young's schema therapy

Schema TherapyDr. Jeff Young

Dr. Jeffrey Young

- American psychologist best known for having developed the schema therapy. He is the founder of Schema Therapy Institute.

- “I look for negative life patterns and help clients to change them.”

He has published widely in the fields of both cognitive and schema therapies

Described are innovative ways to rapidly conceptualize challenging cases, explore the client's childhood history, personality disorders.

book can help people change their lives by stopping the cycle of self-destruction.

"Do you put the needs of others before your own?

Evolution from Cognitive to Schema Therapy

- Challenges facing cognitive behavioral therapy today is developing effective treatments for these chronic, difficult to treat patients.

- Characterological problems can reduce the effectiveness of traditional cognitive behavioural therapy.

- Young who originally worked closely with Dr. Aaron Beck, the founder of Cognitive Therapy.developed schema therapy to treat patients with chronic characterological problems. “Treatment failures”

Case 1“Mario presents for CBT treatment for agoraphobia.

Programs consist of breathing training and challenging catastrophic thoughts. He significantly

reduces his fear of panic symptoms. Treatment ends, patient lapses back into her agoraphobia. He had been in the lifetime of dependence with CBT. “

- The feeling of incompetence which what we call DEPENDENCE AND VULNERABILITY SCHEMAS has been adapted.

Evolution from Cognitive to Schema Therapy

Schema Therapy is designed for characterological problems and not acute psychiatric symptoms.

Schema Therapy expanded form of CBT that put much emphasis on exploring the childhood , and maladaptive coping styles.

Schema ModelSchema focused

model of treatment is designed to

help the person to

break these negative

patterns of thingking,

feeling and behaving.

Schema TherapyTheories on which Schema Therapy is based

Schema Domain Early Maladaptive Schemas

Coping Styles/Responses

Schema Modes

Schema Therapy(Theories)

1. Schema Domain – Category of the met Emotional unwanted of the child

2. Early Maladaptive Schema- Repeatedly use throughout our lives.

Early Maladaptive Schemas with associated Schema Domains

Domain 1(Disconnection/

rejection)1. Abandonment2. Mistrust3. Emotional

Deprivation4. Shame5. Social isolation

Domain 2(Impaired

Performance)

1. Dependence2. Vulnerability to

harm/illness3. Undeveloped

Self4. Failure


Domain 3(Impaired Limits)

1. Entitlement2. Insufficient Self

Control

Domain 4(Other Directedness)

1. Subjugation2. Self Sacrifice3. Approval

Seeking


Domain 5(Over Vigilance and Inhibition)

1. Negativity/Pessimism2. Emotional Inhibition3. Hyper criticalness4. Punitiveness

Case 2 A young woman named kyla comes for treatment.

Kyla was an only child with emotionally cold parents. Although they met all of her physical needs, they did not nurture her or give her sufficient attention or affection. They did not try to understand who she was. In her family, Kyla felt alone. She tells her therapist that she has been depressed her whole life.

Case 2

Kyla has generally been attracted from handsome men. Her husband, ramon, fits this pattern. When Ramon goes to kyla for holding or sympathy, she becomes irritated and pushes him away. The result is , she becomes angry. She felt suffocated by normal expression of tenderness.

What specific Domain and Maladaptive Schema does Case 2 illustrates?

It illustrates how early emotional childhood deprivation leads to the development of a schema which is played out and exhibits later in life.


3. Coping Style/Responses- The way we adapt to schemas

Coping “maladaptive behaviors develop as a

responses to a schema, Thus behaviors are driven by schemas but are not part of the schemas” – (Young 1990,1999)

BEHAVIOR IS NOT PART OF THE SCHEMA, IT IS PART OF THE COPING PROCESS!!

Coping Style vs. Coping response

Coping style

Coping Response

Coping responsesThree maladaptive coping Style

Surrender – Accepting that schema is true

Avoidance- Avoidance of situations that may triggers the schema

Overcompensation- Too much of being positive

Case 3Joseph usually avoid almost any situation in which his schema of abandonment is triggered. When his gf threatened to breakup with him he always get drunk until he passed out.

What is the coping style ? What is the Coping response?

Avoidance is the coping style for abandonment and drinking beer is the coping response

Examples of Maladaptive Coping responses


4. Schema modes –lie for a long time and being activated by triggers.

Schema modes Emotional states that lie dormant for a long time

and being activated by certain triggers.

Child Modes

1. vulnerable child2. Angry Child3. Undisciplined Child4. happy Child



Maladaptive Coping Styles

1. Compliant Surrenderer2. Detached Protector3. Over Compensator



Maladaptive Parent Modes

1. Punitive Parent2. Demanding Parent



Healthy Adult Mode

1. Healthy Adult

Basic characteristics and Assumptions Schemas begin in early childhood or

adolescence as reality-based representations of the child’s environment. Early Maladaptive Schemas and the maladaptive ways in which patients learn to cope with them often underlie chronic Axis I symptoms, such as anxiety, depression, substance abuse, and psychosomatic disorders. Schemas are dimensional, meaning they have different levels of severity and pervasiveness. The more severe the schema, the greater the number of situations that activate it.

Basic characteristics and AssumptionsEarly Life Experiences Toxic childhood experiences are the primary

origin of Early Maladaptive Schemas. There are four types of early life experiences that foster the acquisition of schemas.

The first is toxic frustration of needs. Occurs when the child experiences too little of a good thing and acquires schemas such as Emotional Deprivation or Abandonment through deficits in the early environment.

Basic characteristics and Assumptions

The second type of early life experience that engenders schemas is traumatization or victimization. The child is harmed or victimized and develops schemas such as Mistrust/ Abuse, Defectiveness/Shame, or Vulnerability to Harm.

Basic characteristics and Assumptions Third type, the child experiences too much of a

good thing: The parents provide the child with too much of something that, in moderation, is healthy for a child. With schemas such as Dependence/Incompetence or Entitlement/ Grandiosity, for example, the child is rarely mistreated. Fourth type of life experience that creates schemas is selective internalization or identification with significant others

Basic characteristics and Assumptions

Emotional Temperament Emotional temperament interacts with painful

childhood events in the formation of schemas. Different

temperaments selectively expose children to different life circumstances.

Therapeutic Goal/s The goal of Schema Therapy is to help patients get

their core emotional needs met. Identifying early maladaptive schemas that are

maintaining the presenting problem behaviours and seeing how these schemas are played out in everyday situations.

Changing dysfunctional beliefs and building alternative beliefs, this can be used to fight the schemas.

Breaking down maladaptive life patterns into manageable steps and changing the coping styles, which maintain the schemas, one step at a time.


their core emotional needs met. Providing patients with the skills and experiences

that will create adaptive thinking and healthy emotions.

Empowering patients and validating their emotional needs that were not met, so that their needs will be met in everyday life.

To support parents in the recognition and reduction of dysfunctional, maladaptive, emotional caused by their own schemas.

Explore and identify the origins of schemas

Therapeutic Goal The goal of Schema Therapy is to help patients get

their core emotional needs met. Link current problems and symptoms to schemas

and modes

Utilize cognitive strategies to build a rational response to each maladaptive schema and mode

Use behavioural techniques to change patterns that perpetuate maladaptive schemas and modes

Apply experiential techniques (such as imagery, for example) to change emotional learning


their core emotional needs met. Use the therapy relationship as a safe place to

identify and heal schemas and modes

Encourage and guide maintaining and developing healthy relationships

Build the ‘health adult’ to maximize ability to get core needs met

Therapist Function and Roles

Therapist in training is flexible enough to allow for different interpersonal styles but encourages the person to be particularly attentive to their ability to’re-parent’ effectively.

Good schema therapist should be personally affected by their therapy with clients, and emphasis is placed on the need genuinely to care about them.

Therapist Function and Roles

Flexible The ability to be comfotable being openly

warm and caring, and able to share these feelings with the patient in order to create a re-parenting bond is vital.

Therapist have a clear understanding of their own emotional needs through the formulation of early experiences and schema development.

Three Phases of the treatment ProcessThe treatment process presents the steps in

assessing and changing the schemas.Assessment Phase Assessment comes with, life history

interview, self monitoring and schema questionnaires.

Education Phase Identify schemas and understand the

origins of the schemas in childhood and adolescence.

Change Phase The goal is to convince patients that their

schemas are false

Effective techniques in the Treatment Process

1. Cognitive Techniques2. Experiential techniques3. Behavioral Pattern Breaking

1.Cognitive Technique

Patients learn to disprove the validity of their schema.

“MY SCHEMA IS FALSE!!!”

2. Experiential Technique(Emotional Awareness)

Patient talks about what they needed but did not receive from the parents when they were children.

Sets of childhood pictures comes with this process.

3. Behavioral Pattern Breaking Therapist encourages patients to make

healthier choices.

Patient will discuss the result from imagery, role playing to therapist and Therapist will try to evaluate how patient acknowledge the learning from it.

Advantages of the Approach

Integrative systematic model of treatment for a wide spectrum of chronic, difficult and psychological problems.

Schema Therapy is broader, both conceptually and in terms of techniques

Advantages of the Approach

Schema therapy provides a straightforward, direct approach that goes beyond getting "in-touch" with your feelings.

Schema Therapy is similar in going “deeper”, and Schema Therapy focuses on feelings and thoughts that are out of the people’s awareness.

Disadvantages of the Approach

Can’t make your problems go away without your co-operation.

Consumes lot of your time.

It may not be suitable for people with more complex mental health needs or learning difficulties.


You may feel more anxious or emotionally uncomfortable.

It will not address the possible underlying causes of mental health conditions, such as an unhappy childhood.


It will not address wider problems in systems or families that often have a significant impact on an individual’s health and wellbeing.

Not offered with psychiatric symptoms

Empirical Studies About Schema Therapy

Schema Therapy for Borderline

Personality Disorder

Empirical Studies About Schema Therapy

Schema Therapy for

Bipolar Personality

Disorder

Empirical Studies About Schema TherapySchema Therapy for Personality

Disorders

Empirical Studies About Schema TherapySchema Therapy

with Chronic depression

References: Beckley, K. A. (in press). Team Dynamics: A

schema-focused approach. In P. Willmot & N.S.

Hartung, M., Terwilliger, J., & Rahm, E. (2011). Schema Matching and Mapping. (Z. Bellahsene, A. Bonifati, & E. Rahm, Eds.)Evolution (Vol. 141, pp. 149–190). Springer Berlin Heidelberg.

TEMPLE, S. D. (2003). Schema Therapy: A Practitioner’s Guide. American Journal of Psychiatry.

References: Wegener, I., Alfter, S., Geiser, F., Liedtke, R.,

& Conrad, R. (2013). Schema change without schema therapy: the role of early maladaptive schemata for a successful treatment of major depression. Psychiatry, 76(1), 1–17.

Young, J.E., Arntz, A., Atkinson, T., Lobbestael, J., Weishaar, M., van Vreeswijk, M and Klokman, J. (2008). Schema Mode Inventory. Schema Therapy Institute, 130 West 42nd St., Ste. 501, New York, NY 10036.

References: YoungChapt1.pdf. (n.d.). Retrieved

September 03, 2014, from http://www.therapist-training.com.au/SCHEMA/YoungChapt1.pdf

Bernstein, B. D., & Nentjes, L. (n.d.). Schema Therapy for Forensic Patients with Personality Disorders Manual 2 : “ Theoretical Manual .”

References:

Kellogg, S. H., & Young, J. E. (2006). Schema Therapy for Borderline Personality Disorder �ᮢ, 62(4), 445–458. doi:10.1002/jclk

http://www.therapist-training.com.au/SCHEMA/YoungChapt1.pdf

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