1. Schema Therapy A Very Brief Introduction
Thomas Irelan, Ph.D.
Department of Clinical & Counselling Psychology
NHS Grampian
9 June 2011

2. 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

3. Origins of Schema Therapy
An expansion of cognitive therapy for complex patients (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

4. 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

5. Young’s Early Maladaptive Schemas (EMS)
A broad, pervasive theme or pattern regarding oneself and one’s relationships with others and the world

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Core Emotional Needs 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)

14. Schema Coping Styles Surrender (freeze) Avoidance (flight)
Compliance
Avoidance (flight)
Substance abuse
Detachment
Social isolation, avoidance
Stimulation/workaholism
Overcompensation (fight)
Aggression, hostility
Excessive self-reliance
Manipulation
Demandingness
Perfectionism
Overcontrol

15. 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
Do exercise here.

16. 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

17. 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

18. Schema Therapy Phase 2: Change Cognitive Strategies
Experiential Strategies (imagery, two-chair work, etc.)
Behavioural Pattern-Breaking
Use of the Therapeutic Relationship
Mode Work

19. Future
Solutions
Schemas
Past Origins
Present
Problems

20. The Therapy Relationship
Schema Therapists are:
• personal
• objective and compassionate
• open and direct
• flexible
• focussed on meeting the emotional needs of their
patient

21. 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

22. 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)

23. 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

24. 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

25. Schema Modes Child Modes Maladaptive Coping Modes Adult 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

26. Current Uses of Schema Therapy
Used with BPD, NPD, ASPD, Cluster C PDs
Eating Disorders
Forensic settings
Substance abuse
Couples therapy

27. 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

28. Current Developments (Scotland)
First cohort being trained to accreditation in Schema Therapy
Introductory trainings
Development of supervision networks

29. For Further Information
Thom Irelan