Schema Therapy is a form of psychological treatment for clients who have not recovered after first line treatment approaches. It is an outgrowth of evidence-based practices such as cognitive behavioural therapy.
During treatment, maladaptive schema which are deep-seated self-destructive patterns of thinking, feeling and behaving are identified and addressed. These patterns which are learnt in childhood, or earlier on in life, are the cause of pervasive pain and suffering. This is why these schema have been referred to in the past as ‘lifetraps’.
During recovery, clients identify their problematic schema, learn how they developed and how they play out. Next, they modify and change their schema to meet their needs and reach their goals. These two stages of recovery are described briefly below.
Recognising Schema, why they developed and how they play out
Early life experiences can become internalised as schema. Children who experience unstable relationships devoid of love or inconsistent care and who are harmed, victimized or exposed to trauma can develop maladaptive schema. Children who are overindulged and overprotected and do not develop autonomy or appropriate self- control may also develop problematic schema.
During schema therapy, an assessment questionnaire is often used to identify which maladaptive schema are operating. Most people have one or more schema. An awareness of schema alone can weaken their negative impact on one’s life. The five schema domains and related schema are identified below.
- Disconnection/rejection resulting from early experiences of a detached, explosive, unpredictable or abusive family environment. The five schema in this domain cluster include: abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame and social isolation/alienation.
- Impaired autonomy and or performance where early life experiences have engendered expectations about oneself and the environment that interfere with one’s ability to separate and function independently or survive alone. The four schema in this domain cluster include: dependence, vulnerability to harm or illness, enmeshment and failure.
- Impaired limits where early experiences of neglect, lack of guidance and poor role-modelling give rise to deficiencies in internal limits, respect and responsibilities to others or meeting realistic personal goals. The two schema in this domain cluster are entitlement/self-centredness and insufficient self-control and/or self-discipline.
- Other-directedness where there has been an excessive focus on meeting the needs of others, at the expense of one’s own needs e.g. a child caring for a parent with a mental illness. There are three schema in this domain cluster: subjugation, self-sacrifice and approval-seeking/ reconciliation-seeking.
- Over-vigilance/Inhibition result from learning from an early age to control, suppress or ignore one’s own emotions and spontaneous feelings in order to abide strict rules or avoid making mistakes. There are four schema in this domain cluster: negativity/vulnerability to error/ pessimism, overcontrol/emotional inhibition, unrelenting standards/ hypercriticality and punitiveness.
Changing Schema
Changing schema can be difficult because schema are central to our sense of self and therapy can sometimes feel unnatural. It requires one to understand how schema play out in his or her current life, such as difficulties in relationships, self-esteem and career problems and then modifying one’s attitude and behaviour in these instances. One client, for example, may need to identify what types of relationships are healthy to pursue and which ones to avoid. Another client may need to practice putting his or her needs first.
During treatment, techniques such as role-play or ‘the empty chair’ are used to develop insights, challenge schema and incorporate new adaptive thoughts and alternate ways of responding. Homework exercises may also be used to further challenge, weaken or modify schema. Treatment can take as long as it takes to change the problematic schema. some schema may take longer than others to modify. Perseverance can liberate one from self-destructive patterns of thinking, feeling and behaving and foster a better quality of life.
References
Young, J.E & Klosco, J.S. (1993). Reinventing Your Life: How to Break Free from Negative Life Patterns and Feel Good Again, Scribe, London.
Young, J.E., Klosko, J.S., Weishaar, M.E. (2003). Schema Therapy: A Practitioner’s Guide, The Guilford Press, New York.
