behavior therapy. It can also be used to treat major depressive disorders, and other psychological issues of individuals and couples.
Schema therapy developed from CBT as applied to axis-1 disorders. When trying to apply the same techniques to axis-II disorders clinicians found limited efficacy and began to integrate techniques from other approaches. Schema therapy is therefore a combination of many different therapy techniques, some of which include Cognitive Behavioral Therapy, experential methods (notably Gestalt therapy, object relations, psychoanalysis, mindfulness, Dialectical behavior therapy, interpersonal relation skills, discussion one-on-one, group discussion, and constructivism. Schema Therapy also borrows extensively from a range of theoretical concepts and methods from Transactional Analysis and developmental theories. Schema therapy is best regarded as an integrative therapy rather than an eclectic therapy as some effort has gone into developing the translations between different approaches and providing a unified theoretical underpinning.
Schema Therapy is based on a theory that childhood and adolescent traumas are the most likely causes of Borderline Personality Disorder and other similar personality disorders. The approach assumes that children have basic needs which, when not adequately met, result in the development of dysfunctiona schemas and coping strategies.The approach of Schema therapy emphasizes patients, psychiatrists, and therapists building bonds of trust with each other.
As opposed to some of the more widely known and popular therapy methods, Schema therapy is most often used and considered a specialty form of therapy in the treatment of personality disorders, most commonly borderline personality disorder.. The approach has been found to be effective with Cluster B, Cluster C and paranoid personality disorder .
Definition of maladaptive schemasEdit
Young uses the concept of Schemas as it is defined in Cognitive Psychology, and as such, schemas can be either healthy or maladaptive. In a sense, Schema Therapy ultimately seeks to replace maladaptive schemas by more healthy schemas.
Maladaptive schemas, according to Young, are defined as and relate mainly to the lack of basic emotional needs met in childhood and a lack of appropriate relationships, bonds, and behaviors of the parents, caretakers, and others involved in the life of a growing child.
Maladaptive schemas are considered a pattern of established (from childhood) unstable reactions/behaviors to any given situation in life. Maladaptive schemas may be made up of revisited (sometimes obsessively) memories of past hurt, tragedy, fear, abuse, neglect, unmet safety needs, abandonment, or lack of normal human affection in general. Thus, as an adult, Schema "modes" may become nearly reflexes as the patient is seeking approval due to unmet childhood needs.
Maladaptive schemas can also be bodily sensations associated with such traumas (and/or flashbacks such as with PTSD). The ways of which a person may view him or herself in combination with difficulties establishing one's true identity, body image, and/or one's ability (or lack thereof) to properly or happily socialize with others (as they were never taught/never learned as children) can be considered "Schemas", as well. Schemas may also cause feelings of inadequacy leading to seemingly dramatic, inappropriate, dysfunctional, or generally disruptive behaviors in response to what a "healthy adult" may deem as every day scenarios or situations.
How does schema therapy work?Edit
The basic philosophy of Schema Therapy is that if basic safety, care, guidance, and affection are not met in childhood then as adults these patients feel a void emotionally and thus the schemas begin to develop and often lead to unhealthy/unstable relationships, poor social skills, unhealthy lifestyle choices, self-destructiveness, and overall poor functionality.
By building caring bonds and enforcing self-examination, Schema Therapy aims to help a person to gain the self-confidence needed in order to achieve their ultimate goals. This therapeutic approach attempts to create a peaceful environment in order to help patients to feel more comfortable during discussion groups and lessons.
Schema Modes are defined as emotional states and ways of coping which every human being experiences at one time or another. Life situations that we find disturbing, arouse bad memories, or offend us, or personal topics/situations to which we are sensitive, are referred to as "triggers" that tend to bring out the somewhat explosive behaviors of patients involved in this type of therapy.
According to Young, people suffering with personality disorders especially tend to be hypersensitive and may be "triggered" by a simple image, word of offense, sound, etc. These "triggers" may produce states of being which often lead to reactions perceived as inappropriate and/or overreaction by the general public. Reflection upon a schema of their own dislike instinctively and often brings about the "Flight or fight" response. Schema Therapy's Philosophies of caring and comfort help to step in when someone is "triggered", replacing a self-destructive reaction with a healthy coping skill.
Schema Therapy works with such emotional individuals by focusing on identifying roots of lack of personal self-control, impulsivity, lack of attachments with peers or family, and to positively help a patient build self confidence and to eliminate any self-destructive reactions effectively, as the patient gains healthier coping methods.
Some of the identified Schema modes of which patients and clients are educated about via therapy are as follows
- Angry child- This mode is fueled mainly by feelings of victimization or bitterness, leading towards negativity, pessimism, jealousy, rage, and so forth. While experiencing this schema mode, a patient may have urges to yell, scream, throw/break things, or possibly even self-injury/harming others. The "angry child" is enraged, anxious, frustrated, self-doubting, feels unsupported in ideas, and vulnerable.
- Impulsive Child - This is the mode where anything goes. Theoretically if an individual is having an "identity crisis" or moments of depersonalization this mode might come into play. Behaviors of the "impulsive child" may include: reckless driving, substance abuse, cutting oneself with lack of suicidal thoughts, gambling, fits of rage such as: punching a wall when "triggered" or laying the blame of whatever circumstance upon innocent peers. Unsafe sex, rash decisions to run away from a situation without resolution, tantrums perceived by peers as infantile, and so forth are a mere few of the behaviors of which an "impulsive child" might display. "Impulsive Child" is the rebellious and careless schema mode and can lead to conscious suicidal thoughts if not stopped.
- Detached Protector - This schema mode is based in escape. Individuals in "detached protector" withdraw, dissociate, alienate, or hide in some way. This may be triggered by numerous stress factors or feelings of being overwhelmed. The lack of coping skills when a person is in a life situation involving high-demand or a chain of thoughts/emotions revolving obsessively often can trigger "detached protector." Stated simply, the patient becomes numb in order to protect oneself from the harm or stress of that which they fear is to come/fear of the unknown in general. Mistrust is often a culprit in "triggering" such fears.
- Abandoned Child - The "abandoned child" is a schema mode in which a person may feel defective in some way, thrown aside, unloved, obviously alone, or may be in a "me against the world" mindset. Feeling as though peers, friends, family, and even the entire world have abandoned a person are the things which live within this schema mode. Behaviors of individuals stuck in "abandoned child" include, but are not limited to: falling into major depression, pessimism, feeling unwanted, inferiority complexes arising, feeling unworthy of love, and personality traits perceived as unchangeable flaws are the ways of the "abandoned child." In this mode suicidal idealization, suicidal tendencies, hypersensitivity to criticism/compliments, stubbornness, avoidable behavior, and the "why bother?" attitude all make up "abandoned child."
Rarely, a patient's personal perceived flaws may be intentionally with-held on the inside. When this occurs, instead of showing one's true self, the patient may appear to others as "egotistical", "attention-seeking", selfish, distant, and may exhibit behaviors unlike their true nature. In this mode, the patient might create a narcissistic alter-ego/persona in order to escape or hide the insecurity from others. Due to fear of rejection, of feeling disconnected from their true self and poor self image, these patients (who truly desire companionship/affection) may end up pushing others away. This rare behavior can also be a self-soothing (yet unhealthy) self-therapy technique. It feeds the "abandoned child" delusion and becomes hazardous in the end.
- Abandoned child is a self-defeating mode as a whole. The person feels defective and abandoned, thus may abandon their own self and choose to remain "abandoned" as it is what they believe they know and therefore comforting.
- Punitive Parent - The Punitive Parent schema mode is identified by beliefs of a patient that they should be harshly punished perhaps due to feeling "defective", or making a simple mistake. They may feel that they should be punished for even existing when "punitive parent" takes over the psyche. Sadness, anger, impatience, and judgmental natures come out in "punitive parent" and are directed to the patient and from the patient. Even a small and solvable issue or unrealistic perfectionist expectations and "black and white thinking" all bring forth the "punitive parent." The "punitive parent" has great difficulty in forgiving oneself even under average circumstances in which anyone could fall short of their standards. The "Punitive Parent" does not wish to allow for human error or imperfection, thus punishment is what this mode seeks and what it desires.
- Healthy Adult - The "Healthy Adult" schema mode is what Schema Therapy strives to help a patient achieve as the long-lasting state of well-being. The "healthy adult" is good with decision making, nurturing, comforting, ambitious, sets limits and boundaries, forms healthy relationships, takes on all responsibility, sees things through, and enjoys/partakes in enjoyable adult activities and interests with boundaries enforced, takes care of his/her physical health as well, is rational, a problem-solver, someone who thinks before acting, someone aware of their self worth, well-balanced mentally, emotionally, and physically. The "healthy adult" is grown up and loves his/herself. In this schema mode the person focuses on the present day with hope and strives towards the best tomorrow possible. The "healthy adult" forgives the past, no longer sees oneself as a victim (but as a survivor), and expresses all emotions in ways which are healthy and cause no harm.
The ultimate goal of schema therapy is to help patients to learn to react and live as healthy adults, while over-coming fear-driven lifestyles. Schema Therapy teaches self-discovery, self-discipline, and stops patients from using abnormal or harmful coping styles impulsively.
- ↑ Dr Chris Lee and Graham Taylor. Introduction to Schema Focussed Therapy. therapist-training.com.au.
- Reinventing Your Life: The Breakthrough Program to End Negative Behavior...and Feel Great Again by Jeffrey Young, Ph.D. and Janet Klosko, Ph.D.
- Schema Therapy for Borderline Personality Disorder Publisher: Wiley & Sons Joint Author: Arntz, Arnoud Joint Author: Genderen, Hannie van Translator: Drost, Jolijn
- Schema Therapy: A Practitioner's Guide (Hardcover) by Jeffrey E. Young PhD, Janet S. Klosko Phd, and Marjorie E. Weishaar Phd
- Schema Therapy: Distinctive Features by Eshkol Rafaeli, PhD, David P. Bernstein, Ph.D., and Jeffrey E. Young Ph.D. (Publisher: Routledge)
- Cognitive Schemas and Core Beliefs in Psychological Problems: A Scientist-Practitioners Guide by Lawrence P. Riso, Pieter L. du Toit, Dan J. Stein, and Jeffrey E. Young
- Integrative Brief Therapy: Cognitive, Psychodynamic, Humanistic & Neurobehavioral Approaches (Practical Therapist Series) by John Preston
- Schema modes and childhood abuse in borderline and antisocial personality disorders [An article from: Journal of Behavior Therapy and Experimental Psychiatry] by J. Lobbestael, A. Arntz, and S. Sieswerda
Rafaeli, E, Bernstein, D.P. & Young, J. (2010). Schema Therapy: Distinctive features. London: Routledge. ISBN 978041546298
- Young, J., Klosko, J. and Weishaar, M.(). Schema Therapy: A Practitioner's Guide.
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