Schema Therapy
About Schema Therapy
Schema Therapy is an innovative, integrative, therapeutic approach, originally developed by Dr Jeffery Young as an expansion of traditional cognitive behavioural treatments. The Schema approach integrates elements of cognitive behavioural therapy (CBT), attachment theory, psychodynamic concepts, and emotionally focused tech-niques into one unified, systematic approach to treatment.
In cognitive psychology, a schema is an organised pattern of thought and behaviour. In schema therapy, schemas specifically refer to early maladaptive schemas, defined as "self-defeating life patterns of perception, emotion, and physical sensation". Often they take the form of a belief about the self or the world. For instance, a person with an Abandonment schema could be hypersensitive (have an "emotional button" or "trigger") about his/her perceived value to others, which in turn could make him/her feel sad and panicky in his/her interpersonal relationships.
As such Schema Therapy is particularly well suited for clients with entrenched, chronic psychological disorders, including personality disorders, eating disorders etc. It is also often effective for relapse prevention with depression, anxiety, substance abuse and other AXIS I disorders.
The goal of schema therapy is to help patients meet their basic emotional needs by helping the patient learn how to:
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heal schemas by diminishing the intensity of emotional memories comprising the schema and the intensity of bodily sensations, and by changing the cognitive patterns connected to the schema;
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replace maladaptive coping styles and responses with adaptive patterns of be-havior.
Techniques in Schema Therapy
Treatment plans in schema therapy generally encompass three basic classes of techniques: cognitive, experiential, and behavioural in addition to the basic healing components of the therapeutic relationship. Cognitive strategies expand on standard cognitive behavioural therapy techniques such as listing pros and cons of a schema, testing the validity of a schema, or conducting a dialogue between the "schema side" and the "healthy side". Experiential and emotion focused strategies expand on standard Gestalt therapy psychodrama and imagery techniques.
Behavioural pattern-breaking strategies expand on standard behaviour therapy techniques, such as role playing an interaction and then assigning the interaction as homework. One of the most central techniques in schema therapy is the use of the therapeutic relationship, specifically through a process called limited reparenting.
Outcome Studies
There is a growing literature of outcome studies on schema therapy, where schema therapy has shown impressive results. These include studies comparing Schema therapy vs transference focused psychotherapy outcomes by Dutch investigators, including Josephine Giesen-Bloo and Arnoud Arntz (the project leader), of less intensive outpatient, individual schema therapy by Dutch investigators, including Marjon Nadort and Arnoud Arntz, and a Pilot study of group schema therapy for borderline personality disorder Investigators Joan Farrell, Ida Shaw and Michael Webber. As of 2014, a collaborative randomised controlled trial is under way at 14 sites in six countries to further explore this interaction between groups and schema therapy.
Cost Effectiveness of Schema Therapy
Even the most intensive version of schema therapy mentioned in the first study was found to be cost effective. An economic analysis conducted by the authors of the study indicated that, for each year schema therapy patients were in the study, Dutch society benefited from a net gain of €4,500 Euros per patient (the equivalent of about $5,700 US dollars), despite the cost-intensive treatment.
