Schema Therapy

For some of us, early life or adolescence was challenging and difficult, and those early life problems continue to have an effect on our adult lives.

Schema Therapy is an evidence-based, integrative therapy that helps people to address these early life patterns or schemas, and to adopt healthier ways of thinking and acting.

How Problem Schemas Arise

Each individual is born with a temperament that is beyond their control; some babies are naturally physiologically calm and easy-going, while others are more sensitive and fussy. The genes that a person inherits have an impact on how easy it if for them to fit into their environment.

The family and social circumstances that a child is born into can help to settle or stress that infant. The quality of the fit between a child’s temperament and the family environment has a significant influence on the types of schemas a person develops. Where the fit is good, the family is stable and the child has an easy temperament, positive, trusting and optimistic schemas are likely to develop.

All infants are born with core emotional needs, and are unable to provide for those needs themselves.

Infants require safety, stability, nurturing and acceptance. They need to develop competence, independence and a sense of identity. They need to express their needs and their emotions, and have these expressions reflected and validated by their caregivers. They need to be spontaneous and have room to play, and they need to have realistic limits set for them that help them to develop the self-control necessary to manage social and other relationships.

Schemas are broad themes or patterns that are made up of emotions, thoughts, memories, behaviours and physical sensations. They concern how we relate to ourselves, to others, and to the world in general.

Problem schemas arise when core emotional needs are not met. Caregivers may struggle to meet a child’s core needs because of stress, mental illness, neglect, trauma, victimisation or problem schemas of their own.

Too much of a good thing can also generate problem schemas, because society requires that we observe appropriate limits on our own behaviour so that we don’t interfere with other people’s wellbeing.

How Schemas Can Cause Problems

When we develop problem schemas, we may distort information to fit in with the schema. For instance, a person who believes that people are never trustworthy may interpret a friend being late due to a delayed train as evidence that the friend is unreliable, and get very angry with the friend.

Schemas can also result in self-defeating life-patterns, for instance, somebody who believes that others are more important than they are may choose self-focused friends who take advantage of their kindness.

Problem schemas can also lead to dysfunctional coping strategies, as when a person who has trouble setting appropriate limits over-indulges in alcohol too frequently.

Problem schemas fall into 5 categories:

  1. Disconnection / Rejection – Difficulties connecting with or trusting others, and feeling insecure and unconfident in relationships.
  2. Impaired Autonomy and Performance – Difficulties with independence, confidence and fear, feelings of inadequacy.
  3. Impaired Limits – Difficulties accepting one’s own normal human failings, or setting appropriate limits on one’s pleasurable activities.
  4. Other-Directedness – Difficulty valuing oneself in comparison to other people, or requiring others to provide approval and recognition of one’s own worth.
  5. Overvigilance and Inhibition – Difficulty expressing emotions, accepting natural human limitations as a normal part of ourselves and others, and seeing the positive aspects of life.

Interestingly, when we have developed a problem schema, we don’t necessarily acknowledge that it is there. Here are three ways that people interact with their schemas, and some people do all three at different times:

  • Avoidance: Some people go to such pains to avoid any reminder of a problem schema that they are always distracted by something.
  • Overcompensation: Other people fight their schema aggressively, and take pains to disprove the schema, for instance working extremely hard and striving for success to compensate for a feeling of inadequacy.
  • Surrender: Other people surrender to their schemas, and accept them as true.

Treating Problem Schemas

Treatment in Schema Therapy involves identifying and exploring the presence of problem schemas in your life, and developing a detailed understanding of both the origins of the schema, and how it is creating difficulties in your current life.

You may then work with your therapist to develop a case against your schema, and begin to identify and challenge self-defeating thoughts that are generated by the schema. This may involve the use of imagery exercises to re-live key memories that generated the schema, and heal the damaging interactions in those memories.

In therapy you may change self-defeating behaviour patterns, and practice more helpful ways of behaving with your therapist, or through experiments outside your sessions. You will use a variety of these techniques to gradually shift your unhelpful schemas into more healthy and life-enhancing schemas.

Working with Modes in Schema Therapy

When applying schema therapy to to people with serious attachment traumas, which underly so-called borderline personality disorder and narcissistic personality disorder, the authors of schema therapy developed mode work to make schema therapy more effective. They described 5 modes of being that may be present in people with attachment traumas that may need specific attention during their treatment:

  • Healthy Adult: This mode engages in healthy coping strategies, and the therapy seeks to enhance its skills and influence on the person's life.
  • Abandoned Child: This mode holds the distress associated with unavailable caregivers, and seeks alternative caregivers during adulthood.
  • Angry and Impulsive Child: This mode vents the person's fury and acts out to soothe the distress associated with unmet needs.
  • Detached Protector: This mode uses numbing, detachment, avoidance and submission to cope with the pain of unmet needs.
  • Punitive Parent: This mode internalises the messages of parents during childhood, and directs punishment and difficulties inwardly, rather than outwardly.

These modes are similar to the parts described in the Structural Dissociation Model, or ego states, in Ego State Therapy (link), and may be worked with in similar ways.

Working with Modes in Schema Therapy
References
Young, Klosko and Weishart (2003). Schema Therapy. New York: Guildford Press. Young & Klosko (1993) Reinventing Your Life: How to Break Free from Negative Life Patterns and Feel Good Again. USA: Plume Books.