Counselling: Integrating Theory and Practice - Schema Theory essay

Introduction

Nowadays much attention is paid to the development of various therapeutic methodologies for providing the patients suffering from the psychological disorder with a more effective treatment. The current work will consider one of such approaches under the name of schema therapy. It represents the combination of other concepts, like behavioural, cognitive and experimental for helping persons to deal with their negative feelings and actions. Much attention will be paid to the description of strengths and weaknesses of integrative and specific approaches. Moreover, the description of the skills which are necessary for therapists will be provided in the final part of the essay. The detailed consideration of the schema therapy will provide understanding of its distinct characteristics and effectiveness compared to other intervention concepts.

Discussion of Schema Theory and the Way It Is Used for Clients

This theory represents a comprehensive approach that has its origins in the cognitive behavioural therapy (Roediger & Dieckmann 2012). It is widely used for dealing with chronic personal problems by application of special models which represent “persistent, rigid, and dysfunctional patterns preventing the patient from further personal emotive-interpersonal development” (Roediger & Dieckmann 2012, p. 142). This concept pays much attention to the interrelationship between a client and a therapist, especially during the discussion of the painful experience of the patient in childhood. The professional performs the identification of the core schemas and puts them into a biographical context of the patient. Then, the inappropriate ones are weakened by using various techniques taken from Gestalt therapy.

 

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This approach has been developed by Jeff Young who met the challenge of treatment of persons with various cognitive disorders at the special centre in the University of Pennsylvania (Schema Therapy Center of New Orleans n. d.). The common therapies and treatment methodologies were unsuccessful for some clients. These people were characterized by established strong long-standing patterns (also known as schemas) of thinking and behaving. They are usually formed on the background of their memories and emotions experienced earlier towards oneself and the relationships with other people. Such connections could have the considerable negative influence on the behaviour of clients (Young, Klosko & Weishaar 2003). The additional attention should be paid to the fact that “maladaptive behaviors develop as response to a schema…thus, behaviors are driven by schemas but not a part of schemas” (Young, Klosko & Weishaar 2003, p. 1974). The distinct characteristic of these patterns is that they are repeated during the life of clients. Hence, they form the obstacles for reaching personal goals.

The most common schemas are the following ones: I am a failure, I am unloved, I am not important, and etc. (Schema Therapy Center of New Orleans n. d.). The examples of the devastating schemas are instability, abuse, social isolation, dependence, emotional deprivation, inhibition, and etc. (Schema Therapy Center of New Orleans n. d.). They are formed on the background of unmet core emotional needs of clients at their young age. These needs are a secure attachment to other people, realistic limitations and self-control, freedom in expression of valid emotions and needs, play and spontaneity, competence, autonomy and sense of identity (Young, Klosko & Weishaar 2003). The goal of the discussed therapy is to help individuals to meet these core emotional needs (Young, Klosko & Weishaar 2003).

The additional attention should be paid to the fact that not meeting these needs is reflected in various experiences that can be grouped into the four major categories. The first one is the toxic frustration of the needs reflected in the deficit of the early environment of something important (like love and stability) and insufficient childhood experience (Young, Klosko & Weishaar 2003). It leads to the development of abandonment. The second category is represented by victimization or harming (Young, Klosko & Weishaar 2003). It forms the background for such schemas as mistrust, vulnerability to harm, and defectiveness (Young, Klosko & Weishaar 2003). The third group is represented by the excess of good feelings and emotions obtained from parents that have formed dependence and entitlement in the future (Young, Klosko & Weishaar 2003). The last category is “selective internalization or identification with significant other” (Young, Klosko & Weishaar 2003, p. 1985). Notwithstanding the fact that these feelings and schemas were formed in the clients’ early childhood, they are presented and even developed in their adulthood. It means that they “are perpetuated behaviourally through the coping styles of schema maintenance, schema avoidance, and schema compensation” (Schema Therapy Center of New Orleans n. d.).

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The first style reflects the ways individuals have been passively involved in the schema, i.e. they accept them and act in such a way to confirm them (Bricker & Young 2004). For example, the patient who suffers from the instability schema may choose the partners who cannot commit long-term relationships. The second one is reflected in the approaches which are used for the avoidance of activating these patterns. The reason is that their activation can lead to the extreme negative feelings (Bricker & Young 2004). Currently, three types of avoidance are recognized by psychologists: emotional, behavioural, and cognitive. Emotional avoidance is reflected in the voluntary or automatic attempts directed at the blocking negative emotions. Behavioural type is represented by acting in such a manner to avoid the situations which may cause the development of schemas. For example, the avoidance of taking the difficult job by the individual who suffers from the failure schema for the elimination of the feeling of anxiety that may be caused by this pattern. Cognitive avoidance is reflected in both automatic and voluntary “efforts that people make not to think about upsetting events” (Bricker & Young 2004, p. 12). It also refers to shutting out some of the information that can be painful, like forgetting certain events (Bricker & Young 2004). The behaviour of the client that is opposite to the one suggested by the schema refers to the pattern compensation. Superficial consideration can undermine that these actions can be viewed as healthy. However, they can “cause more problem patterns, which then perpetuate the schema” (Bricker & Young 2004, p.12). For example, the individual who suffers from defectiveness schema can present himself as the perfect one and sharply criticize others. It can give rise to responsive critique and lead to strengthening of the self believes of defectiveness.

The researcher has assumed that only the combination of various intervention methodologies could be helpful for clients. The reason is that it would be more efficient in dealing with negative thoughts and behaviours which are rather tenacious (Schema Therapy Center of New Orleans n. d.). The combination of techniques would enable to use the greater number and variety of methods as well as approaches for breaking these patterns.

Therapists usually use the three stage methodology of the schema-focused therapy for helping their clients. During the first stage, the patients’ behaviour and feelings are identified. It is necessary for the determination and assessment of existing schemas. For this purpose, therapists may use traditional cognitive and behavioural techniques or apply the new ones, like experimental and interpersonal. The cognitive techniques are represented by schema diaries (“a form filled out in-between sessions … to organize your experience when schemas or modes are triggered”), determination of positive and negative sides of patterns and styles of their addressing, and flash cards (the statements in an audio form developed by a therapist) (Cognitive Behavioral Therapy Center 2016). The behavioural techniques are represented by assertiveness and empathy trainings, as well as exposure tasks (Cognitive Behavioral Therapy Center 2016). The experimental-emotional ones have the aim to make the therapy more effective and efficient by creating the emotional shift through imagery, two-chair work or role playing (Cognitive Behavioral Therapy Center 2016). The imagery enables to reconstruct memories, understand and meet the clients’ needs. Moreover, it forms the background for the closer contact between a patient and a therapist. The two-chair work undermines the performance of a dialogue between two parts of the patient’s self, which represents the healthy side and schema parts of individuals. The interpersonal techniques contain limited re-parenting and emphatic confrontation (Cognitive Behavioral Therapy Center 2016). The first sub technique contains “warmth and nurturance, firmness, self-disclosure, confrontation, playfulness, and setting limits” (Cognitive Behavioral Therapy Center 2016). The second one is based on the providing the clients with a clear understanding of the following fact. Negative feelings and actions have their origins in confusion and pain as well as setting limits. It is reached by making the individual feel how the expressed behaviour may influence the lives of others (Cognitive Behavioral Therapy Center 2016).

In the schema therapy, much attention is paid to the patient’s experience of childhood for the clarification of previous and further contexts. It is usually used in the situations when the clients cannot clearly understand the reasons of their actions. In such cases, psychologists track back the underlying schema to its function in the earlier life “a way to cope with toxic experiences in order to facilitate understanding of the present” (Contemporary Psychology 2007).

The next stage is connected with the emotional awareness. The existing problems are organized in a comprehensible manner with the emphasis on the clients’ interpersonal relationships (Young, Klosko & Weishaar 2003). Therapists help their patients to get in touch with their themes. The last ones clearly recognize the devastating consequences. Therapists discuss the ways of spotting with schemas in the everyday life. Hence, clients “gain the ability to view their characterological problems as ego-dystonic and thus became more empowered to give them up” (Young, Klosko & Weishaar 2003, p. 1972). The additional attention should be paid to the fact that the patients’ problems can be met by a schema-focused mode and a mode model. The first one is used in the situations when individuals have not got extensive difficulties, i.e. the majority of their issues can be explained by several schemas. The second model is used for more difficult cases when the person is influenced by more than several simultaneously acting patterns and changeable coping styles. They “can be activated by internal and external stimuli” (Dryden, 2012, p. 167). Thus, this approach represents the combination of distinct features of several schemas. It is often used for the management of borderline and narcissistic personality disorders (Vreeswijk, Briersen & Nadort 2012).

The last stage is reflected in a behavioural change. The clients become actively involved in the identification of schemas and their replacement by healthy emotions and behaviours.

The weakening of the acute symptoms can help to deal with various disorders and their “chronic characterological aspects…not acute psychiatric symptoms (such as full-down major depression or recurring panic attacks” (Young, Klosko & Weishaar 2003, p.1972). The examples of these illnesses are anxiety, depression, the disorders connected with eating behaviors, and some difficulties in inmate relationships. This approach is even used for the prevention of the relapse of substance users and for rendering psychological assistance to criminals (Young, Klosko and Weishaar 2003).

Integration of Schema Theory with Other Theories

The above description of schema therapy provides the understanding that this approach incorporates and expands the major theoretical models. The cognitive one is expanded on a standard cognitive behavioural approach (for example, testing the validity of patients’ schemas, determination of their strong and weak sides, and the performance of some dialogues between the individuals’ healthy and schema sides). The experimental concept is expanded by the use of imagery techniques and methodologies from the Gestalt therapy (like psychodrama). The last approach is presented by such standard techniques as the role playing. Thus, the integration of some aspects of these concepts supplements them and makes more effective and universal. The more detailed comparison between schema therapy and other approaches will be provided below.

Evaluation of the Effectiveness of Schema Therapy

The Strength and Weaknesses of an Integrative Approach

The above mentioned distinct features of schema therapy form the background for the strengths and weaknesses of this approach. The combination of various techniques enables to threat personal and chronic disorders which cannot be managed by other concepts separately. The reason is that they are not so overwhelming.

Unlike psychodynamic therapy that enables a passive determination of negative patterns in the patients’ behaviours, the schema approach asserts their feelings and actions as dysfunctional. Moreover, it provides an active interaction for their management in a form of role playing and other initiatives discussed above. Thus, schema therapy is more dynamic and effective.

Unlike the cognitive behavioural approach, the discussed therapy undermines that the roots of the majority of psychological problems lie in the childhood experience. This experience should be taken into consideration during the management of negative patterns. Thus, this approach clearly determines the background of clients’ problems and the manner of their treatment.

The additional emphasis should be made on the fact that in the cognitive behavioural therapy the relationships between a therapist and a client are considered to form the support for the occurrence of behavioural changes. In the same time, in the schema approach, these connections are viewed as active facilitators of personal changes and compensators of deficiencies. Therefore, they negatively influenced on clients in the childhood. Consequently, the increase of the role of the therapist leads to a raise of involvement and strengths of his influence on the patient. Moreover, the closer relationships between these two parties are the more trustful and open interaction environment is created. Thus, the practitioner can obtain a deeper understanding about the client’s feelings.

However, this approach has a considerable weakness. Schema therapy is rather complex. The therapist should correctly identify the client’s schemas and develop the appropriate methodology of managing negative feelings and actions (Rahimian & Ghaffary 2014). The practitioner should choose one or several intervention strategies which would enable an effective dealing with the person’s problems. The other concepts are less complex as they provide a lower number and variety of possible interventions.

The Strengths and Weaknesses of the Specific Approach

The schema theory is also considered to be a specific approach that is directed on the identification of unique psychological patterns of each individual separately (Jacob & Arntz 2013). The returning to the person’s childhood helps to identify which of the personal needs have been not covered. Notwithstanding that the described set of necessities is viewed as universal, some children have stronger needs than others (Young, Klosko & Weishaar 2003). Moreover, each client has the unique temperament that “partly determines whether an individual identifies which and internalizes the characteristics of significant other” (Young, Klosko & Weishaar 2003, p. 1986). It can be reflected in a personal attitude to the behaviours of other individuals (like parents). Thus, the schema approach enables the therapist to identify particularly the uncovered needs and negative behaviours and provide a more efficient therapy.

The additional emphasis should be made on the fact that unlike other approaches being less specific schema therapy enables to do the following thing. It helps to threat the characterological patients who are less responsive to the standard concepts. Therapists often face some challenges in the establishment of relationships with these clients. The reason is that the latter ones “have had dysfunctional interpersonal relationships that began in early life” (Young, Klosko & Weishaar 2003, p. 1970). The discussed therapy has helped to overcome hopelessness about some changes and assess the effectiveness of the therapy by analyzing the shifts in the interaction between clients and therapists. The utilization of specific strategies from various approaches helps to meet the particular needs of each person.

However, this concept has several strong weaknesses. The first one is reflected in the confusion of cognitive causes and symptoms. The second weakness concerns the fact that the therapy has the aim to deal with negative emotions and actions that in some cases are irrational. However, sometimes, clients’ negative attitudes are quite rational to the situations, in which they are involved. Thus, the major aim of schema therapy does not completely align with the person’s needs. Moreover, this approach has paid insufficient attention to such aspects as health, workplace, education, existing social attitudes to the representatives of certain genders, and races which also have the sufficient influence on the self-evaluation.

The Skills Which Are Necessary for the Conducting of Schema Therapy

The therapist using the discussed therapy should have a great variety of skills for the successful performance of all necessary interventions. It is notable that various types of interventions require availability of different knowledge. For example, for limited re parenting, the therapist should know how to act in such a manner that does not hurt the patient. The practitioner should avoid critique, provocation, invalidating, and rejecting, as well as express warmth and care. If needed, the extra-therapy should be given in the form of additional phones. The understanding of patients’ needs is gained through expression of emphatic skills and listening, using rephrasing methodology, and observing of both verbal and non-verbal expressions. For building an effective collaboration with individuals, therapists should encourage them to take an active part in sessions, as well as ask feedbacks and opinions concerning their intervention. Much attention should be paid to the maintenance of the optimal level of flexibility in the adaptation of the therapists’ style to the clients’ specific needs. In the same time, they should reflect the optimal level of ease, confidence and inner security. The intervention should be held in a comfortable environment.

Conclusion

To summarize, the current work provides the description of schema therapy as an integrative approach that uses the combination of behavioural, cognitive and emotional concepts for helping patients. This therapy undermines that the person’s behaviour is directed, according to certain established schemas. It has several distinct features. The first one refers to the client’s childhood for the determination of the unmet needs. The second feature is represented by the close interaction between the therapist and the active participation in the treatment. The major weaknesses are compared with complexity and insufficient attention to such social factors as biased attitudes and inequality. The effectiveness of schema therapy depends greatly on the skills of the practitioner.