Schema therapy is an integrative approach unifying elements from cognitive behavioural, psychodynamic (object relations), Gestalt and attachment schools. People who benefit from schema therapy often experience a variety of maladaptive patterns that are usually persistent over the years. The focus on human needs is central in schema therapy. When the normal, healthy developmental needs are not met, maladaptive schemas develop.
Maladaptive schemas are psychological constructs that include beliefs about oneself, the world and other people. They develop as a result of unmet childhood needs, innate temperament and toxic childhood experiences. When maladaptive schemas are activated intense states occur, called modes. In other words, a mode is the current state of the individual. Schemas and modes originate in childhood and are activated throughout adult life resulting in a stable view of oneself and the world that is inaccurate, dysfunctional and limiting.
The goals of Schema Therapy are:
Decrease the intensity of schemas or heal the schemas
Develop one’s compassionate healthy adult so that the individual can manage effectively the modes that get triggered in different situations
Learn to care for one’s own emotional needs in an effective way
Break maladaptive dysfunctional patterns and build healthier relationships with oneself and the world.
These goals are accomplished through a variety of cognitive, experiential and behavioural techniques. Two strategies differentiate the nature of the therapeutic relationship in schema therapy: empathic confrontation and limited reparenting. Schema Therapists show empathy for the underlying schemas and modes, make connections with harmful childhood experiences and at the same time encourage clients to develop healthier ways of relating to oneself and others (empathic confrontation). Furthermore, Schema Therapists are trained to respond to clients’ needs in a personal and transparent way avoiding taking the distant role of a therapist (limited reparenting). Schema Therapy is well-liked by both patients and therapists.
Dickhaut V. & Arntz A. (2014). Combined group and individual schema therapy for borderline personality disorder: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 45(2):242-251.
Farrell, J.M., Shaw, I.A. & Webber, M.A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40 (2), 317-328.
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of Schema-focused Therapy vs Transference-focused Psychotherapy. Archives of General Psychiatry, 63(6), 649–658.
Nadort, M., Arntz, A., Smit, J., Giesen-Bloo, J., Eikelenbooma, M., Spinhoven,P., vanAsselt, T., Wensing, M. & vanDyck, R. (2009). Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial. Behavior Research and Therapy, 47, 11, 961-973
Spinhoven, P., van Dyck, R., Giesen-Bloo, J., Kooiman, K. & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transferance-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75, 104-115.
A number of studies support the effectiveness of Schema Therapy in treating a variety of disorders including personality disorders. Major outcome studies have shown that many patients with Borderline Personality Disorder can achieve full recovery across the complete range of symptoms.
In one of those studies Schema Therapy was shown to be more than twice as effective in bringing about full recovery as a widely-practiced traditional treatment. Schema Therapy was also superior in the following:
Reduction in Borderline Personality Disorder manifestations
General psychopathologic dysfunction
Fewer dropouts
Cost-effectiveness
The therapeutic alliance was rated higher by both patients and therapists
Schema therapy has been adopted to address a number of psychiatric problems and the existence of different modes has been investigated. Although evidence for their effectiveness is only available for Borderline Personality Disorder, the conceptualization in modes is described by patients as one of the most useful concepts.
Schema therapy has evolved to treat children and adolescents, couples and groups. Although research is still scarce, initial evidence indicates its effectiveness in treating groups of patients with Borderline Personality Disorder. Group Schema therapy led to even stronger outcomes with a 0% drop out rate and a recovery rate of 94% over an 8 month period.
Schema therapy seems to be very popular among therapists who view it as a truly integrative model and very helpful with their patients. Feedback from our workshops shows that therapists from different orientations (CBT, Gestalt, Psychoanalysis, Body Psychotherapy, Psychodrama and Transactional Analysis) found Schema Therapy integrative, useful and applicable to their own approaches and practice.
Schema Therapy is also, associated with higher levels of patient satisfaction thus benefiting both clients and therapists.
What did the clients say about their experience with Schema therapy?
“Schema therapy is a fantastic approach to psychotherapy, which provides frameworks for understanding the most diverse psychological phenomena (both” negative “and” positive “) and which in practice shows that personality disorders are not a lifelong behavior pattern, as it has been thought for a long time. .. “.
“For the first time I feel that someone really understands me … and that I really understand myself.”
“Schema therapy has taught me to love myself and to choose myself”
What did our trainees say about their experience with the application of the Schema therapy?
“Schema therapy has very effectively conceptualized the cognitive approach, and is therefore a good” guide” for the awareness and the understanding of the problem (how and why), as well as for the integration of behavior, feeling and thoughts.”
“I have very positive experiences with Schema therapy”. Big changes occurred in clients. Some clients who have been blocked for years have made significant progress”.
“The clients responded positively and the space for the better quality of work opened up”.
“Imagination and other techniques are extremely powerful”.
“I have very positive experiences. Schema therapy is an approach that gives a new, more in depth dimension to psychotherapeutic practice. “
“Client responses are excellent, the results are visible even with the most difficult clients”.
“A very significant specialization for REBT and CBT therapists, which provides additional insights and tools for working with difficult and resistant clients. Absolute recommendations for everyone who works with personality disorders. Very useful addition to other psychotherapy approaches. Amazing!”
“Schema therapy can really lead to big changes very fast, even with difficult clients”.
“Highly applicable and valuable techniques”.
“Schema therapy is very useful for working with clients, but it is also very useful for us therapists because it asks that we work on ourselves which is very important”.
“Excellent framework for understanding human behavior and functioning. Comprehensive approach that gives to us therapists powerful tools for helping clients”.
“This approach has amazing theory and wide integration”.
“Clients find Schema therapy acceptable and comprehensive – especially schemas and modes”.
“We often find ourselves being stuck with some clients, especially the ones with personality disorders, do this approach gives us abundant options to help clients and ourselves while working with them”.
“My experiences with Schema therapy are mostly positive – this approach leads to insight, to fast change in maladaptive modes, to release and stronger relationship with clients”.