For those of us with depression and / or an anxiety disorder Cognitive Behavioural Therapy (CBT) is the gold standard, evidence based intervention. CBT has been utilized to great effect for a number of decades now and an enormous amount of research has been conducted regarding this intervention for depression and anxiety disorders. It is the intervention most GPs will recommend to their patients with these sorts of mental health problems and it is likely that this is an intervention that you have had some experience with.
Despite the effectiveness of CBT for certain mental health issues, there remain individuals for whom CBT is of limited effectiveness. Schema Therapy was developed in the 1990s in response to the limited effectiveness of CBT for some people. Schema Therapy was not intended to replace CBT. In fact, Schema Therapy incorporates CBT into it’s methods.
We now have 30 years or so of research behind Schema Therapy and research continues to refine and develop this mode of therapy. There is a large volume of research that supports the effectiveness of Schema Therapy for a wide range of problems.
So, who is likely to benefit from Schema Therapy? Schema Therapy is a needs-based therapy. It is based on the foundational idea that all humans at any point in the lifespan have fundamental emotional needs. If these needs are not met in a significant way during the formative years then unhelpful patterns are established that reverberate throughout life. This is what Jeffery Young (one of the founders of Schema Therapy) coined a Lifetrap.
Meet Jamie:
Jamie’s Dad is a Vietnam Veteran and 10 years ago his Dad was diagnosed with Post-Traumatic Stress Disorder (PTSD). Jamie’s Dad developed PTSD during his deployment to Vietnam as a sniper. Jamie grew up feeling as though he was “walking on eggshells” as his father would fly into angry outbursts at the slightest irritation. In his adult life Jamie is very focused on meeting the needs of others to the point where he doesn’t even know what is own wants or needs are let alone speak up for himself at work or in his relationships.
Jamie did not have the core emotional need of a secure and safe bond with his father met. The history of this need not being adequately met has entrenched a pattern that Jamie has carried through into adulthood.
The core emotional needs are also discussed on the Lifetraps page of this site. They are as follows:
- Attachment and close bonding such that one feels emotionally safe and secure.
- Express oneself / one’s needs and to be understood.
- Develop competencies and autonomy.
- Operate within a context of appropriate boundaries regarding oneself and others.
- Adequate opportunity for spontaneity and playfulness.
Core emotional needs in early childhood interface with temperament.
Within Schema Therapy the following is often used as a guide for assessing client temperament:
- Extraversion – Introversion
- Reactive – Non-reactive
- Pessimistic-Optimistic
- Anxious-Calm
- Perfectionistic-Distractable
- Passive-Aggressive
- Irritable-Cheerful
- Shy-Sociable
So, lifetraps develop when temperament and childhood experiences align poorly and there is a significant deficit in core emotional needs being met.
Schema Therapists give clients a questionnaire to assist in identifying what schemas have developed. I discuss schemas on the lifetraps page of this website. However, for the moment, suffice it to say that schemas are like a lens through which one makes sense of their circumstances. The lens filters or distorts what is being observed according a history of substantially unmet emotional needs.
Meet Sue
Sue is the youngest of 5 siblings. Her parents struggled financially and by the time she was born her mother was depleted and exhausted with childrearing. In addition, Sue understands that from birth she had a temperament that was characterized by the following qualities: irritable, perfectionistic, reactive and introverted. Sue’s mother would disengage from the children by engrossing herself in a book for hours at a time or going about her household duties in a disengaged fashion. Largely, Sue was raised by her oldest sister who would boss and bully her. A core emotional need not met for Sue was the opportunity to express her needs and have those needs adequately understood and responded to. As such, Sue developed an emotional deprivation schema. What this means in terms of a lens through which Sue interprets her circumstances is that she “sees” things through the interpretation that she will not and is not receiving adequate emotional support or understanding.
Sue’s emotional deprivation schema has had a hand in Sue’s lifetraps. For instance, despite being in her 40s and having had aspirations of marriage, Sue has never had a relationship that has lasted more than 3 to 4 years and she has been single for many years. She anticipates that the people she forms relationships with will not be able to meet her needs and will disappoint her. To protect herself so she ends the relationship or she maintains an emotional distance. This distance has caused one of her sisters and one of her brothers to cut ties with her, arguing that they do not feel she “loves” them.
In Schema Therapy, we mostly talk in terms of modes as opposed to specific schemas. Usually, those who are engaged in Schema Therapy have many schemas and these schemas cluster together around particular modes.
We all move in and out of various modes throughout the day and we are all familiar with this. For instance, my “work mode” feels different, presents differently and engages in different behaviours to my “psychologist mode”, “mothering mode” or my “wife mode”. As social creatures living in the society we do, we are aware that to some extent we are different depending on the context we are in. In Schema Therapy we are focused on modes that cause us difficulty and a constructed from clusters of schemas that have evolved from significantly unmet emotional needs.
There are three groups of modes from the Schema Therapy perspective: child modes; critic modes and coping modes. The objective of Schema Therapy is 1. For the therapist and client to really get to know and understand the modes that are operating for a person and how these modes function together. 2. To work on building and strengthening a Health Adult Mode and diminishing the potency of the unhelpful modes.