Schema therapy

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Schema therapy is best applied to psychological problems that are complex, chronic or resistant to change, such as personality disorders, chronic depression, anxiety, eating disorders, substance abuse and trauma-related disorders.

The maladaptive schemas of schema therapy

According to schema therapy, a schema is a pervasive and dysfunctional theme or pattern of memories, emotions, cognitions, and bodily sensations that develops during childhood or adolescence and affects one’s sense of self and relationships with others. Schema therapy identifies 18 maladaptive schemas that are divided into five domains. The domains are based on the core emotional needs that were not met in childhood and led to the formation of schemas. The domains are:

• Disconnection & Rejection: This domain includes schemas that involve the expectation of being isolated, abandoned, abused, or rejected by others.
• Impaired Autonomy & Performance: This domain includes schemas that involve the belief that one is incompetent, dependent, helpless, or vulnerable to harm.
• Impaired Limits: This domain includes schemas that involve the lack of realistic limits, self-control, or respect for others.
• Other Directedness: This domain includes schemas that involve the excessive focus on the needs and desires of others at the expense of one’s own.
• Over-vigilance & Inhibition: This domain includes schemas that involve the suppression of one’s spontaneous feelings, impulses, or preferences to avoid negative consequences.

The goal of schema therapy is to help patients heal their schemas by diminishing the intensity of emotional memories and cognitive patterns connected to the schema, and by replacing maladaptive coping styles and responses with adaptive patterns of behaviour.

The techniques of schema therapy

Some of the main techniques of schema therapy are:

Case conceptualization: The therapist develops a case concept to capture the client’s problems, symptoms, interpersonal patterns, and problematic emotions. This helps to identify the client’s schemas, triggers, and coping mechanisms.

cognitive interventions: The therapist tests the validity of the client’s schemas and modes and challenges their maladaptive coping styles, such as overcompensating, avoiding, or surrendering.

Experiential and emotion-focused techniques: The therapist uses techniques such as imagery rescripting, chair work, role-playing, and limited reparenting to help the client access and process their emotions, correct their schemas, and fulfil their unmet core needs.

Behavioural pattern breaking: The therapist helps the client to change their behaviour patterns that reinforce their schemas and modes. This may involve setting homework assignments, practising new skills, or confronting fears.

Theoretical example of schema therapy in action

A schema therapist works with the client to explore the origins of their schemas, usually in childhood, and how they are triggered in the present. The therapist also helps the client develop healthier ways of coping with their schemas, such as challenging their negative beliefs, expressing their emotions, and meeting their core needs.

A theoretical example of schema therapy in action is as follows:

• The client presents with symptoms of depression, low self-esteem, and social anxiety. They report feeling worthless, hopeless, and isolated.
• The therapist conducts a schema assessment and identifies several schemas that are relevant for the client, such as defectiveness, abandonment, emotional deprivation, and social isolation.
• The therapist explains the concept of schemas to the client and how they affect their mood and behaviour. They also introduce the idea of modes, which are different aspects of the self that are activated by schemas. For example, the client may have a vulnerable child mode that feels helpless and needy, a punitive parent mode that criticizes and blames them, and a detached protector mode that avoids intimacy and emotions.
• The therapist and the client work together to create a schema case conceptualization, which is a diagram that shows the links between the client’s schemas, modes, life events, coping styles, and symptoms.
• The therapist uses various techniques to help the client heal their schemas and modes, such as cognitive restructuring, imagery rescripting, emotion-focused techniques, behavioural experiments, and limited reparenting. For example, the therapist may ask the client to imagine a situation where they felt defective or abandoned as a child, and then guide them to change the outcome in a more positive and supportive way. The therapist may also provide empathy, validation, and guidance to the client’s vulnerable child mode, while challenging and confronting their punitive parent mode.
• The therapist monitors the client’s progress and adjusts the treatment plan accordingly. They also help the client transfer their learning to their daily life and prevent relapse.

Effectiveness of schema therapy

Schema therapy has been proven to be more effective than other approaches for treating a range of personality disorders, such as avoidant, obsessive-compulsive, dependent, paranoid, histrionic, and narcissistic personality disorders. For example, a randomized controlled trial showed that schema therapy led to higher rates of recovery and improvement than transference-focused psychotherapy or treatment as usual for patients with borderline personality disorder. Schema therapy can also help with other conditions, such as anxiety, bipolar disorder, eating disorders, post-traumatic stress disorder (PTSD), and substance use disorders. Schema therapy is based on the assumption that schemas can be modified and replaced by healthier and more adaptive ones through a process of limited reparenting, cognitive restructuring, experiential techniques, and behavioural experiments.

Further reading

If you would like to learn more about schema therapy, here are some weblinks for further reading:

Schema therapy – Wikipedia(https://en.wikipedia.org/wiki/Schema_Therapy)
Schema therapy: what is it and who does it benefit? – Welldoing(https://welldoing.org/types/schema-therapy)
Schema Therapy: Theory, Schemas, Modes, Goals, and More – Healthline(https://www.healthline.com/health/schema-therapy-2)
Schema Therapy | Psychology Today Canada(https://www.psychologytoday.com/ca/therapy-types/schema-therapy)