Schema Therapy
Schema therapy is an integrative approach that combines ideas from cognitive behavioural therapy, psychoanalysis, gestalt therapy, and attachment theory.
This type of therapy has a strong relational emphasis. Schema therapy was developed by Jeffrey E. Young, initially to be used to support individuals with personality disorders, or other clients who had failed to respond to other therapeutic treatment.
In cognitive psychology, a schema is a pattern of thought and/or behaviour; a schema may, for example, create a framework, a filter through which an individual perceives the world.
In schema therapy, a schema is considered to be an early maladaptive coping mechanism, they are patterns that develop as a result of needs not being met in childhood. Schema therapy supports the idea that these patterns can continue to affect individuals into adulthood and cause emotional distress and relational issues.
Early maladaptive schemas may take the form of emotional memories; they can also include physical sensations. Schema therapy aims to help clients find ways to ensure their emotional needs are met in ways that are healthy and do not cause distress.
What can schema therapy help with?
- Childhood trauma
- History of abuse
- History of neglect
- Deep rooted relational difficulties
- Personality disorders
- Bipolar disorder
- High levels of mistrust
- Anger and other challenging emotions
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The 18 maladaptive schemas
There are 18 maladaptive schemas identified in schema therapy.
1. Abandonment/instability
Includes the belief that significant others cannot be relied on for emotional support or connection because they are unreliable and/or absent, or will abandon the individual for someone 'better'.
2. Mistrust/abuse
Expecting others to abuse, humiliate or cheat you.
3. Emotional deprivation
The belief that your desire for emotional support will not be adequately met by others.
4. Defectiveness/shame
The belief that you are fundamentally inferior or defective. May involve hyper-sensitivity to criticism and rejection.
5. Social isolation/alienation
A feeling of being isolated from the world and not part of any community or group.
6. Dependence/incompetence
The belief that you are unable to handle your daily responsibilities and need a lot of help from others. A sense of helplessness.
7. Vulnerability to harm or illness
Out-of-proportion fear that you will be struck by illness or other harm.
8. Enmeshment/underdeveloped self
Enmeshment with significant others, often parents, at the cost of usual social and emotional development. May involve a sense of lacking direction and meaning, being smothered, or feeling like no one in the enmeshment could survive without the others.
9. Failure to achieve
Often includes beliefs that you are stupid and/or less successful than others, that you will inevitably fail.
10. Entitlement/grandiosity
Feeling superior to other people and entitled to special treatment. Or, a focus on achieving this special status.
11. Insufficient self-control/self-discipline
Frustration at not being able to achieve personal goals. Avoidance of pain/discomfort or exertion that may be necessary to achieve goals.
12. Subjugation
Handing over power and control to others in order to avoid predicted anger or retaliation.
13. Self-sacrifice
Excessive emphasis on meeting the needs of others. High sensitivity to the pain of others. May lead to feelings of resentment and exhaustion.
14. Approval-seeking/recognition-seeking
High emphasis placed on seeking approval or recognition from others. A self-esteem that is too dependent on the reactions of others.
15. Negativity/pessimism
Focusing on the negative aspects of life like misfortune, disappointment, conflict, mistakes, betrayals etc. and neglect of positive aspects.
16. Emotional inhibition
Stifling of spontaneous emotional expression, action or communication, with the aim of avoiding disapproval from others or feelings of shame.
17. Unrelenting standards/hypercriticalness
Perfectionism – striving for extremely high ideals of behaviour and competence.
18. Punitiveness
Tendency to be highly punitive towards self and others when mistakes are made. Difficulty forgiving self/others.
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Schema modes
Schema modes are states of mind which everyone experiences from time to time. A schema mode is activated when a situation triggers a person's schemas, or coping styles. In a healthy person, these schema modes can usually be calmed, they are flexible and able to be changed. In individuals who may be struggling with their mental health, these schema modes may become less flexible.
Schema therapy researchers identified ten different schema modes, grouped into four categories:
Child modes
- Vulnerable Child: feels lonely, isolated, sad, misunderstood, unsupported, defective, deprived, overwhelmed, incompetent, doubts self, needy, helpless, hopeless, frightened, anxious, worried, victimised, 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”.
- Happy 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
Dysfunctional 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.
Dysfunctional 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 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 refers to the nature of the internalised high standards and strict rules, rather than the style with which these rules are enforced
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; neutralises 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, and cultural interests; health maintenance; and athletic activities.
Training as a schema therapist
It takes two to three years to train as a schema therapist, and this is most often done on top of prior training in a related field like psychology or psychotherapy.
All therapists on Welldoing are verified annually as members of reputable professional associations to ensure a high standard of training.
Relevant organisations
References
A Client’s Guide to Schema-Focused Cognitive Therapy by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D., Cognitive Therapy Center of New York. 1993
Last updated August 22 2024
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