An Overview of Schema Therapy

Schema therapy has been developed specifically to treat personality disorders but has now been successfully used to treat chronic depression, childhood trauma, criminal offenders, eating disorders, couples work, relapse prevention and substance abuse.

Patients with personality disorders or more chronic conditions have failed to respond fully to traditional cognitive behavioural therapy treatments. Beck, Freeman & associates, (1990).

Mainstream services have largely failed these clients, resulting in them feeling more abandoned, flitting from service to service and therapist to therapist. Clients have difficulty maintaining stable relationships, are impulsive, display inappropriate anger, have recurrent suicidal threats gestures or behaviours. They may also suffer from identity disturbance, chronic feelings of emptiness/ boredom and display efforts to avoid real or imagined abandonment or rejection. Nhs staff therefore remain largely unskilled in dealing with this client group and may result in further feelings of rejection and abandonment as staff are only to relieved to have the client move on to yet another department or service.

“These clients are treated with minimal compassion and much blame in other therapies”, Young, (2003).

Schema therapy therefore is unusually compassionate and humane, normalizes psychological disorders The approach is sympathetic and respectful with the emphasis very much on the therapy relationship.

Schema therapy is a combination of aspects of different therapies, including cognitive behavioural, attachment, gestalt, object relations, constructivist and psychoanalytical. It expands on cognitive behavioural therapy by placing greater emphasis on explaining childhood and adolescent origins of psychological problems, emotional techniques, the client -therapist relationship and on maladaptive coping styles.

Schema’s

A schema can be described as-

- a broad pervasive theme or pattern - comprised of memories, emotions, cognitions and bodily sensations - regarding oneself and one’s relationships with others - developed during childhood or adolescence - elaborated throughout one’s lifetime and - dysfunctional to a significant degree

These early maladaptive schema’s are self defeating emotional and cognitive patterns that begin early in our development and repeat throughout life. These schema’s then cause self defeating patterns or behaviours, i.e., difficulty in relationships, intense anger and attention seeking behaviour which can lead to depression and anxiety. Unless the underlying schema has been healed or modified then the self defeating behaviours will constantly repeat themselves resulting in the client dipping in and out of depression and anxiety. Borderline clients will find themselves limping from crisis to crisis and service to service with no stability in their lives.

Treatment focuses on identifying the maladaptive schema’s and the lack of attachments or indeed the dysfunctional attachments in childhood and adolescence. These deficits will the be linked to present problems encountered in life. The therapist and the client through therapy will attempt to heal the dysfunctional schema’s which will result in less mental health difficulties and a more stable lifestyle.

Research

The latest research which has yet to be published by Arnoud Arntz on a clinical trial of schema-focused therapy for BPD reports that 50% of those treated no longer met criteria for BPD. Young,J.E, (2004) Conference, Strandmillis College, Belfast. Psychological Society.

References

Beck, A.T. Freeman, A., & Associates. (1990). Cognitive therapy of personality disorders. New York: Guilford Press.

Young, J.E., Klosko, J.S., Weishaar, M.E. (2003). Schema Therapy. A practitioners guide. New York. Guilford Press.

Self Help

Young, J.E., Klosko, J.S. (1994) Reinventing your life. New York. Plume.

Web sites http://schematherapy.com

http://cognitive-therapist.co.uk

By Ken Walsh

Cognitive Behavioural Psychotherapist, (Nov, 2004)