Schema Therapy for Complex Posttraumatic Stress Disorder
By Jeff Dwarshuis LMSW ACSW
What Is Schema Therapy?
Schema Therapy is a branch of Cognitive Therapy that was developed by Jeffrey Young PhD and includes several different psychotherapeutic interventions including Behavioral, Gestalt, Psychoanalytic and Relational Therapies. Schema Therapy argues that if individuals are abused or neglected as children, they may develop “maladaptive schemas”. This is particularity true with individuals who have a history of repeated abuse or repeated traumatic incidences causing Complex Posttraumatic Disorder. Maladaptive schemas (Known simply as schemas) can be defined as self-defeating emotional and cognitive patterns that begins in early childhood and continue throughout life. The goal of Schema Therapy is to eliminate the schema(s) by recognizing and challenging it and replacing it with more effective behaviors.
Schema Recognition
The first step in Schema Therapy is schema recognition or evaluating if an individual has any schemas. This can be done in several ways. First, individuals can read “Reinventing Your Life” by Jeffrey Young PhD and complete a brief set of questions on each schema listed throughout the book. This will illustrate both the existence and intensity of the schema. Second, in a therapeutic setting, an individual can complete a questionnaire which will identify the presence of certain schemas as well as their intensity. After a schema is recognized, the person can read schema descriptions, provided in the book or by the therapist. These descriptions can bring clarity and definition to emotional and relational hardship.
Testing Schema Validity
After an individual knows about their schemas and understands the description of the schema, they can begin to challenge the schema by testing its validity. Schemas, in general, are inaccurate negative representations of the person and can reasonably be disproven through evidence. However, people often will identify with their schemas and see a schema as a representation of who they are. Therefore, creating a list supporting how the individual sees themselves relating to the negative qualities of the schema can easily be done while creating a list of evidence about how the person is different from the schema can be difficult.
Testing the validity of the schema can be done by first listing all evidence from the past and present to support the reality of the schema. There should be a general consideration of these questions. How does this description of the schema apply to me? How do I act it out? How might others see me as acting out this schema? Following this, the person should make a list of all the evidence that refutes the schema. The person can do this by evaluating their realistic accomplishments, intentions and capacity shown throughout their life that are different from the schema.
Schema Reframing
After testing the schema’s validity, the individual should challenge the reality of the schema by reframing it. This can be done by taking each piece of evidence that supports the schema and attributing it to another more rational cause. For example, instead of thinking “I am unlovable” the person might instead say “I was not given enough attention and was taught to think I was unlovable” or instead of thinking “I am a failure” the person might list or say “I was not given enough opportunity to recognize my potential.” Typically, these causes have to do with the person’s childhood family, especially the parents who had control over the person’s life and events that may have contributed to the schema development. It is important to not personalize the schema but to rationally consider the influences of its development.
Identifying the Advantages and Disadvantages of the Coping Behaviors
Schemas are themselves emotional and cognitive patterns and each person has a set of behaviors that are used to deal with, display, represent or ignore the schema(s). These behaviors are called “coping responses”. Coping responses generally fall into the behavioral categories of avoiding, surrendering or overcompensating for the schema. One can think about and then list these coping responses then evaluate both the pros and cons of what the coping responses do or don’t do. It is important to recognize that these behaviors may have been adaptive as a child but are no longer beneficial or appropriate as an adult. Then, after listing the coping responses, one can list and use an alternative healthy behavior.
Schema Problem Solving
With the initial exercises completed one is a better position to coordinate and use the learning on a day to day basis. The goal is to use some of the understandings and growing awareness from the previous exercises an apply them together to daily relational and emotional challenges perpetuated by the schema(s).
Completing the framework sentence below will allow for spontaneous change and the elimination of schemas. The goal is to get to the point of being able to do the exercise automatically in real life settings.
I feel (emotion) because of (causal event). This event has triggered my (schema) and has caused me to want to do (coping behavior). Although my schema causes me to believe that I am (negative self-belief) I am (rational positive self-belief) as evidenced by (supporting evidence). Although I would like to do (negative behavior) instead I will do (positive behavior).
Resources
Schema Therapy – A Practitioner’s Guide by Jeffrey Young PhD, Janet Klosko PhD and Marjorie Weishaar PhD (2003)
Reinventing Your Life by Jeffrey Young PhD and Janet Klosko PhD (1993)
Schema Therapy by Eshkol Rafaeli, David Bernstein and Jeffrey Young (2011)
Negative Thinking Patterns: A Schema Therapy Self – Help and Support Book by Gitta Jacob, Hannie Van Genderen and Laura Seebauer
Cognitive Therapy – Basic and Beyond by Judith Beck (1995)
Cognitive Therapy for Challenging Problems by Judith Beck (2005)
Cognitive Therapy for Personality Disorders – A Schema Focused Approach by Jeffry Young (1999)
Cognitive Therapy of Personality Disorders by Aaron Beck, Arthur Freeman and Denise Davis (2004)