abtherapies-schematherapy-1The schema approach is very compassionate, sympathetic, respectful and humane and is highly effective in normalizing psychological disorders, mainly complex issues.
Schema Therapy is an integrative approach to treatment that combines the best aspects of cognitive-behavioral, experiential, interpersonal and psychoanalytic therapies into one unified model. It has shown remarkable results in helping people to change negative (“maladaptive”) patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been largely unsuccessful.

The Schema-Focused model was developed by Dr. Jeff Young, who originally worked closely with Dr. Aaron Beck, the founder of Cognitive Therapy. Dr. Young and his colleagues identified a segment of people who had difficulty in benefiting from the standard approach. He discovered that these people typically had long-standing patterns or themes in thinking, feeling and behaving/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 “life traps.”

abtherapies-schematherapy-3The schemas are enduring and self-defeating, rigid patterns that typically develop from early experiences. These patterns consist of negative/dysfunctional thoughts and feelings, 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,” “I will never be good enough,” “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,” and so on.

The Schema treatment is designed to help to break these negative patterns of thinking, feeling and behaving, and to develop healthier alternatives to replace them.

Schema Therapy consists of three main stages:

  1. the assessment phase, in which schemas are identified. Questionnaires may be used to get a clear picture of the various patterns involved.
  2. the emotional awareness and experiential phase, wherein patients get in touch with these schemas and learn how to identify them when they are activated in their everyday life.
  3. the behavioural change phase in which the client is actively involved in replacing negative, habitual thoughts and behaviours with new, different, healthy cognitive and behavioural options.

abtherapies-schematherapy-2The 18 schemas:

1. ABANDONMENT (AB)
This schema makes people perceive instability or unreliability in those available for them for support and connection. It involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or practical protection because they are emotionally unstable and unpredictable (e.g., angry outbursts), unreliable, or e they will die imminently; or because they will abandon the patient in favour of someone better.

2. MISTRUST / ABUSE (MA)
The expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage of the person, that’s why they don’t let anybody close to themselves. This schema usually involves the perception that the harm is intentional or the result of unjustified and extreme negligence – and of course the person doesn’t open up for such others. It may include the sense that one always ends up being cheated relative to others or “getting the short end of the stick.”

3. EMOTIONAL DEPRIVATION (ED)
Expectation that one’s desire for a normal degree of emotional support will not ever be adequately met by others. The three major forms of deprivation are: A. Deprivation of Nurturance: Absence of attention, affection, warmth, or companionship. B. Deprivation of Empathy: Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from others. C. Deprivation of Protection: Absence of strength, direction, or guidance from others.

4. DEFECTIVENESS / SHAME (DS)
The feeling that one is defective, bad, unwanted, inferior, or invalid in important respects; or that one would be unlovable to significant others if exposed. May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one’s perceived flaws. These flaws may be private (e.g., selfishness, angry impulses, unacceptable sexual desires) or public (e.g., undesirable physical appearance, social awkwardness), but it’s usually a deep inner feeling of: ‘something is (must be) wrong with me.

5. SOCIAL ISOLATION / ALIENATION (SI)
The feeling that one is isolated from the rest of the world, lonely, different from others, and/or not part of any group or community even if there are people around.

6. DEPENDENCE / INCOMPETENCE (DI)
Belief that one is unable to handle one’s everyday responsibilities in a competent manner, without considerable help from others (e.g., take care of oneself, solve daily problems, make good decisions or good judgment, tackle new tasks). Often presents as helplessness.

7. VULNERABILITY TO HARM OR ILLNESS (VH)
Exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it. Fears focus on one or more of the following: (A) Medical Catastrophes: e.g., heart attacks, AIDS; (B) Emotional Catastrophes: e.g., going crazy; (C): External Catastrophes: e.g., elevators collapsing, victimized by criminals, airplane crashes, earthquakes.

8. ENMESHMENT / UNDEVELOPED SELF (EM)
Excessive emotional involvement and closeness with one or more significant others (often parents), at the expense of full individuation or normal social development. Often involves the belief that at least one of the enmeshed individuals cannot survive or be happy without the constant support of the other. Often experienced as a feeling of emptiness and floundering, having no direction, or in extreme cases questioning one’s existence.

9. FAILURE (FA)
The belief that one has failed, will inevitably fail, or is fundamentally inadequate relative to their peers, in areas of any achievement (e. g. school, career, sports, etc.). Often involves beliefs that one is stupid, inept, untalented, ignorant, lower in status, less successful or less lucky than others, etc.

10. ENTITLEMENT / GRANDIOSITY (ET)
The belief that one is superior to other people; entitled to special rights and privileges; or not bound by the rules of reciprocity that guide normal social interaction. Often involves insistence that the person should be able to do or have whatever they want, regardless of what is realistic, what others consider reasonable, or the cost to others. It can mean an exaggerated focus on superiority (e.g., being among the most successful, famous, wealthy) — in order to achieve power or control (not primarily for attention or approval). Sometimes includes excessive competitiveness toward, or domination of others: asserting one’s power, forcing one’s point of view, or controlling the behaviour of others in line with one’s own desires -without empathy or concern for others’ needs or feelings.

11. INSUFFICIENT SELF-CONTROL / SELF-DISCIPLINE (IS)
Pervasive difficulty or refusal to have sufficient self-control and frustration tolerance to achieve personal goals, or to restrain the excessive expression of one’s emotions and impulses. In its milder form, patient presents with an exaggerated emphasis on discomfort-avoidance: avoiding pain, conflict, confrontation, responsibility, or overexertion – at the expense of personal fulfilment, commitment, or integrity.

12. SUBJUGATION (SB)
Excessive surrendering of control to others because one feels coerced – usually to avoid anger, retaliation, or abandonment. The two major forms of subjugation are:
1. Subjugation of Needs: Suppression of one’s preferences, decisions, and desires.
2. Subjugation of Emotions: Suppression of emotional expression, especially anger. Usually involves the perception that one’s own desires, opinions, and feelings are not valid or important to others. Frequently presents as excessive compliance, combined with hypersensitivity to feeling trapped. Generally leads to a build-up of anger, manifested in maladaptive symptoms (e.g., passive-aggressive behaviour, uncontrolled outbursts of temper, psychosomatic symptoms, withdrawal of affection, “acting out”, substance abuse).

13. SELF-SACRIFICE (SS)
Excessive focus on voluntarily meeting the needs of others in daily situations, at the expense of one’s own gratification or interest, setting aside own needs. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling selfish; or to maintain the connection with others perceived as needy. Often results from a sensitivity to the pain of others. Sometimes leads to a sense that one’s own needs are not being adequately met and to resentment of those who don’t return the sacrifices.

14. APPROVAL-SEEKING / RECOGNITION-SEEKING (AS)
It comes with an excessive emphasis on gaining approval, recognition, or attention from other people, or fitting in, at the expense of developing a secure and true sense of self. With this schema the sense of self-esteem depends primarily on the reactions of others rather than on one’s own natural inclinations. Sometimes includes an overemphasis on status, appearance, social acceptance, money, or achievement – as means of gaining approval, admiration, or attention. Frequently results in major life decisions that are inauthentic or unsatisfying; or in hypersensitivity to rejection and critiques.

15. NEGATIVITY / PESSIMISM (NP)
A pervasive, lifelong focus on the negative aspects of life (pain, loss, disappointment, betrayal, conflict, guilt, resentment, death, unsolved problems, potential mistakes, things that could go wrong, etc.) while minimizing or neglecting the positive or optimistic aspects. Usually includes an exaggerated expectation that things will eventually go seriously wrong, or that aspects of one’s life that seem to be going well will ultimately fall apart. Because potential negative outcomes are exaggerated, these patients are frequently characterized by chronic worry, complaining, vigilance or indecision.

16. EMOTIONAL INHIBITION (EI)
The excessive inhibition of spontaneous action, feeling, or communication – usually to avoid disapproval by others, feelings of shame, or losing control of the impulses. The most common areas of inhibition involve: (a) inhibition of anger & aggression; (b) inhibition of positive impulses (e.g., joy, affection, sexual excitement, play); (c) difficulty expressing vulnerability or communicating freely about one’s feelings, needs, etc.; or (d) excessive emphasis on rationality while disregarding emotions.

17. UNRELENTING STANDARDS / HYPERCRITICALNESS (US)
The underlying belief in this schema is that one must strive to meet very high internalized standards both in behaviour and performance, mainly to avoid criticism. Typically results in feelings of pressure or difficulty slowing down; and in hypercriticalness toward oneself and others. Must involve significant impairment in: pleasure, relaxation, health, self-esteem, sense of accomplishment, or satisfying relationships. Unrelenting standards typically present as:
– perfectionism, inordinate attention to detail, or an underestimate of how good one’s own performance is relative to the norm;
– rigid rules and “shoulds” in many areas of life, including unrealistically high moral, ethical, cultural, or religious precepts; or
– preoccupation with time and efficiency, so that more can be accomplished.

18. PUNITIVENESS (PU)
Punitiveness schema is the belief that people should be harshly punished for making mistakes. Involves the tendency to be angry, intolerant, punitive, and impatient with those people (including oneself) who do not meet their expectations or standards. Usually includes difficulty forgiving mistakes in oneself or others, because of a reluctance to consider extenuating circumstances, allow for human imperfection, or empathize with feelings.

Everyone has schemas, coping styles, and modes — they are just more extreme, pervasive and rigid in some cases – when it’s good to have someone to help.