Our thoughts, decisions and reactions are daily biased by mental structures, also known as maladaptive early patterns. They lie dormant in each of us. Depending on their intensity, their repercussions are more or less disabling.  This is why schema therapy was invented by Young. The goal is to specifically target the patterns. To understand what is meant by maladaptive early patterns, I refer you to my last article. In this article, we will look at this therapeutic approach which combines cognitive strategies, emotional methods and behavioral change: the three pillars of cognitive and behavioral therapies.

Conceptualizing the problem and the demand

Schema therapy is classified in the third wave of cognitive and behavioral therapies. It was created in 1990 by Jeffrey Young, the American psychologist who conceptualized maladaptive early patterns. The therapy begins with an initial interview during which the therapist establishes the life history of the patient in order to identify the events that may have initiated the creation of a pattern. The therapist seeks to understand how the patterns came to be, how they were reinforced and how they are currently maintained. To identify your patterns, several questionnaires revealing which of the 18 patterns in the official classification are active in you can be used. The objective is to get you to know your patterns and to acquire the ability to recognize their expressions in your actions. The infantile origin of the pattern that was created during this period of life is investigated. However, the current expression of the pattern in the present is also addressed. Indeed, linking the active patterns to the patient’s current difficulties is fundamental during this phase of the therapy. Making links between the schemas and the patient’s current problems makes it possible to evaluate the extent of the repercussions on the patient’s social, professional and family life.

In a second phase, the therapist explains the way the patterns work to the patient. To be more precise, the model of the patterns is detailed during a session so that the patient understands what they are, how they have an action on his daily life and how they are created. Once the therapist has identified the maladaptive early patterns in the patient, he or she can implement therapeutic strategies to treat them. The patient will then learn and integrate these techniques to change their patterns. We call It the change phase.

Cognitive Strategies: The First Step to Recovery

To enable the patient to challenge these patterns, the therapist uses a particular type of strategy: cognitive methods. The objective is to rationalize and challenge the patterns that the patient has previously seen as absolute truths. The patient will be led to evaluate the level of truth of the schemas while taking a step back. Through this struggle against the deep beliefs of the patterns, the patient will learn to perceive their inadequacy. The collaboration between the therapist and the patient through the logical analysis of the patterns will facilitate this work. To summarize, this step consists of testing the schema with a rational approach. To do this, several methods can be used, namely arguments for/against, the search for objective alternative interpretations to the automatic interpretations of the pattern. These alternative thoughts are called ripostes and are written to counter the patterns with each activation. As the sessions focus on cognition, the patient becomes aware of the erroneous nature of the schemas and learns to counteract them without the help of the therapist. This work can be enriched and facilitated through the use of a cognitive tool called the “schema diary” in which the patient writes down his or her own responses to the schemas. Thanks to his introspective trainings, he takes distance with the schema and reasons in a logical way adapted to the situations.

Emotional methods, a crucial step

Once the cognitive conviction that the patterns are inaccurate is acquired, the therapy continues with emotional work. This step, which focuses on the emotional plane of the schemas, is the one that produces the most change in the patient. The goal is to examine the falsity of the patterns through the affects. Emotional techniques consist of triggering the emotions associated with the schemas in the patient so that he or she is exposed to them. The triggering of the emotion is supervised by the therapist and can be controlled through relaxation methods. Through these exercises, the patient learns a new way of reacting to his emotions. He/she must make the connection between his/her current problematic emotional experiences and those past experiences that led to the creation of these patterns. 

Behavioral modification, the completion of the work

The principle of behavioral modification is to replace pathological behaviors with more appropriate and healthier ones. What is meant by pathological behaviors? They are ways of acting, of behaving that allow the patient to submit to, avoid or compensate for the IPS. In a situation where the schema is active, the patient uses his or her behavioral styles to adapt; these are harmful responses to schema triggers. In fact, these attitudes are counterproductive, they reinforce and perpetuate the patterns, which is why they are called pathological. In order to modify them, they must learn to replace them with styles that will diminish the influence and impact of the patterns. Thus, the therapist will lead the patient towards behaviors that go against the patterns, to reduce their expression through the patient’s actions little by little.

Illustration with an imaginary patient

In the previous article, I gave a concrete example of a pattern in an imaginary patient. We are going to use the same example to explain how we would take care of the imaginary patient in question. As a reminder, this was a child who had been abandoned by a relative and who had, following this event, developed an “abandonment, instability” pattern. In order to take care of this patient, who had become an adult, we would start by explaining to him what this pattern implies and how it is maintained. We would act at the cognitive level on his thoughts such as “I have to rely only on myself, everyone will eventually leave and abandon me” or “I am not good enough for them to stay with me”. We would encourage him/her to find alternative arguments/thoughts such as “I have many friends who care about me and I can always count on”. Attitudes such as excessive jealousy of one’s partner for fear that he/she will leave him/her for someone else would be modified through behavioral strategies. The patient would learn to give and trust his/her partner.  Emotionally, we would work on the negative emotions associated with the triggering event of the pattern, namely early abandonment.

For more information on maladaptive early patterns and their composition, I refer you to this article by Blake Psychology.

Bibliography:

Young, Jeffrey E., Klosko, Janet S., Weishaar, Marjorie E. (2017). Schema therapy: A cognitive approach to personality disorders. (Pascal, B.) Louvain-la-Neuve: De Boeck Supérieur.

S. Dobson, K. (2010). Handbook of cognitive-behavorial therapies [E-book]. The guilford press.