What is Schema Therapy?

Schemas (in general) are our beliefs that we hold about ourselves, the world around us, and the world of others. You can think of schemas as frameworks, or structures, through the lens of which we organize and make sense of our life experiences.

These beliefs operate in the background of our awareness, yet they have great influence over our sense of self, our expectations about life, and the quality of our relationships.  The aim of schema therapy is to help the individual recognize their behaviour, understand the underlying cause(s), and change their thoughts and behaviours so that they’re better able to cope with relationship challenges or emotions in healthy, productive ways.

The idea behind this model is that as a child is growing up, they are largely dependent on their caregivers to meet these emotional needs. According to the theory, children have 5 core emotional needs growing up. These are:

• Secure attachments to others (includes safety, stability, nurturance, and acceptance)
• Autonomy, competence, and sense of identity
• Freedom to express valid needs and emotions
• Spontaneity and play
• Realistic limits and self-control

However, when these needs are repeatedly not (adequately) met, children try to explain why this is happening and thus create certain negative beliefs about themselves and about relationships. These beliefs are called Early Maladaptive Schemas (EMS).

Early Maladaptive Schemas

If a child hurts themselves or gets upset and the caregiver repeated tells them ‘get over it’ , ‘suck it up’ or ‘I don’t have time for this’? What will the child think about themselves and the world around them? I shouldn’t have complained? There’s no point in saying anything? They don’t care? Therefore we make the further conclusion: Nobody cares about me, I’m not important. Repeated often enough, this belief becomes an EMS. 

There are 18 different EMS, and they are:

Emotional Deprivation: The belief and expectation that your primary needs will never be met. The sense that no one will nurture, care for, guide, protect or empathise with you.

Abandonment: The belief and expectation that others will leave, that others are unreliable, that relationships are fragile, that loss is inevitable and that you will ultimately end up alone.

Mistrust/Abuse: The belief that others are abusive, manipulative, selfish, or looking to hurt or use you and are not to be trusted.

Defectiveness: The belief that you are flawed, damaged or unlovable and you will therefore be rejected.

Social Isolation: The pervasive sense of aloneness, coupled with a feeling of alienation.

Vulnerability: The sense that the world is a dangerous place, that disaster can happen at any time and that you will be overwhelmed by the challenges that lie ahead.

Dependence/Incompetence: The belief that you are unable to  make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day-to-day responsibilities.

Enmeshment/Undeveloped Self: The sense that you do not have an identity or “individuated self” that is separate from one or more significant others.

Failure: The expectation that you will fail or the belief that you cannot perform well enough.

Subjugation: The belief that you must submit to the control of others or else punishment or rejection will be forthcoming.

Self–Sacrifice: The belief that you should voluntarily give up your own needs for the sake of others, usually to a point which is excessive.

Approval–Seeking/Recognition–Seeking: The sense that approval, attention and recognition are far more important than genuine self-expression and being true to oneself.

Emotional Inhibition: The belief that you must control your self-expression or others will reject or criticise you.

Negativity/Pessimism: The pervasive belief that the negative aspects of life outweigh the positive, along with negative expectations for the future.

Unrelenting Standards: The belief that you need to be the best, always striving for perfection or that you must avoid mistakes.

Punitiveness: The belief that people should be harshly punished for their mistakes or shortcomings.

Entitlement/Grandiosity: The sense that you are special or more important than others, and that you do not have to follow the rules like other people even though it may have a negative effect on others. Also can manifest in an exaggerated focus on superiority for the purpose of having power or control.

Insufficient Self–Control/Self–Discipline: The sense that you cannot accomplish your goals, especially if the process contains boring, repetitive, or frustrating aspects. Also, that you cannot resist acting upon impulses that lead to detrimental results.

Left unchecked, we take these beliefs we gained in childhood into adulthood. As per our previous example; the person I am seeing said they would call me tonight but didn’t, they obviously don’t like me, I’m not that important to them.

Unhealthy Coping Styles

When our EMS get triggered, we need to respond to them, in schema therapy, there are 3 Unhelathy Coping Styles that we can respond to these schemas. They are:

Surrender: A person with this coping style will give into the schema or accept it as fact and may behave in self-destructive ways as a result. Someone with a schema telling them they deserve to be mistreated, for example, may put up with abuse or not complain when treated unfairly.

Avoidance: A person with this coping style goes to great lengths to avoid triggering the schema. To do this, they may engage in distracting behaviours such as substance use, or they may avoid entering relationship or situations that could set the schema off. They may, as a result, struggle to get close to others or experience personal growth.

Overcompensation: A person with this coping style will try to “fight” the schema by deliberately behaving in ways that are counter to it. While deliberately questioning a schema can be healthy or even a part of the therapeutic process, the coping style of overcompensation often leads to negative outcomes. For example, a person trying to overcompensate for a schema that tells them that they’re worthless may try to instead be ultra-successful, which can lead to burnout, dissatisfaction, or strained relationships.

In therapy, once schemas and coping styles have been identified, the therapist will likely use a range of techniques to change the schemas themselves and/or replace unhealthy coping styles with adaptive behaviours. This is done through a range of cognitive, emotional, and behavioural techniques. Cognitive approaches, for example, may ask the client to look for evidence for and against the schema and directly challenge its validity. Behavioural techniques might include role-playing common situations that trigger the schema, acting out an adaptive response instead of resorting to the maladaptive coping style.

Therapy Techniques

Therapeutic techniques used in this process may include:

Imagery: In this technique, people in therapy explore upsetting childhood memories in an attempt to understand the development of maladaptive schemas. Individuals are first asked to imagine the sights, sounds, and other sensations involved in these memories and then carry on imaginary dialogues with the caregivers involved in these memories and ask for their needs to be met. Following this process, individuals often become more able to identify the current situations eliciting similar emotions and may be more successful at getting needs met in healthy ways in future situations. 

Flash cards: In schema therapy, therapists work to help those in therapy create messages designed for the caregivers who failed to meet their childhood emotional needs. These messages can take the form of simple statements, notes, or even complex poems. The person in treatment will typically look over the flash cards between sessions. This regular review is intended to help individuals learn how to make healthy, effective statements about their emotional needs to important people in their adult lives.

Chair work: This aspect of therapy attempts to help those in therapy identify variations in emotions and personality. In chair work, the person in therapy moves between two chairs, expressing different emotions and aspects of personality in each chair. Chair work can also be used to help a person in treatment imagine dialogues with family, friends, or significant others. In this type of chair work, a person might make statements regarding emotional needs while sitting in one chair and then move to another chair to play the role of a person who might meet these emotional needs. Imagery work is often conducted in conjunction with chair work.

Diaries: People pursuing schema therapy are often asked to keep a diary or log of any experiences activating early maladaptive schemas. In treatment, individuals can learn to identify the thinking patterns associated with these schemas. When these thinking patterns occur between sessions, the diary allows individuals to write about the associated situations, feelings, and behaviours. These diaries are often reviewed in session and can be helpful in determining methods of practicing new ways of meeting emotional needs as well as situations in which these methods may be best applied.