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Mental Disorders

Schema Therapy Continued

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

While schema therapy uses these past experiences to identify the origins of the maladaptive schemas, the focus remains on present-day (here-and-now) concerns.  Therefore, the therapist is constantly attending to situations within the therapy session when a schema may have been activated.  The therapist helps the recovering person to identify these cues as they work together. At the end of the assessment phase, the therapist develops a conceptual summary of the therapy participant's unmet needs, maladaptive schemas, and their maladaptive coping strategies.  These findings are then presented to the participant for consideration and discussion.  Together, the therapist and participant review and modify this summary in a collaborative manner.  Once they have agreed upon an accurate conceptualization, they agree upon a life problem to work on together in the next phase of treatment, the change phase.

therapist and patientSchema therapy uses a variety of cognitive and experiential techniques, to create schema change and to promote emotional healing. Recovering persons learn to use an evidentiary approach to test and challenge the validity of their schemas. In other words, they are encouraged to look for evidence that refutes the schema. For instance, if the schema's theme represents: "People I love will always abandon me," the participant is asked to challenge this extreme assumption by finding multiple examples of people who have loved them but have not abandoned them. An experiential technique that is commonly used to challenge the validity of a schema is to ask healthy adult side of the recovering person to engage in a hypothetical "debate" with the maladaptive schema side. The therapy participant will also receive homework assignments in order to practice replacing maladaptive coping strategies in real world settings. For instance, let's return to the example of the woman with an abandonment schema, who overcompensates whenever her husband goes out town by refusing to take his phone calls. She might receive a homework assignment of initiating phone calls herself. She may be asked in advance of his departure to agree to receive his calls.

The therapist continues to assist the recovering person to identify moments during the therapy session when a schema is activated. The therapist's role is to provide a corrective emotional experience. This is achieved by the therapist meeting the unmet childhood needs, within the boundaries of the therapeutic relationship.  It is through this healing relationship that the recovering person begins to internalize the healthy adult modeled by the therapist, and learns to function from this healthy adult side.

In some cases, caregivers can shame children for having needs in the first place.  This can add a layer of complexity to therapy as shame makes it more difficult to identify and express these needs.  Nonetheless, the therapist's acceptance and validation of these needs, as they are expressed, provides another form of corrective emotional experience.

A variety of other experiential techniques are used to heal the emotions surrounding the schemas. This may include writing letters to caregivers (that are never mailed) and therapeutic exercises that use imagery and role-playing past experiences. For instance, a person who was physically abused might be guided to imagine an abuse scenario but with a different outcome. Instead of being the helpless child-victim, she role-plays asserting her right for protection and expresses her anger to the abuser about such events, as part of this imaginational, role-play exercise. The therapist may also devise therapeutic exercises that encourage the expression of grief over childhood losses.

Schema therapy has also been applied for the treatment of depression and anxiety. A study published in 2006 by Josephine Giesen-Bloo and her colleagues demonstrated good results for this type of therapy in people with Borderline Personality Disorder (Giesen-Bloo, et.al., 2006).

More information about schema therapy can be found at http://www.schematherapy.com/