Schema Therapy
What is schema therapy?
Schema therapy is an integrative approach which draws on several other forms of therapy including cognitive behavioural therapy, attachment and object relations theories, and Gestalt and experiential therapies. It aims to address the more deeply ingrained beliefs (or schemas) that people hold about themselves and the problematic behaviours (or coping styles) that occur as a result.
Schema therapy is based on the concept of core emotional need. When these needs are not met in childhood, people can develop unhelpful schemas. Schema theory has identified 18 key schemas, which fall roughly into 5 categories:
Disconnection and rejection - e.g. believing that others cannot be relied on for emotional support
Impaired autonomy and performance – e.g. believing that you will fail or that you are not capable of living independently
Impaired limits – e.g. believing that you are superior to others
Other-directedness – e.g. believing that other people’s needs should come first
Overvigilance and inhibition – e.g. believing that expressing emotions will have a negative consequence
These schemas are painful and lead to people developing (often subconsciously) alternative ways of getting their needs met. These may seem fairly successful at first, but typically over time they become more problematic, leaving people with entrenched unhelpful coping responses. Schema therapy helps people understand where these difficulties have come from and to find new, healthier ways of getting needs met.
How does Schema Therapy work?
Schema therapy is typically a longer, more exploratory form of therapy. It begins by creating a shared understanding of the difficulties someone is having and where these difficulties have come from. This might involve discussion, possibly some experiential techniques (going back into old memories) and can involve the use of relevant questionnaires as well. This understanding is often drawn out as a “map”, capturing the relevant schema, modes and how someone moves between them.
Over time, work is done to help people notice when they are getting stuck in these patterns in a compassionate and non-judgemental way. Various techniques are used to strengthen alternative, healthier ways of being. Cognitive techniques include thought challenging, schema flashcards and diaries, and schema dialogues. Emotion-focused techniques include role-play / chair work and guided imagery. Behavioural techniques include behavioural experiments or role-playing alternative responses. Crucial to the work is the use of the therapeutic relationship as a healing influence.