Learn about the history and usage of schema therapy for mental health and substance use disorders.
Psychotherapy evolves as new information is found. It adapts to meet the changing needs of society. Schema therapy is one example of how psychology adapts. The staying power and versatility of this form of therapy allows it to be used in a variety of ways. It can even help treat many types of mental disorders.
What Is Schema Therapy?
Since it is mostly used in Europe, some people may not know about it. So what is schema therapy?
A schema is a plan for learning a concept. In psychotherapy, a schema refers to the way the brain sees, understands and responds to the world. They are learned through life experiences and are supported by every idea, belief and action. Schema therapy focuses on aspects of life that negatively affect a person.
This therapy is formed around the idea that there are childhood needs that must be met. They are:
When these needs go unmet in childhood, people may create negative schemas. Such negativity can lead to poor decision making, relationship issues, poor judgment, avoiding people, unusual behavior and weak impulse control.
Schema therapy is used for helping people identify weak schemas and change them to stronger ones. It can also be used to help treat many mental health disorders.
Origins and Development
Schema therapy has strong roots in cognitive behavioral therapy (CBT). It maintains the idea that events and actions can create an automatic belief. Such beliefs can cause their own sets of poor behavior as a result.
The history of schema therapy is brief. It was founded by Dr. Jeffrey Young, a clinical psychologist who trained with the creator of CBT, Dr. Aaron Beck. After many studies hinted at its impact, Dr. Young opened New York’s Schema Therapy Institute in the 1990s to treat people and train other psychologists in schema therapy. Soon, more studies showed that the therapy was particularly effective for borderline personality disorder.
18 Maladaptive Schemas
Dr. Young proposed that there are 18 maladaptive schemas. These describe beliefs from early in a person’s life, which is why they are often referred to as early schemas.
- Emotional deprivation: Thinking that others will not be able to give emotional support.
- Abandonment: The belief that others will leave or die with little or no warning.
- Mistrust and abuse: Feeling like a victim of cheating, lying or humiliation by others.
- Social isolation: Feeling alone in the world and not part of a group.
- Defectiveness: Feeling bad or not as good as others.
- Failure: Feeling like you will not succeed.
- Dependence: Feeling like you cannot take care of your personal needs.
- Vulnerability: Feeling like something bad is about to happen.
- Enmeshment: The tendency to get too emotionally involved with a loved one.
- Subjugation: Feeling like you will be ignored by others or made to feel unimportant.
- Self-sacrifice: The drive to meet the needs of others while skipping your own needs.
- Emotional inhibition: Limiting actions or feelings to avoid shame or disapproval.
- Unrelenting standards: Believing that you hit unlikely standards to avoid criticism.
- Entitlement: Acting in your best interest without feeling the need to return favors.
- Insufficient self-control: Lacking self-discipline, which can lead to addictive behavior.
- Approval-seeking: Seeking attention from others.
- Negativity and pessimism: Always having a major focus on the negative aspects of a situation.
- Punitiveness: Thinking that people should be punished harshly for their mistakes.
How Does Schema Therapy Work?
Though it isn’t simple, the goal is straightforward. People focus on negative factors to fix them. Schema therapy teaches how to see bad patterns as they happen and try to replace them.
To reach that goal, a few tactics are used:
- Image re-scripting: People are asked to remember times from childhood. They are then asked to imagine themselves back then, using cues from all senses. With the help of the therapist, people then create a fake dialogue with their childhood caregiver and ask them to meet their needs. This exercise helps people realize what their needs are.
- Empty chair work: Empty chair work is often used with image re-scripting, and it helps people figure out their emotions. People act out their emotions by moving between two seats and showing a different emotion in each one.
- Journaling: People are urged to log the events that have caused bad schemas. They can go over this log with the therapist, who can help point out patterns and create a plan for the future.
- Cue cards: People can use cue cards to write notes to a caregiver who did not meet their needs as a kid. The notes can be as simple or as complex as needed. The cards serve as a way to learn adult needs.
Issues Treated With Schema Therapy
Schema therapy has been shown to be very useful in the treatment of borderline personality disorder. This disorder can cause people to act in different ways. One study found that this therapy type was more useful than other types of therapy. A person should speak to a doctor to have them help decide what option is best.
Schema Therapy in Addiction and Mental Health Treatment
Schema therapy gives people the means to find the needs that were not met when they were a kid. It also shows people how to meet those needs as an adult. For example, addiction may be the result of unmet needs, and it may reveal one or more schemas. So, this type of therapy is an excellent form of treatment for those with an addiction.
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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.
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