Schema Therapy

Updated October 7, 2022 by BetterHelp Editorial Team

Have you met someone who you had a sense that they went through the same thing repeatedly? Whether it's entering into bad relationships, navigating the challenges of addiction, or other issues like self-esteem, many of their life situations seem like broken records. Would you be surprised to learn that this isn't a coincidence, but a scientifically proven phenomenon that happens because of self-defeating core themes known as "schemas"? These negative feelings and thoughts like "I'm not good enough" and "My needs will never be met" are developed in childhood and morph into deep-seated patterns that cycle on and on until something is done to change them. One way to help change these negative cycles is through online therapy services and meeting with someone who can help you work through them. One of the most beneficial ways to activate this change is schema therapy, which is a type of therapy employed in clinical psychology.

Schema Therapy Offers Many Treatments

Brief Overview: Schema Therapy

Schema therapy was started by Jeffrey Young and is recognized to be an American Psychological Association’s official treatment strategy. It is an integrative and comprehensive therapy that involves important concepts of many different treatment aspects including behavioral, attachment, cognitive, gestalt, and psychodynamic therapies. When dealing with the products of mental disorders, behavior therapy and cognitive techniques are the key modes of treatment. However, the schema therapy model gives more equal importance to therapeutic relationships and focuses on the patient's emotions.

Jeffrey Young's Advancements

Jeffrey Young developed schema therapy for use with people whose mental health concerns could not be solved using cognitive therapy resources. It focuses mainly on the premise that most personality disorders stem from unmet emotional needs during childhood. In the past, mental health conditions and personality disorders, such as borderline personality disorder were thought of as "unchangeable." This caused many mental health professionals to become hesitant to work with patients suffering from BPD and similar conditions. With schema therapy, the therapeutic relationship between the patient and the therapist plays a large role, which is unlike other types of therapy.

But success through schema therapy and other breakout techniques is giving new hope to people whose emotional problems were once thought "untreatable." Schema therapy aims to treat other personality disorders, such as paranoid personality disorder and narcissistic personality disorder among others. In addition, suggests it is also effective in solving such problems as anxiety, bipolar disorder, eating disorders, post-traumatic stress, and substance abuse among others. These are broad categories, however, and it is necessary to keep in mind that everyone’s treatment will likely be different.

What Is A Negative Pattern? 

A maladaptive schema is described as a continuing negative pattern that starts during childhood. For instance, a child may have experienced childhood abuse or emotional neglect that contributed to a schema developing or an unhealthy coping style emerging. Schemas are strengthened by actions, core beliefs, relationships, and thoughts throughout a person's life experiences. Examples of negative trends that are schema beliefs are such as: "No one loves me," "I will never succeed," I'm ugly," and "I'm a failure," among others. It is important to note that some schema beliefs can develop during adulthood and not necessarily during childhood, but those rooted in the early years can be especially powerful.

According to schema therapy, maladaptive schemas start to form because of bad childhood experiences. These are child mode or child modes, including vulnerable child mode, angry, and happy child modes. Maladaptive schemas can also be explained as the ways through which people interpret life occurrences and other people's behaviors, and their effect on life events later. Maladaptive schemas can cause people to make the wrong choices in life, such as engaging in toxic relationships, poor social skills, harmful behaviors, and having negative feelings of low self-esteem or worthlessness. These maladaptive modes may have a profound effect on an individual or cause them to have insufficient skills in terms in some facets of their life.

When emotional needs, such as the need for safety, love, and affection are unmet during childhood, this could lead to emotional distress. It may also allow a person to go into adulthood without the ability to come up with ways of making sure that their core needs are met, by having healthy relationships and meeting their emotional needs independently.

The main aim of schema therapists who use schema therapy is to assist people in addressing and fulfilling their unmet needs. Schema therapy helps in modifying deep-rooted negative feelings or patterns. Unlike cognitive behavioral therapy, which shows the patient how to get rid of the negative emotions, schema therapy uses various techniques to bring out the necessary change in a person with a focus and acceptance of their feelings. One type of therapy that may help symptoms of maladaptive coping styles is dialectical behavior therapy, which helps teach mindfulness. There is research that it might be helpful when it comes to early maladaptive schemas in children, as well as adults.

Common Techniques Used In This Therapy Approach

Schema therapy references CBT techniques and experiential and emotion-focused techniques during treatment. It dwells on the argument that one can experience meaningful change if higher levels of emotions are reached in the brain.

Schema Therapy Offers Many Treatments

During a typical schema therapy session, flashcards are created so that the individual can write messages intended for the people who may have contributed to an emotional inhibition to meet their emotional needs during childhood. One can develop messages by composing simple poems or just writing a few sentences. During the schema therapy session, the person will continuously go through the flashcards. This helps them to come up with positive statements concerning their emotional needs to people who matter during their adult lives. The sentiments that the individual expresses on the flashcards are then internalized, sometimes through overcompensation with the flashcards, and this comes in handy in the development of a healthy adult mode. This may also lead to a more productive coping style.

Schema diaries are also recommended for patients. They provide a guide for the patients to understand their experiences when the schemas are triggered by comparing them to the features of the thoughts they are learning during the schema therapy. The patient can record their progress in comparison to the theoretical concepts that they are introduced to during treatment sessions. For experiential techniques and emotion-focused therapy, the techniques used are imagery, and chairwork is often used as they activate a higher level of emotional change in the individual. Body sensations may also be helpful and required within treatment. This prevents the avoidance of these helpful actions by the patient in the future, producing real results throughout the process. 

Imagery gives people the chance to explore their unpleasant childhood events to a degree and better understand how their maladaptive schemas developed. During childhood, the right side of the brain is dominant, and it is through this that a child's experiences are created. Researchers believe that maladaptive schemas are stored in the right hemisphere, which also is the place where strong feelings are centered. This means if you are around bad company or have bad experiences as a child, these maladaptive schemas will be stored in the right hemisphere, and could lead to maladaptive coping styles or emotional dysregulation throughout an individual’s lifetime. 

During imagery, patients are asked to imagine anything that is involved with their bad memories or experiences and then have imaginary dialogues with the people who caused these bad experiences. They then imaginary ask the caregivers or parents to meet their needs. Imagery is very useful in helping individuals to grieve their losses and overcome traumatic events, giving them freedom from the pain these experiences have caused. Other schema therapy techniques are chair work and limited reparenting. According to schema therapy, if one's needs are not met during childhood this can lead to negative patterns; therefore, having the needs met even as an adult could assist in healing and stopping the maladaptive schemas, and setting up healthy boundaries and thought processes along the way.

What Happens During Schema Therapy?

During a schema therapy session, the treatment approach with a mental health professional or clinical psychologist consists of the following:

Assessing the patient to identify the early maladaptive schemas. They will get to know you and understand your schemas and the effect that they have on you. In other words, they will discuss your life with you, so they are better able to provide a systematic review of one’s lifetime schemas and coping strategies.

Second, the client is helped to develop emotional regulation awareness and get in touch with the schemas. The emotional or experiential awareness helps in activating the schemas.

The next step is the behavior change where the schema mode inventory of maladaptive coping schemas is replaced with the correct ones, which is designed to lead to proper emotion regulation. Check out the following categories of schemas and see if you can relate to a certain schema, in particular.

18 Schemas To Know: Definitions And Examples

Young also developed a schema questionnaire, which is designed to help you and your therapist determine what early maladaptive schema or schemas you may have developed throughout your life. Here’s a look the schemas that are present on this questionnaire.

  • Emotional deprivation: having the belief that other people will not give you or empathy or believing that adequate emotional support cannot be met by others.
  • Mistrust: believing that others will humiliate, use you, abuse, or hurt you. One has the perception that every form of harm is intentional.
  • Dependence: believing that one cannot handle their responsibilities without getting assistance from others. For example, making the right decision and tackling new tasks, etc. The state of helplessness.
  • Defectiveness or shame: having feelings of being unwanted, invalid, or inferior. As a result, one may become hypersensitive to criticism or rejection.
  • Entitlement: It is also known as grandiosity. Often one has beliefs that one is superior to others and should get special rights. It may present with excessive competitiveness, controlling behavior, and lack of empathy.
  • Undeveloped self: having feelings of being intertwined with others, especially a punitive parent. It can compromise development. It has an excessive emotional closeness with significant others, and this often leads to a lack of individualism.
  • Alienation or social isolation: having the belief that you are isolated from the world.
  • Abandonment: belief that others cannot be relied on to provide emotional support that is needed arising from their emotional instability,
  • Vulnerability to harm: having constant worries that bad things or catastrophes will happen.
  • Failure: belief that one is a failure or will eventually fail in terms of life experience achievements such as a career.
  • Insufficient Self-control: refusing to exercise self-control. One presents as having an exaggerated emphasis on avoiding conflict, pain, and responsibilities.
  • Approval is seeking: the excessive desire of getting recognition, attention, and approval from others. In such a case self-esteem depends on the reactions of other people.
  • Punitiveness: believing that people should be punished for their mistakes. Involves difficulty forgiving others and one is often angry, punitive, and intolerant.
  • Unrelenting standards: belief that one must work hard towards meeting very high standards of performance to avoid criticism. Often present as perfectionism and having rigid rules.
  • Negativity or pessimism: having a consistent focus on life's negatives such as betrayal, death, and pain among others. At the same time, one is always reducing the positive aspects of life. People with such traits often present as having chronic worry, constant complaints, and indecisiveness.
  • Self-sacrifice: is the meeting of the needs of people at the expense of personal needs. The main reason for this is for connection maintenance and to avoid being labeled as selfish.
  • Subjugation: giving too much control to others to avoid being abandoned or angering the other party. Subjugation can be n terms of one's needs and emotions. Mostly manifests as being overly compliant and can lead to anger and maladaptive traits such as substance abuse or psychosomatic symptoms.

Effectiveness For Borderline Personality Disorder

Studies have shown that schema-focused therapy is very useful in treating BPD and the like, but users of these techniques don't have to be diagnosed with a personality disorder to benefit. Initial goals during the therapy session are the identification of the client's relevant schema modes or coping styles and linking the schemas to the patient's past or current occurrences as well as their symptoms.

Schema therapy may be effective in helping patients with borderline personality disorder change their coping styles related to damaging patterns. According to one study, participants who underwent the schema therapy treatment approach, and had been previously diagnosed with BPD, saw a difference in their symptoms.

Conclusion

Ready to start learning the tools to help you in reinventing your life? Schema therapy is a practical, evidence-based approach that can be effective in treating personality disorders, addressing early schema domains that may not have been processed by a child in a healthy manner, and could improve coping styles for individuals of all ages. Keep in mind that the exact treatment approach will be different from person to person. You may also be asked to fill out a schema questionnaire, so the proper treatment can be tailored to your coping styles, when you are working with a therapist.

Schema therapy can also help in changing negative patterns or maladaptive schemas that individuals develop during childhood into positive behaviors. At BetterHelp.com, we have highly qualified therapists, counselors, and psychologists who are ready to work with you today on a multitude of devices. All you have to do is reach out to be matched with a qualified mental health specialist to begin therapy from the comfort of your own home and your personal device. They may be able to help you understand your behavioral patterns or coping styles better, and make changes, if this is applicable.

Frequently Asked Questions (FAQs): Schema Approach

What is schema therapy used for?

In particular, schema therapy and schema modes are terms used in therapy for borderline personality disorder. While not exclusively used with this disorder, this approach tends to be most effective at treating borderline personality disorder. Working with a schema therapist, a person living with this disorder can uncover their schemas which are unhelpful patterns developed by a person if their emotional needs aren’t met as a child. A therapist focuses on helping a client become a healthy adults if they have impaired autonomy.

Is schema therapy evidence-based?

Initial research into schema therapy training and the society of schema therapy has found initial evidence for effectiveness. With that said, more research into where schema therapy fits into and the specific applications of the field need to be done. For example, researching the efficacy of schema therapy on other types of disorders such as post-traumatic stress or long-term anxiety and depression. Based on early research, however, the schema therapy institute seems to be beneficial for those who have experienced the coping modes, coping styles, and coping methods associated with the approach. 

What are relationship schemas?

Relationship schemas are core beliefs or stories we have developed about ourselves or others in a relationship, and there are many schema questionnaire sites to help identify those beliefs. A schema-focused relationship can often lead to impaired limits of ideas or a lack of core emotional needs met. Believing something negative about a partner can cause the thought to be ingrained and affect the rest of the relationship as a whole when taken to an extreme. This can lead to defectiveness shame or social isolation. If you believe schema therapy is needed, find a therapist near you and seek the treatment you need.

Can schemas change?

Historically speaking, early maladaptive or long-term schemas are notoriously difficult to change. Some people will distort or change information to make it fit their schema as coping methods or as a way to ensure core emotional needs are met are accurate. This can often happen with post-traumatic stress or long-term anxiety and depression. With that said, a person can change their core emotional schema with effort, though it is usually easier to change these during childhood. Long-term and established ones that have been reinforced by the environment around a person are far harder to change.

What are schema and examples?

A common example of a schema is your friend or family . This could include information about how they act, their behavior, their mannerisms, and their common moods. When something seems off with this person, your schema may be challenged and lead to an empathic confrontation where you try to figure out what is bothering your friend or family. However, it can also be something as simple as seeing a car and understanding its purpose. Many online questionnaire sites can give a better understanding of the different types of schemas and how they interact with our daily lives.

What is schema mode?

Under schema theory, a schema mode is a temporary mindset that includes both your present emotional state as well as how you are handling it. Schema modes get at a person’s core emotional thinking patterns and are used to create coping methods and to ensure that core emotional needs are met. Following schema therapy: A Practitioner’s Guide to schema theory, schema therapy will work closely with you for treatment planning to develop an approach based on your specific mental health challenges and help resolve dysfunctional coping modes and dysfunctional parent modes.

What are the four types of schema?

The four main types of schema are role schema, object schema, self-schema, and event schema. The role schema is the norms and expected behavior from people with a specific role in society. These can include both achieved roles and given roles but cover core emotional behavior associated with these roles. Object schema focuses on helping to interpret inanimate objects and informing one on how those objects should function. Self-schema is all about the knowledge a person accumulates about themselves by dealing with the natural world.

Finally, the event schema is commonly referred to as cognitive scripts that describe behavioral and event sequences in daily activities that occur. Schema theory focuses on what these schemas look like in a healthy adult mode in the long term and use them as baselines for treating borderline personality disorder. During a training program for schema theory, as covered by the American Psychological Association, a professional will be taught the healthy adult mode as well as the aspects of attachment theory that may play a role in schemas and behavior patterns.

What is the goal of schema therapy?

The goal of schema therapy is to help individuals overcome unhealthy maladaptive coping skills and instead develop healthy emotional responses to live a fulfilling adult life.

Is schema therapy good for anxiety?

While schema therapy is not the first option for anxiety disorders, it can help reduce symptoms of anxiety for those that schema therapy is intended to treat, such as those diagnosed with personality disorders.

Does everyone have a schema?

In simplest terms, schemas are the beliefs and values that we carry with us from childhood. They influence how we view people, society, and the world. This can be a positive force in our lives, or for some people with unhealthy upbringings, it can be negative and lead to unhealthy coping skills. 

What happens when a schema is triggered?

When a schema is triggered, it's known as the schema-triggered effect. A schema can be triggered by life changes, transitions, and other stressful situations. It may introduce repressed feelings of depression or anxiety and can result in unhealthy coping mechanisms learned in childhood.

How many sessions is schema therapy?

Schema therapy length and duration depend on the individual's needs and the discretion of their therapist, but they typically follow for about 20 weeks with 60 one to two-hour sessions.

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