What is schema therapy?

Schema therapy is an integrative approach that combines ideas from cognitive behavioural therapy, psychoanalysis, Gestalt therapy, and attachment theory. This type of therapy has a strong relational emphasis. Schema therapy was developed by Jeffrey E. Young, initially to be used to support individuals with personality disorders, or other clients who had failed to respond to other therapeutic treatment.

In cognitive psychology, a schema is a pattern of thought and/or behaviour; a schema may, for example, create a framework, a filter through which an individual perceives the world. In schema therapy, a schema is considered to be an early maladaptive coping mechanism, they are patterns that develop as a result of needs not being met in childhood. Schema therapy supports the idea that these patterns can continue to affect individuals into adulthood and cause emotional distress and relational issues. Early maladaptive schemas may take the form of emotional memories; they can also include physical sensations. Schema therapy aims to help clients find ways to ensure their emotional needs are met in ways that are healthy and do not cause distress.

The 18 maladaptive schemas

There are 18 maladaptive schemas identified in schema therapy. These are categorised into five different domains.

Domain 1: Disconnection and rejection

This domain includes schemas that inhibit the formation of healthy relationships, including:

Abandonment/Instability – the belief that others will leave you and loss is inevitable
Mistrust/Abuse – the belief that others are not to be trusted
Emotional deprivation – believing that your needs will never be met
Defectiveness/Shame – the belief that you are flawed and will be rejected
Social Isolation/Alienation – a pervasive sense of aloneness

Domain 2: Impaired autonomy and performance

This domain includes schemas that make it difficult to maintain a strong sense of self and function appropriately in the world, including:

Dependence/Incompetence – believing that you are not able to make your own decisions and you have to rely on others
Vulnerability – a sense that the world is a dangerous place and that you will be overwhelmed by challenges
Enmeshment/Undeveloped Self – the sense that you do not have a defined sense of self, separate to others
Failure – the expectation that you will fail

Domain 3: Impaired limits

This domain includes schemas that affect self-control, boundaries, and limits, including:

Entitlement/Grandiosity – having a strong sense that you are special and better than others
Insufficient Self-Control and/or Self-Discipline – believing that you cannot engage with boring, repetitive, or frustrating activities in the process of achieving your goals; impulsive behaviours

Domain 4: Other-directedness

This domain includes schemas that prompt people to put others' needs before their own, including:

Subjugation – the belief that you must submit to others out of fear of rejection or punishment
Self-Sacrifice – believing you should give up your own needs for those of others
Approval-Seeking/Recognition-Seeking – the belief that approval and recognition are far more important than being true to yourself

Domain 5: Overvigilance and inhibition

This domain includes schemas that prioritise avoiding failure and encouraging alertness and sticking to rules, disregarding desires or emotions, including:

Negativity/Pessimism – the belief that negatives far outweigh positives in life and having little hope for the future
Emotional Inhibition – believing that you must control your emotional expression or others may reject you
Unrelenting Standards – the belief that you must always be the best, perfectionistic tendencies
Punitiveness – the belief that people should be harshly punished for their mistakes

Schema modes

Schema modes are states of mind which everyone experiences from time to time. A schema mode is activated when a situation triggers a person's schemas, or coping styles. In a healthy person, these schema modes can usually be calmed, they are flexible and able to be changed. In individuals who may be struggling with their mental health, these schema modes may become less flexible.

Schema therapy researchers identified ten different schema modes, grouped into four categories: Child Modes, Dysfunctional Coping Modes, Dysfunctional Parent Modes and Healthy Adult Mode.

Child Modes

Vulnerable Child: feels lonely, isolated, sad, misunderstood, unsupported, defective, deprived, overwhelmed, incompetent, doubts self, needy, helpless, hopeless, frightened, anxious, worried, victimised, worthless, unloved, unlovable, lost, directionless, fragile, weak, defeated, oppressed, powerless, left out, excluded, pessimistic.
Angry Child: feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met.
Impulsive/Undisciplined Child: acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification; often feels intensely angry, enraged, infuriated, frustrated, impatient when these non-core desires or impulses cannot be met.; may appear “spoiled”.
Happy Child: feels loved, contented, connected, satisfied, fulfilled, protected, accepted, praised, worthwhile, nurtured, guided, understood, validated, self-confident, competent, appropriately autonomous or self-reliant, safe, resilient, strong, in control, adaptable, included, optimistic, spontaneous

Maladaptive Coping Modes

Compliant Surrenderer: acts in a passive, subservient, submissive, approval-seeking, or self-deprecating way around others out of fear of conflict or rejection; tolerates abuse and/or bad treatment; does not express healthy needs or desires to others; selects people or engages in other behaviour that directly maintains the self-defeating schema-driven pattern.
Detached Protector: cuts off needs and feelings; detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalised, empty or bored; pursues distracting, self-soothing or self-stimulating activities in a compulsive way or to excess; may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities.
Over compensator: feels and behaves in an inordinately grandiose, aggressive, dominant, competitive, arrogant, haughty, condescending, devaluing, over-controlled, controlling, rebellious, manipulative, exploitative, attention-seeking or status-seeking way. These feelings or behaviours must originally have developed to compensate for or gratify unmet core needs.

Maladaptive Parent Modes

Punitive Parent: feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others. This mode refers to the style with which rules are enforced rather than the nature of the rules.
Demanding Parent: feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to puts others’ needs before one’s own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously. This mode refers to the nature of the internalised high standards and strict rules, rather than the style with which these rules are enforced

Healthy Adult Mode

Healthy Adult: nurtures, validates and affirms the vulnerable child mode; sets limits for the angry and impulsive child modes; promotes and supports the healthy child mode; combats and eventually replaces the maladaptive coping modes; neutralises or moderates the maladaptive parent modes. This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex, intellectual, esthetic, and cultural interests; health maintenance; and athletic activities.

Reference: “A Client’s Guide to Schema-Focused Cognitive Therapy” by David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D., Cognitive Therapy Center of New York. 1993