What is Schema Therapy?

Introduction

Schema therapy like all other therapies was conceptualised by therapists who see a space in the therapy world which called for further curiousity and development. The story (to the best of my ability) goes like this - some time in the 90s, Jeffrey Young observed that he had clients who went along their merry way, living their lives after bouts of treatment using more conventional shorter term therapies which gave them strategies and tools to manage everyday life. Then there were those who saw little to no change or remained perpetually stuck in vicious cycles of anxiety, depression and a whole lot of unbridled pain and suffering (see Young, Jeffrey E; Klosko, Janet S; Weishaar, Marjorie E (2003). Schema therapy: a practitioner's guide. New York: Guilford Press).

I first came across schema therapy in my earlier years of practice in a workshop presented by Dr. Christopher Lee. As a young-ish psychologist, I was not able to fully appreciate schema therapy both for its simplicity in understanding how we work and comprehensiveness in explaining the same. I did curiously however, relate to the idea that patterns of thought, emoting and actions can drive enduring/cycles of depression and anxiety. In my case at the time, I was acutely aware that I possess roller coaster emotions which felt neither intense enough (compared to some clients I was trying to assist) nor consistent enough (compared to some of my peers). Neither here nor there. This started my journey of self-study to see what patterns I had, and later on therapy for myself to reinvent them.

What's it for then?

One of the major differences between schema therapy and other therapies is in its length. Think about it this way - if it took years (formative ones at that) to build our original 'life template', how long would it take to discover and relearn a new one? Now that isn't saying that therapy will last for the same amount of years (that's a lot of years). I find it helpful to set expectations especially to address perceptions driven by our Medicare and other third party funding policies which do not have the capacity to subsidise mental health treatments to its fullest. A clear example of this is the generally recommended length for shorter term therapies such as CBT is 12 sessions (not 10 by the way). But I digress.

The idea that we could benefit from looking deeper into what makes us tick has always been around - particularly in the foundational concepts of nature and nature. Young and his colleagues posited that there were more enduring structures and organised patterns to the chaos that plagued their clients. They took into account how clients' temperament (personality) and early life experiences could form an inter-web of schemas by which clients' use (mostly unknowingly) as templates of how to go about life. This included everything from how they believed society worked, what to expect of fellow human beings and how we treat each other, perceived social norms within their community, self-value, how to relate to others. The list goes on.

Now that is not to say we are carbon copies of how we grew up. The rooted possibility is that the templates we base our lives on was pretty confined to what we experienced as kids. Depending on what schemas are present, clients respond at some level to the conventional strategies and tools learnt in therapy, however, they keep arriving back at the same point because how they see the world, others and themselves remained the same.

So how do we unlearn this? Or rather, how do I begin to have a different template? Surely there is more to the sentiment of, "I don't want my children to grow up the way I did".

The Basics

While many therapies focus on behavioural strategies, cognitive restructuring or emotion-focused strategies, schema therapy values all. Where it stands out is the openness in which strategies are drawn from any therapy and that direction is not based on symptoms or symptom reduction but addressing core emotional needs.

Core emotional needs are universal and have been defined as (1) secure attachment or connection, (2) identity, autonomy and competence, (3) freedom to express oneself, (4) spontaneity and play, (5) realistic boundaries and limits. Any area absent, unfulfilled or opposite to what it can be can form a difficult combination of templates upon which an individual navigates their life. In order to survive or make up for this, we instinctively form coping styles or responses to temper the expectation/weather the emotional deficiency. We continue to (mostly subconsciously) respond similarly even when interacting with new people or when we're 87 years old regardless of new experiences later on in life. More importantly, we continue to respond to ourselves in the same ways in order to compensate for, avoid or sometimes give in to the perceptions we've been taught in spite of our best efforts.

Schemas

The most recent emerging research point to 20 schemas in total (see Ozgur Yalcin, Christopher Lee & Helen Correia (2020) Factor Structure of the Young Schema Questionnaire (Long Form‐3), Australian Psychologist, 55:5 ,546-558). That's a lot of templates and possible combinations. I hope to write about them some time.

Modes

Another component of schema therapy is the recognition of modes. I like to think of it as unique but interconnected networks of personas we all have - different but the same. This is often confused with dissociative identity disorder (popularly referred to as multiple personality disorder). No, it does not mean we have split personalities. It simply means that when put in challenging life situations, depending on what is triggered, different parts/styles of us become a 'representative' of us in that moment. We instinctively embody all thoughts, emotions and therefore behaviours of that 'representative'. This again, happens subconsciously for most people. Ever said to a friend, "When he was yelling at me, I felt like a kid"? And what happens when we feel like kids is different from how we would 'usually' respond.

The modes are roughly divided into three categories: Child Modes, Dysfunctional Parent Modes, Dysfunctional Coping Modes. I prefer to think of them as Child Modes, Could-do-better Parent Modes, and To-be-improved Coping Modes. But that's just me. More about the language of schema therapy later.

Strategies

The emphasis here is any and all strategies that can affect change in patterns/schemas work. Broadly, we are looking at all of what cognitive and behavioural methods have to offer. More of the highlight is the premise to address core emotional needs. In using experiential or 'emotional' strategies aided by the therapist, clients can begin to learn and embody the secret recipe for emotional healing. In some cases, this means the restoration of needs and in all cases, it means upskilling in needs fulfillment by building the Healthy Adult - think one Mode to Rule (Guide) them All. Any reference to Lord of the Rings is worth a shot.

Thinking this might be the therapy for you?

As a mental health advocate, I strongly believe in the self-practice of mental wellbeing (and acknowledge its challenging nature). Schema therapy and its skills are part of my daily life as much as being a psychologist and coach are. I look forward to sharing more with you.

See you soon,

Helen

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