Young (1990) originally developed schema therapy to treat patients who had failed to respond adequately to traditional cognitive-behavioral treatment, especially patients with personality disorders and significant characterological issues underlying their Axis I disorders. These patients violate several assumptions of cognitive-behavioral therapy and thus are difficult to treat successfully with this method. More recent revisions of cognitive therapy for personality disorders by Beck and his colleagues (Beck et al., 1990; Alford & Beck, 1997) are more consistent with schema therapy formulations. However, there are still significant differences between these approaches, especially in terms of conceptual emphasis and the range of treatment strategies.
Schema therapy is a broad, integrative model. As such, it has considerable overlap with many other systems of psychotherapy, including psychodynamic models. However, most of these approaches are narrower than schema therapy, either in terms of the conceptual model or the range of treatment strategies. There are also significant differences in the therapy relationship, the general style and stance of the therapist, and the degree of therapist activity and directiveness.
Early Maladaptive Schemas are broad, pervasive themes or patterns regarding oneself and one’s relationships with others that are dysfunctional to a significant degree. Schemas comprise memories, emotions, cognitions, and bodily sensations. They develop during childhood or adolescence and are elaborated throughout one’s lifetime. Schemas begin as adaptive and relatively accurate representations of the child’s environment, but they become maladaptive and inaccurate as the child grows up. As part of the human drive for consistency, schemas fight for survival. They play a major role in how individuals think, feel, act, and relate to others. Schemas are triggered when individuals encounter environments reminiscent of the childhood environments that produced them. When this happens, the individual is flooded with intense negative affect. LeDoux’s (1996) research on the brain systems involved with fear conditioning and trauma suggests a model for the biological underpinnings of schemas.
Early Maladaptive Schemas are the result of unmet core emotional needs. Aversive childhood experiences are their primary origin. Other factors play a role in their development, such as emotional temperament and cultural influences. We have defined 18 Early Maladaptive Schemas in five domains. A great deal of empirical support exists for these schemas and some of the domains.
We define two fundamental schema operations: schema perpetuation and schema healing. Schema healing is the goal of schema therapy. Maladaptive coping styles are the mechanisms patients develop early in life to adapt to schemas, and they result in schema perpetuation. We have identified three maladaptive coping styles: surrender, avoidance, and overcompensation. Coping responses are the specific behaviors through which these three broad coping styles are expressed. There are common coping responses for each schema. Modes are states, or facets of the self, involving specific schemas or schema operations. We have developed four main categories of modes: Child modes, Dysfunctional Coping modes, Dysfunctional Parent modes, and the Healthy Adult mode.
Schema Therapy has two phases: the Assessment and Education Phase and the Change Phase. In the first phase, the therapist helps patients identify their schemas, understand the origins of their schemas in childhood or adolescence, and relate their schemas to their current problems. In the Change Phase, the therapist blends cognitive, experiential, behavioral, and interpersonal strategies to heal schemas and replace maladaptive coping styles with healthier forms of behavior.