A brief look at schema therapy.

Jason Brien.

     Schema therapy is a therapeutic approach which is a combination of Cognitive Behaviour Therapy (CBT), Gestalt therapy, attachment therapy, objects relations theory and emotion focused-therapy. It was developed specifically to treat personality disorders and other ‘resistant’ conditions not responsive to other therapeutic approaches. 

There are four main concepts within schema therapy; Early maladaptive schemas, core emotional needs (schema domains), modes (4 modes), and maladaptive coping styles. 

Early maladaptive schemas;

Early maladaptive schemas (EMS) are self-defeating feelings and thoughts developed in early childhood. EMS’s are core, maladaptive and erroneous beliefs and behaviour patterns about oneself, one’s relationships/interactions with others and about the outside world itself. EMS’s are developed by children as a way of protecting themselves when their core emotional needs are not met. These early maladaptive schemas are made up of emotional and cognitive memories of past hurts, traumas, fears and grievances.  

The 18 Core emotional needs (schema domains);

Abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, social isolation/alienation, dependence/incompetence, vulnerability to harm or illness, enmeshment/undeveloped self, failure, entitlement/grandiosity, insufficient self-control and/or self-discipline, subjugation, self-sacrifice, approval-seeking/recognition-seeking, negativity/pessimism, emotional inhibition, unrelenting standards/hyper criticalness, punitiveness.  

The four modes;

1.Child modes - characterized by childlike feelings and behaviours (regression). Can include angry child, impulsive child, dependent child and abandoned child. 

2.Dysfunctional coping modes – Detached protector. These modes are centred around escape behaviours and are used to prevent emotional distress. 

3.Dysfunctional parent modes – The punitive parent. The demanding parent. Introjections of critical, demanding, or harsh parental voices. 

4.Healthy adult mode - Your healthy, functional self. This mode can help regulate the other modes by setting limits and countering the effects of other modes.

Particular modes are provoked in response to life events/situational factors and according to the schema (trait) that is activated. For example, a relationship ending suddenly and without warning might provoke your abandonment/instability and isolation/alienation schemas and thus activate your angry child and abandoned child modes. Similarly, if you don’t achieve a goal that you set for yourself then your failure or unrelenting standards/hyper-criticalness schemas might be provoked and your dysfunctional parent mode will activate.

Maladaptive coping styles;

These are the ways that the child adapts to their schemas and reacts to their traumatic and painful childhood experiences. The adaptive coping styles are unhealthy and maladaptive ways of thinking, feeling and behaving in response to not getting core emotional needs met. There are 3 general ways that children can adapt and react to their schemas. First, they can surrender to the schemas – they give into the schemas, not challenge them or try to overcome them and so they keep repeating them over and over again. Second, they can avoid the schemas by finding ways to escape or block out the schemas (cognitive distortions, defence mechanisms, drugs and alcohol) and lastly by overcompensating - doing the opposite of what the schemas makes them feel.

What are the benefits of schema therapy?

Schema Therapy helps people to identify their core emotional needs, their subsequent maladaptive schemas that developed in response to certain needs not being met, the mode that is activated when a particular maladaptive schema is provoked (child mode, etc) and the way in which they cope with the schemas and modes once they have become activated.

Once you understand the core components of schema therapy, it becomes easier to understand why it is a combination of other therapeutic approaches. The CBT aspect focuses on the relationships between thoughts, feelings and behaviours when each of the maladaptive schemas, modes and coping styles are activated. Gestalt therapy emphasises personal responsibility and the present moment. So, focusing on what is actually happening within the present moment (Identifying which schema, mode or coping style is currently activated). 

Likewise, the object relations component focuses on how we interact with certain objects within our minds (the punitive and demanding parent objects, the child objects, etc).  The attachment therapy component helps us to understand how relationships can activate abandonment, dependent or mistrust/abuse schemas for example and also helps us to understand how the activation of these schemas then affect our ability to attach and interact securely with others. Finally, emotion focused-therapy teaches healthy emotional regulation skills which can be used when maladaptive schemas and modes are activated. 

Rather than relying upon the three maladaptive coping styles (surrender, avoid and overcompensate), the emotion focused component of schema therapy helps people to accept, tolerate and eventually overcome their painful feelings and thoughts. Once a person understands the connection between these four aspects, they can begin to change their patterns of feelings and behaviours, confront their unmet emotional needs in healthy, adaptive and constructive ways and learn how to cope with frustration and distress when certain needs are not able to be met. This is not always easy and it can be a hard, long and frustrating road to travel. A good therapist however should be able to make the journey a lot easier.