Schema Therapy integrates elements of cognitive, behavioural, gestalt and object relations therapy in one unified approach.
It’s based on the premise that all children have basic, fundamental needs. The need for safety, secure attachment, acceptance and care; the need for autonomy, competence and a sense of identity; the need for realistic limits and self-control; the need for free expression of needs and emotions; and the need for spontaneity and play. When these needs are unmet, because of an emotionally neglectful environment, miss-match between the parental unit’s ability and the child’s temperament, or physical or sexual abuse, children try to make sense of this. In their attempt to understand why their needs weren’t met, they can develop Schemas, which contain beliefs, emotions, physical sensations and memories. For example, for a child who grows up in a family in which expressing emotions was interpreted as weak or ‘too much’, they may develop the schema of ‘I’m not good enough’’. This schema contains the belief, along with the emotional and physical pain of not feeling enough, as well as a flood of memories tied to this schema. In an environment where their needs aren’t met, the child tries their best to adapt and cope. This usually occurs in one of the ways: by avoiding situations that trigger the schema, by overcompensating for it, or by giving into it and acting as if it were true. At the time, this was a really adaptive and helpful approach, and kept the child safe. It’s only in adulthood, when the individual is no longer in that difficult environment, where these engrained patterns can start to interfere.
Schema therapy aims to identify unmet childhood needs, provide a corrective experience to meet those needs, and as a result, reduce the need for these coping modes.
Formulation in schema therapy centres on identifying which core needs went unmet in your childhood, what schemas developed as a result, and how have you coped with this (your ‘coping modes’). Every single individual has schemas and coping modes, and they aren’t all bad all the time. This process is about understanding which schemas and coping modes are getting in the way of your life and relationships. This process can happen with the help of self-report measures, or in discussion with your psychologist. To use the example above, the young child who developed the ‘I’m not good enough’ schema may have learnt to minimise their hurt and pain through a demanding critic mode (who may say things like ‘DO BETTER’), or a detached self-soother mode (who may turn to food, alcohol, or TV for peace).
COGNITIVE AND BEHAVIOURAL COMPONENTS
Much like CBT, schema therapy uses various cognitive and behavioural techniques to heal the schemas and reduce the modes.
Schemas can misperceive or misrepresent information in such a way that confirms the schema and denies any information that disconfirms it. In the first stages of schema therapy your psychologist will identify any cognitive distortions or biases that are perpetuating the schema and guide you through a process of cognitive evaluation and discussion about the pros and cons to try to shift your perspective away from the schema.
In addition to acting as a filter for information, schemas can also influence your behaviour (and lead to coping modes), which can reinforce the schema. As part of therapy your psychologist will ask you to break certain behavioural patterns, which may look like approaching rather than avoiding, setting limits for overcompensation, or communicating your needs and establishing boundaries to protect yourself.
Unlike some other treatment modalities, schema therapy incorporates evidence based experiential techniques, including imagery and chair work.
The goal of Imagery is to heal painful schemas and reduce coping modes. We do this by asking you to bring to mind a memory, along with all the cognitive, emotional, and physical sensations associated with it. When done as part of the assessment phase, this may be enough to provide a deeper understanding of your patterns. When done during the change phase, your psychologist, or you yourself, may go into the memory and rescript it. The purpose being to provide you an alternative feeling or experience and unstick the schema.
Chair work has similar goals, just done in a different way (and it doesn’t always involve chairs). Chair work is a process in which one particular mode is encouraged to speak to another mode, another person in your life, for example a parent (in an imaginary way), or the psychologist. We want to bypass the coping modes, access what we call the vulnerable child mode (the part of you that houses all the vulnerable emotions), so we can meet the need. For example, your psychologist may ask your adult mode to look at a chair/a location in the room/or an object and speak to the demanding critic mode, explaining that it’s just getting in the way and causing pain. The purpose being to start moving away from these ways of surviving.