I have a special interest in schema therapy, but generally adopt an integrated approach that allows for flexibility and is tailored to the specific needs, desires and difficulties of the client.
What is Schema Therapy?
Schema therapy, originally developed by Jeffrey Young, is a psychotherapeutic model that emerged in response to a need to expand the basic principles of CBT for clients with more complex, long-standing and deeply entrenched problems. Similar to psychodynamic models, schema therapy is interested in deep personal change and seeks to explore and address core representations of the self and the world that have developed since childhood.
It is, thus, an integrative and flexible model that incorporates the most effective elements of established insight-oriented (psychodynamic), emotion-focused and cognitive-behavioural traditions. It has a proven track record with the alleviation of numerous psychological problems in adults, couples and children.
In a pragmatic and accessible manner schema therapy assists in improving client’s present functioning, addressing current problems and also seeks to bring healing to childhood traumas of the past that often drive complex problems in the present.
What is a ‘schema’?
Schemas are enduring, stable and maladaptive patterns of thinking, believing and feeling about oneself and one’s environment that develop from early in life and tend to be self-perpetuating throughout one’s life; as well as being very resistant to change. Thus, they include memories, bodily sensations, cognitions and emotions associated with the destructive aspects of our childhood experience that become organized into patterns that repeat throughout our lives. For instance, children who develop a schema that they are unlovable, perhaps as a result of emotionally detached parents, will often go on experiencing the emotional pain, memories and bodily sensations of this deep belief into adulthood; even if, as adults, there is evidence that they are loved. Furthermore, such a schema is almost always at the root of maladaptive coping styles, self-sabotaging behaviour patterns and distorted ways of thinking.
How do schemas work?
Jeffrey Young and his colleagues identified a number of core emotionally maladaptive schemas. These schemas are kept alive, or perpetuated, by thoughts, feelings and behaviours. For instance, a person who has developed a ‘defectiveness’ schema due to painful childhood experiences will often routinely engage in thinking and behaviour as an adult that confirms this deep-seated belief and in turn strengthens the schema’s influence upon their life.
Schemas are also perpetuated by the ways in which people attempt to cope with them. The three primary schema coping styles include ‘schema surrender’, ‘schema avoidance’ and ‘schema overcompensation’.
Schema surrender: You passively give in to, or surrender, to the ‘truth’ of the schema and act in ways that reinforce the ‘truth’ of the schema. For instance you may have a ‘Failure’ schema and as a result set yourself up for failure by taking on unreasonably large projects, or setting your expectations for yourself very high, ensuring that you will not meet them, and then ‘giving in’ or surrendering to the implication that you are a failure; which in turn perpetuates the Failure schema.
Schema avoidance: This encompasses cognitive, emotional and behavioural ways you may avoid activating schemas to avoid the associated pain. For instance, people may find ways to avoid thinking about painful schemas in their lives or use substances or numbing to avoid feeling the painful emotions associated with their schemas. An individual with a ‘Failure’ schema may actively procrastinate (a form of behavioural avoidance) in the face of manageable tasks at work that have the potential to trigger the schema, be unable to finish them, and so reinforce their sense of failure even as they tried to protect themselves from activating the pain in the first place.
Schema overcompensation: Individuals who overcompensate essentially try to behave or act in a manner that is opposite to their core schemas in order to cope with the associated pain. Once again an individual with a ‘Failure’ schema who copes through overcompensation would likely strive hard in every facet of life to be successful in the eyes of others all the time. When eventually they falter, for whatever reason, the individual would feel as though others have now seen their weakness and their sense of failure would feel confirmed by their inability to sustain their own impossible standards.
What is apparent in all the above examples is that the coping styles in which individuals consciously or unconsciously engage, to prevent the painful activation of their core schemas, all lead to the perpetuation of the schema in the end.
What about schema modes?
In traditional schema therapy the central focus is on identifying core maladaptive schemas, such as Mistrust / Abuse or Abandonment, and exploring their influence on the individual’s life. However, people often find that their lives are characterised by sets of maladaptive schemas that are active at different times and have their own distinct characteristics and purpose and ‘feel’.
For instance, you may find yourself describing a part of yourself, or a way of being and acting, that always capitulates to other’s requests in order to avoid potential rejection. In schema therapy we would understand this as a ‘mode’ that you adopt in order to cope with potentially painful feelings linked to rejection and we may agree to work on building a more healthy sense of assertiveness and thus dislodge or weaken the extent of this mode in your life. Furthermore, in therapy we would begin to identify more parts of the self, or modes, that have arisen in order to cope with those parts of the self that are hurt and vulnerable, often since childhood. We would then work to acknowledge and heal the hurt and vulnerable aspects of the self, weaken the maladaptive coping modes, and attempt to strengthen those parts of the self that represent health, integration, spontaneity and creativity.
Often individuals with severe current psychological problems, or those with traumatic early histories of abuse, abandonment or neglect, tend to present with multiple maladaptive schemas that coalesce into distinct ways of being, or modes, that perpetuate problems in work and relationships. These individuals often connect easily with the mode concept because they recognize how easily they move between, for example, ‘healthy adult modes’, to ‘angry or spoiled child modes’, to ‘detached and withdrawn modes’, to ‘vulnerable and anxious child modes’, to ‘self-critical and demanding modes’. People in your life may even have described you as flipping between more or less extreme ways of being that are sometimes helpful, but often to a large extent unhelpful, disorienting and problematic.
Individuals who have been described as suffering from personality disorders, such as borderline personality disorder, often benefit most over time from schema mode work. They often become adept at recognising the mode that they may be in at any given moment, and so become increasingly empowered to drop the unhealthy modes and practice more functional, healthy, adult ways of being.
How do schemas change?
In therapy the central goal is to help clients gain insight into the nature and working of their core schemas AND to engage in schema healing processes in the therapy room with the therapist and on your own outside in your real world environment between sessions. In schema therapy insight into problems is not seen as enough – schemas must be healed for one to feel fully released from their power.
Following a comprehensive assessment designed to tease out the relevant schemas and coping styles and how these relate to the problems you may be having, the therapy then attempts to weaken the schema’s strength and build up the healthy, adaptive aspects of your identity. This is achieved through interpersonal work that examines the ways in which you may engage in therapy that could be problematic outside the therapy room with others; emotive techniques that help you work through, express and experience the emotional pain of your problems and the schemas underlying them; and cognitive-behavioural work that examines and works to change dysfunctional thoughts driven by schemas that affects your behaviour.