Psychotherapy goes through a process of evolution over time as new information is acquired. It adapts to meet the ever-changing needs of its participants. Schema therapy is one example of how psychology adapts. The staying power and versatility of schema-focused therapy allow it to be used in a variety of treatment settings, and a schema therapy treatment plan can help treat many mental health conditions.
What Is Schema Therapy?
Since it is most commonly practiced in Europe, you may not have seen or heard about schema therapy before. So what is schema therapy?
A schema is “a model or plan for understanding a larger concept.” In psychotherapy, schema refers to the way the brain perceives, understands and responds to the world. Schemas are learned through childhood experiences and are reinforced with every subsequent thought, belief, experience and action. Schema therapy focuses on these models that negatively affect a client’s life.
Schema therapy is formed around the idea that there are needs that must be met in childhood including:
According to schema theory, schemas are beliefs about who you are and how you are supposed to act, which guide how you respond to the world. When these needs go unmet in childhood, individuals will create maladaptive schemas. These beliefs can lead to unhealthy decision making, problematic relationships, judgment lapses, avoidant tendencies, passive-aggressive behavior and poor self-control.
Schema therapy is used for helping clients identify their maladaptive schemas and replace them with healthier strategies. It can be used to help treat several different mental health disorders.
Origins and Development
Schema therapy development stems from several other types of psychotherapeutic practice:
- Cognitive behavioral therapy
- Gestalt therapy
- Emotionally focused therapy
- Psychoanalytic principles.
Schema therapy is most strongly rooted in cognitive behavioral therapy. It maintains the idea that situations and behaviors can elicit an automatic and conditioned belief. These beliefs can cause their own set of maladaptive behaviors as a result.
The history of schema therapy is a young one. Schema therapy was founded by Dr. Jeffrey Young, a clinical psychologist who trained with the creator of cognitive behavioral therapy, Dr. Aaron Beck. After a number of studies suggested its effectiveness, Dr. Young opened New York’s Schema Therapy Institute in the 1990s to treat clients and train other psychologists using schema therapy. Soon, larger studies showed that schema therapy was particularly effective for borderline personality disorder.
18 Maladaptive Schemas
Dr. Young proposed that there were 18 maladaptive schemas. These describe automatic beliefs about ourselves from childhood, which is why they are often referred to as early maladaptive schemas. These maladaptive schemas are triggered by a situation or behavior:
- Emotional Deprivation: The belief that others will not be able to meet your need for emotional support. This schema can be further subdivided into deprivation of nurturance, deprivation of protection and deprivation of empathy.
- Abandonment: The belief that others will not provide or will someday withdraw critical support, sever connections, leave for someone better, die suddenly or otherwise go away.
- Mistrust/Abuse: The sense that you will be a victim of abuse, cheating, lying or humiliation by others.
- Social Isolation: The belief that you are alone in the world and not part of any group.
- Defectiveness: The belief that you are “damaged goods,” bad, inferior or undesirable.
- Failure: The expectation that you will not succeed.
- Dependence: The feeling that you cannot take care of your own basic needs or manage routine tasks well.
- Vulnerability to Harm and Illness: The sense that something bad is about to happen to you. It may take the form of psychological harm, physical harm or external harm from another person or event.
- Enmeshment: The tendency to get emotionally over-involved with a loved one at the expense of developing your own secure sense of self.
- Subjugation: The belief that you will be minimized, ignored by others or otherwise be made to feel unimportant. Subjugation can take place with either your needs or your emotions.
- Self-Sacrifice: The drive to meet the needs of others while foregoing your own gratification.
- Emotional Inhibition: The tendency to inhibit your spontaneous actions or feelings to avoid shame or disapproval by others.
- Unrelenting Standards: The belief that you must meet near-impossible standards in order to avoid criticism. It may present as perfectionism, rigidity or overcommitment to efficiency.
- Entitlement: The tendency to act in your best interest without feeling the need to reciprocate.
- Insufficient Self-Control: A lack of self-discipline, which may make you prone to avoidance, procrastination or addictive behavior.
- Approval-Seeking: A focus on gaining attention or approval from others instead of developing self-assurance.
- Negativity/Pessimism: An overarching focus on the negative aspects of a situation, with minimization of the positive aspects.
- Punitiveness: The belief that people should be punished harshly when they make mistakes.
How Does Schema Therapy Work?
Though it isn’t always easy, the goal of schema therapy is straightforward: Seek, destroy and rebuild patterns that aren’t working. Schema therapy techniques teach clients how to identify their maladaptive patterns as they manifest and try to replace the behaviors that stem from them. A client’s relationship with the therapist provides the template for a healthy, nourishing relationship that can help eliminate the need to use maladaptive strategies.
To accomplish the goal of rebuilding these belief patterns, a number of primarily Gestalt therapy-based exercises are performed.
- Image re-scripting: In this exercise, clients are asked to think of unpleasant memories from childhood. They’re then asked to imagine themselves back in the memory, using cues from all five senses. With the help of the therapist, clients then create an imaginary conversation with their childhood caregiver and ask the caregiver to meet their needs. By performing this exercise and asking for their needs to be met, clients create an understanding of what their needs are. This process makes it easier for them to identify when those needs aren’t being met and how to get them met in a healthy way.
- Empty chair work: Empty chair work is often used with image re-scripting, and it helps clients understand the normal ebb and flow of emotions. In this work, clients roleplay various emotions by moving between two chairs and expressing a different emotion in each one. Chair work can also help clients recreate the dynamics of their relationship with their caregiver, which can help the client identify unmet needs.
- Journaling: Clients are encouraged to log the experiences that have triggered maladaptive schemas. They can review this log with the therapist, who can help point out patterns that emerge and create a strategy for getting needs met in healthier ways.
- Cue cards: Clients can use cue cards to write messages to the caregiver who did not properly meet their needs as children. Messages can be as simple or as complex as the client needs. The cards get reviewed regularly, serving as reminders of how to articulate their adult needs.
Issues Treated With Schema Therapy
Schema therapy has been shown to be impressively effective in the treatment of borderline personality disorder. One study showed that schema therapy was considerably more effective than transference-focused therapy, such as psychodynamic psychotherapy.
In addition to borderline personality disorder, schema therapy can help treat other conditions like:
- Recurrent depressive disorders
- Post-traumatic stress disorder
- Anxiety disorders
- Eating disorders
- Substance use disorders
- Other personality disorders
Schema Therapy in Addiction and Mental Health Treatment
Schema therapy offers clients the ability to identify the needs that were not properly met as well as learn how to meet those needs in a productive, adaptive manner. Addiction is a maladaptive manifestation of an unmet need, and its presence may indicate one or more schemas. Because of this, schema focused therapy is an excellent form of treatment for those with substance use disorders.
At The Recovery Village, our highly experienced therapists can use schema therapy and other techniques to help you develop healthy ways of living your life. If you’re dealing with addiction and a co-occurring mental disorder, this form of therapy may be helpful in your recovery. Call us today to learn how to begin a treatment plan that suits your situation.
Merriam-Webster. “Definition of Schema.” 2019. Accessed May 22, 2019.
Young, J.E., “Cognitive Therapy for Personality Disorders: A Schema Focused Approach.” 1990.
Masley, S.A., Gillanders, D.T., Simpson, S.G., & Taylor, M.A. “A Systematic Review of the Evidence Base for Schema Therapy.” Cognitive Behaviour Therapy, 2012. Accessed May 22, 2019.
Sempertegui, G.A., Karreman, A., Arntz, A., & Bekker, M. “Schema therapy for borderline personality disorder: A comprehensive review of its empirical foundations, effectiveness and implementation possibilities.” Clinical Psychology Review, 2013. Accessed May 22, 2019.
Giesen-Bloo, J. et al. “Outpatient Psychotherapy for Borderline Personality Disorder: Randomized Trial of Schema-Focused Therapy vs. Transference-Focused Psychotherapy.” Archives of General Psychiatry, 2006. Accessed May 23, 2019.