Schema Therapy

WHAT IS SCHEMA THERAPY? 

Schema Therapy is an approach to the treatment of psychological problems that do not usually respond to briefer types of therapy. The model was developed in the USA by Dr. Jeffrey Young over 25 years ago where it is widely used today.  It is an integrative therapy that draws on cognitive-behaviour therapy (CBT), psychodynamic and relational therapies, but in contrast with other models, it also incorporates many forms of experiential and expressive therapies such as imagery rescripting and chair work into one unified model.   Schema therapy has a growing presence in Europe, particularly in Holland, Germany and the UK where much of the current research has been carried out.  The Schema Therapy model came to the attention of researchers in the Netherlands who were developing a large-scale study of treatments for Borderline Personality Disorder.   It is said that “…the clearly articulated approach of Schema Therapy lent itself well to a controlled outcome study”.  See link to articles at the end of this text.

In research, Schema therapy was found to be twice as effective as a psychodynamic approach, Transference Focused Psychotherapy (TFP).  Schema Therapy was also found to be less costly and to have a much lower drop out rate. Borderline Personality Disorder (BPD) has until recent years been considered untreatable, with little scientific justification for longer-term therapy.

These findings have stimulated several lines of on-going research into both the theory and technique of schema therapy and have led to an increase in interest in schema therapy among mental health professionals. The international society of schema therapy (ISST) was founded in 2008 for the purpose of coordinating on-going research and efforts to develop and disseminate schema therapy model.

 

In Ireland, the Schema Therapy Association of Ireland (STAI) was set up in 2014 to further develop ST and aims to promote the practice of ST by trained and accredited therapists, and to facilitate the co-ordinated development of accredited training, supervision, and research in this model of therapy.  The STAI website is at  www.staireland.com.

 

Schema Theory:

The most basic concepts in Schema Therapy is the development of an Early Maladaptive Schema (EMS).   A schema is an extremely stable, enduring negative pattern that develops during childhood or adolescence and is elaborated throughout an individual’s life.   We “view the world” through our schemas.    Schemas can be referred to as “core beliefs” or deeper important beliefs and feelings about oneself and the environment, which the individual accepts without question.  They are self–perpetuating and are very resistant to change.  For instance, children who develop a schema that they are incompetent rarely challenge this belief, even as adults.  The schema usually does not go away without therapy.  A maladaptive schema is one that has developed in childhood from an interplay between the child’s innate temperament and the child’s ongoing damaging experiences with parents, siblings, or peers.

In essence, Young defines schemas as: “broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.”

Therefore, one of the main aims of the model is to validate unmet basic core needs of patients.  The therapy relationship of “limited reparenting” provides the role model of a healthy parent that the patient learns to internalize over the course of therapy. The therapist uses both emotion-focussed and cognitive and behavioral techniques mentioned above to break through dysfunctional patterns in the patient’s life.

It is interesting that the ST model differentiates between the schema itself and the strategies or behaviours a client may use to cope when their schema is triggered.   Therefore, while the schema contains all the emotions, memories, bodily sensations and cognitions that relate to the formation of the belief, the behaviour is seen to be a part of the coping response.   To illustrate, consider 3 clients who all have a Defectiveness Schema, but who may all cope in very different ways.   While all feel defective, one may unintentionally seek out critical partners or friends (surrendering), one may avoid getting close to anyone at all (avoiding relationships), and the last one may develop a superior or critical attitude to others (overcompensating).

Because they begin early in life, schemas become familiar and thus comfortable. We distort our view of the events in our lives in order to maintain the validity of our schemas. For some, schemas may remain dormant until they are activated by situations relevant to that particular schema.  For others, they appear much more frequently – thus causing ongoing difficulties.

ST is an unusually compassionate and humane model in that it works to normalise, not pathologise, psychological disorders by showing that schemas are simply more entrenched in certain clients.   By using the techniques of empathic confrontation and limited reparenting, ST can be both challenging and person-centred equally.   These techniques help to keep the therapist grounded in a caring attitude, allied with the client, yet capable of confronting the schema in operation.

 

Interesting Books on Schema Therapy:

 

  • Young, J.E., Klosko, J.S. & Weishaar, M.E. (2003).  Schema Therapy – A Practitioner’s Guide. London: Guilford       Press.
  • Arntz, A. & Jacob, G. (2012) Schema Therapy in Practice: An Introductory Guide to the Schema Mode Approach. New York,  Wiley.
  • Young, J.E. & Klosko, J.S. (1993). Reinventing Your Life. New York: Plume.
  • Arntz, A. & Van Genderen, H. (2009). Schema Therapy for Borderline Personality Disorder.Chichester: John Wiley & Sons Ltd.
  • Rafaeli, E., Bernstein, D. & Young, J, (2010). Schema Therapy (CBT Distinctive Features), New York, Routledge.
  • Jacob, G, Van Genderen, H, Seebauer, L. (2014)  Breaking negative thinking patterns:  A schema therapy self-help and support book. (1st edition).

 

Research /Articles:

Farrell, J.; Shaw, I.; and Webber, M. A schema-focused approach to group
psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial.
  Journal of Behavior Therapy and Experimental Psychiatry

Volume 40, Issue 2, June 2009, Pages 317-328

Josephine Giesen-Bloo, MSc; Richard van Dyck, MD, PhD; Philip Spinhoven PhD; Willem van Tilburg MD, PhD; Carmen Dirksen, PhD; Thea van Asselt, Msc; Ismay Kremers, PhD; Marjon Nadort, MSc; and Arnoud Arntz, PhD. Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy. Archives of General Psychiatry, 2006 , Vol. 63, No. 6, pp. 649-658.

Nadort, M.; Arntz, A.; Smit, J.; Giesen-Bloo, J.; Eikelenbooma, M.; Spinhoven,P.; vanAsselt, T.; Wensing, M.; vanDyck, R.; Implementation of out patient schema therapy for borderline personality Disorder with versus without crisis support by the therapist outside office hours: A randomized trial Behaviour Research and Therapy xxx (2009 )1–13