New and Emerging Therapies: Schema Therapy

//New and Emerging Therapies: Schema Therapy
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New and Emerging Therapies: Schema Therapy 2020-03-01T23:06:47+00:00

Developed by Jeffrey Young to specifically treat personality disorders, schema therapy is an integrative psychotherapy that cohesively pulls from other therapies to address client needs. In particular, schema therapy integrates techniques and ideas from cognitive behavioral therapy, Gestalt therapy, psychoanalytic object relations theory, and attachment theory. It gets its name from the Greek work σχημα, which means “shape” or “form.” In cognitive psychology, a schema indicates a thought pattern or behavior. Schema therapy helps clients heal these schemas by decreasing the severity of emotional memories in which the schema consists. And also by changing the cognitive patterns connected to the schema. Through this process, the client learns to replace maladaptive coping mechanisms with adaptive ones.

If you’re curious about schema therapy, you might wonder about how it treats borderline personality disorder, schema therapy techniques, how long does schema therapy take, and other related concerns.

Schema Therapy for Borderline Personality Disorder

How does a therapist use schema therapy for borderline personality disorder? According to their work in Schema Therapy: A Practitioner’s Guide, Young and others have identified five broad domains with related unmet needs that contribute to forming the 18 maladaptive schemas which this therapy targets. This includes:

  • Disconnection/Rejection domain
    • Abandonment/Instability
    • Mistrust/Abuse
    • Emotional Deprivation
    • Defectiveness/Shame
    • Social Isolation/Alienation
  • Impaired Autonomy and/or Performance domain
    • Dependence/Incompetence
    • Vulnerability to Harm or Illness
    • Enmeshment/Undeveloped Self
    • Failure
  • Impaired Limits domain
    • Entitlement/Grandiosity
    • Insufficient Self-Control and/or Self-Discipline
  • Other-Directedness domain
    • Subjugation
    • Self-Sacrifice
    • Approval-Seeking/Recognition-Seeking
  • Overvigilance/Inhibition domain
    • Negativity/Pessimism
    • Emotional Inhibition
    • Unrelenting Standards/Hypercriticalness
    • Punitiveness

These maladaptive schemas manifest themselves in thought patterns and behaviors which negatively impact the client’s life. This is especially prevalent with people who suffer from borderline personality disorder. That’s why Young developed schema therapy for borderline personality disorder. An effective schema therapy treatment plan will address these thought patterns and provide healthier ways of coping and living. You can see ways in which schema therapy for borderline personality disorder address particular needs and symptoms of that condition below.

Schema Therapy Techniques

What can one expect to see in schema therapy techniques? Well, along with the 18 maladaptive schemas mentioned above, these schemas can be organized further into 10 schema modes. Schema modes are temporary states of mind that every human being experiences at one time or another. You can almost think of them as character types. People slip into these schema modes when they experience something perturbing, offensive, remember a traumatic event, or are triggered. For people who suffer from borderline personality disorder, this experience feels powerful, unyielding, and it seems split off from the rest of their personality. These modes include:

  • Angry Child
  • Vulnerable Child
  • Impulsive/Undisciplined Child
  • Happy Child
  • Compliant Surrenderer
  • Detached Protector
  • Overcompensator
  • Punitive Parent
  • Demanding Parent
  • Healthy Adult

The goal is to help the person become the “healthy adult” mode.

Schema therapy presents as a highly organized system. The same is true for schema therapy techniques. These techniques delineate into 3 classes:

  • Cognitive
  • Experiential
  • Behavioral

Cognitive schema therapy techniques focus on changing the client’s perspective. It features classic cognitive behavioral techniques such as listing pros and cons of a schema, testing the validity of a schema, or conducting a dialogue between the “schema side” and the “healthy side.” Experiential schema therapy techniques develop Gestalt Therapy, psychodrama and imagery techniques. This focuses on helping the client center their attention on the now, take personal responsibility, and gain a deeper awareness of the environmental and social contexts of their life. Last, the behavioral class involves techniques like role-playing and other behavior therapy methods.

Schema Therapy Treatment Plan

If you’re interested in learning more about schema therapy, you might also want to know more about a schema therapy treatment plan, or you might wonder how long does schema therapy take? A schema therapy treatment plan will be organized according to the three classes of techniques. In turn, these three classes address the 18 maladaptive schemas discussed earlier. Throughout this process, the therapist and client can identify with which schema mode they seem to struggle, discuss what the healthy adult mode might look like, and then develop the plan in order to achieve that end. None of this can be possible without first forming a healthy therapeutic relationship. This can take some time.

Once this relationship forms, other steps in the treatment plan might include using flash cards with valuable, personal therapeutic messages on them. The therapist and client will create these during a session and will be used in between sessions. A schema therapy treatment plan might also include a “schema diary.” The client would use this and fill out in between sessions to keep records of their progress, take notes about certain interactions, and keep track of what they learn.

But how long does schema therapy take? An individual session can last between 60 to 90 minutes. Yet, regarding the entire process, it depends. Recall once more the 18 early maladaptive schemas. These early maladaptive schemas can all have different levels of acuteness and pervasiveness. The more severe and engrained the schema, the more intense and longer lasting is the negative emotion associated with it. The more pervasive the schema, the greater the number of situations that trigger it. The acuteness and pervasiveness of these schemas will determine how long treatment will last. Typically, however, one can expect treatment to take 2-3 years.

If you’d like to learn more about schema therapy, then be sure to check out Jeffrey Young’s work in Schema Therapy: A Practitioner’s Guide. You can also check out the Schema Therapy Institute website for training materials and other relevant information. If, however, you’re not a possible practitioner or student, and you want to see if schema therapy might be useful for you, check out Young’s book Reinventing Your Life.

John Sherk

Master of Divinity (M.Div.) | Westminster Theological Seminary  (2020 Graduation)

Bachelor’s of Social Work, Bachelor of Science (B.S.), Bible | Cairn University

November 2019

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