Schema focus therapy

During ADCP classes in National University of Modern Languages Islamabad

1. Schema focus therapy National UNIVERSITY For MODERN LANGUAGES ISLAMABAD PAKISTAN. Advance Diploma in Clinical Psychology (Morning). Subject; Internship Presented by, Umar Zada. Abdur Rahim Zartashia

2. Schema The word schema comes from the Greek word ( skhema ) which mean shape or more generally plan. Definition: A drawing of thought that represent an idea or theory and make it easier to understand.

3. Schemas A pattern of thoughts or behavior that organizes categories of information and the relationship among them. Is a concept that informs us what to expect from a variety of experiences. They are base on information we have acquired by previous life experiences. Developed during childhood or adolescence and elaborated throughout one's lifetime Library: I need to be quiet Fire: that’s hot

4. Cont.… Schemas can be thought of as central and enduring themes in a person’s life . Schemas reflect deep, difficult to change views of ourselves, others, and the world. Schemas also refer to a broad organizing structure that significantly influences our moment-to-moment experiences . Schemas typically consist of thematically connected feeling states, thinking patterns, expectations, predispositions to believe and emotionally significant memories.

5. Cont. Typical statements that you’ll hear from someone that have harmful and negative thinking patterns include “I’m worthless ”, “ I’m not good enough” or “No one loves me” . In order to effectively address and improve a client’s thinking patterns..

6. Schemas are Useful. Schema is a cognitive framework or concept that helps organize and interpret information. Schema is useful because they allow us to take shortcuts in interpreting the vast amount of information that’s available in our environment. Schema is the structure behind data organization.

7. How to identify The therapist identifies the client’s schemas or life traps through conversation or even questionnaires . The therapist helps the client become more aware of their schemas and learn how to recognize them in their everyday lives. The client becomes more involved in improving their thinking patterns outside of treatment and replaces them with more positive thoughts for more positive outcomes.

8. Schema-Focused Therapy However, schema therapy has been described by its developer as “a truly integrative psychotherapy ”. Schema focused therapy is a form of psychotherapy that combines aspects of  cognitive behavioral therapy , experiential therapy ( such as role-playing or acting, props, arts and crafts, music, animal care, guided imagery, or various forms of recreation) and  interpersonal therapy (   time-limited, focused, evidence-based approach to treat mood disorders ) .

9. Schema-Focused Therapy (SFT) Schema-Focused Therapy (SFT), also known simply as schema therapy, Commonly referred to as a modified cognitive- behavioural treatment Initially conceived of as a cognitive therapy for patients with chronic depression and personality disorders, the theoretical underpinning of schema therapy has evolved to incorporate substantial developments in psychodynamic theory. As in psychodynamic object relations and attachment theories, schema therapy emphasizes the internalization of early relationships into cognitive-affective representations.

10. Conti.. Schema therapy creator Dr. Jeff Young defined the term schema as a “ life trap ” or a pattern of negative behaviors that an individual repeats over and over again throughout their adult life. As Young saw it, individuals that benefited the most from schema focused therapy were those that displayed self-defeating thought patterns.

11. Cont.. Dr. Jeff Young had spent time working alongside  Dr. Aaron Beck, the creator of cognitive behavioral therapy , when he created schema focused therapy. Through years of clinical observation, Young identified 18 schemas or attitudes that the average client tends to display. These schemas include

12. List of Maladaptive Schemas Punitiveness  – The idea that individuals need to be punished for making mistakes. Mistrust  – The preconceived notion that other individuals will hurt or manipulate you. Failure  – The belief that one will fail in virtually all endeavors. Entitlement  – The belief that one is entitled to special privileges. Poor Self-Discipline or Self-Control  – When a person has difficulty achieving personal goals on their own. Approval Seeking  – Always attempts to gain validation or attention from others. Subjugation  – Excessively surrenders control to others in an effort to avoid conflict. Self-Sacrifice  – Delays personal gratification in order to meet the needs of others.

13. Cont.. Vulnerability to Harm  – Unjustifiable fear that you could be harmed at any given time. Defectiveness and Shame  – The idea that one is unwanted or insignificant to others. Enmeshment  – Excessive and unhealthy emotional involvement with other individuals. Dependence and Incompetence  – The idea that one cannot satisfy their daily responsibilities and needs others to help them complete simple tasks. Social Isolation and Alienation  – A lack of a sense of belonging with other groups of people. Abandonment –  Feelings of a lack of emotional support and connection with those around you. Emotional Deprivation  – An individual’s desired level of emotional support cannot be met by others. Negativity and Pessimism  – Excessive focus on the negative aspects of one’s life. Emotional Inhibition  – The inability to show feelings and communicate in a relaxed and natural manner. Unrelenting Standards  – The idea that one must meet unreachable goals in order to avoid criticism from others.

14. Characteristics Borderline Personality Disorder (BPD) is characterized by a predominance of certain maladaptive representations, known as early maladaptive schemas. SFT seeks to modify these schemas through the explicit use of interventions from various therapy models, including CBT, Gestalt, and Emotion-Focused Therapies.

15. Cont.. The schema approach draws equally from cognitive–behavioral therapy, attachment theory, psychodynamic concepts, and emotion-focused therapies. In comparison to cognitive–behavioral therapy, schema therapy emphasizes lifelong patterns, affective change techniques, and the therapeutic relationship, with special emphasis on limited reparenting.

16. Cont.. The initial results of a major comparative outcome study have shown schema therapy to be effective with a high percentage of outpatients with borderline personality disorder, with a low dropout rate. Clients who have spent years gaining valuable insight with psychodynamic treatments, but who are frustrated by their lack of progress, often respond well to the active, systematic, flexible, and depth-oriented schema approach.

17. Cont.. Schema therapy is particularly well-suited for difficult, resistant clients with entrenched, chronic psychological disorders, including personality disorders (including borderline personality disorder and narcissism) and eating disorders, intractable couples problems, and criminal offenders. It has also been found to be effective for relapse prevention in depression, anxiety, and substance abuse.

18. What Can Schema-Focused Therapy Add to Cognitive Therapy? The assessment process in SFT is more comprehensive. The therapist wants to develop a good understanding of the origin of the maladaptive schema (early interactions with significant others) and how the schema has expressed itself throughout the patient’s life (the pattern of painful feelings, self-defeating choices and unmet needs). There is a greater emphasis on understanding the origins of the maladaptive schemas. This enables the client to see his life, especially his struggles and self-defeating behavior, and how they are influenced him to avoid certain situations or tasks that fulfill his basic desires. This kind of understanding can promote not only self-compassion, but also increase motivation to change by appreciating the “price one has paid”. Schema-Focused-Therapy spells out powerful change techniques to “heal ”maladaptive schemas. These techniques include working with painful memories and images that are an intregral part of the schema. Evoking such memories can be emotional for the client. However, it appears to be crucial to restructuring the memory and help “heal” the schema.

19. For What Types of Clients or Problems Would Schema-Focused-Therapy be Indicated? For clients who do not respond well to traditional cognitive therapy or who seem to suffer frequent relapses of their problems. Clients who feel they have been entrenched in self-defeating patterns and whose thinking is rigid and harsh (e.g. “this is the way I am – I just am defective – no matter what I do, I’ll always be unlovable”). Clients who seem to fall into the same relationship traps throughout their life. Here there is almost always a maladaptive schema that needs to be identified and changed.