What is Schema Therapy?

Schema Therapy is an integrative psychotherapy developed by Dr Jeffrey Young. Dr Young originally developed the approach as an extension of Cognitive Behavioural Therapy (CBT). Schema therapy draws its influence from CBT, Attachment Theory, Psychodynamic Theory and Humanistic/Experiential approaches including Gestalt Therapy.

Schema Therapy differs to CBT in that it focuses upon self-defeating life patterns, characterological problems, interpersonal relationship difficulties, and deep-seated emotional themes which contribute to significant distress and suffering. Schema Therapy addresses these difficulties by applying affective change strategies, utilising the therapeutic relationship, emphasising limited reparenting (adaptive self parenting), meeting core needs and re-scripting harmful internalised messages from childhood.

Schema therapy has been developed to address chronic psychological problems in which the client difficulties are entrenched, resistant to change and present with difficult interpersonal styles which can make engaging in therapy difficult. Problems that Schema Therapy is well suited to treat include personality disorders such as Borderline Personality Disorder, Narcissistic Personality Disorder, Obsessive Compulsive Personality Disorder, eating disorders, and forensic presentations. It can often be effective for treatment resistant axis one disorders such as depression, anxiety and substance misuse.

Schema therapy has been demonstrated to be a highly effective therapeutic approach, based on controlled outcome studies, for individuals with a Borderline Personality Disorder diagnosis as well as Anxious and Avoidant personality disorders. Schema therapy is well suited for clients who wish to develop an understanding of their difficulties but wish to meld this with a systematic, flexible and active approach to addressing their difficulties.

Schemas are broad pervasive patterns or themes comprised of memories, emotions, physical sensations (somatic) and thoughts. Schemas concern our relationships with our selves, others and the world in general and help us organise the way in which we understand and consequently respond to events. Schemas can be helpful such as 'people are generally trustworthy', however if our needs are not met in a consistent and healthy way as children then more unhelpful schemas can develop, in Schema Therapy these are called Early Maladaptive Schemas. Below are a list of early maladaptive schemas, along with the basic needs that have generally not been met in childhood.

Basic Emotional Needs

Secure attachment to others

1. Abandonment /instability: I will be alone , no one wants to care for me or look after me to make me less scared

2. Mistrust/abuse: Other people will hurt or abuse me, I can't trust them as they lie and cheat .

3. Emotional deprivation; People don't seem interested in me , they don't understand me, I just feel lost.

4. Defectiveness/shame; I feel bad, flawed and unwanted

5. Social Isolation/alienation; I'm not part of anything; I'm different from others

Early Maladaptive Schemas

Disconnection & Rejection

Autonomy, competence sense of identity

Impaired autonomy & performance

6. Dependence/incompetence:I'm not able to look after myself without the help from others, I can't make decisions, and I'm just not sure about anything.

7. Vulnerability to harm or illness ; Something bad can happen to me at any time and there is nothing I can do to stop it (medical, emotional & external catastrophes)

8. Enmeshment/underdeveloped self; I must be close to them (often parents), I can't survive without them; I'm not sure who I am without them.

9. Failure; I won't succeed; i'm inadequate, stupid.

Realistic limits and self-control

10. Entitlement/grandiosity. I'm special and better than others; I don't have to follow rules other people need to follow. I can do whatever I want no matter what, people need to agree with me.

11. Insufficient self control/self discipline, I get bored easily and can't seem to achieve my goals. I don't like conflict & responsibility

Impaired Limits

Freedom to express needs/emotions

Other-Directedness

12. Subjugation; My Real feelings, opinions & desires are not important, I have to give into others as I am worried about what will happen to me if I don't (abandonment, anger, retaliation)

13. Self -sacrifice; I voluntarily put other people's needs over my own to avoid causing them pain, to avoid guilt.

14. Approval seeking/recognition-seeking; I need people to approve of me, give me attention or admiration or to recognise who I am (through status, money,

appearance), this is more important than being who I really am.

Spontaneity & Play

Over-vigilance & inhibition

15. Negativity & Pessimism; I can never think of the positives in my life, I worry about bad things happening to me all the time (death, Loss, disappointment, conflict, guilt, betrayal).

16. Emotional Constriction; I can't show my true feelings and do what I want to do as i can't bear the disapproval or shame from others, (feelings of anger, positive impulses around pleasure, play, affection are suppressed Now Emotional Constriction and

17. Fear of losing Control;

I excessively inhibit or disconnect from spontaneous emotion, action, or expression, due to a fear that I would otherwise lose control of my impulses resulting in dire consequences.

18.Unrelenting standards/hyper-criticalness; I feel pressured to be my best at all times, at the expense of pleasure, relaxation, health, self-esteem and relationships

19. Punitiveness (self);

I am hypercritical of my mistakes, suffering, or imperfections. I believe I should be punished or held accountable in some way for failing to meet

my and others' expectations

20. Punitiveness (others);

I am hypercritical towards others’ mistakes, their suffering, or imperfections. I believe that others

should be punished or held accountable for their indiscretions, I tend to ignore extenuating

circumstances and natural human error, and I tend to be preoccupied with concepts of justice.

Schema Modes

Schema Modes are parts of our self that are cut off to some degree from other aspects of our self. They can be thought of as emotional states that we enter into from time to time and which tend to be triggered by events and circumstances in our lives. When triggered Modes comprise of schemas, coping responses and healthy reactions. In psychological terms they are considered as the prominent mood 'state' we are in at a given time. In Schema Therapy theory there are 4 main Mode types: Child Modes, Parent Modes, Coping Modes and Healthy Modes. Below are some of the key Modes identified in Schema Therapy.

Child Modes

Vulnerable Child Mode: Lonely Child Mode, Abandoned and Abused Child, Humiliated/inferior Child,Dependent Child.

Strong feelings of being alone, unlovable, unaccepted, worthless and scared or feeling humiliated and inferior. Feeling dependant and needing to be taken care of by a parent figure. Unable to manage feelings of responsibility.

Angry Child Mode: Angry Child, Obstinate Child, Enraged Child

Intense angry feelings, infuriation and frustration or impatience because core needs are not met. Rage may come across as hurting others or damaging objects in an uncontrolled way. Behaviours may seem spoiled or entitled which push others away. Passive aggressive behaviours that come across as stubborn.

Impulsive/Undisciplined Child

Unable to resist acting on urges and desires without regard to others' feelings and consequences. May appear spoiled and unable to tolerate frustration. They may find it hard to complete routine or boring tasks and give up too quickly out of frustration

Dysfunctional Parent Modes

Demanding Parent (Demanding Critic)

Internalised voice of carer which has a constantly high and unrealistic standards to achieve and perform. Person feels only acceptable way is to be perfect striving to be the best is the goal, and putting other needs second is important. Cannot be spontaneous or express feelings

Punitive Parent (Punitve Critic, Gulit Inducing Critic)

Internalised voice of a carer which is cruel, nasty, unforgiving and punishing. The person may feel self-loathing, self criticism, may have thoughts to harm themselves or act on these thoughts.

Dysfunctional Coping Modes

Coping modes are attempts to cope with the Punitive and Demanding Parents Modes and experiencing the vulnerability of the Child Mode. When these Modes first developed they were adaptive attempts to cope with the original situations. There are three main types of coping modes which correspond with the Fight, Flight, Freeze response.

Avoidant Coping Modes

Detached/Avoidant Protector: Avoids emotional pain by switching off, withdrawing from others, avoiding help, including substance abuse, binging, excessive sleep, avoiding connections especially ones which may involve conflict.

Angry Protector: To protect themselves from others perceived to be threatening they use a wall of anger to stay safe by being irritable or angry e.g. complaining

Detached Self-soother: Behaviours to cope with difficult feelings that will soothe, stimulate or distract e.g. working too much, gambling, dangerous sports, promiscuous sex, drug abuse,

Surrender Coping Modes

Compliant Surrenderer: Behaves in a submissive way, seeking reassurance, and is passive in accepting abuse and mistreatment

Over-compensatory Coping Modes

Self-Aggrandiser: One upmanship behaviours such as competition, putting others down, behaving in a way to get what they want. Tend to be self absorbed, with lack of empathy towards others' needs and feelings. Do not feel they need to follow rules that apply to others and crave admiration and boast to improve self esteem.

Attention seeker: Behaving in an extravagant, inappropriate and exaggerated way o make up for underlying loneliness or lack of recognition

Over-controller Mode:

1. Perfectionistic type. Perfectionistic focus to stay in control and prevent criticism or misfortune.

2. Paranoid type. Focusing on others to check for signs of threat, malevolence, suspicious feelings lead to controlling others.

BullyAttack: Using threats, aggression and intimidation to get something they want, or to guard against perceived or real threat.

Predator: Calculated and planned behaviours unlike Bully Attack mode which is 'hot' aggression. Behaviours are cold and ruthless and common in psychopaths.

Functional Healthy Modes

Happy Child: Feels loved, content,safe,secure, knowing their emotional needs are being met. They feel praised, understood, validated and accepted. They are self confident, appropriately autonomous and resilient. They can play freely, be spontaneous, flexible, adaptable and optimistic.

Healthy Adult; Takes healthy steps to look after themselves and getting their needs met appropriately e.g. working, parenting, taking responsibility. Able to healhtily enjoy pleasure in adult activities e.g. sex, intellectual and cultural interests, physical activity and maintaining health