Schemas

Schemas represent core beliefs and ideas about things in the world (people, groups, etc.) that are typically deeply ingrained

If patient is not showing significant progress in a short course of treatment & automatic thoughts are very difficult to modify then the schema may be the area to address

Schema therapy - Jeffrey Young

• Did research on what schemas are common within certain disorders

  • Ideas such as

    • Defectiveness or shame

      • May have been criticized by parents, teachers, or siblings and these critical interactions formed schema of not being enough

        • “I’m defective”, “I’m flawed”, “I’m inadequate”

    • Failure

      • Idea that patient is not able to perform as well as other people

      • Often do not put self out there to avoid what will be “certain failure”

        • “I’m a failure”, “no matter what I do I won’t succeed”

    • Incapable of doing the things that are expected of them, may become dependent on others

      • Often adults did not encourage them to foster independence as a child

        • “I’m incompetent”, “I cant manage”, I cannot handle this”

Early maladaptive schemas

• Not all schemas are maladaptive, some are good for you! The whole point is to have consistent core beliefs to help you make sense of the world

• Schemas are highly tied to emotion

• The degree of flexibility and distress is part of what determines whether or not schemas are adaptive

• Maladaptive schemas

  • Self-defeating, pervasive patterns that begin in childhood and repeat throughout a person’s life

  • Often caused by repeated harmful experiences, and the effects accumulate

  • Interaction of the child’s temperament and specific unmet childhood needs

    • Secure attachments to others

    • Autonomy, competence, sense of identity

    • Freedom to express valid needs and emotions

    • Spontaneity & play

    • Realistic limits and self-control

• Early life experiences that foster maladaptive schemas

  • “Toxic frustration of needs” = emotional deprivation and abandonment

  • “Traumatization” = When child is overly controlled, victimized or otherwise abused. Mistrust, defectiveness, Subjugation

  • “Too much of a good thing” = Dependence, Entitlement

  • “Selective internalization or identification” = Vulnerability

• Adult schemas are triggered by life events that the person perceives as similar to the toxic childhood events

• Schema perpetuation vs. Schema Healing

  • Perpetuation:

  • Healing:

• Who are the best candidates for schema therapy

  • Problem is chronic and long-term

  • Chronic relapses

  • Nonresponsive to short term therapy

  • Long-term relationship problems

  • Highly avoidant

  • Shows rigid patterns of thought and behavior

• Schema therapy targets the chronic & characterological aspects of a disorder

• Schema therapy was originally developed for personality disorders but has since been found to be effective for chronic anxiety and depression, eating disorders, and in couples therapy

Identifying schemas

• Downward arrow technique

  • “if this thought about yourself is true, then what does it mean about you?”

  • Bring from automatic thought level to more ingrained thoughts and ideas about self & world

• Recognizing patterns of automatic thoughts

  • Speech, thought records, homework assignments, assessments/questionnaires

• Life history review

  • Influential people

  • effects of these experiences

  • activities that are important to the client (or were) (what was school like for your? Tell me about your neighborhood, etc.)

  • cultural and social influences

  • education, readings, self study

  • life transforming experiences

Modifying Schemas

• Socratic questioning

  • Not for information gathering

  • Specifically for exploration or metacognition

• Examining the evidence

• Listing advantages and disadvantages

• The cognitive continuum

  • Using real life examples to show a client a concept

    • i.e. video where they make a continuum of people that can be trusted, what degree of trust for each person and showing patterns within continuum

• Generating alternatives

• Cognitive and behavioral rehearsal