Schema Therapy Basics

Laura L.C. Johnson, MBA, MA, LMFT, LPCC, is the Director and Founder of the Cognitive Behavior Therapy Center of Silicon Valley in Saratoga, CA ...Read More

I recently attended a 2-day workshop on Schema Therapy: Basics and Beyond at the New Jersey Institute for Schema Therapy led by the talented therapist and trainer, Wendy Behary, LCSW. Wendy is an international expert on Schema Therapy, especially as applied to narcissism.

In the U.S., Schema Therapy is not very well known. Most of the research is being done in Europe, where government funding is available for long-term evidence-based treatments. In contrast, the focus in the U.S. tends to be on short-term therapy for symptom reduction. In the article, I will introduce you to the basics of Schema Therapy.

What is Schema Therapy?

Schema Therapy is an evidence-based approach for creating change in the personality dynamics of individuals with chronic emotional and relationship problems. While grounded in cognitive behavior therapy strategies, Schema Therapy is considered an integrative model because it draws on cognitive therapy, behaviorism, attachment theory, emotion-focused and relationship-based therapies, and other schools of thought.

While standard cognitive behavior therapy and dialectical behavior therapy are highly effective in reducing acute symptoms, schema therapy is effective in reducing chronic symptoms and:

• Identifying and resolving self-defeating life patterns and deeply rooted emotional themes,
• Building resiliency and productive responses to life challenges, and
• Drawing out and enabling the strong parts of your personality.

Schema Theory

A schema is a stable, enduring negative pattern that develops during childhood or adolescence and is reinforced through thoughts, core beliefs, actions and relationships throughout an individual’s life. Negative schemas develop when core childhood needs are not met. When parents can more or less meet the child’s core emotional needs in appropriate amounts, the child develops into a healthy adult. Children’s basic needs include:

• Safety
• “Stable Base,” Predictability
• Love, Nurturing & Attention
• Acceptance & Praise
• Empathy
• Guidance & Protection
• Validation of Feelings & Needs

When a schema erupts or is triggered by events, your thoughts and feelings are dominated by these schemas. It is at these moments that you tend to experience extreme negative emotions and have dysfunctional thoughts. In order to cope with the pain when your schemas are triggered, you may develop certain coping styles including:

• Surrender: giving in to your schemas and acting/feeling as if they are true,
• Avoidance: finding ways to escape or block out your schemas, and/or
• Overcompensation: trying to deny the schema by doing the opposite of what your schemas make you feel.

When triggered, you may have a strong emotional reaction or mood shift, and you then enter a coping state called a “mode.” There are four categories of schema modes:

• Innate Child modes (vulnerability, anger, undisciplined/impulsive, contented),
• Maladaptive Coping modes (detachment, compliance, overcompensating),
• Maladaptive Parent modes (punitive, demanding/critical), and
• Healthy Adult mode.

18 Schemas Defined

1. Emotional Deprivation: The belief that your primary emotional needs will never be met by others. Three categories: Nurturance-needs for affection, closeness and love; Empathy-needs to be listened to and understood; Protection-needs for advice, guidance and direction.

2. Abandonment: The expectation that you will lose anyone with whom an emotional attachment is formed. You may believe that, one way or another, close relationships will eventually end.

3. Mistrust/Abuse: The expectation that others will intentionally take advantage of you in some way. You may expect others to hurt, cheat, or put you down. You often think in terms of attacking first or getting revenge afterwards.

4. Social Isolation: The belief that you are isolated from the world, different from other people, and/or not part of any community.

5. Defectiveness: The belief that you are internally flawed, and that, if others get close to you, they will realize this and withdraw from the relationship. This feeling of being flawed and inadequate often leads to a strong sense of shame.

6. Failure: The belief that you are incapable of performing as well as your peers in areas such as career, school or sports. You may feel stupid, inept or untalented. As a result, you may not try to achieve because you believe that you will fail.

7. Dependence: The belief that you are not capable of handling day-to-day responsibilities competently and independently. You often rely on others excessively for help in areas such as decision-making and initiating new tasks.

8. Vulnerability to Harm and Illness: The belief that you are always on the verge of experiencing a major catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive precautions to protect yourself.

9. Enmeshment: A pattern in which you experience too much emotional involvement with others – usually parents or romantic partners. It may also include the sense that you have too little individual identity or inner direction, causing a feeling of emptiness or of floundering.

10. Subjugation: The belief that you must submit to the control of others in order to avoid negative consequences. Often you fear that, unless you submit, others will get angry or reject you. 11. Self-Sacrifice: The excessive sacrifice of your needs in order to help others. When you pay attention to your own needs, you often feel guilty so you put others’ needs ahead of your own. You may also gain a feeling of increased self-esteem or a sense of meaning from helping others.

12. Emotional Inhibition: The belief that you must suppress spontaneous emotions and impulses, especially anger, because any expression of feelings would harm others or lead to loss of self-esteem, embarrassment, retaliation or abandonment. You may lack spontaneity, or be viewed as uptight.

13. Unrelenting Standards: The belief that whatever you do is not good enough, that you must always strive harder. The motivation for this belief is the desire to meet extremely high internal demands for competence, usually to avoid internal criticism. You may not feel enjoyment or pleasure in important life areas, such as hobbies, work or family.

14. Entitlement: The belief that you should be able to do, say, or have whatever you want immediately regardless of whether that hurts others or seems reasonable to them. You are not interested in what other people need, nor are you aware of the long- term costs of alienating others.

15. Insufficient Self-Control: The inability to tolerate any frustration in reaching your goals, as well as an inability to restrain expression of your impulses or feelings. When lack of self-control is extreme, addictive behavior (substance abuse, eating disorders, gambling, shopping, etc.) may develop.

16. Approval-Seeking: Placing too much emphasis on gaining approval and recognition from others at the expense of your genuine needs and sense of self. It can also include excessive emphasis on status and appearance as a means of gaining recognition and approval.

17. Negativity/Pessimism: A pervasive pattern of focusing on the negative aspects of life while minimizing the positive aspects. You are unable to enjoy things that are going well in your life because you are so concerned with negative details or potential future problems. You worry about possible failures no matter how well things are going.

18. Punitiveness: The belief that people deserve to be harshly punished for making mistakes. You may be excessively critical and unforgiving of yourself and/or others.

What Does Schema Therapy Entail?

The goal of schema therapy is not to eliminate schemas. Rather, the goal is to help you get your core needs met in an adaptive manner by enhancing the Healthy Adult coping mode so your schemas are triggered less frequently and less intensely and you can recover more quickly.

Phase 1: Assessment and Education

The assessment phase generally lasts for five to seven sessions and focuses on:

• Education about the Schema Therapy model.
• Assessing schemas and coping styles through interviews, inventories and emotional techniques.
• Scoring and interpreting the results of various schema inventories.
• Activating schemas using emotional techniques such as imagery.
• Noticing how schemas show up in the therapy relationship.

Phase 2: Schema Therapy Treatment

As a longer-term, depth-oriented treatment approach for chronic emotional and relationship problems as well as personality change, you can expect the active treatment phase to be about one to two years of weekly therapy. As mentioned earlier, Schema Therapy uses a variety of strategies to contribute to change.

• Cognitive Techniques: schema diaries, pros and cons of schemas and coping styles, schema dialogues and flashcards.
• Emotion-Focused Techniques: emotional change through imagery, role plays and two-chair work.
• Therapy Relationship: empathic confrontation and analyzing schemas when triggered in sessions.
• Behavioral Techniques: behavioral assignments, skills training and exposure tasks to overcome avoidance of trigger situations.

To learn more about Schema Therapy, you can visit the International Society for Schema Therapy at http://isstonline.com.