Therapies

Learn more about the therapies you can benefit from…

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Schema Therapy

Schema therapy is an integrative therapy that is developed by Jeffrey Young in the early 1990s to treat chronic DSM AXIS I disorders and personality disorders. It expands traditional cognitive behavioural therapy techniques and strategies and combines theories and techniques from other therapies such as Object Relations, attachment, psychoanalytic and Gestalt therapies.

ST is an effective treatment for complex, and long-standing problems such as chronic treatment resistant depression, anxiety and relationship problems as well as personality difficulties. It is a long-term treatment that identifies and targets self-defeating patterns through cognitive, experiential and behavioural techniques.

What are schemas?

Schemas are broad, self-defeating life patterns, which influence emotions, cognitions, perceptions, memories, body sensations, social perception and interaction and behaviour patterns. In life we all have core needs such as safety (stable base), love, nurturance, attention and praise, acceptance, empathy, guidance and protection, validation of feelings and needs, and autonomy. Maladaptive schemas develop when our core childhood needs are not met, which is also influenced by our innate temperament and our early environment. They often get elaborated in adolescence and repeated in our lifespan. Schemas are social constructs that include beliefs we have about ourselves, the worlds and other people in our lives.

Young identified 18 different schemas. They are:

  • Abandonment/Instability
  • Mistrust/Abuse
  • Emotional Deprivation
  • Defectiveness/Shame
  • Social Isolation
  • Failure
  • Dependence/Incompetence
  • Vulnerability to Harm or Illness
  • Enmeshment/Underdeveloped Self
  • Entitlement/Grandiosity
  • Insufficient Self Control
  • Subjugation
  • Self-Sacrifice
  • Emotional Inhibition
  • Unrelenting Standards
  • Approval Seeking
  • Negativity/Pessimism
  • Punitiveness

Schema Mode Model

Schema modes refer to a state that is prominent at a certain moment. In other words, modes are instantaneous and constantly changing states of minds. There are child modes, critic modes, maladaptive coping modes and healthy adult mode.

Child modes

Mode model assumes that everyone is born with an innate capacity to express all of these childhood modes, which are influence by our temperament and experiences. The child modes are vulnerable child mode, angry child mode, impulsive/undisciplined child mode, and happy child mode.

Critic Modes

These are the internalizations of parents or other important adults from children’s early life experiences. When in these modes, people often take the voice of a parent or another adult in their self-talk. The critic modes are Punitive Critic and Demanding Critic.

Maladaptive Coping Modes

In order to deal with early difficult experiences and get their needs met, children learn survival strategies, which are called coping modes in schema therapy. In childhood they are the best efforts to deal with difficult situations but in our adult life, they are ineffective and serve to maintain schemas. The coping modes are surrender, avoidance and counterattack.

Healthy Adult mode

The goal of schema therapy is to develop healthy adult part of the self, that nurtures, and protects the vulnerable child modes, set limits with angry and impulsive parts, reduces the impact of the critic modes and reduces maladaptive coping modes by developing healthier ones.

Phases in Schemas Therapy

There are two phases to schema therapy. The first part is called assessment and formulation phase of therapy, which can take up to 4-6 sessions. During this time, we will discuss what brings you to therapy, identify current life problems and stressors in your life, identify relevant schema and modes and discuss childhood origins of the schemas which might include early memories. After the first session, I will give you questionnaires to assess your schemas, and share your results with you once I score them. We will complete a Needs assessment to identify how your childhood needs were met or unmet during early childhood and adolescence and how you meet them now. We will also identify the critic modes and maladaptive coping modes.

Second phase is called the change phase. After having a shared formulation, we will begin challenging your schemas first cognitively by looking at evidence for and against these schemas, and challenging the beliefs associated with them. These might include developing healthier thoughts and beliefs about yourself. Then we will work on changing your emotions about these schemas, which might include chair work and imagery rescripting exercises. Once you can challenge these schemas both cognitively and emotionally, we will work on behavioural strategies to enhance the healthy adult mode. Depending on the complexity of your difficulties, schema therapy could range from short term to long term.

Cognitive Behavioural Therapy (CBT)

Cognitive Behavioural Therapy (CBT) principles date back to the ideas of Aaron T. Beck, who was the first person to develop CBT theories and interventions in the 1960s. The core principles are our thoughts influence our emotions and behaviours, and how we act or behave in the world can strongly affect our thoughts and emotions. CBT is an evidence-based treatment that focuses on changing thoughts and behaviours that are linked to emotional problems.

Compassion Focused Therapy (CFT)

CFT was developed by Professor Paul Gilbert in order to help clients to understand their emotional suffering by cultivating compassion. It is based on various scientific-based approaches such as evolutionary psychology, affective neuroscience and CBT for understanding human condition. It was originally developed for people who had self-critical and shame-based difficulties who struggled to engage in evidence-based treatment protocols such as CBT. Often these clients were able to generate alternative healthy thoughts but struggled to change their emotions or feel reassured by them. CFT helps client learn to develop compassion for themselves and other in dealing with their emotional struggles. Proffesor Gilbert defines compassion as “a sensitivity to one’s suffering with an intentions to alleviate it.” CFT has been applied to a range of difficulties that includes depression, psychosis, anxiety, trauma, social anxiety and personality disorders.

Dialectical Behaviour Therapy (DBT)

DBT is an evidence-based treatment that was developed by Marsha Linehan for clients diagnosed with Borderline Personality Disorder (BPD). DBT is based on CBT, behavioural interventions and mindfulness. It has been demonstrated in multiple clinical trials that DBT is an effective treatment for a range of disorders and problems including self-harm, suicidal ideation, hopelessness, mood disorders such as depression, substance abuse and dependence, eating disorders, impulsive behaviours and anger expression. DBT helps clients develop skills such as mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.

Since I am not a part of the DBT treatment team that offers skills training groups, I do not provide a full DBT. In order to receive full DBT, please seek treatment from a treatment team that offers individual therapy, skills training group and phone coaching.

Mindfulness

Mindfulness is a set of practices that focuses on purposely paying attention to present moment and bringing a non-judgemental, compassionate awareness to the nature of things.

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