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Section 7
Schema Therapy

Question 7 | Test | Table of Contents


Schema therapy has been developed specifically to treat personality disorders, but has now been successfully used to treat chronic depression, childhood trauma, criminal offenders, eating disorders, couples work, relapse prevention and substance abuse.

Patients with personality disorders or more chronic conditions have failed to respond fully to traditional cognitive behavioural therapy treatments. (Beck, Freeman & Associates, 1990.)
Clients have difficulty maintaining stable relationships, are impulsive, display inappropriate anger, have recurrent suicidal threats, gestures, or behaviours. They may also suffer from identity disturbance, chronic feelings of emptiness/boredom, and display efforts to avoid real or imagined abandonment or rejection. NHS staff therefore remain largely unskilled in dealing with this client group and may result in further feelings of rejection and abandonment as staff are only too relieved to have the client move on to yet another department or service.

"These clients are treated with minimal compassion and much blame in other therapies," Young, (2003).

Schema therapy therefore is unusually compassionate and humane and normalizes psychological disorders. The approach is sympathetic and respectful with the emphasis very much on the therapy relationship. Schema therapy is a combination of aspects of different therapies, including cognitive behavioural, attachment, gestalt, object relations, constructivist and psychoanalytical. It expands on cognitive behavioural therapy by placing greater emphasis on explaining childhood and adolescent origins of psychological problems, emotional techniques, the client -therapist relationship and on maladaptive coping styles.

Schema's: A schema can be described as a broad pervasive theme or pattern comprised of memories, emotions, cognitions and bodily sensations regarding oneself and one's relationships with others developed during childhood or adolescence elaborated throughout one's lifetime and dysfunctional to a significant degree.

These early maladaptive schema's are self defeating emotional and cognitive patterns that begin early in our development and repeat throughout life. These schema's then cause self defeating patterns or behaviours, i.e., difficulty in relationships, intense anger and attention seeking behaviour which can lead to depression and anxiety. Unless the underlying schema has been healed or modified then the self defeating behaviours will constantly repeat themselves resulting in the client dipping in and out of depression and anxiety. Borderline clients will find themselves limping from crisis to crisis and service to service with no stability in their lives.

Treatment focuses on identifying the maladaptive schema's and the lack of attachments or indeed the dysfunctional attachments in childhood and adolescence. These deficits will be linked to present problems encountered in life. The therapist and the client through therapy will attempt to heal the dysfunctional schema's which will result in less mental health difficulties and a more stable lifestyle.

The latest research which has yet to be published by Arnoud Arntz on a clinical trial of schema-focused therapy for BPD reports that 50% of those treated no longer met criteria for BPD. Young,J.E, (2004) Conference, Strandmillis College, BelFASDt. Psychological Society.
- Walsh, Ken, Schema Therapy: An Overview, Guilford Press: New York, 2004.

Personal Reflection Exercise Explanation
The Goal of this Home Study Course is to create a learning experience that enhances your clinical skills. We encourage you to discuss the Personal Reflection Journaling Activities, found at the end of each Section, with your colleagues. Thus, you are provided with an opportunity for a Group Discussion experience. Case Study examples might include: family background, socio-economic status, education, occupation, social/emotional issues, legal/financial issues, death/dying/health, home management, parenting, etc. as you deem appropriate. A Case Study is to be approximately 50 words in length. However, since the content of these “Personal Reflection” Journaling Exercises is intended for your future reference, they may contain confidential information and are to be applied as a “work in progress.” You will not be required to provide us with these Journaling Activities.

Personal Reflection Exercise #1
The preceding section contained information about schema therapy. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Schema Therapy for Violent PD Offenders:
A Randomized Clinical Trial

Bernstein, D. P., Keulen-de Vos, M., Clercx, M., de Vogel, V., Kersten, G. C. M., Lancel, M., Jonkers, P. P., Bogaerts, S., Slaats, M., Broers, N. J., Deenen, T. A. M., & Arntz, A. (2023). Schema therapy for violent PD offenders: a randomized clinical trial. Psychological medicine, 53(1), 88–102.

Peer-Reviewed Journal Article References:
DeShong, H. L., Grant, D. M., & Mullins-Sweatt, S. N. (2019). Precursors of the emotional cascade model of borderline personality disorder: The role of neuroticism, childhood emotional vulnerability, and parental invalidation. Personality Disorders: Theory, Research, and Treatment, 10(4), 317–329.

Haliczer, L. A., Woods, S. E., & Dixon-Gordon, K. L. (2020). Emotion regulation difficulties and interpersonal conflict in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment.

Metcalfe, R. K., Fitzpatrick, S., & Kuo, J. R. (2017). A laboratory examination of emotion regulation skill strengthening in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 8(3), 237–246.

Southward, M. W., & Cheavens, J. S. (2020). Quality or quantity? A multistudy analysis of emotion regulation skills deficits associated with borderline personality disorder. Personality Disorders: Theory, Research, and Treatment, 11(1), 24–35.

QUESTION 7
What percent of those treated no longer met criteria for Borderline Personality Disorder? To select and enter your answer go to Test.

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