Schema Therapy

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The schema therapy is a form of psychotherapy . It belongs to the so-called third wave of cognitive-behavioral therapies and expands the methods of cognitive therapy to include elements of psychodynamic concepts and other established psychological theories and therapy methods such as object relationship theory , transaction analysis , hypnotherapy and gestalt therapy . It was developed by Jeffrey E. Young from the "cognitive therapy for personality disorders" according to A. Beck . Young worked in Beck's group for years. Most of the schema therapists are grouped together in the International Society for Schema Therapy (ISST).

Schema therapy assumes that there are certain learned basic schemas that aim to satisfy basic psychological needs and to control the behavior of people.

Influences

Schema therapy is based on various psychological and psychotherapeutic approaches, including a .:

application

Schema therapy was developed to treat chronic, characterological aspects of mental disorders . It is successfully used in the treatment of chronically ill patients with depression , anxiety disorders , personality disorders (especially borderline and narcissistic personality disorders ), but also for eating disorders , substance abuse , couple treatment and long-term relationship disorders . It is used in both outpatient and inpatient treatment.

Basics

Schemes

Probably the most common concept of the schema in psychology comes from Jean Piaget , who based it on his constructivist epistemology ( schème d'assimilation ). Schema therapy is an explanatory and treatment model for patients, especially those with severe personality disorders. It assumes that schemata are acquired in childhood and in the course of life which contain wide-ranging patterns of memories , emotions , cognitions and body sensations and which control behavior . These can be incompatible with one's own personality, oppose it and be a hindrance, i.e. be I-dystonic . The schema concept of schema therapy must not be confused with the depth psychological term “conflict pattern” from psychodynamic psychotherapies (analytical and depth psychologically based psychotherapy). In contrast to the stable internal psychic schema of schema therapy, a conflict scheme describes “no circumscribed stable conflict pattern”, as is typical for so-called structural disorders p. 100 . Young refers to those early acquired obstructive schemes as "early maladaptive schemas" ( Early Maladaptive schemas ). An early maladaptive scheme, according to Young et al. a. (2005) p. 36 um

  • a broad, comprehensive topic or pattern,
  • which consists of memories , emotions , cognitions and body sensations ,
  • which relate to the person concerned and his contacts with other people,
  • a pattern that arose in childhood or adolescence ,
  • became more pronounced in the course of further life and
  • is severely dysfunctional.

Problematic (dysfunctional) behaviors arise as a reaction to a scheme, but are not themselves part of the scheme.

A maladaptive scheme arises from harmful childhood experiences that are based on the violation of basic human needs. A distinction is made between traumatic experiences , the experience of non-fulfillment of essential basic needs by the early caregivers , but also their over-fulfillment through “too much of the good” or selective internalization or identification with important caregivers. Thus, almost all schemes arise from harmful (but not necessarily traumatic) experiences that are repeated regularly during childhood and adolescence and together lead to the development of the scheme. Schemes are sustained because of the human pursuit of consistency . Although it causes suffering, the scheme feels "right" because of its familiarity. This makes you feel drawn to events that activate your own scheme. This is where the schema concept of schema therapy overlaps with the concept of the unconscious neurotic conflict of psychodynamic therapies, which manifests itself in repetitive-dysfunctional relationship behavior.

Schemas are also similar to the psychodynamic concept of the introject , but are more comprehensive in that the emotions and body sensations resulting from norms and values as well as the associated memories are integrated into the concept, which at the same time explains their resistance to change.

So far, 18 maladaptive schemes have been identified, several of which usually occur in one patient, and which Young has assigned five scheme domains pp. 42–54 :

1. Schematic domain separateness and rejection (Disconnection and Rejection)

  • Abandonment / instability
  • Distrust / abuse (and mistreatment) (mistrust / abuse)
  • Emotional deprivation (emotional deprivation)
  • Defectiveness / Shame
  • Social isolation / alienation

2. Scheme domain impairment of autonomy and power (Impaired Autonomy and Performance)

  • Dependence / Incompetence
  • Vulnerability to harm or illness
  • Entanglement / Undeveloped Self
  • Failure

3. Schema domain Impairments in dealing with limits (Impaired Limits)

  • Entitlement / Grandiosity
  • Inadequate self-control / self-discipline

4. Scheme domain foreign relatedness (Other-directedness)

  • Subjugation
  • Self-Sacrifice
  • Striving for approval and recognition (approval seeking / recognition seeking)

5. Scheme domain Excessive vigilance and self-consciousness (Overvigilance and inhibition)

  • Negativity / pessimism
  • Emotional inhibition
  • Excessive standards / excessively critical attitude (unrelenting standards / hypercriticalness)
  • Punitiveness

Among the schemes mentioned, Young distinguishes between unconditionally valid and conditionally valid schemas, the unconditionally valid schemas generally being those that arise the earliest. On the other hand, schemes that arise later are conditionally valid. So z. For example, the Excessive Standards scheme is often a response to the Inadequacy / Shame scheme . Conditionally valid schemes are:

  • Subjugation
  • Self-Sacrifice
  • Striving for approval and recognition (approval seeking / recognition seeking)
  • Emotional inhibition
  • Excessive standards / excessively critical attitude (unrelenting standards / hypercriticalness)

All other schemes from the above list are unconditionally valid according to Young.

Within a treatment, the effective schemes for the patient should be identified. As a clarification-oriented component of therapy, it is important for the patient to understand how the individual schemes were developed in order to change them. For this change process, certain treatment strategies are used which, according to Young, only become effective in changing behavior through experience and action-oriented components. The process of the therapeutic relationship is of central importance, as the patient can subsequently experience limited parental care from the therapist, which recognizes and fulfills his core needs.

Examples of maladaptive schemes and associated coping responses

Schemas concern the realm of interpersonal relationships. Their emergence causes the person to develop coping styles and coping reactions corresponding to the scheme.

In humans, for example, the pattern of their own “inadequacy” arises when, as a child, they had the feeling that they were not worth loving. From this, as an adult, he develops, for example, the coping reaction of being afraid of love because he can hardly believe that one can appreciate him (coping reaction corresponding to a form of "flight" within the framework of the three coping styles "struggle", "freezing" or " Escape ").

If a person was not brought up to be independent as a child, so that he felt incompetent, the scheme of "dependency" arises. The corresponding coping reaction could be to make yourself dependent on your partner as an adult and allow yourself to be dominated (“enduring” / “freezing”).

If a person was spoiled as a child due to the inconsistent behavior of their parents and no limits were set for them, the scheme of “aspirations” emerges. The coping reaction developed from this could be that as adults, people quickly get angry if they don't get what they want (“attack”).

If a person was often left alone or rejected as a child, the pattern of "abandonment" emerges. The coping reaction that develops from this could be that the adult person clings to other people for fear of being abandoned.

The form of coping style and response can manifest as behavior or as thought / cognition or feeling / affect. Coping reactions and styles can change for a person in different phases and situations in life, even if the scheme remains the same. That is why schemes and coping responses are described separately from one another.

Coping styles and coping responses

Young distinguishes three maladaptive coping styles that those affected develop early in life in order to adapt to the schemas (and the associated difficult-to-bear feelings). These coping styles are not themselves part of the schema, nor are they necessarily stable. Often times, different coping styles are used in different situations or different stages of life. According to Young, pp. 67–70, the three coping styles are :

  • Submission : The person concerned fits into his scheme, takes on the role of the "child" and chooses e.g. B. Partners who treat him as the offending parent did.
  • Overcompensation : The person concerned tries to behave as opposed to the schema as possible (e.g. in the schema 'inadequacy' the attempt to achieve perfection; in the schema 'submission' the attempt to subjugate others).
  • Avoiding : The person concerned tries to behave in such a way that his scheme is not activated as far as possible (suppresses feelings, drinks alcohol, looks for the kick in ever new arousal, develops an obligation to cleanliness, avoids confidential relationships or professional challenges, etc.).

According to Young, a coping style is a collection of coping responses that a person uses to submit, overcompensate, or avoid. A coping reaction is thus a certain behavior or a strategy (e.g. drinking beer) that belongs to a coping style (e.g. avoidance) that involves coping with a certain pattern (e.g. abandonment) in a certain situation (e.g. quarrel with partner) is used.

Schema Modes

According to Young, schema modes are “schemas or schema operations that are active in a person at a specific moment”. Schema modes can be functional or dysfunctional. Dysfunctional schema modes are “parts of the self that are more or less severely cut off from other aspects of the self” ( dissociated ). When working with patients with borderline personality disorder , the authors found that they had an unmanageably large number of schemes and coping reactions, which also changed constantly. The concept was therefore developed in order to explain and work with constantly changing states. Pp. 74-80

Young describes 10 schema modes that fall into four categories:

1. Child modes:

  • vulnerable child (also: abandoned, abused, abused, deprived, rejected child)
  • upset child (upset about failure to meet his needs; acts without thinking about the consequences)
  • impulsive / undisciplined child (acts according to his wishes, ruthlessly follows his natural inclinations, also without thinking of the consequences)
  • happy child (central emotional needs are met at the moment)

2. Dysfunctional coping (corresponding to the three coping styles):

  • Willingly surrender (submits to the scheme, becomes a passive, helpless child who gives in to others)
  • Overcompensating (fighting back by treating others badly or displaying other extreme behaviors to refute the scheme)
  • distanced protector (emotionally detached from the scheme, practices substance abuse, avoids others or practices other forms of escape)

3. Dysfunctional parenting modes

  • punishing parent (punishes child mode because it is supposedly "bad")
  • Demanding parent (constantly pushing the child to meet exaggerated requirements)

4. healthy adult (should be strengthened in therapy)

In therapy, individual names can also be found for these designations, which the patient perceives as more appropriate.

Course of therapy

In order to be able to achieve the change in life desired by the patient, the schemes or modes must be identified in a first phase of assessment and education that cause him to repeatedly perform certain undesirable behaviors. The patient is informed about the basic assumptions and the procedure of the schema therapy, an assessment of the current problems and a problem history and the therapy goals are made. With the help of questionnaires, the maladaptive schemes are identified and checked in conversation with the patient. The latter is also informed about the therapist's assumptions. This then creates a case concept. Thereafter, the therapy enters the second phase of change . Five intervention principles are used in the two therapy phases:

  1. Assessment and education via schemes,
  2. Cognitive interventions,
  3. Experience-based interventions,
  4. Interruption of maladaptive behavior patterns, in which the overcoming of undesirable behavior patterns is to be achieved with the help of proven methods from behavior therapy.
  5. Finally, the intervention principle is the conscious use of the relationship between therapist and patient as a means of change.

So that the undesired behavior is not automatically carried out again, the patient works out ways within the therapy to create an "inner distance" to his established behavioral patterns. To this end, he is given the task of observing and analyzing his own behavioral repertoire from a distance. The neutral observation should enable self-knowledge and understanding of the causes of the patient's undesirable behavior. Based on self-knowledge, the patient can act more consciously in the next corresponding situation, avoid the “trap of old behavior patterns” and design new patterns of action that he wishes for these situations.

Therapeutic splitting / dissociation is used as an aid to distancing oneself from one's own feelings, to understanding the old and working out new behavior patterns . This is a therapeutically desired and deliberately induced splitting into different aspects of one's personality, which vividly imagine ( Imagination ) are, for example, the inner child in various forms / modes such as: wounded, angry, undisciplined or happy child. P. 341 f.

During the treatment, the therapist guides imaginations and, for example, takes on a role of the parents in imaginative role play. In doing so, he offers the patient the parental qualities that were missing through so-called " reparenting ". Depending on the problem and the existing schemes, this can be parental care, strengthening trust, imparting stability, emotional affection, promoting independence. The aim of the therapeutic work is to internalize the “healthy adult” schema mode, following the example of the therapist. With its help, the patient should be able to recognize the effect of maladaptive schemes in the future and develop healthy behaviors, i.e. replace learned automatisms with targeted, conscious and appropriate actions. P. 233

The associated therapeutic process works with inner distancing, conscious perception, very detailed consideration and naming of the various aspects of the basic behavioral pattern.

literature

  • Arnoud Arntz, Hannie van Genderen: Schema therapy for borderline personality disorder. Beltz, Weinheim 2010
  • H. Berbalk, JE Young: Schema Therapy. In: Margraf, Schneider (Ed.): Textbook of Behavioral Therapy Vol. 1. Springer, New York 2009
  • H. Berbalk: Schematherapy. In: Margraf, Schneider (ed.). Textbook of behavior therapy vol. 4 materials. Springer, New York 2010
  • Gitta Jacob, Arnoud Arntz: Schema therapy in practice. Beltz, Weinheim 2011
  • Gitta Jacob, Arnoud Arntz: Schema therapy for borderline personality disorder. In: Neuro aktuell Vol. 24, No. 8 (2010), pp. 31–33.
  • Gitta Jacob, D. Bernstein, K. Lieb, A. Arntz: Schema therapy with the mode concept in personality disorders. In: Up2date Psychiatrie , 3 (2009), pp. 105-119.
  • Christof Loose, Peter Graaf, Gerhard Zarbock (eds.): Scheme therapy with children and adolescents: With online materials . Beltz, Weinheim 2013, ISBN 978-3-621-28014-3
  • N. Reiss, GA Jacob: Schema therapy in borderline personality disorder. Interactive training by the Academy for Psychotherapy AfP. on-line
  • N. Reiss, I. Shaw, J. Farrell: Using schema therapy successfully: resources for setting up and implementing in individual, group and combined settings . Junfermann, Paderborn 2015, ISBN 978-3-955-71056-9
  • N. Reiss, F. Vogel: Empathic confrontation in schema therapy: With e-book inside and working material . Beltz, Weinheim 2014, ISBN 978-3-621-28137-9
  • Eckhard Roediger: Practice of schema therapy. Schattauer, Stuttgart 2009, ISBN 978-3-7945-2621-5
  • Eckhard Roediger: What is schema therapy? An introduction to the basics, model and application . Junfermann, 2009
  • Eckhard Roediger, Jacob Gitta: Advances in schema therapy: concepts and applications. Hogrefe, 2010
  • Eckhard Roediger: Out of the trap of life: How schema therapy can help. Junfermann, 11/2010
  • Jeffrey E. Young, Janet S. Klosko, Marjorie E. Weishaar: Schematherapy. A practice-oriented manual. White hair. 2008.
  • Gerhard Zarbock: Invitation to schema therapy: basics, concepts, application . Beltz, Weinheim 2014, ISBN 978-3-621-28134-8

Web links

Individual evidence

  1. ↑ Aaron T. Beck, Arthur Freeman Cognitive Therapy of Personality Disorders BeltzPVU; Edition: 4th edition (April 1, 1999) ISBN 3-621-27155-4
  2. ↑ Interview with H. Berbalk ( Memento of the original from August 18, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (accessed on August 18, 2011) @1@ 2Template: Webachiv / IABot / www.psychotherapie-wissenschaft.info
  3. ^ Working group OPD "Operationalized Psychodynamische Diagnostik OPD-2" Verlag: Huber 2009 ISBN 978-3-456-84753-5
  4. ↑ a b c d e f Jeffrey E. Young, Janet S. Klosko, Majorie E. Weishaar “Schematherapy. A practical handbook “Verlag: Junfermann 2005 ISBN 3-87387-578-0