“I Know What’s Gonna Happen Next”
This article is largely based on the practice theories developed by Jeffrey E. Young, PhD in his book “Schema Therapy”. Our internal schematic is a pattern or an organizing framework that we personalize for ourselves over a lifetime. It is the lens through which we see ourselves and the world and thereby make sense of things “out there” as well as “in here”
Schemas are used as a “shortcut” in which we make assumptions about a particular circumstance based on only limited information. Of course, this is a vital skill in negotiating the world and we do it many times a day, making determinations based on someone’s tone of voice or choice of words.
But when we have developed a negative or destructive schema, there are many innocuous events or “triggers” which precipitate a set of assumptions about negative or harmful things which are about to happen or worse which cause a cascade of internal negative and self-defeating dialogue.
Schema Therapy is heavily influenced by Cognitive Behavioral theories (CBT) and can be effective over time with deeply entrenched and maladaptive or destructive thought patterns.
Unlike traditional CBT which focuses primarily on breaking the cycle of maladaptive thoughts and actions, the Schema model also is focused on the initial etiology of the development which typically is most profoundly evident in childhood. In this way, Schema Therapy (ST) also shares roots with traditional psychoanalytic theory.
Because it is often used to treat longstanding conditions of problematic thought and behavioral patterns, Schema Therapy typically takes a while to be effective. Two to three years of treatment is most often necessary to see significant change and improvement and rarely is the therapy less than one year.
This is intuitive. It took a long time to build up the entrenched mental schematic and it will take time (though far less time) to change them to a more healthy one.
There are two primary approaches that the effective ST therapist will take with the patient. First is Empathic Confrontation. In this, the therapist acknowledges the reasonableness of the existing schema. He recognizes, appreciates, and accepts the legitimacy of the patient's perspective's development and enduring quality. However, at the same time, this is gently but consistently challenged and questioned.
The goal is to demonstrate that alternatives exist. That the way the patient sees themselves and the world is not an objective truth, but a choice. And it is a choice that was reasonable at the time it was selected but is no longer useful. In fact, it is destructive and must be changed. The fact that it “feels true” is only because it has gone unchallenged for so long.
The second approach is termed “corrective emotional experience through limited re-parenting experience”. In short, this describes an experience the patient has in which the therapist is parentified in a healthy and limited way, thereby allowing the patient to have an approximation of a different parent/child relationship than the one they in fact experienced.
This creates an opportunity for the patient to directly and indirectly seek and to an extent have some of the caregiving needs that they failed to attain in childhood. While the above scenario may sound complex or contrived, it should be experienced as neither, but rather as a natural by-product of a healthy therapeutic rapport between therapist and patient.
ST presumes that we all have these core emotional needs. They include a need for safety, stability, nurturance, acceptance, autonomy, competence, self-identity, the ability to express oneself, play, and a world with realistic limits which encourages self-control.
Schema Therapy aims to provide the patient with these experiences in an adequate and creative way to compensate for deficits in childhood and adulthood. For the therapist to be effective in this form of treatment, he must not only be well versed in the process and skilled, he must also have genuine care for the patient, he must be flexible, creative and he must be comfortable being openly warm and caring to the patient.
For further information and training please visit the International Society of Schema Therapy