Schema Therapy - The Basics

The most basic concept in Schema Therapy is that of Early Maladaptive Schemas.

We define 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.”

Healthy schemas develop when the basic needs of a child are met. This enables children to develop positive images about other individuals, themselves and the world as a whole.

The basic needs of the child include:

Safety – Children need to be able to depend on a reliable adult for care and a safe place to live, develop and grow.

Belonging – Children need to feel that they are connected to others and are able to share their experiences, thoughts and feelings with others.

Autonomy – Children need to have a safe and secure environment from where they can explore and learn about the world. The ultimate goal of matur­ing to adulthood is to eventually be able to learn to stand more solidly on their own two feet. Caregivers need to slowly but surely allow children to separate from them in order to grow into autonomous adults.

Self-appreciation – Children need an adequate sense of appreciation. In order to develop a strong sense of self-esteem, they need to be appreci­ated for who they are as people and what they are capable of doing.

Self-expression – The expression of opinions and feelings needs be learnt and stimulated without being held back by strict or oppressive rules.

Realistic limits – In order to live in a society with others, it is helpful for children to learn certain rules. They need to understand when, at times, to subdue their autonomy or self-expression when dealing with others and be capable of doing so. Children need to learn healthy ways to tolerate and deal with their frustrations

Schemas develop in childhood from an interplay between the child’s innate temperament, and the child’s ongoing experiences with parents, siblings, or peers.

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. Schemas may remain dormant until they are activated by situations relevant to that particular schema.

SO WHAT HAPPENS IF OUR (CHILDHOOD) NEEDS ARE NOT MET?

We develop maladaptive schemas or “life-traps”.

These life themes, patterns, or “traps” are formed when needs are not met during childhood (but also may result from deprivation in adolescence). From then on, the schema prevents similar needs from being fulfilled in adulthood. For instance a child whose need for secure attachments is not fulfilled by his parents may go for many years in later life without secure relationships as a response to not having valid, early needs met and repeat throughout life.

This may at first seem counter-intuitive, but psychotherapy and psychology as far back as Freud recognises this “repetition compulsion”. We recreate in our adult lives early childhood deficiencies, because we somehow feel more “comfortable” with these schema even whilst realising that they aren’t serving us as adults. Herein lies the conflict.

Schemas are extremely stable and enduring patterns, comprising of memories, bodily sensations, emotions, and cognitions. Once activated, intense emotions are often felt and they can usually underlie long-term issues we feel we’re struggling with.

One of the reasons that schemas are hard to change is because they are not stored through logic, but in an emotional part of the brain called the amygdala, as opposed to a part of the brain that’s readily amenable to logical analysis or discourse (where for example “classic” CBT might target).

Although schema therapy uses many of the procedures of a cognitive/mindful approach, it also probes more deeply into early life experiences, utilising behavioural and interpersonal techniques, which promotes higher levels of affect in sessions and is somewhat longer-term.

A BIT MORE ABOUT SCHEMAS

We view the world through our schemas.

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 some form of therapy or perhaps a number of life experiences that negate the schema we’ve been carrying. But sometimes, even overwhelming success in people’s lives is often still not enough to change the schema. The schema fights for its own survival, and, usually, quite successfully.

Even though schemas persist once they are formed, they are not always in our awareness. Usually they operate in subtle ways, out of our awareness. However, when a schema erupts or is triggered by events, our thoughts and feelings are dominated by these schemas. It is at these moments that people tend to experience extreme negative emotions and have dysfunctional thoughts.

In Young and Klosko’s work with many patients, they found eighteen specific schemas. We all have these schemas functioning as part of our personality style and make-up, set at different levels dependent on our care-givers interaction with us growing up, our life experiences, our genetic inheritance, but it is quite common for certain of these schema to be elevated if we are persistently finding ourselves struggling with our thoughts, feelings, and relationships. A brief description of each of these schemas is provided below. Do any of these resonate with you?

Emotional Deprivation

This schema refers to the belief that one’s primary emotional needs will never be met by others. These needs can be described in three categories: Nurturance – needs for affection, closeness and love; Empathy – needs to be listened to and understood; Protection – needs for advice, guidance and direction. Generally parents are cold or removed and don’t adequately care for the child in ways that would adequately meet the above needs.

Abandonment/Instability

This schema refers to the expectation that one will soon lose anyone with whom an emotional attachment is formed. The person believes that, one way or another, close relationships will end imminently. As children, these clients may have experienced the divorce or death of parents. This schema can also arise when parents have been inconsistent in attending to the child’s needs; for instance, there may have been frequent occasions on which the child was left alone or unattended to for extended periods.

Mistrust/Abuse

This schema refers to the expectation that others will intentionally take advantage in some way. People with this schema expect others to hurt, cheat, or put them down. They often think in terms of attacking first or getting revenge afterwards. In childhood, these clients were often abused or treated unfairly by parents, siblings, or peers.

Defectiveness/Shame

This schema refers to the belief that one is internally flawed, and that, if others get close, they will realize this and withdraw from the relationship. This feeling of being

flawed and inadequate often leads to a strong sense of shame. Generally parents were very critical of their children and made them feel as if they were not worthy of being loved.

Social Isolation/Alienation

This schema refers to the belief that one is isolated from the world, different from other people, and/or not part of any community. This belief is usually caused by early experiences in which children see that either they, or their families, are different from other people.

Dependence/Incompetence

This schema refers to the belief that one is not capable of handling day-to-day responsibilities competently and independently. People with this schema often rely on others excessively for help in areas such as decision-making and initiating new tasks. Generally, parents did not encourage these children to act independently and develop confidence in their ability to take care of themselves.

Vulnerability to Harm and Illness

This schema refers to the belief that one is always on the verge of experiencing a major catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive precautions to protect oneself. Usually there was an extremely fearful parent who passed on the idea that the world is a dangerous place.

Enmeshment/Undeveloped Self

This schema refers to a pattern in which you experience too much emotional involvement with others – usually parents or romantic partners. It may also include the sense that one has too little individual identity or inner direction, causing a feeling of emptiness or of floundering. This schema is often brought on by parents who are so controlling, abusive, or overprotective that the child is discouraged from developing a separate sense of self.

Failure

This schema refers to the belief that one is incapable of performing as well as one’s peers in areas such as career, school or sports. These clients may feel stupid, inept or untalented. People with this schema often do not try to achieve because they believe that they will fail. This schema may develop if children are put down and treated as if they are a failure in school and other spheres of accomplishment. Usually the parents did not give enough support, discipline, and encouragement for the child to persist and succeed in areas of achievement, such as schoolwork or sport

Subjugation

This schema refers to the belief that one must submit to the control of others in order to avoid negative consequences. Often these clients fear that, unless they submit, others will get angry or reject them. Clients who subjugate ignore their own desires and feelings. In childhood there was generally a very controlling parent.

Self-Sacrifice

This schema refers to the excessive sacrifice of one’s own needs in order to help others. When these clients pay attention to their own needs, they often feel guilty. To avoid this guilt, they put others’ needs ahead of their own. Often clients who self-sacrifice gain a feeling of increased self-esteem or a sense of meaning from helping others. In childhood the person may have been made to feel overly responsible for the well being of one or both parents.

Emotional Inhibition

This schema refers to 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. This schema is often brought on by parents who discourage the expression of feelings.

Approval -Seeking

This schema refers to the placing of too much emphasis on gaining the approval and recognition of others at the expense of one’s genuine needs and sense of self. It can also include excessive emphasis on status and appearance as a means of gaining recognition and approval. Clients with this schema are generally extremely sensitive to rejections by others and try hard to fit in. Usually they did not have their needs for unconditional love and acceptance met by their parents in their early years.

Unrelenting Standards

This schema refers to 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. People with this schema show impairments in important life areas, such as health, pleasure or selfesteem. Usually these clients’ parents were never satisfied and gave their children love that was conditional on outstanding achievement.

Entitlement

This schema refers to 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 longterm costs to you of alienating others. Parents who overindulge their children and who do not set limits about what is socially appropriate may foster the development of this schema. Alternatively, some children develop this schema to compensate for feelings of emotional deprivation or defectiveness.

Insufficient Self-Control/Self-Discipline

This schema refers to the inability to tolerate any frustration in reaching one’s goals, as well as an inability to restrain expression of one’s impulses or feelings. When ack of self-control is extreme, criminal or addictive behavior rule your life. Parents who did not model self-control, or who did not adequately discipline their children, may predispose them to have this schema as adults.

Negativity/Pessimism

This schema refers to a pervasive pattern of focusing on the negative aspects of life while minimizing the positive aspects. Clients with this schema are unable to enjoy things that are going well in their lives because they are so concerned with negative details or potential future problems. They worry about possible failures no matter how well things are going for them. Usually these clients had a parent who worried excessively.

Punitiveness

This schema refers to the belief that people deserve to be harshly punished for making mistakes. People with this schema are critical and unforgiving of both themselves and others. They tend to be angry about imperfect behaviors much of the time. In childhood these clients usually had at least one parent who put too much emphasis on performance and had a punitive style of controlling behavior.

Often, if we are in a particularly severe crisis, or experiencing abrupt changes in thoughts, feelings and behaviours the therapist will choose to present and work with the client’s schema through a “mode model”. Modes are clusters of early maladpative schema and coping responses which may feel like distinct and quite different parts of ourselves (often in conflict).

Together with the client, these different modes will be given names and treated almost like “characters” in the internal world of the client’s psyche, examining how these different parts interact and how they function in perpetuating whatever distressful patterns/life-traps the client keeps on returning to as well as ways in which in seeking to sometimes cope with our own unmet needs, we create further problems for ourselves in the form of partially helpful, but usually, in the long term unhelpful modes.

How Schemas Work

There are two primary schema operations: Schema healing and schema perpetuation. All thoughts, behaviours and feelings may be seen as being part of one of these operations. Either they perpetuate the schema or they heal the schema. In a later section on the therapy process we will explain more about schema healing.

Schema perpetuation refers to the routine processes by which schemas function and perpetuate themselves. This is accomplished by cognitive distortions, self-defeating behaviour patterns and schema coping styles.

Earlier we mentioned that cognitive distortions are a central part of cognitive therapy. These distortions consist of negative interpretations and predictions of life events. The schema will highlight or exaggerate information that confirms the schema and will minimize or deny information that contradicts it. Likewise, unhealthy behaviour patterns will perpetuate the schema’s existence. Someone who was abused in childhood and developed a Mistrust/Abuse schema may seek out abusive relationships in adulthood and remain in them, providing a constant stream of evidence for the schema.

In order to understand how schemas are thus perpetuated, there are three coping styles that must be defined. These styles are schema surrender, schema avoidance, and schema overcompensation. It is through these three styles that schemas exert their influence on our behaviour and work to insure their own survival.

Schema surrender refers to ways in which we sometimes passively give in to our schema. We accept the schema as truth and then act in ways that confirm the schema. For instance, a young man with an Abandonment/Instability schema might choose partners who are unable to commit to long-term relationships. He might then react to even minor signs indications of abandonment, such as spending short times without his partner, in an exaggerated way and feel excessive negative emotion. Despite the emotional pain of the situation, he might also passively remain in the relationship because he sees no other possible way to connect with women.

Schema avoidance refers to the ways in which we do anything we can to avoid activating schemas. As mentioned earlier, when schemas are activated, this causes extreme negative emotion. So we might find ways to avoid triggering schemas in order not to feel this pain. There are three types of schema avoidance: cognitive, emotional and behavioral.

Cognitive avoidance refers to efforts that people make not to think about upsetting events. These efforts may be either voluntary or automatic. People may voluntarily choose not to focus on an aspect of their personality or an event, which they find disturbing. There are also unconscious processes which help people to shut out information which would be too upsetting to confront. People often forget particularly painful events. For instance, children who have been abused sexually often forget the memory completely.

Emotional or affective avoidance refers to automatic or voluntary attempts to block painful emotion. Often when people have painful emotional experiences, they numb themselves to the feelings in order to minimize the pain. For instance, a man might talk about how his wife has been acting in an abusive manner toward him and say that he feels no anger towards her, only a little annoyance. Some people drink or abuse drugs to numb feelings generated by schemas.

The third type of avoidance is behavioural avoidance. People often act in such a way as to avoid situations that trigger schemas, and thus avoid psychological pain. For instance, a woman with a Failure schema might avoid taking a difficult new job which would be very good for her. By avoiding the challenging situation, she avoids any pain, such as intense anxiety, which could be generated by the schema.

The third schema process is Schema overcompensation. The individual behaves in a manner which appears to be the opposite of what the schema suggests in order to avoid triggering the schema. On the surface, it may appear that the overcompensators are behaving in a healthy manner, by standing up for themselves. But when they overshoot the mark they cause more problem patterns, which then perpetuate the schema. For instance, a young man with a Defectiveness schema might overcompensate by presenting himself as perfect and being critical of others. This would likely lead others to criticize him in turn, thereby confirming his belief that he is defective.

Case Examples

In this section six case examples are presented. In each one, the schema coping styles are demonstrated. By reading through this section, you will get a better feel for how these processes can operate in real life situations.

Abby is a young woman whose main schema is Subjugation. She tends to see people as very controlling even when they are being appropriately assertive. She has thoughts such as “I can’t stand up for myself or they won’t like me’ and is likely to give in to others (Schema surrender). At other times she decides that no one will get the better of her and becomes very controlling (Schema overcompensation). Sometimes when people make unreasonable demands on her she minimizes the importance of her own feelings and has thoughts like “It’s not that important to me what happens.’ At other times she avoids acquaintances with whom she has trouble standing up for herself (Schema avoidance).

Stewart’s main schema is Failure. Whenever he is faced with a possible challenge, he tends to think that he is not capable. Often he tries half-heartedly, guaranteeing that he will fail, and strengthening the belief that he is not capable (Schema surrender). At times, he makes great efforts to present himself in an unrealistically positive light by spending excessive amounts of money on items such as clothing and automobiles (Schema overcompensation). Often he avoids triggering his schema by staying away from challenges altogether and convinces himself that the challenge was not worth taking (Schema avoidance).

Rebecca’s core schema is Defectiveness/Shame. She believes that there is something basically wrong with her and that if anyone gets too close, they will reject her. She chooses partners who are extremely critical of her and confirm her view that she is defective (Schema surrender). Sometimes she has an excessive defensive reaction and counterattacks when confronted with even mild criticism (Schema overcompensation). She also makes sure that none of her partners get too close, so that she can avoid their seeing her defectiveness and rejecting her (Schema avoidance).

Michael is a middle-aged man whose main schema is Dependence/Incompetence. He sees himself as being incapable of doing daily tasks on his own and generally seeks the support of others. Whenever he can, he chooses to work with people who help him out to an excessive degree. This keeps him from developing skills needed to work alone and confirms his view of himself as someone who needs others to help him out (Schema surrender). At times, when he would be best off taking advice from other people, he refuses to do so (Schema overcompensation). He reduces his anxiety by procrastinating as much as he can get away with (Schema avoidance).

Ann’s core schema is Social Isolation/Alienation. She sees herself as being different from other people and not fitting in. When she does things as part of a group she does not get really involved (Schema surrender). At times she gets very hostile towards group members and can be very critical of the group as a whole (Schema overcompensation). At other times she chooses to avoid group activities altogether (Schema avoidance).

Sam’s central schema is Emotional Deprivation. He chooses partners who are not very capable of giving to other people and then acts in a manner which makes it even more difficult for them to give to him (Schema surrender). At times he will act in a very demanding, belligerent manner and provoke fights with his partners (Schema overcompensation). Sam avoids getting too close to women, yet denies that he has any problems in this area (Schema avoidance).

Therapeutic Process – Changing Schemas

In schema therapy the goal of the treatment is to engage in schema healing processes. These processes are intended to weaken the early maladaptive schemas and coping styles as much as possible, and build up the your healthy side. An alliance is formed between the therapist and the healthy part of the client against the schemas. Any of the therapy activities described below may be seen as examples of schema healing.

The first step in therapy is to do a comprehensive assessment of the client. The main goal of this assessment is to identify the schemas and coping styles that are most important in the client’s psychological makeup. There are several steps to this process. The therapist generally will first want to know about recent events or circumstances in the clients’ lives which have led them to come for help. The therapist will then discuss the client’s life history and look for patterns which may be related to schemas.

There are several other steps the therapist will take in assessing schemas. We use the Young Schema Questionnaire, which the client fills out, listing many of the thoughts, feeling and behaviours related to the different schemas; items on this questionnaire can be rated as to how relevant to the client’s life they are.

There are also various imagery techniques which the therapist can use to assess schemas. One specific technique involves asking clients to close their eyes and create an image of themselves as children with their parents. Often the images that appear will lead to the core schemas. Also, just describing key, painful, memories will help us do this.

Jonathan, for example is a 28 year old executive whose core schema is Mistrust/Abuse. He came to therapy because he was having bouts of intense anxiety at work, during which he would be overly suspicious and resentful of his co-workers. When asked to create an image of himself with his family, he had two different images. In the first he saw himself being terrorized by his older brother. In the second he saw his alcoholic father coming home and beating his mother, while he cowered in fear.

There are many techniques that the therapist can use to help clients weaken their schemas. These techniques can be broken down into four categories: emotive,

interpersonal, cognitive and behavioral. Each of these categories will be briefly discussed, along with a few examples.

Emotive techniques encourage clients to experience and express the emotional aspects of their problem. One way this is done is by having clients close their eyes and imagine they are having a conversation with the person to whom the emotion is directed. They are then encouraged to express the emotions as completely as possible in the imaginary dialogue. One woman whose core schema was Emotional Deprivation had several such sessions in which she had an opportunity to express her anger at her parents for not being there enough for her emotionally. Each time she expressed these feelings, she was able to distance herself further from the schema. She was able to see that her parents had their own problems which kept them from providing her with adequate nurturance, and that she was not always destined to be deprived.

There are many variations on the above technique. Clients may take on the role of the other person in these dialogues, and express what they imagine their feelings to be. Or they may write a letter to the other person, which they have no intention of mailing, so that they can express their feelings without inhibition.

Interpersonal techniques highlight the client’s interactions with other people so that the role of the schemas can be exposed. One way is by focusing on the relationship with the therapist. Frequently, clients with a Subjugation schema go along with everything the therapist wants, even when they do not consider the assignment or activity relevant. They then feel resentment towards the therapist which they display indirectly. This pattern of compliance and indirect expression of resentment can then be explored to the client’s benefit. This may lead to a useful exploration of other instances in which the client complies with others and later resents it, and how they might better cope at those times.

Another type of interpersonal technique involves including a client’s spouse in therapy. A man with a Self-Sacrifice schema might choose a wife who tends to ignore his wishes. The therapist may wish to involve the wife in the treatment in order to help the two of them to explore the patterns in their relationship and change the ways in which they interact.

Cognitive techniques are those in which the schema-driven cognitive distortions are challenged. As in short-term cognitive therapy, the dysfunctional thoughts are identified and the evidence for and against them is considered. Then new thoughts and beliefs are substituted. These techniques help the client see alternative ways to view situations.

The first step in dealing with schemas cognitively is to examine the evidence for and against the specific schema which is being examined. This involves looking at the client’s life and experiences and considering all the evidence which appears to support or refute the schema. The evidence is then examined critically to see if it does, in fact, provide support for the schema. Usually the evidence produced will be shown to be in error, and not really supportive of the schema.

For instance, let’s consider a young man with an Emotional Deprivation schema. When asked for evidence that his emotional needs will never be met, he brings up instances in which past girlfriends have not met his needs. However, when these past relationships are looked at carefully, he finds that, as part of the schema surrender process, he has chosen women who are not capable of giving emotionally. This understanding gives him a sense of optimism; if he starts selecting his partners differently, his needs can probably be met

Another cognitive technique is to have a structured dialogue between the client and therapist. First, the client takes the side of the schema, and the therapist presents a more constructive view. Then the two switch sides, giving the client a chance to verbalize the alternative point of view.

After having several of these dialogues the client and therapist can then construct a flashcard for the client, which contains a concise statement of the evidence against the schema.

A typical flashcard for a client with a Defectiveness/Shame schema reads: “I know that I feel that there is something wrong with me but the healthy side of me knows that I’m OK. There have been several people who have known me very well and stayed with me for a long time. I know that I can pursue friendships with many people in whom I have an interest.”

The client is instructed to keep the flashcard available at all times and to read it whenever the relevant problem starts to occur. By persistent practice at this, and other cognitive techniques, the client’s belief in the schema will gradually weaken.

Behavioural techniques are those in which the therapist assists the client in changing long-term behavior patterns, so that schema surrender behaviours are reduced and healthy coping responses are strengthened.

One behavioural strategy is to help clients choose partners who are appropriate for them and capable of engaging in healthy relationships. Clients with the Emotional Deprivation schema tend to choose partners who are not emotionally giving. A therapist working with such clients would help them through the process of evaluating and selecting new partners.

Another behavioral technique consists of teaching clients better communication skills. For instance, a woman with a Subjugation schema believes that she deserves a raise at work but does not know how to ask for it. One technique her therapist uses to teach her how to speak to her supervisor is role-playing. First, the therapist takes the role of the client and the client takes the role of the supervisor. This allows the therapist to demonstrate how to make the request appropriately. Then the client gets an opportunity to practice the new behaviors, and to get feedback from the therapist before changing the behavior in real life situations.

IN SUMMARY, schema therapy can help people understand and change long-term life patterns. The therapy consists of identifying early maladaptive schemas, coping styles and modes, and systematically confronting, challenging and healing them.

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