Schema Therapy

SCHEMA THERAPY is an integrated and innovative therapeutic model that blends thinking from Cognitive Behavioral Therapy, Gestalt Therapy, Attachment Therapy and other psychodynamic theories into a rich and comprehensive treatment model.

This model is very effective at addressing issues around depression and anxiety as well as changing the deep-seated and dysfunctional patterns or “schemas” that undermine a person’s emotional health and functional living.  It also addresses and changes the various coping styles that work to perpetuate these schemas.  The means by which these important changes are made include a comprehensive and focused approach that addresses the cognitive, emotional and behavioral systems.

Schema Therapy calls for a collaborative therapeutic relationship between the therapist and client in addressing the coping styles and schemas which impede healthy living and the work is to change and heals these coping styles and schemas so that they can better understand their innate emotional needs to learn better ways to meet these important needs in a more functional manner.

Schema Therapy is in fact, a needs-based therapy which means that it is based on the assumption that humans have a set of basic needs that need to be met in the context of human relationships.  The lack of meeting these basic human needs, particularly in childhood, will create maladaptive schemas.

The basic emotional and relational needs that all people have are as follows: safety, connection and acceptance, autonomy and skill building, appropriate boundaries, nurturing and validation, and self-expression.

Schemas are deep-seated and entrenched patterns that are developed through basic needs not being met, which are caused by neglect and all forms of abuse and trauma.  These schemas are dysfunctional to a significant degree and are expressed throughout the lifespan.

Schema Therapy has identified 18 maladaptive schemas:

1. Abandonment/Instability: The perceived instability and unreliability of those available for support and connection.
2. Mistrust/Abuse. The expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage.
3. Emotional Deprivation: The expectation that one’s desire for a normal degree of emotional support will not be adequately met by others.  The 3 forms of deprivation include deprivation of nurturance, deprivation of empathy and the deprivation of empathy.
4. Defectiveness/Shame: The feeling that one is defective, bad, unwanted, inferior, or invalid in important respects, or that one would be unlovable to a significant degree if exposed.
5. Social Isolation/Alienation: The feeling that one is isolated from the rest of the world, different from other people, and/or not part of any group or community.
6. Dependence/Incompetence: Belief that one is unable to handle one’s everyday responsibilities in a competent manner, without considerable help from others.  Often presents as helplessness.
7. Vulnerability to Harm or Illness: Exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it.
8. Enmeshment/Undeveloped Self: Excessive emotional involvement and closeness with one or more significant others (often parents), at the expense of full individuation or normal social development.
9. Failure: The belief that one has failed, will inevitably fail, or is fundamentally inadequate relative to one’s pees, in areas of achievement (school, career, sports, etc.).
10. Entitlement/Grandiosity: The belief that one is superior to other people; entitled to special rights and privileges; or not bound by the rules of reciprocity that guide normal social interaction.
11. Insufficient Self-Control/Self-Discipline: pervasive difficulty or refusal to exercise sufficient self-control and frustration tolerance to achieve one’s personal goals, or to restrain the excessive expression of one’s emotions and impulses.
12. Subjugation: Excessive surrendering of control to others because one feels coerced – usually to avoid anger, retaliation, or abandonment.
13. Self-Sacrifice: Excessive focus on voluntarily meeting the needs of others in daily situations, at the expense of one’s own gratification.
14. Approval-Seeking/Recognition-Seeking: Excessive emphasis on gaining approval, recognition, or attention from other people, or fitting in, at the expense of developing a secure and true sense of self.
15. Negativity/Pessimism: A pervasive, lifelong focus on the negative aspects of life (pain, death, loss, disappointment, conflict, guilt, resentment, unsolved problems, potential mistakes, betrayal, things that could go wrong, etc.) while minimizing or neglecting the positive or optimistic aspects.
16. Emotional Inhibition: The excessive inhibition of spontaneous action, feeling, or communication – usually to avoid disapproval by others, feelings of shame, or losing control of one’s impulses.
17. Unrelenting Standards/Hypercriticalness: The underlying belief that one must strive to meet very high internalized standards of behavior and performance, usually to avoid criticism.
18. Punitiveness: The belief that people should be harshly punished for making mistakes.  Involves the tendency to be angry, intolerant, punitive, and impatient with those people (including oneself) who do not meet one’s expectations or standards.

There are 3 coping styles that perpetuate the above mentioned schemas:

1. Schema Surrender: To act in an overt way to demonstrate yourself and others, consciously or unconsciously, that the schema(s) is true of you. For instance, a person with an emotional deprivation schema may demonstrate schema surrender by only relating to people who are cold and withholding.
2. Schema Counterattack: To act in a way that demonstrates that the schema(s) is not true of you but probably true of others.  Could also be called overcompensation.  For example, a person with a defectiveness schema may not acknowledge any faults of their own but will be quick to point out other’s failings.

3. Schema Avoidance: To act in a way to prevent the schema from being triggered even though the schema(s) is still true of you.  Addictions and other kinds of compulsive behaviors could be forms of schema avoidance. For instance, a person with abandonment schema will divert interactions with others by watching excessive TV, or surfing the internet so as not to meet anyone or establish a relationship

The work is to work through the coping styles and schemas and identify the needs that require meeting and to then learn more appropriate and healthier ways to meet these needs.

Research has shown that Schema Therapy is very effective in helping people with moderate to severe characterlogical disorders and anecdotally, many others with far less severe struggles and issues have seen very positive results after working with a skilled schema therapist.

To make an appointment with Jeff Conway, you can contact him at 212/481-2460.

He is conveniently located in midtown at 315 5th Avenue (on the corner of 5th Avenue and 32 Street) in suite 707.