What Can Schema Therapy Help With?
Schema therapy’s goal is to help those in need recognize and treat their emotional needs.
Schema therapy can help treat emotional needs by helping the client:3
- Stop using maladaptive coping skills
- Stop using schema modes that block contact with true feelings
- Repair schemas and modes by working to meet needs in and out of the therapy relationship
- Establish reasonable limits for anger, impulsivity, and overcompensating
- Resist and combat punitive, critical, and demanding schemas and modes
- Create and nurture healthy schemas and modes
The types of mental health disorders and diagnoses that may be successfully treated with schema therapy are broad.
Researchers have found the schema therapy to be effective for:
Personality disorders like borderline personality disorder and avoidant personality disorder are more persisting and long lasting conditions, so schema therapy is a great option to address the long-term impacts of the condition. Studies show that schema therapy is effective for treating all personality disorders by reducing the effect of schemas at the end of sessions and at future follow ups.1
Bulimia, anorexia, and other eating disorders can result in serious physical and mental health consequences to the individual. According to several studies, schema therapy is helpful in improving body mass index and reducing the severity of schemas.1
People with symptoms of panic and agoraphobia may struggle for long periods before finding helpful treatments that allow them to routinely leave their home. With the use of schema therapy, these people can expect a reduction of overall symptoms and schema ratings. Studies show best results with a combination of schema and cognitive behavioral therapies.1
Chronic depression may make people feel hopeless and that not treatments will create benefit. One study found that schema therapy can make a significant improvement in depressive symptoms, but interestingly, the effects were not immediate. At the end of treatment, the improvements were minor, but when the researchers completed follow up assessments, larger benefits were found.1
Post-Traumatic Stress Disorder (PTSD)
Schema therapy appears to provide substantial benefit to people with PTSD with notable improvements from intake to follow up contact months after treatment ends.1
Schema Therapy Examples
All schema therapies will focus on assessing and changing schemas. By completing this process, the client can find new happiness and freedom from the influence of unwanted childhood experiences.
No matter the condition, schema therapy is separated into two phases:2
- Assessment & education phase-The therapist helps the person identify their schemas, where they come from, and the schema mode. Next, the therapist works to help the client notice their unhelpful coping styles, how these continue to maintain their schemas, and when they flip from one mode to another.
- Change phase-By implementing a combination of cognitive, experiential, behavioral, and interpersonal techniques, the therapist aims to challenge and dispute schemas in place. When a schema is challenged and found to be false, it will have a less impactful influence.
Schema Therapy With Borderline Personality Disorder
Borderline personality disorder is a serious mental health disorder marked by chaotic, intense, and inconsistent relationships where the individual commonly fears a threat of abandonment.5
Treatment will start in the assessment and education phase by ensuring the person understands their diagnosis and works to learn about schemas in play.
If the person fears rejection and instability in relationships, the therapist will likely focus on the disconnection and rejection schema domain. By searching for examples of love, acceptance, and nurturance, the therapist and client can work to combat the negative pattern of thinking.
Schema Therapy for Post-Traumatic Stress Disorder
Schema therapy with PTSD symptoms will begin with a period of assessment and education. By investigating the nature of the trauma, the timing of the trauma, and the schemas that interact with the trauma, the therapist will build a conceptualization of the client’s symptoms.
>During this period, the schema therapist will inform the client about schema therapy, the effects of schema, and common effects of trauma. They will also emphasize connections between the trauma and the client’s childhood.
Since a person with symptoms of PTSD may experience issues within the domains of disconnection and rejection as well as over vigilance and inhibition, the therapist will examine present schemas and coping skills. The client may prefer to isolate and avoid as their primary coping skill, so the therapist will push them towards changing their behaviors through a slow and steady progression.1
Schema Therapy for Depression
Chronic, low-grade depression, like that found in persistent depressive disorder, can make life feel like a never-ending cycle of pain, doubt, and unhappiness.5 People with this condition will be great candidates for schema therapy.
After the assessment and education phases, the schema therapist will work to illustrate to the client the connections between their childhood, their parents, their schema, and their depression. As people with depression seek out maladaptive coping skills to manage their symptoms, the client may have issues within the other-directedness domain. They may give and give to others as a way to create bursts of happiness, but these feelings will be fleeting.
The therapist will point out how being more selfish as times can improve the client’s mental health and well-being. The therapist will also prepare the client for the possible negative reactions from people who normally take advantage of the client’s kindness. With communication, behavioral, and cognitive skills learned from the therapist, the client will control and shift their schemas.
Cost of Schema Therapy
Schema therapy is a widely-recognized form of psychotherapy that integrates other styles and orientations into sessions, which means insurance will typically cover its use. People with high deductibles or no insurance may have to pay an average of $50 to $150 for one session.4
Professionals with higher levels of education may charge higher rates, with psychiatrists and psychologists being more expensive than social workers and counselors. Some providers who are especially renowned may charge higher for their services and might not accept insurance coverage.
How to Find a Schema Therapist
People interested in therapists offering schema therapy directly may find it challenging to locate providers through common means like asking the family doctor or local mental health agency for a referral. Schema therapists will not be as common as CBT practitioners.
The International Society of Schema Therapy offers a directory here. If that does not yield any success, consider typing “schema therapist near me” into a search engine for more options.
Who Is Able to Offer Schema Therapy?
Any therapist can claim to use schema therapy as their primary approach, but their credentials and experience may be lacking. Schema therapists will have at least a masters degree in counseling, social work, psychology, or a related field, specific training, and frequent supervision in the practice of schema therapy.
Key Questions to Ask a Therapist Before Beginning Schema Therapy
With any therapist, it is helpful to prepare a list of questions before treatment begins or during the first session. Good questions to ask a schema therapist include:
- What are your experiences and credentials as a schema therapist?
- Is schema therapy a good fit for my symptoms?
- I don’t want to talk about the past. Can schema therapy help me?
- How long will I need to attend schema therapy?
- What, if any, other psychotherapy orientations do you utilize in sessions?
What to Expect at Your First Appointment
As outlined earlier, the first session or several sessions of schema therapy will likely involve a lot of assessment and education. Depending on the therapist and their particular style, they could accomplish this by completing an informal interview of your presenting problems and symptoms, or the therapist could use a formal assessment tool like the Young Schema Questionnaire (YSQ), the Young-Atkinson Mode Inventory, or the Schema Mode Inventory.1
From the earliest sessions, the therapist will employ empathic confrontation and limited reparenting to improve symptoms.2
- Empathic confrontation – offering support and encouragement for the client while showing that their schemas are distorting client perceptions
- Limited reparenting – supplying the client with what the client never received from their parents, within the appropriate limits of the therapeutic relationship
Is Schema Therapy Effective?
Schema therapy may not be as widely-known as CBT, but the treatment is proven effective for a variety of long-term mental health issues and complications.
Schema can improve schemas and coping skills for people with:1
- Borderline personality disorder
- Other personality disorders like avoidant personality disorder
- Eating disorders
- Anxiety disorders
In the coming years, professionals and clients should expect to be able to learn more about the efficacy of schema therapy as the treatment receives more attention and testing. Currently, the full capabilities of schema therapy are not well understood.
Criticisms of Schema Therapy
Perhaps the most significant criticism or drawback of schema therapy is how new the treatment is. In the field of psychology, the most well-known and respected treatments have been around for between 60 and 160 years, so schema therapy is somewhat unproven after only 30 years.2
For people only interested in a large body of evidence-based research to support a therapy style, schema therapy does not yet have the backing to put it on the same level as others like CBT.
The History of Schema Therapy
Jeffrey Young began as a therapist using a cognitive therapy or cognitive behavioral therapy (CBT) model for treatment, but around 1990, he noted limitations to the treatment style. Although treatments worked really well for some people, others, like those with personality disorders, never seemed to make the progress he wanted.
Over years of theorizing and research, he began to develop the framework of schema therapy that took many aspects of CBT and blended it with the idea of “going deeper” that is fundamental to approaches like psychoanalysis. By taking helpful aspects of various established treatments, Young created something unique in schema therapy.6
With schema therapy being a contemporary therapy style, it continues to grow and evolve under the mentorship of its creator. As awareness and acceptance builds, Young hopes that schema therapy can be applied to more psychological concerns.