Schema therapy has been developed specifically to treat personality
disorders, but has now been successfully used to treat chronic depression,
childhood trauma, criminal offenders, eating disorders, couples work, relapse
prevention and substance abuse.
Patients with personality disorders or
more chronic conditions have failed to respond fully to traditional cognitive
behavioural therapy treatments. (Beck, Freeman & Associates, 1990.) Clients
have difficulty maintaining stable relationships, are impulsive, display inappropriate
anger, have recurrent suicidal threats, gestures, or behaviours. They may also
suffer from identity disturbance, chronic feelings of emptiness/boredom, and display
efforts to avoid real or imagined abandonment or rejection. NHS staff therefore
remain largely unskilled in dealing with this client group and may result in further
feelings of rejection and abandonment as staff are only too relieved to have the
client move on to yet another department or service.
are treated with minimal compassion and much blame in other therapies,"
Schema therapy therefore is unusually compassionate and
humane and normalizes psychological disorders. The approach is sympathetic and
respectful with the emphasis very much on the therapy relationship. Schema therapy
is a combination of aspects of different therapies, including cognitive behavioural,
attachment, gestalt, object relations, constructivist and psychoanalytical. It
expands on cognitive behavioural therapy by placing greater emphasis on explaining
childhood and adolescent origins of psychological problems, emotional techniques,
the client -therapist relationship and on maladaptive coping styles.
Schema's: A schema can be described as a broad pervasive theme or pattern
comprised of memories, emotions, cognitions and bodily sensations regarding oneself
and one's relationships with others developed during childhood or adolescence
elaborated throughout one's lifetime and dysfunctional to a significant degree.
These early maladaptive schema's are self defeating emotional and cognitive
patterns that begin early in our development and repeat throughout life. These
schema's then cause self defeating patterns or behaviours, i.e., difficulty in
relationships, intense anger and attention seeking behaviour which can lead to
depression and anxiety. Unless the underlying schema has been healed or modified
then the self defeating behaviours will constantly repeat themselves resulting
in the client dipping in and out of depression and anxiety. Borderline clients
will find themselves limping from crisis to crisis and service to service with
no stability in their lives.
Treatment focuses on identifying
the maladaptive schema's and the lack of attachments or indeed the dysfunctional
attachments in childhood and adolescence. These deficits will be linked to present
problems encountered in life. The therapist and the client through therapy will
attempt to heal the dysfunctional schema's which will result in less mental health
difficulties and a more stable lifestyle.
The latest research which has
yet to be published by Arnoud Arntz on a clinical trial of schema-focused therapy
for BPD reports that 50% of those treated no longer met criteria for BPD. Young,J.E,
(2004) Conference, Strandmillis College, Belfast. Psychological Society. -
Walsh, Ken, Schema Therapy: An Overview, Guilford Press: New York, 2004.
Borderline Personality Disorder
- National Institute of Mental Health. Borderline Personality Disorder. U.S. Department of Health and Human Services.
Personal Reflection Exercise Explanation The
Goal of this Home Study Course is to create a learning experience that enhances
your clinical skills. We encourage you to discuss the Personal Reflection
Journaling Activities, found at the end of each Section, with your colleagues.
Thus, you are provided with an opportunity for a Group Discussion experience.
Case Study examples might include: family background, socio-economic status, education,
occupation, social/emotional issues, legal/financial issues, death/dying/health,
home management, parenting, etc. as you deem appropriate. A Case Study is to be
approximately 150 words in length. However, since the content of these Personal
Reflection Journaling Exercises is intended for your future reference, they
may contain confidential information and are to be applied as a work in
progress. You will not
be required to provide us with these Journaling Activities.
Reflection Exercise #1 The preceding section contained information
about schema therapy. Write three case study examples regarding how you might
use the content of this section in your practice.
8 What percent of those
treated no longer met criteria for Borderline Personality Disorder? To select and enter your answer go to theTest.