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What Is Schema Therapy?

By Christina Whyte
Updated Feb 21, 2024
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Schema therapy or schema-focused cognitive therapy is a type of psychotherapy or talk therapy which is related to cognitive behavioral therapy. It is often used to treat patients with personality disorders or multiple serious mental health problems, which have historically been difficult to treat, as well as patients for whom other types of therapy have been ineffective. This type of therapy is structured and directive, and has historically produced good results for many patients.

The concept of schemas and in particular early maladaptive schemas is central to schema therapy. Schemas are deeply-held, pervasive patterns of thought and belief which can seriously disrupt a person's life if they are negative. They are very difficult to change or even recognize, since they permeate a patient's life in many different areas and form part of the backbone of a patient's views on self and life. These are most commonly developed in childhood, in which case they are called early maladaptive schemas, although they can also be developed later in life.

In schema theory, these patterns of thought are the reason that some people persist in repetitive, destructive, and maladaptive patterns of behavior towards themselves and in their relationships with other people. For example, a patient with a schema about failure may believe that he or she will fail at work, in romantic relationships, and as a parent, and that failure is inevitable and deserved. People deal with this in three ways according to schema theory: surrender to it and embrace situations that support it, avoid encountering situations which relate to it, or overcompensate for it, often with hostility.

Through schema therapy, the therapist and the patient work to identify and change the patient's maladaptive schemas. There are three stages to schema therapy: assessment, awareness, and behavioral change. Patients first discover their schemas through questionnaires and exploratory conversation, then learn how to recognize incidences in daily life and see how these issues have an impact upon them. Finally, they learn how to make changes that challenge the schema, and develop positive coping skills and attitudes.

As opposed to short term treatment which addresses a single behavioral issue or helps a patient recover from a mental health crisis, schema therapy is intended for people who have had lifelong struggles. Schema therapy is a structured kind of therapy in which the patient and therapist interact and follow certain steps which demonstrate the patient's progress towards overcoming negative patterns. This is unlike other types of therapy such as psychoanalysis where the therapist is mostly a passive listener.

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