Schema Therapy

Schema therapy is a relatively new therapy that uses the concept of core mental schemas to address unmet emotional needs in people with long-term mental health conditions.

What Is Schema Therapy?

Schema therapy is an integrative psychotherapy [mfn] Taylor, C. D. J., Bee, P., & Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and psychotherapy, 90(3), 456–479. https://doi.org/10.1111/papt.12112 [/mfn] that combines theory and clinical techniques from pre-existing therapies, including

• Cognitive-behavioral therapy
• Psychoanalytic object relations theory
• Attachment theory
• Gestalt therapy

Read More About Cognitive Behavioral Therapy Here

Schema therapy was first developed to treat patients with mental health conditions who frequently resisted treatment or suffered from relapses due to underlying personality issues. It delves into the core schemas in a person to figure out the root cause of their behavior.

Schema therapy for depression [mfn] Malogiannis, I. A., Arntz, A., Spyropoulou, A., Tsartsara, E., Aggeli, A., Karveli, S., Vlavianou, M., Pehlivanidis, A., Papadimitriou, G. N., & Zervas, I. (2014). Schema therapy for patients with chronic depression: a single case series study. Journal of behavior therapy and experimental psychiatry, 45(3), 319–329. https://doi.org/10.1016/j.jbtep.2014.02.003 [/mfn] (especially of a chronic nature) has been found to be quite effective. More recently, schema therapy for couples is also gaining popularity.

Coping Styles Caused By Schemas

Before we talk about schema therapy, it is important to know the different ways that our personality differs based on how we cope with our predominant schema.

For coping with unmet emotional needs, neglect, abuse, and trauma, we may develop one of the following styles [mfn] Masley, S. A., Gillanders, D. T., Simpson, S. G., & Taylor, M. A. (2012). A systematic review of the evidence base for Schema Therapy. Cognitive behaviour therapy, 41(3), 185–202. https://doi.org/10.1080/16506073.2011.614274 [/mfn].

1. Surrendering to our circumstances and accommodating ourselves to the way we are treated—thereby believing that it is the way things should be.
2. Avoiding confrontation with our inner conflicts by disconnecting from the people who mistreat us and/or our own emotions.
3. Overcompensating by attempting to fight against the schema and repeating the same patterns we have been trying to avoid.

What Are Schema Modes?

Schema modes are the combinations of the activated schemas and coping strategies, being momentary reflections of the individual’s emotional, cognitive, and behavioral state. The popular schema modes are divided into four categories [mfn] Edwards D. J. A. (2022). Using Schema Modes for Case Conceptualization in Schema Therapy: An Applied Clinical Approach. Frontiers in psychology, 12, 763670. https://doi.org/10.3389/fpsyg.2021.763670 [/mfn]:

1. Child mode

The child schema modes are characterized by child-like thoughts, behavior, and feelings. The commonly known child modes include:

• Vulnerable child
• Angry child
• Impulsive/undisciplined child
• Happy child

2. Maladaptive parent mode

Dysfunctional or maladaptive parent modes include internalizations of critical, demanding, or harsh parental voices. These include:

• The punitive parent mode
• The demanding parent mode

3. Healthy adult mode

The ‘healthy adult’ is usually efficient and thoughtful in decision-making and problem-solving. They are also appropriately ambitious, comfortable with limits and boundaries, open to nurturing oneself and others, as well as forming healthy relationships.

They take on responsibilities, see things through, and can partake in enjoyable adult activities and interests with boundaries enforced, take care of their physical health, and value themself.

Goals Of Schema Therapy

The main goals [mfn] Dadomo, H., Grecucci, A., Giardini, I., Ugolini, E., Carmelita, A., & Panzeri, M. (2016). Schema Therapy for Emotional Dysregulation: Theoretical Implication and Clinical Applications. Frontiers in psychology, 7, 1987. https://doi.org/10.3389/fpsyg.2016.01987 [/mfn] of schema therapy are:

• Identifying and commencing with healing schemas
• Identifying and addressing coping styles for emotional wants and needs
• Altering thought and behavior patterns that result from schemas
• Learning to achieve emotional goals in healthy, adaptive ways
• Devising healthy coping mechanisms to deal with difficult situations
• Reassure and replace unhealthy coping modes of thought and behavior

Schema Therapy Techniques

Common techniques [mfn] Aalbers, G., Engels, T., Haslbeck, J. M. B., Borsboom, D., & Arntz, A. (2021). The network structure of schema modes. Clinical psychology & psychotherapy, 28(5), 1065–1078. https://doi.org/10.1002/cpp.2577 [/mfn] of schema-focused therapy are as follows:

1. Limited reparenting

In this technique, the therapist provides limited parenting within professional guidelines to recognize, address, and fulfill the client’s emotional needs.

2. Empathic confrontation

With this technique, the therapist empathically confronts the client about “interpersonal patterns”, maladaptive behavior, and distorted cognitive processes as part of the therapeutic relationship.

3. Guided imagery

Diagnostic imagery helps the client understand the origins of existing emotional problems and dysfunctional behavior and thought patterns. The therapist accesses traumatic memories and unmet emotional needs and rewires them, so as to meet the needs of the ‘autobiographical’ badly treated child.

4. Behavioral techniques

Certain behavioral therapy techniques are used in schema therapy. These include:

• Behavioral homework
• Flashcards
• Rewarding adaptive behavior
• Rehearsal of adaptive behavior in imagery
• Role-play, etc.

5. Other techniques

Cognitive interventions and techniques as well as emotion-focused interventions (like chair dialogues) are also used in schema therapy to address client needs.

Uses Of Schema Therapy

The uses of schema therapy lie in treating various conditions, such as

1. Anxiety [Read more]
2. Chronic depression
3. Psychopathy [Read more]
4. Eating disorders [Read more]
5. Personality disorders [Read more]
6. Stress disorders [Read more]
7. Trauma
8. Relationship issues
9. Substance abuse disorders

Benefits Of Schema Therapy

Why choose schema therapy over other therapies? There are several benefits to taking schema therapy: 

• It addresses unresolved childhood conflicts that may be behind certain behaviors [mfn] Systematic review of the clinical effectiveness of schema therapy. (n.d.). Www.oatext.com. Available from: https://www.oatext.com/Systematic-review-of-the-clinical-effectiveness-of-schema-therapy.php [/mfn]. 
• It can be implemented in both individual and group settings [mfn] Gülüm İ. V. (2018). Dropout in schema therapy for personality disorders. Research in psychotherapy (Milano), 21(2), 314. https://doi.org/10.4081/ripppo.2018.314 [/mfn]. 
• Schema therapy can be tailored based on each individual’s needs. 
• It integrates various approaches taking the best out of different therapies.  

How To Find A Schema Therapy Specialist?

Consider researching how schema therapy (online or face-to-face) can help with your emotional and mental health needs. Then, locate a practicing therapist near you.

See to it that the therapist holds the standard certification in schema therapy and has a license to practice. Go through the details of the therapy sessions, particularly the specifications about time commitment and fees.

Limitations Of Schema Therapy

While schema therapy has been widely lauded, it is not completely free of criticisms. Schema therapy suffers from the following drawbacks:

• Research into schema therapy is scarce and its clinical potential is untapped, even if it has been around since the 1990s.
• It can be applied limitedly to certain mental health concerns, including eating disorders, personality disorders, and depression.
• Schema therapy is an expensive long-term commitment and is not easily affordable for everyone.

Takeaway

Recent research into schema therapy reveals that patients undergoing schema therapy show significant improvement after the first year, with continuing improvement in subsequent years.

In some cases, schema therapy for borderline personality disorder is more successful [mfn] Kopf-Beck, J., Zimmermann, P., Egli, S., Rein, M., Kappelmann, N., Fietz, J., Tamm, J., Rek, K., Lucae, S., Brem, A. K., Sämann, P., Schilbach, L., & Keck, M. E. (2020). Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC psychiatry, 20(1), 506. https://doi.org/10.1186/s12888-020-02880-x [/mfn] than other therapies. Therefore adequate research should be fostered to utilize the full potential of schema therapy.

At A Glance

1. Schema therapy is an integrative psychotherapy that combines theory and clinical techniques from pre-existing therapies.
2. It combines techniques from cognitive-behavioral therapy (CBT), psychoanalysis, attachment theory, and emotion-focused therapy.
3. There are several benefits to schema therapy, such as in treating personality disorders, trauma disorders, and interpersonal issues.

Frequently Asked Questions (FAQs)