Schema focused therapy

Schema focused therapy developed by Young. Basic fundamentals of SFT. Emphasis on maladaptive schema and process of healing. It includes cognitive, experiential and behavioural techniques as well as patient-therapist relationship as an anchor.

1. SCHEMA FOCUSED THERAPY - Pragya (Clinical Psychologist) 1

2. introduction Developed by Young in 1990,1999 Systematic approach which expands on CBT by integrating techniques from several different schools of therapy Originally designed to treat patient with chronic characterological problems (not active psychiatric symptoms) who were not helped by traditional CBT C an be brief, intermediate, or longer term 2

3. Place greater emphasis on : Exploring childhood and adolescent origin of psychological problems Emotive techniques Therapist-patient relationship Maladaptive coping style H elpful in treatment of chronic depression, anxiety, eating disorder, couple problems, criminal offenses, substance abuse, etc. 3

4. Addresses core psychological themes ( Early Maladaptive Schemas ) that are typical of patients with characterological disorders Helps patients & therapists to make sense of chronic, pervasive problems and to organize them in comprehensible manner Model traces these schemas from early childhood to the present and patient’s interpersonal relationships 4

5. schemas P attern imposed on reality or experience to help individuals explain, mediate perception and to guide their responses An abstract representation of distinct characteristics of an event These are formed early in life and continue to be elaborated Further, superimposed on later life experiences 5

6. Early maladaptive schemas Broad , pervasive pattern developed during childhood or adolescence which is dysfunctional to a significant degree S elf-defeating emotional and cognitive patterns Comprised of memories, emotions, cognitions and bodily sensations regarding oneself and relationships with others Maladaptive behavior develop as response to schema 6

7. Schema domains 1. Abandonment/Instability 2. Mistrust/Abuse 3. Emotional Deprivation : A. Deprivation of Nurturance: Absence of attention, affection, warmth, or companionship B. Deprivation of Empathy: Absence of understanding, listening, self-disclosure C. Deprivation of Protection: Absence of strength, direction, or guidance from others 4. Defectiveness/Shame 5. Social Isolation/Alienation 6. Dependence/Incompetence 7. Vulnerability to Harm or Illness 8. Enmeshment/Undeveloped 9. Failure 7

8. Schema domains cONTD … 10. Entitlement/Grandiosity 11. Insufficient Self-Control/Self-Discipline 12. Subjugation Excessive 13. Self-Sacrifice Excessive 14. Approval-Seeking/Recognition-Seeking 15. Negativity/Pessimism 16. Emotional Inhibition 17. Unrelenting Standards/ Hypercriticalness 18. Punitiveness 8

9. Origin of schemas 9

10. 1. Core emotional need There are 5 core emotional needs which are universal in nature Secure attachment (safety, stability, nurturance and acceptance) Autonomy Freedom to express valid needs & emotions Spontaneity and play Realistic limit and self control Healthy individual adaptively meet theses core emotional needs 10

11. 2. Early life experiences There are 4 types that foster the acquisition of schemas: Toxic frustration of needs- child experiences too little of good things acquires schema such as emotional deprivation or abandonment Traumatization or victimization- develops schemas such as mistrust, shame, vulnerability to harm/ illness Too much of good things- develops schemas such as dependence, incompetence and grandiosity Selective internalization- child selectively identifies with parent’s thoughts, feelings, experiences and behavior Schemas that develop earliest are strongest 11

12. 3. Emotional Temperament Each child has unique and distinct “personality” or temperament from birth such as some children are more irritable or shy or aggressive It interacts with painful childhood events in formation of schemas Different temperaments selectively expose children to different life circumstances For example, an aggressive child might be more likely to elicit physical abuse from violent parent than passive, appeasing child. 12

13. Schema operations 13

14. Schema perpetuation R efers to everything patient does (internally and behaviorally) that keeps the schema going I ncludes all the thoughts, feelings, and behaviors that end up reinforcing Schemas are perpetuated through three primary mechanisms : 14

15. Schema healing U ltimate goal of schema therapy It involves diminishing : I ntensity of the memories connected to the schema S chema’s emotional charge S trength of the bodily sensations M aladaptive cognitions It involves behavior change, as patients learn to replace maladaptive coping styles with adaptive patterns of behavior 15

16. maladaptive coping styles All organisms have 3-basic responses to threat: fight, flight and freeze. These correspond to 3-schema coping styles of overcompensation, avoidance and surrender They generally operate out of awareness (unconsciously) Triggering of schema is a threat (the frustration of a core emotional need) to which individual responds with a coping style A coping style is a collection of coping responses that an individual characteristically utilizes to avoid, surrender, or overcompensate 16

17. 1. surrender When patients surrender to a schema, they do not try to avoid it or fight it rather accept that schema is true When patient encounter schema triggers, their emotional responses are disproportionate and they experience their emotions fully and consciously They behave in ways that confirm the schema In therapy relationship , patients may play out schema with themselves in the “child” role and therapist in role of the “offending parent” 17

18. 2. Avoidance When patients utilize avoidance, they try to arrange their lives or attempt to live without awareness as though schema does not exist A void thinking about schema and block thoughts & images as well as any situation (such as intimate relationships or work challenges) that might trigger it When feelings surface, they reflexively push them back down, as a result they may drink excessively, take drugs, have promiscuous sex, overeat, compulsively clean, seek stimulation or become workaholics 18

19. 3. Overcompensation P atients fight schema by thinking, feeling, behaving and relating as though opposite of schema were true They endeavor to be as different as possible from the children they were when that schema was acquired (example: If they felt worthless as children, then as adults they try to be perfect) Temperament probably plays greater role in determining patients’ coping styles. For example- individuals who have passive temperaments are probably more likely to surrender or avoid whereas individuals who have aggressive temperaments are more likely to overcompensate 19

20. Coping response A coping response is the specific behavior (or strategy) that the individual is exhibiting at a given point in time Coping responses are specific behaviors or strategies through which coping styles are expressed They include all the responses to threat in the individual’s behavior Coping style is a trait , whereas a coping response is a state 20

21. Schema modes M oment-to-moment emotional states and coping responses (adaptive and maladaptive) that we all experience Triggered by life situations to which we are oversensitive and are actively interested in working with these modes Adaptive or maladaptive schemas/schema operations that are currently active for an individual D ysfunctional schema mode : activated when specific maladaptive schemas or coping responses results in distressing emotions, avoidance responses, or self-defeating behaviors that take over and control an individual’s functioning 21

22. 10 schema modes that can be grouped into 4-broad categories: Child modes Dysfunctional Coping modes Dysfunctional Parent modes Healthy Adult mode Child modes are innate and universal (All children are born with the potential to manifest them) 3-dysfunctional coping modes: Compliant Surrenderer Detached Protector Overcompensator These three modes correspond to the three coping styles of surrender, avoidance, and overcompensation 22

23. Angry Child is enraged about unmet emotional needs & acts in anger without regard to consequences Impulsive/Undisciplined Child expresses emotions, acts on desires & follows natural inclinations in reckless manner without regard to possible consequences for the self or others Happy Child is one whose core emotional needs are currently met. 23

24. treatment process 1. Assessment and Education Phase 2. Change Phase 24

25. Assessment and Education Phase S chema therapist helps patients to identify their schemas and to understand the origins of the schemas in childhood and adolescence Therapist educates patient about schema model Patients learn to recognize their maladaptive coping styles (surrender, avoidance, and overcompensation) and to see how their coping responses serve to perpetuate their schemas 25

26. A ssessment is multifaceted which include Life history interview several schema questionnaires self-monitoring assignments imagery exercises that trigger schemas emotionally Help patients make emotional links between current problems and related childhood experiences By the end of this phase, the therapist and patient have developed a complete schema case conceptualization 26

27. Change Phase S chema-focused treatment plan encompasses in a flexible manner: Cognitive Experiential Behavioral strategies Healing components of the therapist–patient relationship . 27

28. 1. Cognitive Techniques This disprove the validity of schema on a rational level Patients list all the evidence supporting and refuting the schema throughout their lives, and therapist and patient evaluate the evidence If not enough existing evidence to challenge the schema, then patients evaluate what they can do to change this aspect of their lives Therapist and patient summarize case against the schema on a flash card that they compose together Patients carry these flash cards with them and read them frequently 28

29. 2. Experiential Techniques Patients fight the schema on emotional level Use experiential techniques such as imagery and dialogues, they express anger and sadness about what happened to them as children In imagery, they stand up to the parent and other significant childhood figures, and they protect and comfort the vulnerable child P atient link childhood images with images of upsetting situations in their current lives 29

30. 3. Behavioral Pattern-Breaking B ehavioral homework assignments are given in order to replace maladaptive coping responses with new and more adaptive patterns of behavior P atient comes to see how certain choices or life decisions perpetuate the schema, and begins to make healthier choices that break old self-defeating life patterns P atient gradually gives up maladaptive coping styles in favor of more adaptive patterns. 30

31. 4. The Therapist–Patient Relationship Therapist assesses and treats schemas, coping styles, and modes as they arise in the therapeutic relationship Therapist–patient relationship serves as a partial antidote to the patient’s schemas P atient internalizes therapist as a “Healthy Adult” who fights against schemas and pursues an emotionally fulfilling life . 31

32. THANK YOU 32