Understanding Schema Therapy
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Derived from cognitive therapy (CBT), Schema therapy is another evidence-based approach therapists use. Developed in the 1990s by Dr Jeffrey E. Young, Schema therapy is a combinative approach with components from psychodynamic therapy, cognitive behavioural therapy and gestalt therapy. This approach aims to develop healthier alternatives to replace problematic patterns of feeling, thinking, and behaving that have left you in an unhelpful state.
A Schema is a process of how the mind organises information and the patterns of thinking and behaving to understand and interpret the world. The assumption around schema therapy is that individuals develop early maladaptive schemas (EMS) in their childhood due to unmet emotional needs such as trust, safety and nurturance. This results in dysfunctional coping styles and difficulties in relationships in adulthood because these schemas were deeply embedded during youth. Schema therapy is a familiar approach therapists use to treat mental health conditions; below is a list of them
Mental health conditions treated with schema:
Schema therapy was first developed to treat borderline personality disorders. However these days there are multiple mental health issues that schema therapy is effective in treating:
Depression
Anxiety Disorder
Substance Use
Borderline Personality Disorder
Mood Disorders
Is used to improve interpersonal relationships
Is used to enhance self-esteem and self-awareness
Techniques used in Schema Therapy:
The original model of schema therapy was based on 18 early maladaptive schemas (EMS); this is defined by Young, Klosko, and Weishaar (2003) as “a broad, pervasive theme or pattern comprised of memories, emotions, cognitions, and bodily sensations regarding oneself and one’s relationships with others developed during childhood or adolescence elaborated throughout one’s lifetime and dysfunctional to a significant degree”. The most recent development of the framework has incorporated concepts of modes. Modes are a part of the ‘self’ and are how we express ourselves at a given time or prominent state. It consists of our current behaviour, cognitions, and mood state.
Five domains and 18 types of EMS are addressed during schema therapy. We will go through and define each of these schemas below:
Abandonment: This is defined by the perceived unreliability and instability of those closely related to them. People who have developed this schema have exaggerated expectations that their partners will leave them and will display chronic anxiety about loved ones leaving them. They usually struggle to be alone or, conversely avoid relationships as they don’t want to hurt.
Emotional Deprivation: If developed earlier in life, this schema will result in you ignoring your emotional needs in adulthood. This is usually developed when your needs are not met by your partner in terms of love, understanding and guidance. They will display the look of not being important or that being independent and strong doesn’t require emotion. Dr young identifies three significant forms of deprivation:
Missing love, affection, and nurturing: one lacks care, physical proximity, and attention.
Lacking empathy: one does not feel understood and listened to by others.
Missing guidance and protection: one doesn’t feel like they have someone to rely on for support.
Mistrust/Abuse: This is characterised by the expectation that others will mistreat them by hurting, humiliating, abusing, cheating, manipulating and lying to them. They think the worst of people and find them untrustworthy, causing them to avoid intimacy or distance themselves from relationships.
Social Isolation: People with this schema feel they don’t belong anywhere and think they are isolated from the world. This schema is usually developed when a child grows up in a socially isolated family or is different from the mainstream (for example, family background, out-of-ordinary appearance or extraordinary intelligence). Although people with this schema can build relationships, many end up alone.
Defectiveness/Shame: People with this schema believe something seriously wrong with themselves, finding themselves defective, unwanted, harmful or invalid. This can do with their appearance, personality and social behaviour. People who have developed this schema have endured strong criticism and rejection earlier in life, causing them to become more sensitive. Their constant worry and anxiety about themselves cause them to view relationships as a threat and avoid serious relationships.
Dependence/Incompetence: This schema often presents as helpless as they believe they cannot make proper judgments and decisions or handle daily situations independently. People with this schema are highly dependent on others as they think they need considerable help from them to survive. This schema is developed when as a child the parents would make all the decisions for them, causing them to learn their independent judgment. Those with this schema usually avoid responsibility and change, as they feel they lack an independent voice.
Enmeshment/Undeveloped Self: People with this schema don’t have a stable sense of who they are and need their ‘enmeshed figure’ to feel whole due to excessive emotional involvement. An enmeshed figure can be a parent, sibling, friend or someone else with whom, as a child, developed this strong emotional bond. People with this schema usually have their world revolve around their 'enmeshment figure”, as they will always talk about them and depend on them.
Vulnerability to Harm/Illness: People with this schema fear that imminent catastrophe will afflict them at any moment, and they will be unable to prevent this. Their fear and anxiety focus on events related to medical emergencies (e.g. heart attack), mental illness (e.g. going crazy) and external catastrophes (e.g. victim of a crime or an earthquake).
Failure: This schema causes people to believe they have failed or will eventually fail. They feel that compared with their peers, they are not as efficient, smart, talented or skilled in performance. They often engage in self-sabotaging behaviour because they believe they will fail anyways.
Insufficient Self-control/Self-Discipline: People with this schema are characterised by emotional intolerance and are perceived as unreliable, impulsive and disorganised. This usually develops in children when they grow up without limits, and their parents don’t encourage long-term goals or support emotional discomfort.
Entitlement/Grandiosity: People who have developed this schema believe they are superior to others and feel as though they are entitled and privileged to special rights. They do whatever they feel like as they perceive that rules don’t apply to them and tend to focus on their strengths and minimise their flaws. Dr Young describes three subtypes for this schema.
Fragile entitlement → when people overcompensate for defectiveness/emotional deprivation schema; related to narcissism. Pure entitlement → not related to other schemas; the parents usually spoiled the child.
Dependent entitlement → connected to the dependence schema; one believes that others are obliged to take care of them (because
one is special and superior)
Subjugation: This schema is characterised by surrendering control to others because they believe one’s needs, emotions, opinions and preferences are unimportant. This results in them suppressing their feelings because they fear something terrible will happen to them if they don’t. In terms of relationships, adults with this schema often enter relationships with dominating partners. There are two significant forms of subjugation which are:
Subjugation of Needs: Suppressing one’s preferences, decisions, and desires.
Subjugation of Emotions: Suppression of emotional expression, especially anger.
Approval/Recognition-Seeking: People with this schema tend to define their self-worth based on others’ reactions, opinions and self- appreciation. They place a massive focus on status, money, social acceptance, appearance and achievements as a means of gaining attention. This schema is developed in children whose parents’ values focus more on being socially desirable than what is best for their kids.
Self Sacrifice: People with this schema tend to focus on other people’s needs before their own. They provide excessive focus to help others meet their needs at their own expense as they believe it is the right thing to do. Those with this schema often end up exhausted and stressed because of how much they give others.
Negativity/Pessimism: People with this Schema tend to focus on negative aspects of life, such as pain, failure, disappointment, guilt, and suffering, while forgetting and neglecting the positive areas of their life. Their life is filled with constant anxiety and worry because they believe things will go seriously wrong or eventually fall apart. Children usually develop this schema by being influenced by their parent’s negative attitude or if they experienced hardship or adversity growing up.
Unrelenting Standards: This schema is characterised by underlying beliefs to constantly meet high internalised standards of performance and behaviours, usually to prevent external criticism. Children typically develop this schema when they grow up in a household with extremely high standards. Therefore as adults, they pursue perfection in life and have high attention to detail, productivity and efficiency. As a result, it usually leaves them anxious, pressured and exhausted.
Emotional Inhibition: People with this schema want to avoid disapproval of others by valuing self-control. Therefore they inhibit spontaneous feelings, actions and communications and tend to act less naturally. This is usually developed in children who are shamed or criticised for behaving naturally and playfully when growing up. Therefore to avoid disapproval in the future, they control the way they act.
Punitiveness: People with schema believe that mistakes made should be harshly punished instead of forgiven. This is usually developed in children who mirror the attitudes and beliefs seen in their parents and generations before. As adults, they are unforgiving and intolerant towards themselves and others and will live by strict standards and not condone human failure.
When looking at the Modes there are 4 Major modes which are Child, Maladaptive coping, Maladaptive parent and Healthy adult. Within these modes, there are a number of sub-categories for each of them which are listed below.
Child Modes:
Vulnerable Child: Feels isolated, lonely, sad, misunderstood, defective, unsupported, overwhelmed, deprived, incompetent, needy, doubts self, hopeless, helpless, anxious, frightened, victimised, worried, unloved, worthless, lost, unloveable, directionless, weak, fragile, depressed, defeated, left out, powerless, pessimistic and excluded.
Impulsive/undisciplined child: Selfishly or uncontrollably acts on non-core desires or impulses to get their way and has difficulty delaying short-term gratification. They often feel intensely angry, infuriated, enraged, frustrated and impatient when these non-core desires or impulses cannot be satisfied.
Angry Child: Feels intensely enraged, angry, frustrated, infuriated, and impatient because the vulnerable child’s core needs are not getting met emotionally (or physically).
Happy Child: Feels contended, loved, connected, fulfilled, satisfied, accepted, protected, worthwhile, praised, guided, nurtured, validated, understood, competent, self-confident, appropriately autonomous or self-resilient, in control, strong, included, adaptable, spontaneous and optimistic.
Maladaptive Coping Modes:
Compliant Surrender: Acts in a subservient, passive, submissive, approval-seeking, or self-deprecating way around others out of fear of rejection or conflict. They do not express healthy desires or needs to others and tolerate poor treatment and/or abuse. They continually engage in behaviour and with people who maintain this self-defeating schema-driven pattern.
Detached Protector: This type of coping rejects help from others and emotionally pulls away from them; they feel the need to cut off needs and feelings. They feel withdrawn, distracted, disconnected, spacey, empty, bored, personalised, distracted, self-soothing or self- stimulating excessively during activities. They often adopt a pessimistic stance to keep from investing in activities and people.
Over Compensator: Behaves and feels in an inordinately grandiose, dominant, arrogant, competitive, condescending, haughty, overcontrolled, devaluing, rebellious, controlling, exploitative, manipulative, status-seeking and attention-seeking. Due to core needs
being unmet these behaviours and feelings are developed.
Maladaptive Parent Modes:
Punitive Parent: Holds a belief that they or others deserve punishment or blame. They frequently act upon these feelings by engaging in self-blame, punishment, or abusive behaviours towards themselves or others. It's important to note that this mode pertains to how rules are enforced rather than the content of the regulations themselves.
Demanding Parent: Feels that being perfect or achieving at an exceptionally high level, maintaining order, pursuing high status, practising humility, prioritising others’ needs over their own, being efficient, and avoiding time wastage is the "right” way to be. Alternatively, they may feel that expressing emotions or acting spontaneously is incorrect. This mode relates to the internalised high standards and strict rules they hold rather than the enforcement style of these rules. It’s important to note that these rules do not serve a compensatory function.
Healthy Adult Mode:
Healthy Adult: This mode performs appropriate functions of being an adult such as parenting, working, coming, taking responsibility, pursuing pleasurable adult activities, health maintenance, athletic activities, and having intellectual and cultural interests. Below is a list of positive effects this mode had on the other modes.
Affirms that the vulnerable child mode feels nurtured and validated. For the angry and impulsive child modes, it sets limits.
Promotes and supports the healthy child mode.
Combats and eventually replaces the maladaptive coping modes. Moderates or neutralises the maladaptive parent mode.
Techniques of Schema Therapy
Schema therapy is effective in individual, couples, and group therapy, although it is usually completed individually in weekly sessions. Sessions may run from 50 to 90 minutes, and depending on the presenting problem, the duration of the treatment might vary. Schema therapy uses a range of techniques to help individuals acknowledge their EMSs and modify them; these include cognitive, experimental and behavioural interventions.
Cognitive techniques involve modifying and challenging problematic beliefs and are usually used to test the validity of the client’s schemas
and modes. This involves discussing with the client about their behaviour and coping mechanisms and listing out the pros and cons of these. Some other tools used are diaries, schema flashcards, schema dialogues, data collection, reframing and reattribution. Behavioural techniques involve a more adaptive process to practice new skills and behaviours to transform outcomes. Some tools used through this approach are behavioural homework, rewards, flashcards, adaptive behaviour and the rehearsal of adaptive behaviour through role-play or imagery. Imagery (or guided imagery) is a practical approach used to help clients access past childhood experiences and better understand the origins of their current problematic emotions, behaviour and thinking patterns. Through this, trauma is reimagined and hopefully meets the needs of the child who was mistreated. Some other techniques used are listed below.
Case Conceptualisation
Chair dialogues
Empathic Confrontation
Limited reparenting
Schema Therapy is a trusted and common approach used by therapists in helping clients through the collaboration with schemas and modes and many techniques used to help change problematic thoughts, behaviours and emotions.
Reference
Shemas source : Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003) Schema therapy. New York: Guilford Press.
Modes source: 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
What is Schema
Techniques:
Book - Van Vreeswijk, M., Broersen, J., & Nadort, M. (2012). The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research, and Practice. John Wiley & Sons.
the 18 schemas and modes:
Article written by Aochi Dibbin
Psychology student at Deakin University who completed a student internship at Wise Psychology
