Schema Therapy is an innovative and comprehensive therapeutic approach that combines Cognitive Behavioural Therapy (CBT), Gestalt Experiential Therapy and Psychoanalytic thinking into one process. It is specifically designed to help people to change some of the long-standing patterns of thinking and acting.
A schema is a cognitive framework that helps you organise and interpret information. Schemas can be useful because they allow us to take shortcuts in interpreting the vast amount of information that is available in our environment.
However, these mental frameworks also cause us to exclude important information, so instead, we might only focus on things that confirm our pre-existing beliefs and ideas.
Schema therapy works by changing those defeating core themes which you keep repeating throughout your life. These deep-rooted patterns are associated not only with thoughts but also feelings and even physical sensations, e.g. “I’m unlovable,” “People don’t care about me,” “Something bad is going to happen,” or “I will never be good enough.”
Because they tend to begin early in life, they are schema which become comfortable and familiar, but they are not healthy.
Schema therapy has been shown to be as effective as CBT in treating depression
Schema therapy has been used in the treatment of depression and anxiety. A study published in 2006 by Josephine Giesen-Bloo1 and her colleagues demonstrated good results for this type of therapy in people with Borderline Personality Disorder. Although the use of Schema Therapy is not restricted to treating personality disorder, it has produced impressive results when it comes to treating treatment-resistant personality disorders, chronic depression, relationship issues and other complex difficulties.
You may find Schema therapy helpful if any of the following apply to you:
You find yourself over-reacting to certain situations (which may lead to impulsive behaviours that you later regret).
You are drawn to the same type of partner over and over, even your emotional needs are not met in these relationships.
You feel stuck in habitual patterns or addictive behaviours that you can’t seem to change.
You struggle to say no, or with the thought of others disliking you.
You have low self- esteem or confidence, which holds you back from fulfilling your potential.
Many clients who come for schema therapy have spent years in other types of therapies, such as psychoanalysis or traditional CBT, and were frustrated with the lack of progress. Schema therapy is a very collaborative and empowering process that truly aims to help you turn insights into real changes. Schema therapy has also recently been blended with mindfulness meditation and elements of neuroscience for clients who can further benefit from them
Why might Schema Therapy be the wrong therapy for me?
You may want to consider the following in deciding if Schema therapy is right for you:
If your problems are not of a long-standing nature, CBT may be better for you. Schema Therapy works well with more ingrained problems which may have been around a very long time. Schema Therapy works at a more intensive level and emphasises the building of positive patterns of thinking and behaviour. It can take time to understand how these problems have evolved, so Schema Therapy is best for people whose problems may be more deep-seated.
Schema Therapy is not appropriate for people with severe drug or alcohol misuse problems.
Schema Therapy is not appropriate for people who are currently experiencing psychotic episodes.
You will need to be prepared to undertake a variety of experiential techniques. These may include therapeutic exercises that use imagery and role-plays. Your therapist may also ask you to write letters to caregivers (that you will not be expected to send).
I felt like the Psychologist really understood my issues and took the time and care to tailor the sessions to what I needed. They were incredibly valuable to me.
What should I expect from Schema Therapy?
Firstly, you will work with your therapist to identify some of your enduring and self-defeating patterns that typically begin early in life.
Questionnaires may be used as well to get a clear picture of the various patterns involved.
Next, you will work together to use a combination of talking and experiential exercises to raise your emotional awareness; during this phase, you may get in touch with some of the early experiences and learn how to spot them when they are being triggered in your daily life.
Your focus will turn to behavioural change. Structured assignments may be given so you can continue to work outside of sessions. You can actively practise these to replace some of the negative, habitual schemas with a fresh perspective.
We all have an image of ourselves, and a way we see the world which is unique. This self-image is based on our environment, our experience and in conjunction with our genetic history. For some of us, the way we think about ourselves and the coping mechanisms we have adopted over time can become problematic. Schema Therapy helps us understand how we see ourselves and how we have constructed ways to cope that are no longer working well for us.
Dr Jane McNeill is a doctor of counselling psychology and works in London. She is an experienced and highly empathetic psychologist who works with young people and adults with often complex mental health problems.
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