Introduction to Schema Therapy
Schema Therapy (or more properly, Schema-Focused Cognitive Therapy) is an integrative approach to treatment that combines the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model. Schema-Focused Therapy has shown remarkable results in helping people to change negative (“maladaptive”) patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.
The Schema-Focused model was developed by Dr. Jeff Young, who originally worked closely with Dr. Aaron Beck, the founder of Cognitive Therapy. While treating clients at the Center for Cognitive Therapy at the University of Pennsylvania, Dr. Young and his colleagues identified a segment of people who had difficulty in benefiting from the standard approach. He discovered that these people typically had long-standing patterns or themes in thinking, feeling and behaving/coping that required a different means of intervention. Dr. Young’s attention turned to ways of helping patients to address and modify these deeper patterns or themes, also known as “schemas” or “life traps.”
The schemas that are targeted for treatment are enduring and self-defeating patterns that typically begin early in life. These patterns consist of negative/dysfunctional thoughts and feelings, have been repeated and elaborated upon, and pose obstacles to accomplishing one’s goals and getting one’s needs met. Some examples of schema beliefs are:
- I’m unlovable.
- I’m a failure.
- People don’t care about me.
- I’m not important.
- Something bad is going to happen.
- People will leave me.
- I will never get my needs met.
- I will never be good enough.
Although schemas are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemas are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. The Schema-Focused model of treatment is designed to help the person to break these negative patterns of thinking, feeling and behaving, which are often very tenacious, and to develop healthier alternatives to replace them.
Schema-Focused Therapy consists of three stages.
- The assessment phase, in which schemas are identified during the initial sessions. Questionnaires may be used as well to get a clear picture of the various patterns involved.
- The emotional awareness and experiential phase, wherein patients get in touch with these schemas and learn how to spot them when they are operating in their day-to-day life.
- The behavioral change stage becomes the focus, during which the client is actively involved in replacing negative, habitual thoughts and behaviors with new, healthy cognitive and behavioral options.
What is a Maladaptive Schema/Wound?
A broad, pervasive pattern or theme comprised of memories, emotions, cognitions, and bodily sensations regarding oneself and one’s relationships with others. It is developed in childhood or adolescence, elaborated throughout one’s lifetime and dysfunctional to a significant degree. Often inflexible/rigid & egosyntonic (problems are central to the patient’s identity and feel, to them, as a part of who they are/how they understand the world). Self-defeating behaviors are a response to the underlying schema, not the schema itself. Schemas/Wounds are not experienced as a constant state of being but can be activated and operate at certain points in time.
How does a Maladaptive Schema/Wound Form?
1st: People have Core Emotional Needs:
- Secure attachments to others (includes safety, stability, nurturance & acceptance).
- Autonomy, competence, and a sense of identity.
- Freedom to express valid needs and emotions.
- Spontaneity and play.
- Realistic limits & self-control.
2nd: People’s Core Emotional Needs are not met:
Toxic childhood experiences are the primary origin of Early Maladaptive Schemas/Wounds. The wounds created earliest are typically strongest and usually originate within the nuclear family. To a large extent, the dynamics of a child’s family are the dynamics of that child’s entire early world. The 4 types of early life experiences which foster the acquisition of wounds are:
- Toxic frustration of needs. The child experiences too little of a good thing such as love/stability/understanding. (Wounds: Emotional Deprivation, Abandonment).
- Traumatization/Victimization (Schemas: Mistrust/Abuses, Defectiveness/Shame, Vulnerability to Harm).
- Too much of a good thing. Parents give too much of something, that in moderation, is a good thing. (Schemas: Dependence/Incompetence & Entitlement/Grandiosity).
- Selective internalization or identification with significant others. The child selectively identifies with and internalizes the parent’s thoughts, feelings, experiences, and behaviors- the origins of identifying as the victim or the abuser.
2 Types of Wounds:
1st Unconditional Wounds: These are the core wounds at the heart of maladaptive behaviors which are disrupting a person’s life and relationships. Typically, they are created in childhood, when the person was most vulnerable and consist of beliefs about oneself and others. Unconditional Wounds are felt as absolute and unchanging. They demand individuals operate in faulty ways, often without insight or awareness. This is what you believe about yourself, others, and the world you live in.
2nd Conditional Wounds: In contrast with unconditional wounds, these hold out the possibility outcomes can be changed in a favorable manner, if the person will operate with these beliefs as a guidepost. They are created as a faulty attempt to address unconditional wounds, which the individual sees as absolute and unchanging. These are behaviors you engage in because of what you believe to be true (ie: your unconditional wound/s listed previously).
Schema Domains:
#1 Disconnection & Rejection
(The expectation that one’s needs for security, safety, stability, nurturance, empathy, sharing of feelings, acceptance, and respect will not be met in a predictable manner. Typical family of origin is detached, cold, rejecting, withholding, lonely, explosive, unpredictable, or abusive.)
1. Abandonment/Instability
The perceived instability or unreliability of those available for support and connection. Involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or practical protection because they are emotionally unstable and unpredictable (e.g., have angry outbursts), unreliable, or present only erratically; because they will die imminently; or because they will abandon the individual in favor of someone better.
2. Mistrust/Abuse
The expectation that others will hurt, abuse, humiliate, cheat, lie manipulate, or take advantage. Usually, involves the perception that the harm is intentional or the result of unjustified and extreme negligence. May include the sense that one always ends up being cheated relative to others or “getting the short end of the stick.”
3. Emotional Deprivation
The expectation that one’s desire for a normal degree of emotional support will not be adequately met by others. The three major forms of deprivation are:
A: Deprivation of Nurturance– Absence of attention, affection, warmth, or companionship.
B: Deprivation of Empathy– Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from others.
C: Deprivation of Protection– Absence of strength, direction, or guidance from others.
4. Defectiveness/Shame
The feeling that one is defective, bad, unwanted, inferior, or invalid in important respects or that one would be unlovable to significant others if exposed. May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one’s perceived flaws. These flaws may be private (e.g., selfishness, angry impulses, unacceptable sexual desires) or public (e.g., undesirable physical appearance, social awkwardness).
5. Social Isolation/Alienation
The feeling that one is isolated from the rest of the world, different from other people, and/or not part of any group or community.
#2 Impaired Autonomy and Performance
(Expectations about oneself and the environment that interfere with one’s perceived ability to separate, survive, function independently, or perform successfully. Typical family origin is enmeshed, undermining of the child’s confidence, overprotective, or failing to reinforce child for performing competently outside the family.)
6. Dependence/Incompetence
The belief that one is unable to handle one’s everyday responsibilities in a competent manner, without considerable help from others (e.g., take care of oneself, solve daily problems, exercise good judgment, tackle new tasks, make good decisions). Often presents as helplessness.
7. Vulnerability to Harm or Illness
Exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it. Fears focus on one or more of the following:
A: Medical catastrophes (e.g., heart attacks, AIDS).
B: Emotional catastrophes (e.g., going crazy).
C: External catastrophes (e.g., elevators collapsing, victimization by criminals, airplane crashes, earthquakes).
8. Enmeshment/Undeveloped Self
Excessive emotional involvement and closeness with one or more significant others (often parents) at the expense of full individuation or normal social development. Often involves the belief that at least one of the enmeshed individuals cannot survive or be happy without the constant support of the other. May also include feelings of being smothered by or fused with others or insufficient individual identity. Often experienced as a feeling of emptiness and floundering, having no direction, or in extreme cases questioning one’s existence.
9. Failure
The belief that one has failed, will inevitably fail, or is fundamentally inadequate relative to one’s peers in areas of achievement (school, career, sports, etc). Often involves beliefs that one is stupid, untalented, lower in status, less successful than others, and so forth.
#3 Impaired Limits
(Deficiency in internal limits, responsibility to others, or long-term goal orientation. Leads to difficulty respecting the rights of others, cooperating with others, making commitments, or setting and meeting realistic personal goals. Typical family origin is characterized by permissiveness, overindulgence, lack of direction, or a sense of superiority rather than appropriate confrontation, discipline, and limits in relation to taking responsibility, cooperating in a reciprocal manner, and setting goals. In some cases, the child may not have been pushed to tolerate normal levels of discomfort or may not have been given adequate supervision, direction, or guidance.)
10. Entitlement/Grandiosity
The belief that one is superior to other people; entitled to special rights and privileges; or not bound by the rules of reciprocity that guide normal social interaction. Often involves insistence that one should be able to do or have whatever one wants regardless of what is realistic, what others consider reasonable, or the cost to others; or an exaggerated focus on superiority (ie: being among the most successful, famous, wealthy) in order to achieve power or control (not primarily for attention or approval). Sometimes includes excessive competitiveness toward or domination of others: asserting one’s power, forcing one’s point of view, or controlling the behavior of others in line with one’s own desires without empathy or concern for others’ needs or feelings.
11. Insufficient Self-Control/Self-Discipline
Pervasive difficulty or refusal to exercise sufficient self-control and frustration tolerance to achieve one’s personal goals or to restrain the excessive expression of one’s emotions and impulses. In its milder form, the patient presents with an exaggerated emphasis on discomfort avoidance: avoiding pain, conflict, confrontation, responsibility, or overexertion at the expense of personal fulfillment, commitment, or integrity.
#4 Other-Directedness
(An excessive focus on the desires, feelings, and responses of others, at the expense of one’s own needs in order to gain love and approval, maintain one’s sense of connection, or avoid retaliation. Usually involves suppression and lack of awareness regarding one’s own anger and natural inclinations. The typical family of origin is based on conditional acceptance: Children must suppress important aspects of themselves in order to gain love, attention, and approval. In many such families, the parents’ emotional needs and desires—or social acceptance and status—are valued more than the unique needs and feelings of each child.)
12. Subjugation
Excessive surrendering of control to others because one feels coerced—submitting in order to avoid anger, retaliation, or abandonment. The two major forms of subjugation are:
A: Subjugation of needs: Suppression of one’s preferences, decisions, and desires.
B: Subjugation of emotions: Suppression of emotions, especially anger. Usually involves the perception that one’s own desires, opinions, and feelings are not valid or important to others. Frequently presents as excessive compliance, combined with hypersensitivity to feeling trapped. Generally, leads to a buildup of anger, manifested in maladaptive symptoms (e.g., passive-aggressive behavior, uncontrolled outbursts of temper, psychosomatic symptoms, withdrawal of affection, “acting out,” substance abuse).
13. Self-Sacrifice
Excessive focus on voluntarily meeting the needs of others in daily situations at the expense of one’s own gratification. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling selfish; or to maintain the connection with others perceived as needy. Often results from an acute sensitivity to the pain of others. Sometimes leads to a sense that one’s own needs are not being adequately met and to the resentment of those who are taken care of. (Overlaps with the concept of codependency).
14. Approval-Seeking/Recognition-Seeking
Excessive emphasis on gaining approval, recognition, or attention from the other people or on fitting in at the expense of developing a secure and true sense of self. One’s sense of esteem is dependent primarily on the reactions of others rather than on one’s own natural inclinations. Sometimes includes an overemphasis on status, appearance, social acceptance, money, or achievement as a means of gaining approval, admiration, or attention (not primarily for power or control). Frequently results in major life decisions that are inauthentic or unsatisfying or in hypersensitivity to rejection.
#5 Overvigilance and Inhibition
(Excessive emphasis on suppressing one’s spontaneous feelings, impulses, and choices, or on meeting rigid, internalized rules and expectations about performance and ethical behavior, often at the expense of happiness, self-expression, relaxation, close relationships, or health. Typical family origin is grim, demanding, and sometimes punitive: performance, duty, perfectionism, following rules, hiding emotions, and avoiding mistakes predominate over pleasure, joy, and relaxation. There is usually an undercurrent of pessimism and worry that things could fall apart if one fails to be vigilant and careful at all times.)
15. Negativity/Pessimism
A pervasive, lifelong focus on the negative aspects of life (pain, death, loss, disappointment, conflict, guilt, resentment, unsolved problems, potential mistakes, betrayal, things that could go wrong, etc.) while minimizing or neglecting the positive or optimistic aspects. Usually includes an exaggerated expectation—in a wide range of work, financial, and interpersonal situations—that things will eventually go seriously wrong or that aspects of one’s life that seem to be going well will ultimately fall apart. Usually involves an inordinate fear of making mistakes that might lead to financial collapse, loss, humiliation, or being trapped in a bad situation. Because they exaggerate potential negative outcomes, these individuals are frequently characterized by chronic worry, vigilance, complaining, and indecision.
16. Emotional Inhibition
The excessive inhibition of spontaneous action, feeling, or communication, usually to avoid disapproval by others, feelings of shame, or losing control of one’s impulses. The most common areas of inhibition involve:
A: Inhibition of anger and aggression.
B: Inhibition of positive impulses (e.g., joy, affection, sexual excitement, play).
C: Difficulty expressing vulnerability or communicating freely about one’s feelings, needs, and so forth.
D: Excessive emphasis on rationality while disregarding emotions.
17. Unrelenting Standards/Hypercriticalness
The underlying belief that one must strive to meet very high internalized standards of behavior and performance, usually to avoid criticism. Typically results in feelings of pressure or difficulty slowing down and in hypercriticalness towards oneself and others. Must involve significant impairment in pleasure, relaxation, health, self-esteem, sense of accomplishment, or satisfying relationships. Unrelenting standards typically present as:
A: Perfectionism, inordinate attention to detail, or an underestimate of how good one’s own performances is relative to the norm.
B: Rigid rules and “shoulds” in many areas of life, including unrealistically high moral, ethical, cultural, or religious precepts.
C: Preoccupation with time and efficiency, the need to accomplish more.
18. Punitiveness
The belief that people should be harshly punished for making mistakes. Involves the tendency to be angry, intolerant, punitive, and impatient with those people (including oneself) who do not meet one’s expectations or standards. Usually includes difficulty forgiving mistakes in oneself or others because of a reluctance to consider extenuating circumstances, allow for human imperfection, or empathize with feelings.
Sources:
Schema Therapy– Young, Klosko & Weishaar, The Guilford Press, New York 2003
http://www.schematherapy-nola.com/what-is-schema-therapy