What is Schema Therapy?
Schema therapy is a form of psychotherapy ideally suited for patients with entrenched, chronic problems originating in childhood. The therapy integrates elements from cognitive-behavioural, attachment, Gestalt and psychoanalytic schools into a comprehensive, unified treatment model.
Schema-focused psychotherapy is used for a wide range of mental health issues, including:
- Personality disorders
- Borderline presentations
- Relational problems
- Eating disorders
- Complex trauma
Broadly, schemas are adaptive mechanisms that our brains use to categorise and interpret information about the world. These are often unconscious – we often do not realise that we have these beliefs until they are unravelled. Schemas are perceptions, beliefs, thoughts, and emotions that a person builds based on interacting with their environment across the lifespan.
People with childhood trauma don’t have faulty brains. They have minds designed in threatening environments to help them survive.Peggy Leigh
Growing up in an unstable environment may result in maladaptive schemas. Early maladaptive schemas are self-defeating patterns of beliefs, memories, attitudes, thoughts, emotions and bodily sensations that manifest in childhood or adolescence and persist into adulthood. Such schemas develop in response to basic emotional needs not being adequately met during the developmentally sensitive years of childhood and adolescence and can come from childhood trauma, mistreatment or overprotection.
The development of these schemas manifests into adulthood. It allows maladaptive interpretation of the adult’s environment, consistent with their earlier stages of life. It becomes an unhelpful lens through which a person regards themselves, others and the world.
Each schema represents specific, unmet emotional needs across a range of domains. These schema modes are emotional states that are also frequently associated with habitual behavioural responses prompted by sensitive life situations (our “emotional buttons”). Schema modes can change rapidly and may cause people to act or react in ways that exacerbate their distress in the long run. Individuals may also adopt and engage in unhelpful behaviours, perpetuating problems later in life. Often, maladaptive childhood coping styles persist into adulthood and manifest as blocking out pain, fighting back, or people-pleasing with detrimental results.
As such, schemas are activated when stressful situations or events that remind us of traumatic experiences from early childhood are triggered. When a schema is activated, intense emotions and distorted or unhelpful perceptions and ways of thinking about ourselves, others, and the environment are experienced. Schemas are also felt in the body, both as painful feelings such as anxiety and somatic (body) memories of traumatic experiences.
Schema-focused therapy aims to identify, restructure, and transform maladaptive patterns from the past in order to enhance present-day well-being.
What are therapy sessions like?
In the first session, a thorough history is taken to understand your upbringing, family structure, relationships with both parents, siblings, and other family members, as well as your school, adolescent, and romantic relationships. You will also complete a schema questionnaire, enabling the therapist to identify the early maladaptive schemas and understand how they impact you now. Current coping strategies, modes, and emotional temperament are also revealed at this stage.
Subsequent sessions of schema-focused therapy will focus on learning and practicing cognitive, behavioural, and experiential strategies.
Cognitive strategies endeavour to modify automatic thoughts, uncover cognitive distortions, and restructure and override maladaptive schemas and their modes. At this stage, you will work on transforming them into more realistic, functional, adult-created beliefs instead of those formed in childhood. It involves accessing your vulnerable child mode by bringing the emotions associated with your childhood-based triggers to the surface. In these situations, you learn to “reparent” yourself using your healthy adult mode. As the healthy adult matures, you develop greater emotional resiliency. Behavioural and experiential work includes visual imagery, roleplaying, and creative work to represent positive memories and reparenting symbolically.
Throughout therapy, you will learn how to heal your attachment wounds by altering maladaptive schemas, modes, and coping mechanisms that have not served you. Instead, changing them into more adaptive ways of relating to yourself, others and the world around you in order to lead a more fulfilling life.