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Schema-focused therapy

Ong Ruo Yun

ong ruo yun

on 26 July 2010

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Transcript of Schema-focused therapy

Schema-focused Therapy Target clients Axis I mood disorders
Axis II personality disorders
Relapse in substance abusers Literature Lack of randomised trials
Single case studies Ong Ruo Yun History & development Developed by Dr. Jeffrey Young
Expanded on traditional CBT

WHY? Characterological patients have no clear identifiable problems
Seek treatment for chronic r/s or work difficulties
Interpersonal difficulties
Psychologically rigid
Avoid painful feelings and thoughts
Theoretical Assumptions Schemas - core of personality disorders, chronic mood disorders
Memories, emotions, cognitions & bodily sensations
Developed during childhood or adolescence
Unmet core emotional needs
Painful early experiences cumulate
Full-blown schema
Elaborated throughout one’s lifetime
Largely dysfunctional
Gets triggered intense emotions & psychological problems e.g. depression
1. Early Maladaptive Schemas Examples
Emotional lack from parents
Victim of harm/abuse
Being excessively lavished on
What childhood experiences? Characteristic of Schemas Resistance to change
Range in severity & pervasiveness
II. Schema Domains III. Schema Operation Cognitive distortions
Self-defeating life patterns
Maladaptive coping styles
Surrender Avoidance Overcompensation Schema Healing Ultimate goal of therapy
18 Schemas IV. Schema Modes A group of schemas that are currently active
“Flip” = switching of modes
10 Modes Treatment Understand origins of schemas
Challenge them
Replace maladaptive coping responses
Improve interpersonal relationship
I. Assessment & Education phase II. Change phase Identify: presenting problems & dysfunctional life patterns
(Life History Assessment Form)
Identify: Schemas & its origin
(Young Schema Questionnaire, Young Parenting Inventory, Imagery, Therapeutic r/s)
Imagery Imagine childhood setting
“Close you eyes. Imagine yourself in an upsetting childhood situation with one of your parents. How do you feel? What are you thinking? What are your parents thinking? How would you like your parent to change/ be different?”

Links to current problem
“Now, imagine yourself in your current life which feels the same as your childhood situation. What are you feeling? What are you thinking? Who is in the image?”
Therapeutic relationship E.g. Mistrust/Abuse schema ask suspiciously about therapists’ adherence to confidentiality Identify: maladaptive coping styles
(Young compensation Inventory, Young-Rygh Avoidance Inventory)
Assess emotional temperament
Educate clients 1. Cognitive Aim:
Strengthen Health Adult mode
Empathetic confrontation
Contrary evidence
Evaluate adv & disadv of coping styles
Written on schema flash cards
2. Experiential Aim:
Trigger emotions related to EMS
Fulfill unmet childhood needs (reparenting)

Imagery dialogues
“Close you eyes. Picture yourself with you parent in an upsetting situation. What are you doing? What are you thinking? What are you feeling?”
Help express strong emotions, especially anger
Aim: replace maladaptive coping styles with adaptive ones
Very important --> Prevent relapse
3. Behavioural pattern-breaking Imagery
Traditional behavioural techniques
E.g. anger management, self-control strategies
Flash cards
Rehearse healthy behaviours
Agree on homework assignment
Application Lonely (Lonely/Vulnerable Child)
Overcompensate for feelings of emotional deprivation (Self-Aggrandizer)
Maladaptive coping styles
Extreme activities to distract feelings (Detached Self-Soother)
Narcissistic personality disorder (NPD) WHAT? HOW? Identify schema & childhood origins (imagery & dialogues)
Work through different modes
- Replace Self-aggrandizer & Detached Self-Soother modes with Healthy Adult mode
- Meet emotional needs of Lonely Child
Interpersonal relationships
- Therapeutic relationship
Cognitive-behavioural homework assignments
Things to note NPD patients leave treatment
- Feel cared & treasured through limited reparenting
Grandiosity, talk down
- Aware of own feelings
Manipulative, bullying
- Set clear limits
Schema Perpetuation
Full transcript