Week 8 - Schema Therapy Flashcards
What is schema therapy?
A newer type of therapy that combines elements of CBT, psychoanalysis, attachment theory and emotion-focused therapy, among others.
What is the aim of schema therapy?
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
What are schemas?
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.
What are the 3 stages of schema therapy?
- Assessment phase
- Emotional awareness and experiential phase
- Behavioural change
During the assessment phase, what is being done?
Identification of schemas during formal assessments
During the emotional awareness and experiential phase, what is being done?
Getting clients to be in touch with their schemas and learning to spot them when operating in their day-to-day life.
What should occur during the behavioral change state?
Client should be actively invovled in replaing negative, habitual thoughts and behaviours with new, healthy cognitive and behavioral options.
List 2 traits of schema therapy.
• High resource – Long-term treatment – Intensive (high frequency of sessions) • Experiential – Role plays with therapist – Emotional process
What are the core needs of a child?
- sense of safety and being securely attached to others
- building a sense of self-identity and autonomy
- freedom to express how you feel and ask from others what you need
- ability to play and be spontaneous
- safe, age-appropriate limits and boundaries.
List 4 types of negative experiences that can give rise to negative schemas.
- Unfulfilled needs
- Traumatization or victimization
- Overindulgence or lack of limits
- Selective identification and internalization
How do unfulfilled needs lead to negative schemas?
don’t receive affection from caregivers or fail to have other core emotional needs met.
so u think damn i am unlovable af
How does overindulgence lead to negative schemas?
no proper boundaries set - overprotective or overinvolved parents.
How does selective identification and internalization lead to negative schemas?
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
There are ____ domains and ____ schemas.
5, 18
Domain 1 is disconnection and rejection, which includes schemas that makes it difficult to?
incel cannot do what?
develop healthy relationships
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
impaired autonomy and performance
Domain 3 is _______ and that includes schemas that affect self-control and the ability to respect boundaries.
impaired limits
Domain 4 is other-directedness, which leads you to?
overly prioritize others over yourself.
Domain 5 is _________, where you prioritize avoiding failure or mistakes through alertness, rules and disregarding desires or emotions.
over-vigilance and inhibition
Describe 4 types of modes/coping mechanisms one can have, according to schema therapy
- Child mode
- Dysfunctional coping modes
- Dysfunctional parent modes
- Healthy mode.
Child mode is characterized by __________
childlike feelings and behaviours
What are 4 subtypes of child mode?
- Vulnerable
- Angry
- Impulsive/undisciplined
- Happy
What are the goals of schema therapy?
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
How does the vulnerable child mode behave?
Experience unhappy or anxious emotions, especially fear, sadness and helplessness, when in touch with associated schemas.
E.g abandonment, mistrust/abuse, emotional deprivation, defectiveness
How does the angry child mode behave?
Vents anger directly in response to perceived unmet core needs or unfair treatment related to core schemas
E.g abandonment, subjugation, emotional deprivation
How does the impulsive child behave?
Impulsively acts according to immediate desires for pleasure without regard to limits or others’ needs/feelings
E.g entitlement, insufficient self-control
What are maladaptive coping modes?
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.
list 3 types of maladaptive coping modes.
- compliant surrender (compliance and dependence)
- detached protector (emotional withdrawal, isolation, behavioural avoidance)
- overcompensator (counterattack and control)
How do dysfunctional parental modes manifest themselves?
Internalizations of parents or other important adults in your life. take on the voices of these people and use them to talk to yourself.
List 2 types of dysfunctional coping modes.
- punitive/critical
2. demanding
List 4 essential segments in treating clients with BPD using schema therapy.
1) awareness creating
2) cognitive techniques
3) behavioual experiments
4) experiential techniques
What is done during awareness creating?
clinical interview - focus on interpersonal relationships across life
questionnaires
schema diary to identify the triggers, emotions, thoughts, schemas, behaviours etc
What is done in cognitive techniques?
socratic questioning (downward arrow)
evaluate evidence for and against schema
Experiential techniques include _________ the client and showing them ________ so that they can recreate new positive schemas
re-parenting
positive regard
Evaluate the suitability of ST for clients.
Who suitable and who not suitable (life stage)
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.
ST is generally suitable for PTSD clients. True or false?
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
List 3 styles of coping with distress caused by early maladaptive schemas in clients with BPD.
- overcompensation
- avoidance (emotional detacher)
- surrender
Overcompensation manifests itself in the form of ?
Fighting one’s own schemas and faking a different reality
Avoidance manifests itself in the form of _____
triggers that activate a schema
Surrendering is when?
give up and allow schemas to rule you.
Describe how EMS trigger pathology in BPD clients.
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
Evaluate the effectiveness of ST (against TFP)
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
List 5 domains governing schemas.
- Disconnectedness and rejection.
- Impaired autonomy and performance
- Impaired limits
- Other-directedness
- Over-vigilance and inhibition
