Schema therapy can be an incredibly powerful treatment modality. It is used by many Psychologists here at SHIPS to heal a range of psychological concerns, including complex trauma, persistent mood difficulties as well as relationship and intimacy concerns.

Previous blogs have also introduced the idea of schemas and how they can help us understand patterns in how we make sense of and respond to ourselves and the world and their influence on our psychological and sexual well being.

If you are curious about schema therapy or if schema therapy has been suggested as a helpful approach to your healing journey, I hope that this blog can clarify if Schema Therapy might be helpful for you and what you can expect from sessions.

What are Schemas?

Our brains are innately designed from birth to look for patterns in our internal and external environments to organise our experience and guide behaviour. We can have schemas about anything, from chairs, clocks and cars for example, with internal representations or blueprints for what they are, their function, how to interact with them, or associated memories. These blueprints include thoughts, beliefs, body sensations, and sensory information.

Schema therapy focuses on blueprints for our relationships to self and others and their impact on our psychological well-being. It helps us to identify schemas that relate to our human needs not being met, how we cope with this, and how this plays out in moment-by-moment emotional states.

Schema Therapy might be helpful for you if…

You have tried CBT or ACT and your symptoms have continued or progress has been difficult to maintain.
Your distress/symptoms tend to be related to relationships or your core sense of identity.
You find frameworks helpful when making sense of problems
You have noticed patterns in your thoughts, feelings, behaviours and relationships you would like to understand more.

Note: It is always helpful to discuss your concerns and symptoms with a psychologist to identify what approach might be helpful for your individual needs.

Where do schemas come from?

Schemas usually develop during childhood and adolescence based on the experiences we have with significant people in our lives including caregivers, and as we mature, siblings, peers, teachers and society.

Our brains pick up on patterns in these experiences, including emotions, bodily sensations, thoughts and what we observe in others to create a blueprint for how to be in the world. They contribute to our ability to have a consistent and stable sense of self and can be helpful or unhelpful as they continue to be applied into adulthood.

Schemas can be developed at any age however, those that are developed early in life are often more pervasive and difficult to change. They are usually in response to a mismatch between a child's temperament, core psychological needs and a caregivers ability to consistently meet these needs. Schemas can also develop from too much of a good thing e.g. excessive limits and control or overprotection or from an internalisation or identification of a caregivers thoughts and behaviours.

Healthy development is supported when our core psychological and physical needs are consistently met within these spaces. These core psychological needs are:

Secure attachment to others,
Autonomy, competence and sense of identity,
Freedom to express valid needs and emotions,
Spontaneity and play and,
Realistic limits and self-control.

When one or more of these needs are frustrated or unmet this is a threat to survival and growth. A child can unconsciously and automatically respond to these experiences through flight, fight, freeze or fawn as attempts to cope. There is also a somatic, cognitive, emotional, and behavioural response that is distressing leading to the development of a schema or a child's best attempts to make sense of what is happening. This unconsciously guides future behaviour in response to situations that are relevant to the particular schema and continues to be reinforced and elaborated on over time.

Our innate temperaments also interact with developmental experiences and the formation of schemas. Some children will innately be born with a tendency toward being more cheerful, irritable, reactive or low in mood for example. In the same environment children with different temperaments may come away with a different experience of a caregiver and their behaviour and adapt to those experiences in different ways.

Schemas are grouped into five domains; disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness and over vigilance and inhibition.

Here is a list of schemas, how they relate to our psychological needs and how they might show up during relationships and intimacy:

What to expect and stages of therapy

Assessment:

When you initially meet with a schema therapist there will be a focus on information gathering and assessment. This is to help the therapist see you in your life context and move beyond an exploration of current symptoms to identification of patterns and themes in your experiences, bodily sensations, thoughts, beliefs and behaviours that could point to the development of schemas and coping styles.

This might also include completion of questionnaires and surveys to not only better understand you but potentially as a baseline to track your progress. Another way your therapist may help you understand your schemas is through guided imagery. Early life experiences and those that involve significant distress tend to be organised differently in the brain. It is thought that the right hemisphere, which organises experiences related to self, others and affect, does so primarily through images making it easier to connect with the memories associated with the development of a schema in this phase of treatment.

Building cognitive awareness:

Together with your therapist you are working towards a collaborative and co-constructed understanding of what led to the development and maintenance of your present concerns and difficulties.

While most of the assessment is completed early in sessions, new information can continue to arise the more insight is built and the stronger the trust is in the therapist and therapeutic relationship.

By the end of this process you should have a sense of what your schemas are, where they tend to show up in your life and how you tend to cope with their presence. The goal of this stage is awareness building.

Building awareness of coping modes is one part of this. When schemas are activated in the present they lead to distressing emotions and bodily sensations leading to three broad patterns of coping behaviours which confirm or reinforce what the schema holds to be true:

Schema Avoidance/Flight: when people avoid activation of a schema or the thoughts and emotions associated with them. This may be automatic or intentional e.g. social withdrawal, avoidance of people or places that may trigger a schema, avoidance of being in contact with emotions through distraction, drug or alcohol use, overworking or eating. E.g. a person with a defectiveness schema acting in ways that prevent a partner getting too close and potentially seeing their perceived flaws/rejecting them.

Schema support/Freeze or Fawn: routine aspects of how the schema maintains and reinforces its view on self and the world through minimising contradictory evidence, amplifying confirming evidence or motivating behaviours that are consistent with it, E.g. a person with a defectiveness schema unconsciously being drawn to people who are critical of them, which confirms their view that there is something wrong with them.

Schema compensation/Fight: When people act in ways that are the opposite of what the schema holds to be true to prevent it being triggered in the first place. E.g. a person with a defectiveness schema becoming highly critical and angry themselves in response to even minor criticisms.

How they show up moment to moment in your life will vary and can be explored in more detail in therapy.

Change:

Once a good understanding is built, the focus of treatment moves into the development of a more realistic view of self-image and the world that allows you to better meet your own core emotional needs, and move toward living life in a way that feels more authentic to your values.

Cognitive challenging:

Together with your therapist you will be supported in identifying experiences where your schemas are active, perhaps even in session, and practising new ways of responding to them. You will build confidence in recognising the presence of schemas, acknowledging their origin as well as how your usual ways of responding might be inadvertently supporting the schema message. You might then look for evidence for and against what the schema holds to be true, find alternative ways to think about the experience and even engage in a structured dialogue between the perspective of the schema and a more balanced viewpoint.

Behavioural challenges:

This includes activities designed to support the reduction of schema maintaining behaviours and strengthen healthy coping responses. This will be individualised based on your unique pattern of schemas and coping modes. An example of this might be a person with a subjugation schema and schema support or fawn mode. This schema may make it challenging to express an important boundary with a partner in response to the expectation of a critical response. A therapist can provide support with the development, practice and implementation of healthy communication skills, strategies for self-regulation and practising self-compassion versus judgement around the importance of their needs in a healthy relationship.

Emotive exercises:

This might include exercises to experience and express the impact of your early experiences and schemas. This could be through letter writing e.g. to your child self or to a caregiver and the impact of their actions. This could also be through creative or therapeutic art practices or through chair work, involving dialogues between yourself and a schema or coping mode, or even a person who played a role in the development of a schema.

Imagery exercises:

This can include a range of activities designed to elicit a connection to the emotional, cognitive and bodily sensations related to a schema and coping response being active, paired with practice and rehearsal of healthier and more adaptive ways of responding to core emotional needs through guided imagery.

Imagery rescripting involves bringing up the memory of a time where you learnt to see the world through a schema, for example defectiveness, acknowledging how this related to an unmet need, its related emotional, cognitive and bodily experiences and how you responded at the time. The therapist acts as a coach to help you identify what your younger self may have needed in the moment and imagine this playing out for example, sharing validation or acceptance to your younger self. This experience can start to influence your own self-talk in situations where your defectiveness schema may be active.

Memory processing:

Schema change may also involve addressing any disturbing or traumatic memories, bodily sensations and emotional states that have contributed to schema learning and reinforcement.

This can be addressed through a number of supplemental approaches which utilise memory reconsolidation as a mechanism of change (EMDR, Internal Family Systems, Emotion-focused therapy, Coherence therapy etc …). Memory reconsolidation approaches are based on the idea that learning that occurs in presence of significant emotions and bodily sensations, including schemas and coping modes, are locked into circuits in the brain (a process called memory consolidation) which are implicit or unconscious and resistant to change. Procedures such as EMDR are able to unlock these circuits (de-consolidation) and create the potential for the blueprints within them to be updated with new and more adaptive ways of experiencing self and the world which are then locked back into place (re-consolidation) and go onto influence behaviour and decisions in helpful ways.

In all of these ways a new internal voice/mindset is strengthened (healthy adult) that can continue to guide you, regulate and foster ongoing growth and healthy engagement in life after therapy.

Your therapist also acts as a role model for the healthy adult through the consistency of the therapeutic relationship for example, in their attunement to your emotions and recognition of transference and , show care and empathy, recognise underlying needs and support skill building.

This stage is often the hardest, schemas are resistant to change. As they are a core part of lived experience and reality for people as unhelpful as they can be, it can be helpful to acknowledge that they provide a sense of predictability and certainty that can be difficult to let go of.

Patience and compassion for the non-linear nature of progress can be helpful and may also directly relate learning to change your schemas as you build a new foundation that is more authentic and supportive of your life.

Final Thoughts:

Schemas never disappear completely as the memories, emotions, bodily experiences and behaviours associated will always be a part of your history. The goal of therapy is to be able to change your relationship with schemas and work with them. Through healing however they will be active less often, feel less intense when they do and you will have more capacity to think around them, acknowledge and show compassion toward their history and pain and gauge a more helpful response. As life changes or challenges arise it might be helpful to revisit schema therapy and how it may apply in your life.

This blog post is a brief exploration of this topic and does not replace therapy. At SHIPS, we have practitioners that are knowledgeable and skilled in a variety of areas including sex therapy, relationships and more. If you may benefit from some support, please check out our website resources, or contact us.

We are also always happy to hear feedback about our blog articles. If you would like to share your experience or feel we may have missed something on this topic, please contact us to let us know.