A Client’s Guide to Schema Therapy
David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D.
Schema Therapy Institute
HARRY is a 45-year old middle-level manager. He has been married for 16 years, but his
marriage has been very troubled. He and his wife are often resentful of each other, they
rarely communicate on an intimate level, and they have few moments of real pleasure.
Other aspects of Harry’s life have been equally unsatisfying. He doesn’t enjoy his work,
primarily because he doesn’t get along with his co-workers. He is often intimidated by
his boss and other people at the office. He has a few friends outside of work, but none
that he considers close.
During the past year Harry’s mood became increasingly negative. He was getting more
irritable, he had trouble sleeping and he began to have difficulty concentrating at work.
As he became more and more depressed, he began to eat more and gained 15 pounds.
When he found himself thinking about taking his own life, he decided it was time to get
help. He consulted a psychologist who practices cognitive therapy.
As a result of short-term cognitive therapy techniques, Harry improved rapidly. His mood
lifted, his appetite returned to normal, and he no longer thought about suicide. In
addition he was able to concentrate well again and was much less irritable. He also
began to feel more in control of his life as he learned how to control his emotions for
the first time.
But, in some ways, the short-term techniques were not enough. His relationships with
his wife and others, while they no longer depressed him as much as they had, still failed
to give him much pleasure. He still could not ask to have his needs met, and he had few
experiences he considered truly enjoyable. The therapist then began schema therapy to
help Harry change his long-term life patterns.
This guide will present the schema therapy approach, developed by Dr. Jeffrey Young to
expand cognitive therapy for clients with more difficult long-term problems. Schema
therapy can help people change long-term patterns, including the ways in which they
interact with other people. This overview of schema therapy consists of six parts:
1) A brief explanation of short-term cognitive therapy
2) An explanation of what a schema is and examples of schemas;
3) An explanation of the processes by which schemas function;
4) An explanation of modes and how they function within schema therapy;
5) Several case examples; and
6) A brief description of the therapeutic process
Short-Term Cognitive Therapy
Cognitive therapy is a system of psychotherapy developed by Aaron Beck and his
colleagues to help people overcome emotional problems. This system emphasizes
changing the ways in which people think in order to improve their moods, such as
depression, anxiety and anger.
Emotional disturbance is influenced by the cognitive distortions that people make in
dealing with their life experiences. These distortions take the form of negative
interpretations and predictions of everyday events. For instance, a male college student
preparing for a test might make himself feel discouraged by thinking: “This material is
impossible” (Negative Interpretation) and “I’ll never pass this test” (Negative Prediction).
The therapy consists of helping clients to restructure their thinking. An important step in
this process is examining the evidence concerning the maladaptive thoughts. In the
example above, the therapist would help the student to look at his past experiences and
determine if the material was in fact impossible to learn, and if he knew for sure that he
couldn’t pass the test. In all probability, the student would decide that these two
thoughts lacked validity.
More accurate alternative thoughts are then substituted. For instance, the student might
be encouraged to think: “This material is difficult, but not impossible. I’ve learned
difficult material before” and “I’ve never failed a test before, so long as I’ve done
enough preparation.” These thoughts would probably lead him to feel better and cope
better.
Often short-term cognitive therapy is enough to help people overcome emotional
problems, especially depression and anxiety. Recent research has shown this to be so.
However, sometimes this approach is not enough. Some clients in short-term cognitive
therapy find that they don’t get all the benefits they want. This has led us, as well as
various other researchers (Beck, xxxx) to look at deeper and more permanent cognitive
structures as a means to understand and treat problem moods and behaviors. Schema
therapy was created as a result of these efforts.
Schemas - What They Are
A schema is an extremely stable, enduring negative pattern that develops during
childhood or adolescence and is elaborated throughout an individual’s life. We view the
world through our schemas.
Schemas are important beliefs and feelings about oneself and the environment which
the individual accepts without question. They are self -perpetuating, and are very
resistant to change. For instance, children who develop a schema that they are
incompetent rarely challenge this belief, even as adults. The schema usually does not go
away without therapy. Overwhelming success in people’s lives is often still not enough
to change the schema. The schema fights for its own survival, and, usually, quite
successfully.
It’s also important to mention the importance of needs in schema formation and
perpetuation. Schemas are formed when needs are not met during childhood and then
the schema prevents similar needs from being fulfilled in adulthood. For instance a child
whose need for secure attachments is not fulfilled by his parents may go for many years
in later life without secure relationships.
Even though schemas persist once they are formed, they are not always in our
awareness. Usually they operate in subtle ways, out of our awareness. However, when a
schema erupts or is triggered by events, our thoughts and feelings are dominated by
these schemas. It is at these moments that people tend to experience extreme negative
emotions and have dysfunctional thoughts.
In our work with many patients, we have found eighteen specific schemas. Most clients
have at least two or three of these schemas, and often more. A brief description of each
of these schemas is provided below.
Emotional Deprivation
This schema refers to the belief that one’s primary emotional needs will never be met by
others. These needs can be described in three categories: Nurturance – needs for
affection, closeness and love; Empathy – needs to be listened to and understood;
Protection – needs for advice, guidance and direction. Generally parents are cold or
removed and don’t adequately care for the child in ways that would adequately meet
the above needs.
Abandonment/Instability
This schema refers to the expectation that one will soon lose anyone with whom an
emotional attachment is formed. The person believes that, one way or another, close
relationships will end imminently. As children, these clients may have experienced the
divorce or death of parents. This schema can also arise when parents have been
inconsistent in attending to the child’s needs; for instance, there may have been
frequent occasions on which the child was left alone or unattended to for extended
periods.
Mistrust/Abuse
This schema refers to the expectation that others will intentionally take advantage in
some way. People with this schema expect others to hurt, cheat, or put them down.
They often think in terms of attacking first or getting revenge afterwards. In childhood,
these clients were often abused or treated unfairly by parents, siblings, or peers.
Defectiveness/Shame
This schema refers to the belief that one is internally flawed, and that, if others get
close, they will realize this and withdraw from the relationship. This feeling of being
flawed and inadequate often leads to a strong sens e of shame. Generally parents were
very critical of their children and made them feel as if they were not worthy of being
loved.
Social Isolation/Alienation
This schema refers to the belief that one is isolated from the world, different from other
people, and/or not part of any community. This belief is usually caused by early
experiences in which children see that either they, or their families, are different from
other people.
Dependence/Incompetence
This schema refers to the belief that one is not capable of handling day-to-day
responsibilities competently and independently. People with this schema often rely on
others excessively for help in areas such as decision-making and initiating new tasks.
Generally, parents did not encourage these children to act independently and develop
confidence in their ability to take care of themselves.
Vulnerability to Harm and Illness
This schema refers to the belief that one is always on the verge of experiencing a major
catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive
precautions to protect oneself. Usually there was an extremely fearful parent who
passed on the idea that the world is a dangerous place.
Enmeshment/Undeveloped Self
This schema refers to a pattern in which you experience too much emotional
involvement with others – usually parents or romantic partners. It may also include the
sense that one has too little individual identity or inner direction, causing a feeling of
emptiness or of floundering. This schema is often brought on by parents who are so
controlling, abusive, or overprotective that the child is discouraged from developing a
separate sense of self.
Failure
This schema refers to the belief that one is incapable of performing as well as one’s
peers in areas such as career, school or sports. These clients may feel stupid, inept or
untalented. People with this schema often do not try to achieve because they believe
that they will fail. This schema may develop if children are put down and treated as if
they are a failure in school and other spheres of accomplishment. Usually the parents
did not give enough support, discipline, and encouragement for the child to persist and
succeed in areas of achievement, such as schoolwork or sport
Subjugation
This schema refers to the belief that one must submit to the control of others in order to
avoid negative consequences. Often these clients fear that, unless they submit, others
will get angry or reject them. Clients who subjugate ignore their own desires and
feelings. In childhood there was generally a very controlling parent.
Self-Sacrifice
This schema refers to the excessive sacrifice of one’s own needs in order to help others.
When these clients pay attention to their own needs, they often feel guilty. To avoid this
guilt, they put others’ needs ahead of their own. Often clients who self -sacrifice gain a
feeling of increased self -esteem or a sense of meaning from helping others. In childhood
the person may have been made to feel overly responsible for the well being of one or
both parents.
Emotional Inhibition
This schema refers to the belief that you must suppress spontaneous emotions and
impulses, especially anger, because any expression of feelings would harm others or
lead to loss of self -esteem, embarrassment, retaliation or abandonment. You may lack
spontaneity, or be viewed as uptight. This schema is often brought on by parents who
discourage the expression of feelings.
Approval-Seeking/Recognition-Seeking
This schema refers to the placing of too much emphasis on gaining the approval and
recognition of others at the expense of one’s genuine needs and sense of self. It can
also include excessive emphasis on status and appearance as a means of gaining
recognition and approval. Clients with this schema are generally extremely sensitive to
rejections by others and try hard to fit in. Usually they did not have their needs for
unconditional love and acceptance met by their parents in their early years.
Unrelenting Standards/Hypercriticalness
This schema refers to the belief that whatever you do is not good enough, that you
must always strive harder. The motivation for this belief is the desire to meet extremely
high internal demands for competence, usually to avoid internal criticism. People with
this schema show impairments in important life areas, such as health, pleasure or self -
esteem. Usually these clients’ parents were never satisfied and gave their children love
that was conditional on outstanding achievement.
Entitlement/Grandiosity
This schema refers to the belief that you should be able to do, say, or have whatever
you want immediately regardless of whether that hurts others or seems reasonable to
them. You are not interested in what other people need, nor are you aware of the longterm
costs to you of alienating others. Parents who overindulge their children and who