September 16th, 2020

Schema Therapy: An introduction

By Dan Whale

  • Personality disorders
  • Eating disorders
  • Addiction

Schema Therapy is a form of talking therapy which integrates aspects of multiple different therapeutic approaches, such as Cognitive Behavioural Therapy and Psychoanalytic Therapy. This means that whilst it does help you identify unhelpful ways of thinking and behaving in your day-to-day life (the CBT approach), it also helps you look into your past and examine what has led you to where you currently are (Psychoanalytic approach).

Developed in the 1980s by Jeffrey Young, Schema Therapy teaches us that when our emotional needs are not met as children, it can lead us to adopt and develop ‘schemas’. These schemas, comprised of memories, emotions, thoughts and bodily sensations, are often untrue or unhelpful self-characteristics that cause emotional distress.

To prevent this distress, we create coping styles - however these are often unhealthy or harmful. The goal of schema therapy is to recognise how to make sure our needs are met as adults, use more useful coping styles and move away from behaviours that result from schemas.

Why might a therapist suggest Schema Therapy

Schema Therapy can be applied to many different mental health conditions but it’s specifically designed for people that have deeply entrenched feelings or patterns of behaviour that are preventing them living the life they want.

It’s most commonly associated with Borderline Personality Disorder but it’s also been shown to work well with those experiencing substance abuse or disordered eating.

On the whole, it is used on conditions which have a strong determination on how we live our lives and the decisions we make. Schema Therapy wouldn’t usually be suggested for conditions such as depression, anxiety or grief.

How does it work?

Your therapist will help you unpack the four main concepts of Schema Therapy: childhood emotional needs, early maladaptive schemas, maladaptive coping styles and schema modes. That may sound like a lot of jargon, but it is all relatively straightforward.

Childhood emotional needs

Schema Therapy teaches us that as children we all have certain basic emotional needs. These involve safety, self-identity/autonomy, freedom to express ourselves, ability to play, and age-appropriate limits and boundaries.

Early maladaptive schemas

When childhood emotional needs are not met, we can develop early maladaptive schemas. Experts have identified 18 different schemas and most people tend to develop multiple as opposed to just one, but they share certain characteristics.

They all involve the way we see ourselves or our relationship with others. They will all become deepened throughout our life (without being addressed) and, most importantly, they cause a significant level of dysfunction.

Examples of a maladaptive schema might be something like, ‘I’m not worth loving’ or ‘everyone always leaves me’.

Maladaptive coping styles

In turn, these schemas cause us to create coping styles in an effort to prevent emotional distress. Whilst this sounds like a good thing, these are often problematic.

Coping styles will be different for everyone but they usually fit within three categories.

Surrender: Accepting our schema, which usually results in behaviour that reinforces the pattern. For example, if you feel that you are not worth loving, you may accept being in a neglectful relationship.

Avoidance: Attempting to avoid our schema by any means possible. This may result in substance misuse, reckless behaviour or other actions that provide a distraction.

Overcompensating: Doing the complete opposite of how your schema makes you feel, in a way which generally goes ‘too far’. If your schema makes you feel out of control, you may develop an obsessive disorder or experience disordered eating, as you try to get as much control over your life as possible.

Schema modes

Finally, schema modes can be described as temporary mindsets which encompass what you’re currently feeling and how you’re dealing with it. These can be healthy, or more dysfunctional.

They’re used by therapists to group together schemas and coping styles and address them as single states of mind, as opposed to seeing everything individually.

Your therapist will help you work through each of these concepts, improving ways to get your needs met as an adult and learning more helpful coping strategies when they are not. Assessments or Q&A may be used to explore your past, and as Schema Therapy can be made up of several approaches, different therapists may use different techniques.

What we know so far

Schema Therapy has only been around since the 1980s which, in psychology terms, is not all that long. However, studies have shown it to be an effective form of treatment.

A 2016 systematic review concluded it was an effective treatment for personality disorders, and whilst more research needs to be undertaken, empirical support for its effectiveness in treating other mental health conditions is growing.

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Schema Therapy is an interesting option if you have had long-standing challenges with your mental health which relate to your relationship with yourself and others. If you think it would be a good fit for you, contact us at hello@helloself.com and we can connect you to a therapist which provides this approach.

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