Schema Therapy (ST)

Schema Therapy (also previously known as Schema-Focused Cognitive Therapy) was developed by Dr Jeffrey Young in the early 1990s for the treatment of more complex psychological problems.

Dr Young. who worked closely with Dr Aaron Beck (the originator of CBT) observed that personality disorders and other chronic psychological conditions were less responsive to treatment by traditional CBT alone and required a different, more in-depth and attachment-focused approach. Further research in the past two decades has produced very positive evidence for the efficacy of Schema Therapy in helping people with complex problems for which other methods of therapy might have failed.

What is Schema Therapy?

Schema therapy is a systemic, integrative approach that utilises elements of Gestalt therapy, Object Relations, Psychodrama, Mindfulness, Meditation and recently Yoga, yet is based on an underlying cognitive behavioural framework. It comprises a large spectrum of techniques to address, in the course of therapy, emotions, cognitions and behaviour in the present life of the patient and related events and experiences in the past. Schema Therapy is a more in-depth and long-term therapy than traditional CBT.

While aiming to affect positive change in the here-and-now of a person’s life, Schema Therapy places great emphasis on understanding how the past has shaped a person’s current patterns or themes of thinking, feeling and behaving or coping. These deep-rooted patterns or themes are referred to as schemas.

Schemas help us process new information, organise current knowledge and provide a framework for future understanding. Our underlying schemas influence the way we select and absorb new knowledge because we are more likely to notice things that fit with our acquired schemas. At the same time, we are likely to interpret apparent contradictions to the schemas as exceptions or twist them to fit our existing inner framework of ideas.

Schemas are mostly developed early in life (during childhood and adolescence) but can also form in adult life. Schemas can be dysfunctional or maladaptive if they are based on pervasive themes or patterns of early traumatic experiences, such as abandonment, abuse, emotional deprivation, shame or lack of self-esteem or were formed in response to highly distressing events in adult life. In the latter case our schemas can turn into enduring, self-defeating ‘life traps’ that restrict our functioning in life and cause great unhappiness and psychological ‘dis-ease’.

These early maladaptive schemas (see list below) do not shift without therapeutic intervention because they are not stored in our rational logical brain, but as part of the emotional and sensory brain systems. They do not shift in response to logic or reasoning and are perpetuated behaviourally through three coping mechanisms, referred to as schema maintenance, schema avoidance and schema compensation. These coping mechanisms occur in response to the activation of different schema modes (see list below).

Schema Modes are moment-to-moment emotional states and coping responses. These are often triggered in response to situations in daily life that feel overwhelming to us and can lead to reactions that are hurtful to others or ourselves in our environment. Unfortunately, these reactions are then often interpreted as further confirmation of our negative maladaptive schemas and this maintains a negative, self-perpetuating pattern from which it is difficult to escape without therapeutic help.

How does Schema Therapy work?

The aim of schema therapy is to help people address, validate and eventually meet their unmet needs and modify their deep-rooted and often pervasive negative patterns of thinking, feeling and behaving so that they can develop healthier alternatives to replace these with.

Schema Therapy is a very collaborative, empowering, long-term therapy in which the safe relationship between client and therapist plays a very important role. It consists of three stages. The first is the assessment phase, in which specific schemas are identified during the initial sessions. The second phase helps clients develop emotional awareness and, through experiential work, get in touch with these schemas and learn to recognise when these become activated in day-to-day life. This phase enables clients to become aware and interact with their specific schema modes and develop, grow and strengthen an internal healthy adult mode. The third phase is the behavioural change stage during which the client is actively involved in replacing their negative, habitual thoughts, behaviours and feelings with more healthy alternatives. By this stage clients will have established a much stronger healthy adult mode that can assist with their healing process.

Schema Therapy can help with:

• Chronic Depression
• Anxiety
• Eating Disorders
• Childhood Abuse and Trauma
• Couples Problems
• Substance Abuse
• Personality Disorders
• Chronic Characterological Problems

At The Oxford Development Centre all our therapists incorporate underlying principles and elements from Schema Therapy and tailor these as appropriate to each of our individual clients’ needs. Dr Herbert is a certified Schema Therapist and combines Schema Therapy with elements from other therapeutic orientations based on her long-standing experience and her clients’ individual needs.

List of 18 currently identified Schemas¹:

Abandonment/Instability: The belief and expectation that others will leave, that others are unreliable, that relationships are fragile, that loss is inevitable and that you will ultimately end up alone.

Mistrust/Abuse: The belief that others are abusive, manipulative, selfish, or looking to hurt or use you and are not to be trusted.

Emotional Deprivation: The belief and expectation that your primary needs will never be met. The sense that no one will nurture, care for, guide, protect or empathise with you.

Defectiveness/Shame: The belief that you are flawed, damaged or unlovable and you will therefore be rejected.

Social Isolation/Alienation: The pervasive sense of aloneness, coupled with a feeling of alienation and isolation.

Vulnerability to Harm or Illness: The sense that the world is a dangerous place, that disaster can happen at any time and that you will be overwhelmed by the challenges that lie ahead.

Dependence/Incompetence: The belief that you are unable to make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day-to-day responsibilities.

Enmeshment/Undeveloped Self: The sense that you do not have an identity or “individuated self” that is separate from one or more significant others.

Failure: The expectation that you will fail or the belief that you cannot perform well enough.

Subjugation: The belief that you must submit to the control of others or else punishment or rejection will be forthcoming.

Self-Sacrifice: The belief that you should voluntarily give up your own needs for the sake of others, usually to a point which is excessive.

Approval-Seeking/Recognition-Seeking: The sense that approval, attention and recognition are far more important than genuine self-expression and being true to oneself.

Emotional Inhibition: The belief that you must control your self-expression or others will reject or criticise you.

Negativity/Pessimism: The pervasive belief that the negative aspects of life outweigh the positive, along with negative expectations for the future.

Unrelenting Standards/Hypercriticalness: The belief that you need to be the best, always striving for perfection or that you must avoid mistakes.

Punitiveness: The belief that people should be harshly punished for their mistakes or shortcomings.

Entitlement/Grandiosity: The sense that you are special or more important than others, and that you do not have to follow the rules like other people even though it may have a negative effect on others. Also can manifest in an exaggerated focus on superiority for the purpose of having power or control.

Insufficient Self-Control/Self-Discipline: The sense that you cannot accomplish your goals, especially if the process contains boring, repetitive, or frustrating aspects. Also, that you cannot resist acting upon impulses that lead to detrimental results.

• Angry Child: feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met.

• Impulsive/Undisciplined Child: acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification; often feels intensely angry, enraged, infuriated, frustrated, impatient when these non-core desires or impulses cannot be met; may appear “spoiled”.

• Happy Child: feels loved, contented, connected, satisfied, fulfilled, protected, accepted, praised, worthwhile, nurtured, guided, understood, validated, self-confident, competent, appropriately autonomous or self-reliant, safe, resilient, strong, in control, adaptable, included, optimistic, spontaneous.

Maladaptive Coping Modes

• Compliant Surrenderer: acts in a passive, subservient, submissive, approval-seeking, or self-deprecating way around others out of fear of conflict or rejection; tolerates abuse and/or bad treatment; does not express healthy needs or desires to others; selects people or engages in other behaviour that directly maintains the self-defeating schema-driven pattern.

• Detached Protector: cuts off needs and feelings; detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalised, empty or bored; pursues distracting, self-soothing or self-stimulating activities in a compulsive way or to excess; may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities.

• Over compensator: feels and behaves in an inordinately grandiose, aggressive, dominant, competitive, arrogant, haughty, condescending, devaluing, over-controlled, controlling, rebellious, manipulative, exploitative, attention-seeking or status-seeking way. These feelings or behaviours must originally have developed to compensate for or gratify unmet core needs.

Maladaptive Parent Modes

• Punitive Parent: feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (for example, self-mutilation) or others. This mode refers to the style with which rules are enforced rather than the nature of the rules.

• Demanding Parent: feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to put others’ needs before one’s own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously. This mode refers to the nature of the internalised high standards and strict rules, rather than the style with which these rules are enforced

Healthy Adult Mode

• Healthy Adult: nurtures, validates and affirms the vulnerable child mode; sets limits for the angry and impulsive child modes; promotes and supports the healthy child mode; combats and eventually replaces the maladaptive coping modes; neutralises or moderates the maladaptive parent modes. This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, aesthetic, and cultural interests; health maintenance and athletic activities.

¹Reference: Adapted from “A Client’s Guide to Schema-Focused Cognitive Therapy” by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D., Cognitive Therapy Center of New York. 1993

Love After Love

The time will come

when, with elation

you will greet yourself arriving

at your own door, in your own mirror

and each will smile at the other’s welcome.

 

and say, sit here.  Eat.

You will love again the stranger who was your self.

Give wine. Give bread. Give back your heart

to itself, to the stranger who has loved you.

 

all your life, whom you ignored

for another, who knows you by heart.

Take down the love letters from the bookshelf.

 

the photographs, the desperate notes,

peel your own image from the mirror.

Sit. Feast on your life.

– Derek Walcott