Schema therapy was developed by Dr. Jeffrey Young in 1990 as an alternative to cognitive behavioral therapy (CBT) for patients who relapsed following conventional treatment. The therapy focuses on ingrained patterns of negative behavior from childhood, known as maladaptive schemas. Therapists help patients explore these schemas and associated schema modes to address negative thinking and learn healthy adult behaviors. Schema therapy is effective for difficult-to-treat conditions, including personality and eating disorders, depression and anxiety. It’s also been found helpful for treating trauma and PTSD.
Overview of Schema Therapy and Its Purpose
Schema therapy incorporates elements of cognitive behavioral and gestalt therapies. It identifies negative emotional patterns and promotes healthy thinking. The therapy emphasizes achieving specific goals, including:
- Identifying negative thought patterns. Finding and changing negative thought patterns developed in early life
- Encouraging healthier thinking. Replacing dysfunctional or maladaptive views with healthier beliefs
- Meeting emotional needs. Understanding how early life experiences affect emotions and fulfilling emotional requirements
- Improving interpersonal relationships. Addressing underlying relationship issues and forming meaningful connections
Schema psychology definitions include maladaptive schemas and schema modes.
What Are Maladaptive Schemas and How Do They Form?
Maladaptive schemas are ingrained attitudes and thought patterns developed during childhood due to unmet social and emotional needs. They result from emotional damage caused by the actions of family members and other people in the child’s life, and they shape the individual’s belief system and worldview. Maladaptive schemas are broken down into five categories referred to as domains:
Disconnection and Rejection
An individual in this domain expects their basic emotional requirements such as security, love, empathy and acceptance won’t be met. These feelings of disconnection and rejection develop from cold, withdrawn and lonely relationships, as well as those that are unpredictable and abusive.
Impaired Autonomy and Performance
Due to feelings of low self-worth, individuals in this domain lack confidence in their ability to be independent or succeed. They feel incompetent, fear failure and show excessive dependence.
Impaired Limits
A person who falls within this domain may have been overindulged as a child and allowed excessive freedom with few limits. They lack a sense of purpose, don’t respect the rights of others and have a sense of entitlement.
Other-Directedness
Individuals in this domain suppress their natural feelings and desires in an attempt to win approval from others. They prioritize the needs of others over their own to gain love and approval and avoid retaliation.
Over-Vigilance and Inhibition
In this domain, individuals have an unhealthy focus on the negative aspects of life. They’re pessimistic and expect things to go wrong. They suppress spontaneity and live by rigid, internalized rules and expectations.
Schema Modes: Emotional States and Coping Mechanisms
A schema mode is a state of mind or an emotional state arising from the coping mechanisms individuals develop. A person may switch between modes depending on internal and external triggers. In healthy individuals, schema modes are mild and easily managed, but in those who are emotionally damaged, these modes are strong and rigid. There are four broad mode categories:
Child Mode
These modes reflect primary emotions from childhood and include:
- Vulnerable child. Characterized by feelings of loneliness, helplessness, fear, anxiety and powerlessness
- Angry child. Defined by frustration, outbursts and rebellion
- Impulsive child. Marked by short-term gratification seeking and showing impulsive and irresponsible behavior
- Happy child. Characterized by feeling loved, contented, self-confident and optimistic
Maladaptive Coping Mode
There are three maladaptive coping modes:
- Compliant surrenderer. Characterized by passive and subservient behavior out of a fear of rejection or conflict
- Detached protector. Marked by withdrawal and emotional detachment and a cynical, pessimistic attitude
- Over-compensator. Defined by aggressive, arrogant, manipulative and grandiose behavior
Maladaptive Parent Modes
These modes are related to how children were reared and include:
- Punitive parent. This individual believes they and other people deserve severe punishment and criticism for real or perceived failures and mistakes.
- Demanding parent. This person expects perfection and demands a high standard from themselves and others.
Healthy Adult Mode
An individual in healthy adult mode can control emotions, balance needs and adapt. They can manage harmful modes and show responsibility, empathy and respect for the desires of others.
Core Techniques Used in Schema Therapy
Therapists use the following methods to help patients understand, address and modify dysfunctional schemas and coping styles.
Assessment Techniques
The therapist initially asks the patient to fill in a Young Schema Questionnaire and uses the results to identify their maladaptive schemas. They then discuss the results and their meanings.
Experiential Techniques
Practical techniques are applied, such as visualizing memories of negative childhood experiences associated with parents, family members and others. The therapist works with the patient to rescript and process negative recollections and emotions. They may have a patient perform “chair work” to address the experiences, which involves carrying on an imagined dialogue with themselves and significant others to achieve closure.
Cognitive Techniques
Using techniques such as CBT, the therapist guides the patient to confront and reframe their dysfunctional attitudes and beliefs. The goal is to reduce the degree to which schemas dominate the person’s thinking and provide skills so they can react normally when confronted with these memories.
Behavioral Techniques
Patients are taught to change maladaptive behaviors through exposure therapy and assertiveness training. Using role-playing and real-life situations, patients learn how to modify their schemas and achieve long-lasting behavioral changes.
Mindfulness and Acceptance Therapies
Mindfulness training helps patients review their thought processes and dysfunctional behaviors in a nonjudgmental manner. They learn to better understand and regulate their emotions. Acceptance techniques aid them in acknowledging maladaptive schemas for what they are and learn not to suppress them.
Who Can Benefit Most From This Approach?
Schema therapy may benefit individuals with maladaptive personality disorders and conditions that have resisted more conventional forms of counseling. These include:
- Borderline personality disorders
- Narcissistic personality disorders
- Eating disorders
- PTSD
- Severe anxiety disorders
- Treatment-resistant depression
Integrating Schema Therapy Into Broader Treatment Plans
Schema therapy is useful for helping patients when CBT or other treatment techniques have failed or a person has relapsed. Schema therapy focuses on the role of negative childhood experiences in mental illnesses, whereas other methods, such as CBT, address current thoughts and behaviors. Bringing the two concepts together in an integrated treatment plan can increase the likelihood of success.
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