Schema Therapy

Schema therapy is a type of evidence-based talk therapy. It blends together with other well-known psychotherapies. For example, psychoanalytic, emotion-focussed and cognitive behaviour therapy. It also draws on attachment theory, which explores the relationships and bonds between children and their caregivers.

This is useful for a range of mental health problems. But it is particularly well suited to people with longstanding psychological difficulties. Schema therapy is effective in treating mental health diagnoses. For instance chronic depression, eating disorders, and personality disorders, including borderline personality disorder.

In schema therapy, you will work with your therapist to identify your own unhelpful schemas, coping styles and find new or more helpful ways to meet your emotional needs.

The process of Schema Therapy involves two main phases, 1) the Assessment and Education Phase and 2) the Change Phase.

During the Assessment and Education phase, you and your therapist will work together to:

• Gain a shared understanding of your story
• Learn about the schema model
• Identify your schemas
• Understand the origins of your schemas from childhood and adolescence
• Learn to recognise your unhelpful coping styles and their consequences in your life
• Identify your schema modes
• Co-create a schema-focused treatment plan

In the Change Phase, your therapist will guide you through your individualised treatment plan. This often involves:

• Cognitive techniques, which aim to help you disprove the validity of your schemas on a national level
• Experiential techniques, which utilise imagery and role-playing in session
• Behavioural techniques, which help you examine your relationships and replace unhelpful coping styles with more healthy ones
• Using your relationship with the therapist as a platform for ‘correcting’ your unhelpful schemas

The process of changing schemas can be challenging, but well worth the investment.

Many people have heard of, or even experienced, cognitive behaviour therapy or CBT, so you might be wondering, “what’s the difference between this and schema therapy”?

Whilst cognitive therapists acknowledge the importance of early life, CBT is often less focussed on the past and more focussed on solving problems in the here and now. CBT is often a brief therapy focussed mainly on reducing symptoms and building new skills.

Whilst CBT is effective for many people, it does not work for everyone.

Schema therapy was developed as a treatment for people with chronic problems who were not responding to traditional CBT. It can be brief, intermediate or long term, depending on the client. Schema therapy is less focused on reducing acute psychiatric symptoms and more targeted towards the chronic, character-based aspects of mental disorders.

Compared to CBT, schema therapy uses emotion-based techniques more heavily and focuses more on a person’s unhelpful coping styles and the early origins of their current problems (i.e. how they link back to childhood and adolescence). Schema therapy also recognises that interpersonal problems are common across most diagnoses, and emphasises the importance of the therapist-client relationship as a vehicle for change in this domain.

A schema is a cognitive framework that helps us organise and interpret our life experiences. Schemas include the deep beliefs we hold about ourselves, our relationships and the world around us. They also comprise memories, emotions, thoughts and body sensations.

Some schemas are unhelpful and often persist from early childhood into adult life. Once schemas are developed, they are generally resistant to change and can unconsciously influence our thoughts, feelings and actions. If left unmanaged, schemas can cause destructive, self-defeating behaviour.

Five main domains

There are 18 different schemas, each of which falls into one of the following five domains:

1. Disconnection and rejectionschemas that make it hard to form secure, satisfying relationships with others
2. Impaired autonomy and performanceschemas that make it hard to develop a strong identity and function independently as an adult
3. Impaired limitsschemas that affect self-discipline and respecting others’ boundaries
4. Other-directednessschemas that prioritise meeting the needs of others above your own
5. Over vigilance and inhibitionschemas that prioritise achievement at the expense of happiness, self-expression, relaxation and close relationshipss

Unhelpful schemas are the result of unmet emotional needs. They are often caused by adverse childhood experiences, ranging from the emotional unavailability of a parent to extreme forms of abuse.

Other factors also play a role in schema development. Likewise the child’s temperament (e.g. degree of irritability, shyness, aggression etc.) and cultural/familial influences.

People develop ways of coping so that they can avoid the intense, overwhelming emotions that occur when a schema is triggered. Coping styles may have been helpful for survival in childhood. However, they often become unhelpful as we get older and our circumstances change.

Many coping styles cause short term relief. On the other hand, it can actually strengthen the schema and make things worse in the long run. In schema therapy.

There are three main unhelpful coping styles:

1. Surrender – the person believes the schema is true and acts in ways that confirm it. For example, someone with an abusive mother as a child chooses intimate relationships with abusive partners as an adult.
2. Avoidance – the person tries to live their life so that the schema isn’t activated. For example, someone who avoids social contact and intimacy or drinks to numb his emotions.
3. Overcompensation – the person fights the schema by thinking, feeling, and acting as though the opposite of the schema was true. This style often results in extreme behaviour, which can take a huge toll on relationships. For example, someone who was controlled as a child later becomes controlling themselves.

In schema therapy, you and your therapist will work to understand and replace your unhelpful coping styles with more helpful ones.

Every thought, feeling, action and experience we have in life can either perpetuate (strengthen) or heal (weaken) unhelpful schemas. Schemas are often perpetuated by the following factors, which are targeted in therapy:

• Distorted thinking – A person may focus on information that confirms their schema and discount or minimise information that contradicts it.
• Self-defeating behaviour patterns– A person may be unconsciously drawn to situations and relationships that trigger and reinforce their unhelpful schemas.
• Unhelpful coping styles – A person may surrender to their schema by acting in line with it, they may overcompensate for it by acting the polar opposite, or they may avoid triggering it altogether by avoiding things like social contact, intimacy or taking on new challenges.

The opposite of schema perpetuation is schema healing. It is the ultimate goal of schema therapy. Healing involves weakening the power of the schema and the intensity of the associated memories, feelings, body sensations and unhelpful thoughts. Schema healing also involves replacing unhelpful coping styles with more helpful ones.

As people heal they become less overwhelmed and impacted by the activation of their unhelpful schemas. They are able to exert more control over their choices.

Unhelpful schemas have the potential to wreck traditional psychotherapies, such as CBT.

Schemas may make it difficult for people to meet many of the basic assumptions of CBT. It includes things like:

• Treatment compliance
• Motivation for change
• Awareness of one’s own thoughts and feelings
• Identification of goals and the ability to set goals
• Collaborate with the therapist early on in therapy.

For example, people with schemas in the Disconnection/Rejection domain may not be able to establish a strong connection with the therapist in a short period of time. People with schemas in the Impaired Autonomy/Performance domain may find it difficult to identify what they want and set clear goals for therapy. Finally, people with schemas in the Impaired Limits domain may initially lack the motivation or discipline to comply with the treatment protocol.

If dysfunctional schemas are playing an important role in a person’s problems, schema therapy may be more appropriate than CBT. We encourage you to discuss the different therapeutic options available to you with your psychologist at Epsychiatry.

In schema therapy, a schema mode is a combination of active schemas and coping styles. We group schemas into modes so we can address them in therapy as a single state of mind.

Schema modes can be helpful or unhelpful and are divided into 4 groups:

• Child modes
• Dysfunctional coping modes
• Dysfunctional parent modes

The aim of schema therapy, put very simply, is to strengthen your healthy adult mode. The healthy adult mode can help keep other modes in check and reduce the intensity of their influence over your life

If you would like to see a Epsychiatry have done extra training in schema therapy. You can reach our friendly support team via webchat, phone or email. You will need a referral (Mental Health Care Plan) from your GP to see one of our psychologists.