Week 8 - Schema Therapy

Question 1

What is schema therapy?

Answer 1

A newer type of therapy that combines elements of CBT, psychoanalysis, attachment theory and emotion-focused therapy, among others.

Question 2

What is the aim of schema therapy?

Answer 2

getting clients to change negative/maladaptive patterns which they have lived with for a long time when other methods and efforts they have tried before have been largely unsuccessful

Question 3

What are schemas?

Answer 3

Enduring, deep patterns or themes which are self-defeating “e.g i am unlovable”

Usually formed early in life, but can be in adulthood too.

Question 4

What are the 3 stages of schema therapy?

Answer 4

1. Assessment phase
2. Emotional awareness and experiential phase
3. Behavioural change

Question 5

During the assessment phase, what is being done?

Answer 5

Identification of schemas during formal assessments

Question 6

During the emotional awareness and experiential phase, what is being done?

Answer 6

Getting clients to be in touch with their schemas and learning to spot them when operating in their day-to-day life.

Question 7

What should occur during the behavioral change state?

Answer 7

Client should be actively invovled in replaing negative, habitual thoughts and behaviours with new, healthy cognitive and behavioral options.

Question 8

List 2 traits of schema therapy.

Answer 8

• High resource
– Long-term treatment
– Intensive (high frequency of sessions)
• Experiential
– Role plays with therapist
– Emotional process

Question 9

What are the core needs of a child?

Answer 9

1. sense of safety and being securely attached to others
2. building a sense of self-identity and autonomy
3. freedom to express how you feel and ask from others what you need
4. ability to play and be spontaneous
5. safe, age-appropriate limits and boundaries.

Question 10

List 4 types of negative experiences that can give rise to negative schemas.

Answer 10

1. Unfulfilled needs
2. Traumatization or victimization
3. Overindulgence or lack of limits
4. Selective identification and internalization

Question 11

How do unfulfilled needs lead to negative schemas?

Answer 11

don’t receive affection from caregivers or fail to have other core emotional needs met.

so u think damn i am unlovable af

Question 12

How does overindulgence lead to negative schemas?

Answer 12

no proper boundaries set - overprotective or overinvolved parents.

Question 13

How does selective identification and internalization lead to negative schemas?

Answer 13

Refers to the way you absorb some of your parents’ attitudes and behaviours

Might identify with some of these and internalize others.

Some develop into schemas, some into modes/coping methods

Question 14

There are ____ domains and ____ schemas.

Answer 14

5, 18

Question 15

Domain 1 is disconnection and rejection, which includes schemas that makes it difficult to?

incel cannot do what?

Answer 15

develop healthy relationships

Question 16

Domain 2 is _____________, people with this usually find it difficult to develop a strong sense of self and function in the world as an adult.

hint: a is for adult and a is also for ________?
2nd word can be related to school or SECKS

Answer 16

impaired autonomy and performance

Question 17

Domain 3 is _______ and that includes schemas that affect self-control and the ability to respect boundaries.

Answer 17

impaired limits

Question 18

Domain 4 is other-directedness, which leads you to?

Answer 18

overly prioritize others over yourself.

Question 19

Domain 5 is _________, where you prioritize avoiding failure or mistakes through alertness, rules and disregarding desires or emotions.

Answer 19

over-vigilance and inhibition

Question 20

Describe 4 types of modes/coping mechanisms one can have, according to schema therapy

Answer 20

1. Child mode
2. Dysfunctional coping modes
3. Dysfunctional parent modes
4. Healthy mode.

Question 21

Child mode is characterized by __________

Answer 21

childlike feelings and behaviours

Question 22

What are 4 subtypes of child mode?

Answer 22

1. Vulnerable
2. Angry
3. Impulsive/undisciplined
4. Happy

Question 23

What are the goals of schema therapy?

Answer 23

identify and begin healing schemas
identify and address coping styles that get in the way of emotional needs
change patterns of feelings and behaviors that result from schemas
learn how to get your core emotional needs met in healthy, adaptive ways
learn how to cope (in a healthy way) with frustration and distress when certain needs cannot be met

Question 24

How does the vulnerable child mode behave?

Answer 24

Experience unhappy or anxious emotions, especially fear, sadness and helplessness, when in touch with associated schemas.

E.g abandonment, mistrust/abuse, emotional deprivation, defectiveness

Question 25

How does the angry child mode behave?

Answer 25

Vents anger directly in response to perceived unmet core needs or unfair treatment related to core schemas E.g abandonment, subjugation, emotional deprivation

Question 26

How does the impulsive child behave?

Answer 26

Impulsively acts according to immediate desires for pleasure without regard to limits or others' needs/feelings E.g entitlement, insufficient self-control

Question 27

What are maladaptive coping modes?

Answer 27

Represents child's attempt to adapt to living with unmet emotional needs in a harmful environment. Adaptive in childhood maybe, but defo not in adulthood.

Question 28

list 3 types of maladaptive coping modes.

Answer 28

1. compliant surrender (compliance and dependence) 2. detached protector (emotional withdrawal, isolation, behavioural avoidance) 3. overcompensator (counterattack and control)

Question 29

How do dysfunctional parental modes manifest themselves?

Answer 29

Internalizations of parents or other important adults in your life. take on the voices of these people and use them to talk to yourself.

Question 30

List 2 types of dysfunctional coping modes.

Answer 30

1. punitive/critical | 2. demanding

Question 31

List 4 essential segments in treating clients with BPD using schema therapy.

Answer 31

1) awareness creating 2) cognitive techniques 3) behavioual experiments 4) experiential techniques

Question 32

What is done during awareness creating?

Answer 32

clinical interview - focus on interpersonal relationships across life questionnaires schema diary to identify the triggers, emotions, thoughts, schemas, behaviours etc

Question 33

What is done in cognitive techniques?

Answer 33

socratic questioning (downward arrow) evaluate evidence for and against schema

Question 34

Experiential techniques include _________ the client and showing them ________ so that they can recreate new positive schemas

Answer 34

re-parenting positive regard

Question 35

Evaluate the suitability of ST for clients. Who suitable and who not suitable (life stage)

Answer 35

Suitable for people who are vocal and able to imagine. May not be suitable for everyone, so hence, try a bit first to see how well the client receives it. Do it more for adults because young children are still developing schemas and it may be complex for them to understand. Adolescence? Maybe don't do the whole schema technique as schemas may not be that solid yet.

Question 36

ST is generally suitable for PTSD clients. True or false?

Answer 36

Schema therapy may not be useful for clients who have faced recent traumatic events because schema therapy generally targets early experiences but trauma could be due to a sudden and recent stressor

Question 37

List 3 styles of coping with distress caused by early maladaptive schemas in clients with BPD.

Answer 37

1. overcompensation 2. avoidance (emotional detacher) 3. surrender

Question 38

Overcompensation manifests itself in the form of ?

Answer 38

Fighting one's own schemas and faking a different reality

Question 39

Avoidance manifests itself in the form of _____

Answer 39

triggers that activate a schema

Question 40

Surrendering is when?

Answer 40

give up and allow schemas to rule you.

Question 41

Describe how EMS trigger pathology in BPD clients.

Answer 41

When EMS is activated, coping strategy leads to activation of related vulnerable modes People with BPD can only present one schema mode at a time which represents facets of personality that have not been integrated into a whole - this gives rise to a functional dissociative self which manifests itself as abrupt changes The more extreme the dissociative personality, the greater the degree of pathology and more separated the schema modes Therapeutic relationship is important to test and change the maladaptive character of the schema Unmet needs in early life stages lead to the development of negative assumptions/schemas which mediate and maintain BPD symptoms Maladaptive schemas of mistrust, abandonment, defectiveness and insufficient self-control seem to mediate general childhood maltreatment and BPD severity Emotional abuse always associated with BPD whereas sexual abuse is not always associated

Question 42

Evaluate the effectiveness of ST (against TFP)

Answer 42

After 3 years of ST and TFP, clients showed significant improvements in quality of life, reduction of BPD symptoms, general psychopathology and therapy specific outcomes On all outcomes, clients of ST showed a larger treatment effect, regarding impulsivity, identity disturbances, fear of abandonment, parasuicidality, quality of relationships More effective than TFP More cost effective than TFP because therapist can be successfully trained with a set of DVDs and they do not really have to provide supportive contact outside of working hours However, changes in attentional processes might be an alternative mechanism for improvement in functional outcomes (other than a change in EMS) which needs to be further studied

Question 43

List 5 domains governing schemas.

Answer 43

1. Disconnectedness and rejection. 2. Impaired autonomy and performance 3. Impaired limits 4. Other-directedness 5. Over-vigilance and inhibition