Schema Therapy
Schema therapy was developed as a model that built on the classical cognitive model, but it gradually evolved into a distinct school of therapy.
Schema therapy was developed by the psychologist Dr Jeffrey Young and several fellow researchers. Young studied under Dr Aaron Beck, the founder of cognitive behavioural therapy (CBT), but encountered some difficulties in applying the method. He encountered these mainly when working with people with characterological difficulties or personality disorders. These clients often struggled to identify the thoughts underlying their extremely intense and sometimes rapidly shifting feelings, or found it difficult to change those thoughts through the empirical analysis used in classical CBT. They also often struggled to carry out experiments or engage in the therapeutic work between sessions, and had difficulty forming a therapeutic alliance. Their problems were usually difficult to translate into clear therapeutic goals because they were ill-defined, chronic and pervasive.
In the experience of the developers of schema therapy and a number of other therapists, the method has proved effective in treating personality disorders as well as chronic depression and anxiety, eating disorders, relationship problems in couples, long-standing difficulties in maintaining satisfying intimate relationships, substance use disorders and other difficulties.
Broadly speaking, schema therapy places greater emphasis than cognitive therapy on early experiences and the roots of the client’s problems. It makes greater use of emotionally focused techniques, imagery, role-play and other methods.
Schema therapy is based on a fairly complex formulation that looks at our lifetraps, known as schemas, and how they affect our lives.
These lifetraps, or schemas, are pervasive constructs through which we experience the world. In many situations, they dictate how we feel, what we notice in our bodies and how we explain to ourselves what is happening and what it means about us, the world and the future. Schemas usually develop out of harmful early childhood experiences, including abandonment, abuse and neglect. They can also arise from broader patterns in family relationships, such as overprotective parenting.
In developing schema therapy, Young and his colleagues identified 18 schemas. They grouped them into five schema domains according to which early childhood need went unmet. One such domain is ‘Disconnection and Rejection’, which includes ‘Abandonment/Instability’, ‘Mistrust/Abuse’, ‘Emotional Deprivation’, ‘Defectiveness/Shame’ and ‘Social Isolation/Alienation’. When a schema is triggered, a person feels intense negative emotions such as sadness, shame, fear or rage in situations that do not warrant that kind or intensity of emotion. For example, someone who was frequently criticised by their parents may develop a Defectiveness schema. Later in life, it may be triggered in neutral interactions, even though the person, the people they are dealing with and what is happening between them are all very different from the circumstances of their childhood.
Schema therapy also includes concepts such as coping styles and functional and dysfunctional modes.
Different schemas can lead to a range of behaviours and feelings, sometimes even opposite ones, depending on the person, the situation and the client’s coping style. This is where the model becomes a little counterintuitive.
Young describes three coping styles: surrender, avoidance and overcompensation. These reflect three different ways of responding to the pain of our schemas. In surrender, the person behaves as though the schema were true. They give in to its message and directly experience the pain it brings. For example, someone who grew up in an emotionally distant family might surrender to the schema by choosing an emotionally cold partner.
Avoidance involves steering clear of situations, activities, contact with others, or even feelings and thoughts that might trigger the schema. Alcohol or drug misuse is one common form of avoidance in our society. Avoidance can also take the form of social withdrawal or choosing ‘safe’ jobs and relationships.
Overcompensation is the opposite of surrender. The person goes on an all-out counterattack, doing whatever they can, often at considerable cost, to behave in exactly the opposite way to what the schema dictates. They try to be as different as possible from the child they were when the schema developed. They may appear well adjusted or even successful, but the schema seeps into their life. In trying to defeat it, they become extreme, ineffective and rigid. Although the three coping styles work in different ways, they generally perpetuate the lifetrap and keep it at the centre of our lives.
Alongside coping styles, the schema therapy model includes the concept of modes. A mode is a combination of the schema and the behaviours that are active at a given moment. Modes can be maladaptive or adaptive. One example of a maladaptive mode is the Punitive Parent, in which the person is extremely demanding and unforgiving towards themselves and others. Another is the Angry Child, in which the person reacts with disproportionate anger to an innocent remark or a minor frustration. The Healthy Adult should be our most frequent and adaptive mode. It allows us to stand up to the Punitive Parent, soothe the Angry Child and feel and behave in ways that fit the situation as it is.
The goal of therapy is to ‘defeat’ schemas and dysfunctional modes.
In therapy, the therapist and client join forces against the schema and work together to ‘defeat’ it so it no longer dominates the person’s life. The client begins to act in ways that reflect their current circumstances and the resources available to them now, rather than those they had as a child. If this work succeeds and the schema no longer dominates the person’s thoughts and feelings, the coping modes are no longer needed. The Healthy Adult and Happy Child then become the most active functional modes.
To achieve this, schema therapy uses a wide range of methods, including emotionally focused imagery techniques and role-play.
The relationship between therapist and client is especially important in schema therapy. The therapist has the difficult task of practising empathic confrontation. This means showing genuine empathy for the client’s painful emotional experiences while challenging the maladaptive behaviours and modes that perpetuate the schema. The therapist also models the Healthy Adult at the beginning of therapy, particularly when this mode is very weak. Schema therapy also uses a process with the intriguing name ‘limited reparenting’. The therapist takes on the role of an alternative ‘parent’, responding to the client in a way that fits their circumstances and needs, rather than being driven by the needs, emotions and maladaptive behaviours that the client’s actual parent or parents may have brought to the relationship.
In conclusion.
Schema therapy is a newer, integrative approach that grew out of cognitive behavioural therapy and extends it with models and techniques drawn from other schools. Its developers identify these as psychodynamic therapy, Gestalt therapy, object relations theory, constructivism and psychoanalysis. It places greater emphasis than cognitive therapy on early childhood experiences and uses experiential and imagery techniques that work directly with emotions. The method initially focused on clients with characterological difficulties or limited access to their thoughts and feelings, with whom Dr Young and his colleagues had encountered difficulties when using classical CBT. It gradually developed into a distinct school of therapy and has proved effective for a range of emotional and everyday difficulties, as well as for many other disorders outside the category of personality disorders.
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