Practice in Clinical & Health Psychology
What is Schema-Focused Therapy?

 

 
A Treatment for Life-Long
Dysfunctional Patterns
Schema-Focused Cognitive Therapy is a therapy approach developed by Dr. Jeffrey Young, who originally worked closely with Dr. Aaron Beck, the founder of Cognitive Therapy. While treating clients at the Center for Cognitive Therapy at the University of Pennsylvania, Dr. Young and his colleagues found a segment of people who had difficulty in benefiting from the standard Cognitive-Behavioral approach. He discovered that these people typically had long-standing patterns or themes in thinking and feeling—and consequently in behaving or coping—that required a different means of intervention. Dr. Young’s attention turned to ways of helping patients to address and modify these deeper patterns or themes, also known as “schemas” or “lifetraps.”
This cognitive-development model is based on the assumption that many negative cognitions have their roots in past experiences.
Schema-Focused Cognitive Therapy proposes an integrative systematic model of treatment for a wide spectrum of chronic, difficult and characterological problems. Dr. Young developed the schema-focused approach to deliberately address lifelong, self-defeating patterns that typically begin early in life, called early maladaptive schemas (EMS). Through clinical observation over more than 15 years, Dr. Young and his associates have identified 18 early maladaptive schemas that are common sources of problems seen in therapy.
The basic premise of Dr. Young's approach is that individuals with more complex problems have one or more early maladaptive schemas that must be targeted in treatment.
Early maladaptive schemas are defined as 'broad pervasive themes or patterns regarding oneself and one's relationship with others, developed during childhood and early adolescence and elaborated throughout one's lifetime, that are dysfunctional to a significant degree'. These patterns consist of negative or dysfunctional thoughts and feelings that have been repeated and elaborated upon, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Some examples of schema beliefs are: “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” and so on.
Although schemas are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemas are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. The Schema-Focused model of treatment is designed to help the person to break these negative patterns of thinking, feeling and behaving, which are often very tenacious, and to develop healthier alternatives to replace them.
The Schema-Focused approach combines the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model of treatment. Schema-Focused Therapy has shown remarkable results in helping people to change patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been unsuccessful.
What type of early childhood experiences lead to the acquisition of maladaptive schemas?
  • The child who does not get his or her core needs met-- e.g., needs for nurturance, protection, affection, empathy, and guidance, etc.
  • The child who is traumatized or victimized by a very domineering, abusive, or critical parent or peers.
  • The child who learns primarily by internalizing the parent's voice. Every child internalizes or identifies with both parents and absorbs certain characteristics of both parents, so when the child internalizes the punitive punishing voice of the parent and absorbs these characteristics they become schemas.
  • The child who receives too much of a good thing. The child is overprotected, overindulged, or given an excessive degree of freedom and autonomy without limits being set. 
Therefore early maladaptive schemas begin with something that was done to us by our families or by other children, which damaged us in some way. We might have been abandoned, criticized, overprotected, emotionally or physically abused or bullied, excluded or deprived and, consequently, the schema becomes part of us. Schema are essentially valid representations of early childhood and adolescence experiences, and serve as templates for processing and defining later behaviors, thoughts, feelings, and relationships with others. Early maladaptive schema include entrenched patterns of distorted thinking, disruptive emotions and dysfunctional behaviors. These schemas become fixed when they are reinforced and/or modeled by parents and important others in our early years.
Long after we leave the home and environment we grew up in, we continue to create situations in which we are mistreated, ignored, put down, or controlled and in which we fail to reach our desired goals.
Schemas are perpetuated throughout our lifetime and become activated under conditions relevant to that particular schema. 
Some of the more common schema that have been identified by Dr. Young and has colleagues 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 empathize 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 wind up alone.
Mistrust/Abuse:
The belief that others are abusive, manipulative, selfish, or looking to hurt or use you. Others are not to be trusted.
Defectiveness:
The belief that you are flawed, damaged or unlovable, and you will thereby 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 effectively 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 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 of 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 criticize 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 to 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.
Is Schema-Focused Cognitive Therapy right for you?
Schema-focused therapy deals with life-long patterns rather than current situations, which have arisen. Because schemas are dimensional it is not whether you have it or don't have it that's relevant but how much you have it. In other words, how intense is the schema when it is activated and how pervasive and broadly does it affect your life.
Some of the problems or signs that could indicate that you have an early maladaptive schema influencing your life include...
  • being stuck in some area of your life which you don't seem to be able to change,
  • feelings of inadequacy, loneliness, chronic anxiety, or relapsing depression,
  • over-dependency on others,
  • problems choosing appropriate partners in life--e.g., getting into relationships where you always feel criticized, deprived or ignored, controlled, always fighting and feeling angry, etc. 
  • being out of touch with your feelings.
Presenting problems which are chronic or long-term such as eating disorders, substance abuse, relapsing depression or general anxiety, rigid and inflexible thinking and behavior patterns, and repeating relationship problems.
Cognitive therapy is often combined with schema therapy and focuses on exactly what many other forms of psychotherapy tend to leave out-- i.e., how to achieve beneficial change, as opposed to mere explanation or "insight". Because understanding the past is rarely curative without change, both traditional cognitive therapy and schema-focused cognitive therapy are structured and systematic, helping patients to identify, challenge and change core cognitive schemas.
The main goals of schema-focused therapy are...
  • Identifying early maladaptive schemas that are maintaining the presenting problem behaviors and seeing how these schemas are played out in everyday situations.
  • Changing dysfunctional beliefs and building alternative beliefs, which can be used to fight the schemas.
  • Breaking down maladaptive life patterns into manageable steps and changing the coping styles, which maintain the schemas, one step at a time.
  • Providing patients with the skills and experiences that will create adaptive thinking and healthy emotions.
  • Empowering patients and validating their emotional needs that were not met, so that their needs will be met in everyday life.
 
 
Reference: "A Client's Guide to Schema-Focused Cognitive Therapy" by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D., Cognitive Therapy Center of New York. 1993.