Schema therapy can help individuals identify the thought and behavior patterns underlying and perpetuating mental health conditions. The treatment approach integrates elements from cognitive behavioral therapy, attachment theory, and a number of other approaches, expanding on CBT through exploration of emotions, maladaptive coping methods, and the origin of mental health concerns.
Mental health professionals work with those seeking treatment to discover the origins of any unmet emotional needs. Through schema therapy, people frequently become better able to develop a greater sense of self-worth and adequacy, explore methods of constructing nurturing relationships, and develop and achieve goals to work toward a healthy and happy life experience.
Dr. Jeffrey Young began the development of schema therapy in the mid-1980s after he found cognitive behavioral therapy to be less helpful for some individuals than others, particularly those with chronic characterological concerns. He combined concepts from Gestalt, object relations, constructivist, and psychoanalytic approaches into a unified modality that focused on the particular strengths of each method.
The first Schema Therapy Institute opened in Manhattan in the 1990s. A number of studies conducted with the approach found it to be a highly effective treatment for borderline personality, and research further developing schema therapy and demonstrating its efficacy continues today. More recently, schema therapy has also been combined with mindfulness meditation to form a more spiritual approach.
When emotional needs—one’s basic needs for affection, guidance, love, shelter, and safety—go unmet in childhood, individuals may enter adulthood with deficits in their abilities to find ways for these needs to be met, independently and through healthy relationships with others. Schema therapy is based on the belief that early maladaptive schemas form based on these adverse childhood experiences. These maladaptive schemas, which can be described as ways individuals interpret life events and the behavior of others, can later disrupt life: Individuals may make unhealthy choices, form toxic relationships, lack fully developed social skills, engage in destructive behavior patterns, have a poor sense of judgment, and experience feelings of worthlessness or self-doubt.
Identifying and modifying maladaptive schemas is central to schema therapy. Discovering the origins of one’s unmet emotional needs and learning to construct nurturing relationships through schema therapy can help people begin to build feelings of self-worth and adequacy.
Therapeutic techniques used in this process may include:
Schema therapy was developed to more effectively treat mental health conditions affecting individuals across many periods and aspects of their lives after Dr. Young noticed not only were some concerns especially difficult to treat, but aspects of these conditions continued to cause problems for some individuals, even after generally effective treatment.
Studies conducted on schema therapy show this type of therapy is often effective in addressing:
Schema therapy has been shown to be particularly effective in the treatment of borderline personality, and research shows individuals in treatment dropped out of schema therapy at lower rates than they dropped out of other types of treatment.
In addition, schema therapy has shown potential as a treatment for narcissistic personality. Further research may be necessary to fully establish schema therapy as an effective treatment for narcissism, as individuals with narcissistic personality do not commonly seek treatment voluntarily.
The International Society of Schema Therapy (ISST) provides training and certification for therapists who wish to practice schema therapy and also maintains an online database of therapists trained in delivery of schema therapy. Schema therapists typically have a thorough background in the treatment of chronic mental health conditions and personality-related concerns.
To obtain standard certification in schema therapy, individuals must:
Self-therapy and peer supervision are strongly recommended as part of the certification process.
Advanced certification is also offered. Upon completion of an advanced certification program, practitioners are qualified to become certified as a supervisor or trainer and, after three years of practice, run training programs.
Schema therapy is a fairly new form of psychological intervention, and research on this approach to treatment is still emerging. A recent review of research on schema therapy found initial evidence of effectiveness but also noted the necessity of a more comprehensive research base regarding positive outcomes and cost-effectiveness.
One major concern regarding schema therapy relates to the cost and length of time of the treatment. Given that schema therapy works to treat chronic problems, treatment often takes longer and costs more than other time-limited evidence-based interventions. But because chronic mental health conditions often become costly to health care organizations if left untreated, schema therapy may, in the end, be less expensive than the costs associated with chronic conditions when they are not successfully treated.
References: