Psychological Therapy in Warwickshire
Dr Jane Cornwall
Chartered Counselling Psychologist
EMDR Practitioner - Trauma Specialist
Schema Therapy, also known as Schema-Focused Cognitive Therapy, is an integrative therapeutic approach to psychological treatment that has its basis in attachment theory and utilises the most effective components of cognitive-behavioural, experiential, interpersonal and psychoanalytic therapies into one combined model of working.
Schema-Focused Therapy has shown to be effective with people who have deep-seated characterological traits and attachment issues which interfere in their ability to establish, develop and maintain interpersonal relationships. Schema therapy enables individuals for whom other psychological interventions have been unsuccessful to identify and change long-standing negative ("maladaptive") patterns in thinking, feeling and behaving/coping.
Schemas may best be described as an individual’s core beliefs regarding self and/or significant others, which have developed from the learned and possibly critical, negative parental messages in early childhood which have become established and internalised to form a negative self-perception.
These unhelpful patterns of thinking, feeling and behaving, also aptly named ‘life traps’, have the capacity to skew and negatively influence the individuals expectations and beliefs with regard to interpersonal relationships.
A person’s early maladaptive schemas tend to develop into enduring, pervasive and self-defeating patterns and are identified and focused upon in treatment. These repeating patterns consist of negative, dysfunctional cognitions and emotions, which inhibit individuals from accomplishing their aims and prevent them from adequately getting their emotional needs met. For example a core belief might be: "I am unlovable," "I am a failure," "People don't care about me," "I am not important," "Something bad is going to happen," "People inevitably leave me," "I will never get my needs met," "I am not good enough," and so on.
The schemas tend to be perpetuated behaviourally through the coping styles of schema maintenance, schema avoidance, and schema compensation. The Schema-Focused therapeutic approach assists the individual in disrupting these negative patterns of cognition, effect and behaviour, which are often persistent, and to establish healthier ways of thinking, feeling and behaving.
The four main concepts in the Schema Therapy model are:
1. Early Maladaptive Schemas,
2. Core Emotional Needs,
3. Schema Mode, and
4. Maladaptive Coping Styles.
The Early Maladaptive Schemas are self-defeating, core themes or patterns that we keep repeating throughout our lives.
Early Schema relates to the basic emotional needs of a child. When these needs are not met in childhood, schemas develop that lead to unhealthy life patterns. Each of the schemas represents specific emotional needs that were not adequately met in childhood or adolescence.
Maladaptive Coping Styles are the ways the child adapts to schemas and to damaging childhood experiences. For example, some children surrender to their schemas; some find ways to block out or avoid pain; while other children fight back or overcompensate.
Schema Modes are the moment-to-moment emotional states and coping responses that we all experience. Often our schema modes are triggered by life situations that we are oversensitive to (our "emotional buttons"). Many schema modes lead us to over-react to situations, or to act in ways that end up hurting us.
The main goals of Schema Therapy are:
• to help patients strengthen their Healthy Adult mode
• weaken their Maladaptive Coping Modes so that they can get back in touch with their core needs and feelings
• to heal their early maladaptive schemas; to break schema-driven life patterns and
• eventually get their core emotional needs met in everyday life.
Schema-Focused Therapy consists of three stages:
• the assessment phase, in which he unhelpful schemas are initially identified during the initial sessions using self-reporting psychometric questionnaires.
• the emotional awareness and experiential phase, wherein individuals connect with their unhelpful schemas and learn how to become aware of them in their daily functioning
• the behavioural change stage whereby the client is actively involved in replacing negative, repeating thoughts and behaviours with new, more adaptive cognitive and behavioural alternatives.
Early Maladaptive Schemas
1. Abandonment / Instability (AB)
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., angry outbursts), unreliable, or erratically present; because they will die imminently; or because they will abandon the patient in favor of someone better.
2. Mistrust / Abuse (MA)
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 (ED)
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 (DS)
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 (SI)
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.
6. Dependence / Incompetence (DI)
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 (VH)
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, victimized by criminals, airplane crashes, earthquakes.
8. Enmeshment / Undeveloped Self (EM)
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 (FA)
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, inept, untalented, ignorant, lower in status, less successful than others, etc.
10. Entitlement / Grandiosity (ET)
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 (e.g., 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 behaviour of others in line with one's own desires -without empathy or concern for others' needs or feelings.
11. Insufficient Self-Control / Self-Discipline (IS)
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, patient presents with an exaggerated emphasis on discomfort-avoidance: avoiding pain, conflict, confrontation, responsibility, or overexertion - at the expense of personal fulfilment, commitment, or integrity.
12. Subjugation (SB)
Excessive surrendering of control to others because one feels coerced - usually 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 emotional expression, 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 build up 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 (SS)
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 resentment of those who are taken care of. (Overlaps with concept of co-dependency.)
14. Emotional Inhibition (EI)
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 & 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, etc.; or (d) excessive emphasis on rationality while disregarding emotions.
15. Unrelenting Standards / Hypercriticalness (US)
The underlying belief that one must strive to meet very high internalised standards of behaviour and performance, usually to avoid criticism. Typically results in feelings of pressure or difficulty slowing down; and in hyper-criticalness toward 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 performance is relative to the norm; (b) rigid rules and "shoulds" in many areas of life, including unrealistically high moral, ethical, cultural, or religious precepts; or (c) pre-occupation with time and efficiency, so that more can be accomplished.
Individual Coping Styles
Different people deal with their schemas in different ways. Consequently children who are raised in the same family environment can appear to be so different. For example, two children with abusive parents may respond very differently. One may become a passive, frightened victim, and remains that way throughout his/her life. The other child becomes openly rebellious, aggressive and defiant, and may even leave home early to find their own way in life.
Partly this is because we have different temperaments at birth. Temperamentally, we may tend to be more frightened, active, outgoing, or shy. Our temperaments push us in certain directions.
Partly this is because we may unconsciously choose different parents to "copy" or model ourselves after. For example, because an "abuser" often marries a "victim," the child in this family could model either the abusive parent, the victimised parent, or have elements of both coping styles.
We view coping styles as normal attempts on the part of the child to survive in a difficult childhood environment. Unfortunately, we keep repeating our coping styles throughout adulthood, even when we no longer need them to survive.
Most of the time, as adults, these coping styles lead us to act in ways that end up blocking our development: for example, we may abuse alcohol, become excessively rigid and stubborn, isolate ourselves from other people, stop feeling emotions, or mistreat other people.
According to the model, there are three general ways that an individual may adapt to his/her schemas:
• Surrender, which means giving in to the schemas and repeating them over and over again
• Avoidance, which means finding ways to escape from or block out the schemas
• Overcompensation, which means doing the opposite of how the schemas make him/her feel
Schema Mode Sub-categories
Innate Child Modes
Vulnerable Child: feels lonely, isolated, sad, misunderstood, unsupported, defective, deprived, overwhelmed, incompetent, doubts self, needy, helpless, hopeless, frightened, anxious, worried, victimized, worthless, unloved, unlovable, lost, directionless, fragile, weak, defeated, oppressed, powerless, left out, excluded, pessimistic
Angry Child : feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met
Impulsive/Undisciplined Child: acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification; often feels intensely angry, enraged, infuriated, frustrated, impatient when these non-core desires or impulses cannot be met.; may appear “spoiled”
Contented Child: feels loved, contented, connected, satisfied, fulfilled, protected, accepted, praised, worthwhile, nurtured, guided, understood, validated, self-confident, competent, appropriately autonomous or self-reliant, safe, resilient, strong, in control, adaptable, included, optimistic, spontaneous
Maladaptive Coping Modes
Compliant Surrenderer: acts in a passive, subservient, submissive, approval-seeking, or self-deprecating way around others out of fear of conflict or rejection; tolerates abuse and/or bad treatment; does not express healthy needs or desires to others; selects people or engages in other behaviour that directly maintains the self-defeating schema-driven pattern
Detached Protector: cuts off needs and feelings; detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalised, empty or bored; pursues distracting, self-soothing, or self-stimulating activities in a compulsive way or to excess; may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities
Over-compensator: feels and behaves in an inordinately grandiose, aggressive, dominant, competitive, arrogant, haughty, condescending, devaluing, over-controlled, controlling, rebellious, manipulative, exploitative, attention-seeking, or status-seeking way. These feelings or behaviours must originally have developed to compensate for or gratify unmet core needs
Maladaptive Parent Modes
Punitive Parent: feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others. This mode refers to the style with which rules are enforced rather than the nature of the rules.
Demanding or Critical Parent: feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to puts others needs before one's own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously. This mode refer to the nature of the internalised high standards and strict rules, rather than the style with which these rules are enforced; these rules are not compensatory in their function.
Healthy Adult Mode
Healthy Adult nurtures, validates and affirms the vulnerable child mode; sets limits for the angry and impulsive child modes; promotes and supports the healthy child mode; combats and eventually replaces the maladaptive coping modes; neutralizes or moderates the maladaptive parent modes. This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, aesthetic, and cultural interests; health maintenance; and athletic activities.
Young, J.E., Klosko, J.S., & Weishaar, M. (2003). Schema Therapy: A Practitioner's Guide. Guilford Publications: New York.