Schema Therapy for Personality Disorders
Schema therapy is based upon schema theory. It has recently emerged as an effective treatment for Borderline Personality Disorder and has been successfully applied to other personality disorders as well (Young & Klosko, 2005). Schema therapy was developed by the psychologist Jeffrey Young, Ph.D. and is considered to be an integrative psychotherapy approach; meaning, it draws from several psychological theories to formulate a corrective strategy for repairing a damaged personality. Schema therapy derives mainly out of cognitive-behavioral theory, but also includes elements of attachment theory, and object relations theory.
The theoretical underpinning of schema therapy have been previously discussed. By way of brief review, schemas are considered an organizing framework of the mind and represent patterns of internal experience including memories, beliefs, emotions, and thoughts. Maladaptive schemas form when a child's core needs are not met. These core needs may include: safety, security, nurturance, acceptance, respect, autonomy, guidance, direction, love, attention, approval, self-expression, joy, pleasure, and relaxation. Young contends that the problem for people with personality disorders is that these core needs were not met which led to the development of "early maladaptive schemas." Maladaptive schemas and the associated unmet core needs are a focal point of schema therapy.
Young believes that people with personality disorders have developed maladaptive schemas stemming from "toxic childhood experiences" that caused the formation of self-defeating patterns of interaction with the world. These self-defeating patterns of interaction get played out throughout the person's lifetime causing them a great deal of trouble, heartache, and grief. People with personality disorders tend to use maladaptive coping strategies in response to the maladaptive schemas. These maladaptive coping strategies can be categorized into three basic types: 1)surrender strategies, 2) avoidance strategies, or 3) overcompensation strategies. Ironically, the coping strategies themselves end up causing people problems. Schema therapy attempts to elucidate these maladaptive coping strategies and to replace them with more adaptive ones. For a more detailed explanation of these concepts, please return to the section on schema theory.
Let's consider the example of a woman with Borderline Personality Disorder who was abandoned as a child. This could include abandonment through divorce or death of a parent, but could also include emotional abandonment through neglect or parental indifference. A maladaptive schema would emerge to represent "Everyone I love will leave me." During adulthood, whenever she experiences an event that reminds her of this early abandonment, her abandonment schema is triggered and the she will experience strong negative emotions such as rage, shame, or fear. In response to the schema activation, a maladaptive coping strategy will be elicited. So, whenever her husband goes away on a business trip, this schema is triggered. As her husband prepares to go on his trip she may directly experience an intense emotional response in anticipation of his "abandonment," and she may become overwhelmed by these emotions. She responds with a maladaptive coping strategy of overcompensation. So, she refuses to take his phone calls in an effort to prove, "I don't need you" when in fact, this is quite opposite her true feelings of needing him very much. Schema therapy would assist this woman to identify her maladaptive schema and the maladaptive coping strategy, and to make corrections to both.
Schema therapy follows a fairly structured approach. It begins with an assessment phase where participants review their life history in an effort to link present-day problems to historical events. Next, assessment tools and questionnaires are used to assist the participant to identify their maladaptive schemas with an emphasis on linking present-day problems to childhood events. In addition, several experiential exercises are used to connect emotions to upsetting childhood events and to help the therapy participant to identify what core needs were unmet. This is accomplished by asking the participant to reflect back upon an upsetting, significant childhood event and to vividly image that event. Then, therapy participants are asked to engage in an imaginary dialogue with their caregiver, and to identify what it was they needed from their caregiver, but did not receive. This further clarifies unmet needs and illustrates how maladaptive schemas may have developed.