What is schema therapy, and how does it work?

During my studies I heard the name "schema therapy" here and there, but to be honest it was never taught in any of my university courses. For a long time all I knew was that some therapists are schema therapists and that schemas have something to do with our beliefs; I thought a schema simply meant a belief. There were always hundreds of higher-priority books to read, so I did not get to learn more. Later I saw schema therapy offered in workshops, but they were expensive, and even though I worked while studying I could not afford all of them. So I put off learning it until I decided to use reputable academic websites to learn the topic.

In this article we look at what schema therapy is, how it works and what it is used for.

What is schema therapy?

A schema is a pattern of thoughts or behaviours that forms early in life and that we carry into adulthood; it may be helpful or unhelpful. Schema therapy aims to identify problematic schemas and replace them with healthier, more adaptive ways of organising and understanding new information and situations in our personal and working relationships. Schema therapy was developed by Jeffrey Young in the 1980s and 1990s for people who did not respond well enough to classic cognitive behavioural therapy, especially people with personality disorders. It holds that when a child's emotional needs are not met, this can lead to problematic coping styles, schemas and ways of behaving.

How does schema therapy work?

Treatment often begins by assessing whether the person uses one or more of three unhelpful coping styles: avoidance, surrender or overcompensation.

Avoidance

Avoidance means actively escaping or sidestepping situations that might trigger the schema.

Surrender

Surrender means falling back into an old schema that has proven unhelpful, without trying new ways of approaching problems or challenges.

Overcompensation

Overcompensation (or counterattack) means the person puts in a great deal of effort to make sure the outcome they fear does not happen.

The goal of schema therapy

The goal of schema therapy is to help clients meet their core emotional needs. It does this by helping them learn to heal their schemas: reducing the intensity of the emotional memories and bodily sensations linked to a schema, and changing the thinking patterns connected to it. Therapy also aims to replace unhelpful coping styles and responses with healthier patterns of behaviour.

What schema therapy is used for

Schema therapy has been used to treat borderline personality disorder and problems linked to childhood abuse and deprivation. It may also help when someone keeps facing difficulties in personal and working relationships, repeating unhelpful or problematic behaviour to deal with a real or perceived threat, and keeps failing.

The schema domains

Jeffrey Young described 18 early maladaptive schemas and grouped them into 5 domains. Each domain relates to a core emotional need of childhood that was not met:

1. Disconnection and rejection

This domain includes the schemas abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, and social isolation/alienation.

2. Impaired autonomy and performance

This domain includes dependence/incompetence, vulnerability to harm or illness, enmeshment/undeveloped self, and failure.

3. Impaired limits

This domain includes entitlement/grandiosity and insufficient self-control or self-discipline: difficulty respecting the rights of others, cooperating, or working towards long-term goals.

4. Other-directedness

This domain includes subjugation, self-sacrifice, and approval-seeking/recognition-seeking: focusing too much on the wishes and reactions of others at the expense of one's own needs.

5. Overvigilance and inhibition

This domain includes negativity/pessimism, emotional inhibition, unrelenting standards/hypercriticalness, and punitiveness: suppressing feelings and following rigid rules at the expense of happiness and ease.

A note on the word "schema"

Cognitive psychology also talks about "schemas", but with a different meaning: mental frameworks for understanding people, social situations, ourselves and events (such as the "script" for how to behave in a restaurant). These are different from the early maladaptive schemas of schema therapy.