Transcript Slide 1

Schema Therapy
A Very Brief Introduction
Thomas Irelan, Ph.D.
Department of Clinical & Counselling Psychology
NHS Grampian
9 June 2011
Schema Therapy is:
• An integrative theory and treatment that
combines cognitive, behavioural, interpersonal,
and experiential techniques
• Designed to treat the chronic, characterological
aspects of disorders that have their origins in
childhood and adolescence
Origins of Schema Therapy
• An expansion of cognitive therapy for complex patients
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(severity, duration, and co-morbidity) and personality
disorders
These patients have more rigid cognitions and behaviours
The gap between cognitive and emotive change is much
greater
Intimate relationships are more central to their problems
Often will not engage with traditional CBT techniques
Schema Therapy vs Cognitive Therapy
• Greater emphasis on the therapeutic relationship
• More emphasis on affect and mood states
• More discussion of childhood origins and
developmental processes
• More emphasis on lifelong coping styles
• More emphasis on core themes
Young’s Early Maladaptive Schemas (EMS)
• A broad, pervasive theme or pattern regarding
oneself and one’s relationships with others and the
world
Bodily
Sensations
Emotions
Thoughts
Schema
Images
Memories
General Definition of a Schema
• Schemas continue to be elaborated over time
through assimilation and accommodation
• Schemas may be adaptive or maladaptive
• A script is a schema for an event
Young’s Early Maladaptive Schemas (EMS)
• Developed during childhood or adolescence as a
result of core emotional needs not being met
adequately
• Elaborated throughout one’s lifetime
• Dysfunctional to a significant degree
Characteristics of EMSs
• A theme or understanding, not just a belief
• Drives behaviours (rather than behaviours being
a part of the schema)
• Dimensionality: i.e. variation in degree of
intensity, pervasiveness, and frequency
• Many are pre-verbal and associated with the
amygdala
Characteristics of EMSs
• Capable of generating high levels of disruptive affect,
self-defeating, and can be harmful to others
• Capable of interfering significantly with getting core
needs met
• Deeply entrenched patterns central to one’s sense of
self
• Triggered by everyday events
The 18 Early Maladaptive Schemas
Disconnection & Rejection
• Emotional Deprivation
• Abandonment
• Mistrust/Abuse
• Social Isolation
• Defectiveness
Impaired Autonomy
• Failure
• Dependence
• Vulnerability
Impaired Limits
• Entitlement
• Insufficient Self-Control
Other-Directedness
• Subjugation
• Self-Sacrifice
• Approval Seeking
Overvigilence & Inhibition
• Emotional Inhibition
• Unrelenting Standards
• Negativity/Pessimism
• Punitiveness
Origins of EMS: Temperament
• EMS form through the interaction of temperament
and early life experiences (including cultural factors)
• Dimensions of temperament:
Shy ↔ Outgoing
Non-Emotional ↔ Emotional
Calm ↔ Anxious
Pessimistic ↔ Optimistic
Passive ↔ Active
• Result is variance in levels of resiliency
Origins of EMS: Early Life Experiences
Core emotional needs of the individual are not met
through:
• Toxic frustration of needs (deprivation)
• Traumatisation and victimisation
• Over-indulgence
• Selective internalisation or identification with
significant others
Core Emotional Needs
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Safety
Predictability
Love, nurturance, and attention
Acceptance and praise
Empathy
Guidance and protection
Validation of emotions and needs
The goal of Schema Therapy is to help patients find
adaptive ways to meet their core emotional needs (by
changing maladaptive schemas, coping responses,
and modes)
Schema Coping Styles
Surrender (freeze)
Overcompensation (fight)
• Compliance
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Avoidance (flight)
• Substance abuse
• Detachment
• Social isolation,
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avoidance
Stimulation/workaholism
Aggression, hostility
Excessive self-reliance
Manipulation
Demandingness
Perfectionism
Overcontrol
Schema Perpetuation
• Cognitive distortions and coping styles produce
behaviour that leads to self-fulfilling prophecies; either
results are assimilated into the schema or selectively
processed if they do not fit the schema
• Repetition results in self-defeating life patterns and
schemas are perpetuated
Schema Therapy
The goal of Schema Therapy is schema healing, i.e.
reducing the intensity of memories and bodily
sensations associated with a schema, the emotional
charge of the schema, and the restructuring of
maladaptive cognitions
Schema Therapy
Phase 1: Assessment and Education
• Determine suitability for Schema Therapy
• Introduce model
• Go through questionnaires (Young Schema Questionnaire
and/or Schema Mode Inventory and Young Parenting
Inventory
• Imagery for assessment
• Develop shared formulation and goals for treatment
Schema Therapy
Phase 2: Change
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Cognitive Strategies
Experiential Strategies (imagery, two-chair work, etc.)
Behavioural Pattern-Breaking
Use of the Therapeutic Relationship
Mode Work
Future
Solutions
Schemas
Past Origins
Present
Problems
The Therapy Relationship
Schema Therapists are:
• personal
• objective and compassionate
• open and direct
• flexible
• focussed on meeting the emotional needs of their
patient
The Therapy Relationship
Assessment
• watch for schema triggering during sessions and
point out to the patient
• identify and discuss schemas that were activated
• link schema activation in the session with
experiences outside of therapy
Self-disclosure
• judiciously based upon the needs of the patient
• can be especially helpful with Social Isolation
schema
The Therapy Relationship
Limited Reparenting
• meeting the unmet emotional needs of their patients in
healthy ways within the bounds of a therapeutic relationship
Empathic Confrontation
• by validating schemas coping styles based on their origins
• gently and firmly pointing out the problems they create in the
present (including in the therapeutic relationship)
• how they prevent the patient from getting his or her
emotional needs met (including the therapeutic relationship)
Schema Mode Work: History
• Developed for more severe clients (BPD, NPD,
ASPD)
• Places more focus on here-and-now mood states
• Provides more effective strategies for overcoming
avoidance and overcompensation
What is a Mode?
• The specific schemas that are currently activated
for any individual
• The predominant state we are in at any given time
• Schemas= traits, modes= states
• An aspect, side, or part of a person or his/her
personality
Schema Modes
Child Modes
• Vulnerable Child
• Angry/Enraged Child
• Impulsive/Undisciplined
Child
• Contented Child
Adult Modes
• Punitive Parent
• Demanding Parent
• Healthy Adult
Maladaptive Coping Modes
• Compliant Surrenderer
• Detached Protector
• Overcompensator
Current Uses of Schema Therapy
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Used with BPD, NPD, ASPD, Cluster C PDs
Eating Disorders
Forensic settings
Substance abuse
Couples therapy
Current Developments (International)
• Research being done in all areas on previous slide
• Group models being developed, with research trials
beginning for group ST with Borderline Personality
Disorder
Current Developments (Scotland)
• First cohort being trained to accreditation in
Schema Therapy
• Introductory trainings
• Development of supervision networks
For Further Information
Thom Irelan
[email protected]
01224 557475
www.isst-online.com
www.schematherapy.com