Schema therapy

– a further development of CBT

Schema therapy is a further development of CBT. There are patients and clients who are unable to follow a CBT manual. Some patients and clients have functional impairments and some become so triggered emotionally that they find it difficult to reflect on their thoughts and behavior patterns. Then you need to work in a different way.

Schema therapy was developed in the USA in the 80s by Dr. Jeffrey Young who was basically a behavioral therapist. He had done some work with Dr. Aaron Beck at his cognitive institute in Philadelphia and noticed that some patients had more rigid behavior patterns that were difficult to change. These patients had difficulties of a personality nature. He then began to further develop traditional CBT by focusing on emotional wounds (so-called schemas) that may have occurred earlier in life. In this development of CBT, he incorporated influences from attachment theory and Gestalt therapy. It developed into a form of therapy that integrates important elements from several different forms of therapy that allow you to work more on the basis of how the individual patient/client functions and tailor a therapy that suits it.

Schemas, emotional wounds or life themes as they are also called often develop at an early age in relation to important caregivers. Schema therapy assumes that all people have core emotional needs when they grow up that need to be met by adults who are there, which is usually the parents, but it can also be other important people who are available in a child's growing up environment. The core emotional needs are that we feel safe, loved, seen, that we are accepted for who we are with strengths and weaknesses, that we receive attention and confirmation and are guided in our feelings, that we receive help to put our feelings into words which we as children do not understand, that we get reasonable, loving boundaries and that we get the opportunity to develop spontaneity and playfulness. It is also important that our caregivers support us and lead us in a direction where we are given challenges at a reasonable level so that we feel that we can handle things and have an opportunity to develop a sense of independence and competence. If we do not get these core emotional needs satisfied, a need frustration arises and we find different strategies to survive the lack of needs. For example, if we have parents who are not there and calm us down when we are afraid, we can develop wounds of abandonment. If we don't have parents who help us understand our feelings, show acceptance around our feelings and convey that they are understandable, we may develop a wound of emotional neglect. If we are exposed to violence, we can develop wounds of distrust and vulnerability. To avoid feeling these painful feelings that are connected to the wounds, we develop different survival strategies, which protect us in a dysfunctional environment. 

We may then continue to use these strategies/protections as it is no longer functional. We may choose partners who cannot give us love because we don't think anyone will give us love. We can be convinced that we are unlovable and have to take what we get. It may mean that we put up with a partner who treats us badly. Many times we may meet partners who fit into the dysfunctional patterns. We humans like to find ourselves in environments that are familiar to us. Dysfunctional environments can be predictable in that we know how to deal with them because we have learned dysfunctional strategies early in life. For example, a strategy can be to shut down emotions because you have never been taught that it is ok to show emotions and you may not have experience that there are people who can understand, listen and take care of us.

In schema therapy, we work to heal emotional wounds and give the patient tools to better take care of themselves in different situations. We do this by identifying these emotional wounds that trouble the patient/client today. We investigate which needs were not met while growing up, meet the needs in the therapy relationship and help the patient/client to become a healthy adult themselves who can take care of their emotional needs in an effective way. We identify different coping modes (states we end up in when we are emotionally triggered) and the patient/client learns new strategies to take care of their feelings and emotional needs in a more functional way.