schema therapy a very brief introduction thomas irelan, ph.d. department of clinical &...
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Schema TherapySchema TherapyA Very Brief IntroductionA Very Brief Introduction
Thomas Irelan, Ph.D.Thomas Irelan, Ph.D.Department of Clinical & Counselling PsychologyDepartment of Clinical & Counselling Psychology
NHS GrampianNHS Grampian
9 June 20119 June 2011
Schema Therapy is:Schema Therapy is:
• An integrative theory and treatment that An integrative theory and treatment that combines cognitive, behavioural, interpersonal, combines cognitive, behavioural, interpersonal, and experiential techniquesand experiential techniques
• Designed to treat the chronic, characterological Designed to treat the chronic, characterological aspects of disorders that have their origins in aspects of disorders that have their origins in childhood and adolescencechildhood and adolescence
Origins of Schema TherapyOrigins of Schema Therapy
• An expansion of cognitive therapy for complex patients An expansion of cognitive therapy for complex patients (severity, duration, and co-morbidity) and personality (severity, duration, and co-morbidity) and personality disordersdisorders
• These patients have more rigid cognitions and behavioursThese patients have more rigid cognitions and behaviours• The gap between cognitive and emotive change is much The gap between cognitive and emotive change is much
greatergreater• Intimate relationships are more central to their problemsIntimate relationships are more central to their problems• Often will not engage with traditional CBT techniquesOften will not engage with traditional CBT techniques
Schema Therapy vs Cognitive TherapySchema Therapy vs Cognitive Therapy
• Greater emphasis on the therapeutic relationshipGreater emphasis on the therapeutic relationship• More emphasis on affect and mood statesMore emphasis on affect and mood states• More discussion of childhood origins and More discussion of childhood origins and
developmental processesdevelopmental processes• More emphasis on lifelong coping stylesMore emphasis on lifelong coping styles• More emphasis on core themesMore emphasis on core themes
Young’s Early Maladaptive Schemas (EMS)Young’s Early Maladaptive Schemas (EMS)
• A broad, pervasive theme or pattern regarding A broad, pervasive theme or pattern regarding oneself and one’s relationships with others and the oneself and one’s relationships with others and the worldworld
Emotions
Images Memories
Thoughts
BodilySensations
Schema
General Definition of a SchemaGeneral Definition of a Schema
• Schemas continue to be elaborated over time Schemas continue to be elaborated over time through through assimilationassimilation and and accommodationaccommodation
• Schemas may be adaptive or maladaptiveSchemas may be adaptive or maladaptive• A A scriptscript is a schema for an event is a schema for an event
Young’s Early Maladaptive Schemas (EMS)Young’s Early Maladaptive Schemas (EMS)
• Developed during childhood or adolescence as a Developed during childhood or adolescence as a result of result of core emotional needscore emotional needs not being met not being met adequatelyadequately
• Elaborated throughout one’s lifetimeElaborated throughout one’s lifetime• Dysfunctional to a significant degreeDysfunctional to a significant degree
Characteristics of EMSsCharacteristics of EMSs
• A theme or understanding, not just a beliefA theme or understanding, not just a belief• Drives behaviours (rather than behaviours being Drives behaviours (rather than behaviours being
a part of the schema)a part of the schema)• Dimensionality: i.e. variation in degree of Dimensionality: i.e. variation in degree of
intensity, pervasiveness, and frequencyintensity, pervasiveness, and frequency• Many are pre-verbal and associated with the Many are pre-verbal and associated with the
amygdalaamygdala
Characteristics of EMSsCharacteristics of EMSs
• Capable of generating high levels of disruptive Capable of generating high levels of disruptive affect, self-defeating, and can be harmful to othersaffect, self-defeating, and can be harmful to others
• Capable of interfering significantly with getting core Capable of interfering significantly with getting core needs metneeds met
• Deeply entrenched patterns central to one’s sense of Deeply entrenched patterns central to one’s sense of selfself
• Triggered by everyday eventsTriggered by everyday events
The 18 Early Maladaptive SchemasThe 18 Early Maladaptive SchemasDisconnection & RejectionDisconnection & Rejection
• Emotional DeprivationEmotional Deprivation• AbandonmentAbandonment• Mistrust/AbuseMistrust/Abuse• Social IsolationSocial Isolation• DefectivenessDefectiveness
Impaired AutonomyImpaired Autonomy• FailureFailure• DependenceDependence• VulnerabilityVulnerability
Impaired LimitsImpaired Limits• EntitlementEntitlement• Insufficient Self-ControlInsufficient Self-Control
Other-DirectednessOther-Directedness• SubjugationSubjugation• Self-SacrificeSelf-Sacrifice• Approval SeekingApproval Seeking
Overvigilence & InhibitionOvervigilence & Inhibition• Emotional InhibitionEmotional Inhibition• Unrelenting StandardsUnrelenting Standards• Negativity/PessimismNegativity/Pessimism• PunitivenessPunitiveness
Origins of EMS: TemperamentOrigins of EMS: Temperament• EMS form through the interaction of temperament EMS form through the interaction of temperament
and early life experiences (including cultural factors)and early life experiences (including cultural factors)• Dimensions of temperament:Dimensions of temperament: Shy ↔ OutgoingShy ↔ Outgoing
Non-Emotional ↔ EmotionalNon-Emotional ↔ Emotional
Calm ↔ AnxiousCalm ↔ Anxious
Pessimistic ↔ OptimisticPessimistic ↔ Optimistic
Passive ↔ ActivePassive ↔ Active• Result is variance in levels of resiliencyResult is variance in levels of resiliency
Origins of EMS: Early Life ExperiencesOrigins of EMS: Early Life Experiences
Core emotional needsCore emotional needs of the individual are not met of the individual are not met through:through:
• Toxic frustration of needs (deprivation)Toxic frustration of needs (deprivation)• Traumatisation and victimisationTraumatisation and victimisation• Over-indulgenceOver-indulgence• Selective internalisation or identification with Selective internalisation or identification with
significant otherssignificant others
Core Emotional NeedsCore Emotional Needs• SafetySafety• PredictabilityPredictability• Love, nurturance, and attentionLove, nurturance, and attention• Acceptance and praiseAcceptance and praise• EmpathyEmpathy• Guidance and protectionGuidance and protection• Validation of emotions and needsValidation of emotions and needs
The goal of Schema Therapy is to help patients find The goal of Schema Therapy is to help patients find adaptive ways to meet their core emotional needs (by adaptive ways to meet their core emotional needs (by changing maladaptive schemas, coping responses, changing maladaptive schemas, coping responses, and modes)and modes)
Schema Coping StylesSchema Coping Styles
Surrender (freeze)Surrender (freeze)• ComplianceCompliance
Avoidance (flight)Avoidance (flight)• Substance abuseSubstance abuse• DetachmentDetachment• Social isolation, Social isolation,
avoidanceavoidance• Stimulation/workaholismStimulation/workaholism
Overcompensation (fight)Overcompensation (fight)• Aggression, hostilityAggression, hostility• Excessive self-relianceExcessive self-reliance• ManipulationManipulation• DemandingnessDemandingness• PerfectionismPerfectionism• OvercontrolOvercontrol
Schema PerpetuationSchema Perpetuation
• Cognitive distortions and coping styles produce Cognitive distortions and coping styles produce behaviour that leads to self-fulfilling prophecies; either behaviour that leads to self-fulfilling prophecies; either results are assimilated into the schema or selectively results are assimilated into the schema or selectively processed if they do not fit the schemaprocessed if they do not fit the schema
• Repetition results in self-defeating life patterns and Repetition results in self-defeating life patterns and schemas are perpetuatedschemas are perpetuated
Schema TherapySchema Therapy
The goal of Schema Therapy is The goal of Schema Therapy is schema healingschema healing, i.e. , i.e. reducing the intensity of memories and bodily reducing the intensity of memories and bodily sensations associated with a schema, the emotional sensations associated with a schema, the emotional charge of the schema, and the restructuring of charge of the schema, and the restructuring of maladaptive cognitionsmaladaptive cognitions
Schema TherapySchema Therapy
Phase 1: Assessment and EducationPhase 1: Assessment and Education• Determine suitability for Schema TherapyDetermine suitability for Schema Therapy• Introduce modelIntroduce model• Go through questionnaires (Young Schema Questionnaire Go through questionnaires (Young Schema Questionnaire
and/or Schema Mode Inventory and Young Parenting and/or Schema Mode Inventory and Young Parenting InventoryInventory
• Imagery for assessmentImagery for assessment• Develop shared formulation and goals for treatmentDevelop shared formulation and goals for treatment
Schema TherapySchema Therapy
Phase 2: ChangePhase 2: Change• Cognitive StrategiesCognitive Strategies• Experiential Strategies (imagery, two-chair work, etc.)Experiential Strategies (imagery, two-chair work, etc.)• Behavioural Pattern-BreakingBehavioural Pattern-Breaking• Use of the Therapeutic RelationshipUse of the Therapeutic Relationship• Mode WorkMode Work
FutureFutureSolutionsSolutions
PresentPresentProblemsProblems
Past OriginsPast Origins
SchemasSchemas
The Therapy RelationshipThe Therapy Relationship
Schema Therapists are:Schema Therapists are:• • personalpersonal• • objective and compassionateobjective and compassionate• • open and directopen and direct• • flexibleflexible• • focussed on meeting the emotional needs of theirfocussed on meeting the emotional needs of their
patientpatient
The Therapy RelationshipThe Therapy Relationship
AssessmentAssessment• • watch for schema triggering during sessions andwatch for schema triggering during sessions and
point out to the patientpoint out to the patient• • identify and discuss schemas that were activatedidentify and discuss schemas that were activated• • link schema activation in the session withlink schema activation in the session with
experiences outside of therapyexperiences outside of therapySelf-disclosureSelf-disclosure
• • judiciously based upon the needs of the patientjudiciously based upon the needs of the patient• • can be especially helpful with Social Isolationcan be especially helpful with Social Isolation
schemaschema
The Therapy RelationshipThe Therapy Relationship
Limited ReparentingLimited Reparenting •• meeting the unmet emotional needs of their patients in meeting the unmet emotional needs of their patients in
healthy ways within the bounds of a therapeutic relationshiphealthy ways within the bounds of a therapeutic relationship
Empathic ConfrontationEmpathic Confrontation• • by validating schemas coping styles based on their origins by validating schemas coping styles based on their origins • • gently and firmly pointing out the problems they create in the gently and firmly pointing out the problems they create in the present (including in the therapeutic relationship)present (including in the therapeutic relationship)• • how they prevent the patient from getting his or her how they prevent the patient from getting his or her emotional needs met (including the therapeutic relationship)emotional needs met (including the therapeutic relationship)
Schema Mode Work: HistorySchema Mode Work: History
• Developed for more severe clients (BPD, NPD, Developed for more severe clients (BPD, NPD, ASPD)ASPD)
• Places more focus on here-and-now mood statesPlaces more focus on here-and-now mood states• Provides more effective strategies for overcoming Provides more effective strategies for overcoming
avoidance and overcompensationavoidance and overcompensation
What is a Mode?What is a Mode?
• The specific schemas that are currently activated The specific schemas that are currently activated for any individualfor any individual
• The predominant state we are in at any given timeThe predominant state we are in at any given time• Schemas= traits, modes= statesSchemas= traits, modes= states• An aspect, side, or part of a person or his/her An aspect, side, or part of a person or his/her
personalitypersonality
Schema ModesSchema Modes
Child ModesChild Modes• Vulnerable ChildVulnerable Child• Angry/Enraged ChildAngry/Enraged Child• Impulsive/Undisciplined ChildImpulsive/Undisciplined Child• Contented ChildContented Child
Adult ModesAdult Modes• Punitive ParentPunitive Parent• Demanding ParentDemanding Parent• Healthy AdultHealthy Adult
Maladaptive Coping ModesMaladaptive Coping Modes• Compliant SurrendererCompliant Surrenderer• Detached ProtectorDetached Protector• OvercompensatorOvercompensator
Current Uses of Schema TherapyCurrent Uses of Schema Therapy
• Used with BPD, NPD, ASPD, Cluster C PDsUsed with BPD, NPD, ASPD, Cluster C PDs• Eating DisordersEating Disorders• Forensic settingsForensic settings• Substance abuseSubstance abuse• Couples therapyCouples therapy
Current Developments (International)Current Developments (International)
• Research being done in all areas on previous slideResearch being done in all areas on previous slide• Group models being developed, with research trials Group models being developed, with research trials
beginning for group ST with Borderline Personality beginning for group ST with Borderline Personality DisorderDisorder
Current Developments (Scotland)Current Developments (Scotland)
• First cohort being trained to accreditation in First cohort being trained to accreditation in Schema TherapySchema Therapy
• Introductory trainingsIntroductory trainings• Development of supervision networksDevelopment of supervision networks
For Further InformationFor Further Information
Thom IrelanThom [email protected]@nhs.net01224 55747501224 557475
www.isst-online.comwww.schematherapy.comwww.schematherapy.com