The ideas, beliefs and concepts we hold about the world shape who we are and how we interact with others. Unfortunately, these beliefs do not always act in our favour. This is where schema therapy comes in—combining the idea of a maladaptive schema with therapeutic techniques from across the spectrum of psychotherapy to change beliefs that hinder development toward some form of self-actualisation.
The Basics of a Schema
Schemas can be referred to somewhat ethereally by well-meaning psychologists because their meaning requires a bit of conceptual imagination. Renowned Swiss Psychologist Jean Piaget coined the term when he was studying and developing his concepts of childhood and development. Piaget described the schema as a pattern of learning or way of thinking that lets the developing child understand concepts based on his current knowledge base.
Piaget saw much of development as a balance between what schemas can explain and what happens when we are confronted with new information or situations that challenge our schemas to either adapt to account for this information or to create a new schema altogether.
A simplified example is that of a child who has been raised his whole life surrounded by dogs; the child has developed an understanding of what dogs are, what they do, how they smell, etc. One day, the child is walking in the forest with his parents and sees a wolf. He says to his parents, “Look at that big grey dog.” The child has used his understanding or “schema” for what a dog is and expanded it to include a wolf–which is similar enough–but very dangerous, so his parents must explain that a wolf is not a dog. Hopefully, the child will create a new schema for the wolf and avoid getting eaten.
Schemas Applied
Despite its older roots, schema therapy is a relatively new practice that incorporates elements of cognitive behavioural therapy (CBT), psychoanalysis and attachment theories. It generally takes a talk therapy format and looks to unpack specific schemas. In the clinical setting, the target schemas are generally ‘maladaptive’ and cause distress to the individual or those around them.
Targeting these maladaptive schemas requires a stable relationship between the mental health practitioner and the client. This bond serves as a foundation for exploring deep-seated emotional wounds and unmet needs. Through this collaboration, the client is guided to recognize patterns that perpetuate negative behaviors or emotions. The ultimate goal is to challenge and reframe these schemas, paving the way for healthier coping mechanisms and relationships.
Schematic Domains: Unpacking the Foundations of Emotional Triggers
This model of therapy sorts schema into about five broad developmental categories emerging from past experiences:
1. Disconnection and Rejection
This schema category involves the belief that one’s basic emotional needs, such as security, acceptance and empathy, will not be met–because they have not been at some point. Key subtypes include abandonment, mistrust/abuse, emotional deprivation, defectiveness/shame and social isolation. These patterns can stem from cold or abusive early life environments, leading to feelings of insecurity, mistrust, emotional neglect, shame and alienation as an adult.
2. Impaired Autonomy and Performance
This category looks at beliefs that hinder independence or success, often rooted in overprotective or enmeshed family dynamics. It includes feelings of dependence, fear of harm, excessive emotional involvement with others and a deep sense of failure or incompetence in personal achievements, leading to helplessness and anxiety about future failure.
3. Impaired Limits
Impaired limits involve difficulty with self-discipline, respecting others’ rights and setting realistic goals. This often stems from overindulgent or permissive family backgrounds. People with these issues may seem entitled, believing they deserve special treatment or superiority over others, and may struggle with self-control, avoiding discomfort or responsibility.
4. Other-Directedness
Prioritising the needs of others to gain approval or avoid conflict can lead to self-neglect–meeting others’ needs at a personal cost. The subcategory of approval-seeking focuses on gaining validation from others rather than developing genuine self-esteem, leading to inauthentic life choices and potential resentment.
5. Over-Vigilance and Inhibition
Over-vigilance and inhibition refer to the excessive suppression of emotions and adherence to rigid internal rules, often at the cost of happiness and relationships. Negativity involves a persistent focus on potential failures, while emotional inhibition suppresses spontaneous feelings to avoid disapproval. Unrelenting standards create pressure for perfection, while punitiveness leads to harsh personal judgments of mistakes.
What The Research Says About the Efficacy of Schema Therapy?
Schema therapy has been around long enough for criticism. A systematic review in 2016 found schema therapy was effective in reducing early maladaptive schemas but lacked studies to prove significant symptom change in borderline personality disorder (BPD). Further research on BPD found it to be effective in twice-weekly sessions.
Research on schema therapy for anxiety disorders found it to be useful but lacking enough studies. The problem with evaluating how well a specific type of therapy works lies in collecting quantitative data for something that is generally evaluated qualitatively. However, there is evidence that schema therapy works and many people have found it effective–especially when the issue stems from an early maladaptive schema.
Therapeutic Interventions
As you can tell by now, schemas that therapists look to adjust are not quite as simple as ‘dog, not wolf.’ Changing deeply helpful concepts or maladaptive ideas can be life-changing, but it requires work from both parties.
To start the process, the therapist and client may have to unpack the early life experiences that shaped the issues that present today. Practitioners of schema therapy believe that many of the problematic schemas arise because, at some developmental point, needs were not met.
Of course, delving into the depths of childhood is not enjoyable, but for issues like personality disorders, the research shows it to be highly effective, placing a higher emphasis than CBT on the root cause of current personality issues.
Breaking Patterns
Schema therapy is not the first form of psychotherapy to address harmful patterns that bring people to therapy, and it will not be the last. However, the evidence-based approach to issues like personality disorders shows great promise. For those who have tried Dialectical Behavioural Therapy, CBT, psychoanalysis or another modality and failed to resonate with it, schema therapy could be a good option.
References:
Peeters, N. et. Al. (2022) The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda. British Journal of Clinical Psychology; 61(3): 579-597.
Tan, Y. M. et. Al. (2018) Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PLoS One; 13(11): e0206039.
Taylor, C. et. Al. (2016) Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychol Psychother; 90(3):456–479.
**Please note this article should not serve as medical advice; if you or someone you care about is struggling, contact one of the many helplines, your GP, counsellor, or psychologist.
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