Şema Terapi

by Jeffrey E. Young, Marjorie E. Weishaar, Janet S. Klosko

The schema approach draws equally from cognitive-behavioral therapy, attachment theory, psychodynamic concepts, and emotion-focused therapies. In comparison to cognitive-behavioral therapy, schema therapy emphasizes lifelong patterns, affective change techniques, and the therapeutic relationship, with special emphasis on limited reparenting. Schema therapy is particularly well-suited for difficult, resistant clients with entrenched, chronic psychological disorders, including personality disorders (including borderline personality disorder and narcissism) and eating disorders, intractable couples problems, and criminal offenders. It has also been found to be effective for relapse prevention in depression, anxiety, and substance abuse. The initial results of a major comparative outcome study have shown schema therapy to be effective with a high percentage of outpatients with borderline personality disorder, with a low dropout rate. Clients who have spent years gaining valuable insight with psychodynamic treatments, but who are frustrated by their lack of progress, often respond well to the active, systematic, flexible, and depth-oriented schema approach.

Genres: Psychology, Nonfiction, Mental Health, Counselling, Science, Self Help, Reference

628 pages, Paperback

First published January 1, 2003

About the author

Jeffrey E. Young is an American psychologist best known for having developed schema therapy. He is the founder of the Schema Therapy Institute.
After earning an undergraduate degree at Yale University, he obtained a higher education degree at the University of Pennsylvania, where he then pursued postdoctoral studies with Aaron T. Beck.
He has written numerous books on cognitive behavioral therapy and schema therapy. His two most famous books are Schema Therapy (for professionals), and Reinventing Your Life (for the general public).

Reviews

[Tara · Rating 5 out of 5]

Loved this book. Instead of classifying people into symptoms, Young separates them into the underlying schemas which determine those behaviours. I am a beginning therapist and found this book a joy to read. It is fascinating to realise how unconscious out behavior can be, and how it often relates to our early experiences.

Highly recommended for those who want to extend beyond the self help book, he goes through the exercises and provides scripts from actual sessions so you can see what it would be like in therapy. A must read in the field.

[Jessica · Rating 1 out of 5]

I ..... hate .... social work school. I .... do not .... want .... to be a therapist. I ....... hate ........ THERAPY!!!

That said, if I were going to do therapy, I can think of far worse ways to go about it. Schema therapy actually seems pretty sensible to me, as far as this kind of thing goes.

UGH!!!! ARGH! I FEEL LIKE I'M BEING TORTURED!!!

No, actually, really, it's great. If you're into this kind of thing, schema therapy's ... great. CBT but with a pinch of respect for humanity, and to my mind a bit more realistic. Yeah. Whew. Man. I feel .... like I'm being ..... TORTURED. But then, that's probably just my "I hate therapy" schema being activated.

[Marta Ribas · Rating 5 out of 5]

This book helped me to see personality patterns beyond diagnostic criteria. People are so much more complex than that! Although it helps to identify and predict patients' personality patterns, it also gives space for each individual to have his own set of specific colors (each one of us has his personality patterns, with specific intensities and that can combine in an idiosyncratic way; besides, each one of us has his coping styles and modes to deal with challenges).
Another interesting aspect that caught my attention was raising awareness to the psychologist' personality patterns that can interfere (and sometimes reinforce) the patients' patterns.
I really liked this therapeutic approach - for now, I not only find it one of the most appropriate models for the treatment of axis II disorders, but also for axis I disorders that have a significant basis in lifelong charactereological themes.

[Baris Balcioglu · Rating 3 out of 5]

I checked it out from the SU library and couldn't read and renewed it a couple of times until someone else put a hold on it. I had to rush through it. It is written for the therapist rather than the client. I found the theatrical, comfort your vulnerable child yourself, to some extent funny. As if, what we see as our personality were a byproduct of a game we call life. Which may be true of course. Compared to Reinventing your life (RYL) there were new concepts introduced here. The defectiveness schema was something I identified with, the inhibition schema is something that I identify with a character on whom I want to develop a novel. But these were briefly mentioned. I read more about the defectiveness in the much earlier released RYL which covered only 11 schemas whereas this one had seven more one of which was inhibition.

[Ioana Crețu · Rating 5 out of 5]

Schemele care se dezvoltă ca rezultat al experiențelor toxice din copilărie, iar conform modelului, ar putea sta la baza tulburărilor psihologice și de personalitate. Cu toate că nu toate schemele au origini în traume, toate au efecte negative.

Schemele rezultă din nevoi emoționale fundamentale frustrate, neîmplinite în copilărie.
Există cinci nevoi emoționale fundamentale, inerente oricărei fiinţe umane:
Atașament securizant (siguranță, stabilitate, grijă și acceptare)
Autonomie, competență şi identitate
Libertatea exprimării nevoilor și emoțiilor
Spontaneitate și joc
Limite realiste şi autocontrol

[Talieh · Rating 2 out of 5]

As much as I like the idea of schemata as emerging mental states (that act like attractors in dynamical systems), there is a lacking balance between scientific evidence and practicalities in this approach. In a rush to make their theory applicable for practitioners, the authors don't mention their reasoning for proposing this and that specific "fundamental need" and claiming them to be "deeply rooted in human nature". Although the schemata are intuitively recognizable, the borders between them are fuzzy and given the lack of sufficient scientific endeavour in this theory, it should be categorised as a semi-scientific psychological approach, and I really don't understand how people are able to trust therapists practicing it.

[Fatma · Rating 4 out of 5]

Terapistlere hitaben yazılmış, ders kitabı olarak kullanılabileceğini düşündüğüm güzel bir kaynak. Fakat çevirisi ne yazık ki kitabın akıcılığına baya sekte vuruyor. Örnek olması açısından :
"...Bilmiyorum, herkesten sanırım. O çok tatlıdır. Kimseyi istemiyorum... naifti. Sadece iyilikle bir şeyler yapmaktan hoşlanıyordu ve insanlar faydalanacak ve bundan hoşlanmıyorum, bu yüzden..." gibi acaba tam olarak ne demek istiyor diye bir kaç kez okumak zorunda kaldığım çok sayıda cümle var.
Ek olarak, psikoloji ile alakalı çok fazla kitap ve makale okuyan biriyim. Çoğunda "danışan" ifadesi kullanılırken bu çeviride "hasta" ifadesi kullanılmış bunun da tekrar gözden geçirilmesinin faydalı olacağını düşünüyorum.

[Simon · Rating 5 out of 5]

This is an excellent, comprehensive guide to Schema Therapy. The authors go through a range of "early maladaptive schemas" and how to treat them. They also challenge some of the untenable assumptions of the "psychiatrists bible", the DSM.

[Kateryna Sobolieva · Rating 5 out of 5]

База. Чудово книга для всіх психологів, хто працює в схема-терапії. Структура, чіткість, приклади, все просто чудово.

[J. · Rating 3 out of 5]

Overall, Schema Therapy is superb for what it is: a way of simplifying some of the more complex (and often inaccessible or impractical) treatments that have emerged from third-wave CBT treatments.

It is, however, incomplete as compared to these other treatments, and serves best when used as a “gap-filler” for other, more thorough techniques.

Of course, this book was written a decade ago, and I’d be remiss to ignore how important it is when placed in its temporal context. It does a better job at viewing clients as people (not problems) than traditional CBT and offers practical guidance to therapists (and clients) who have trouble identifying and organizing complex cognitions into digestible bits.

It can be extraordinary validating and normalizing for clients to see their core beliefs written out and shared by others as “schemas” (even if this method does risk, at times, becoming like another attempt to group clients into “personality types” under the guise of schema-types or modes). I do worry that, once a schema type is found, a client and therapist could use this similarly to a horoscope and thus go-down the road of self-fulfilling prophecies. I would hope the therapist using schema therapy would be sufficiently trained in empathy and person-centered approaches.

My primary criticism (especially considering that I and others may be reading this in 2021) is that despite the authors’ repeated acknowledgement that clients are not to blame for their current predicaments, the book repeatedly relies on outdated and misogynistic examples that can color budding-therapists perception of their patients.

Notably, I recall the frequent use of the example of a client who is a survivor os sexual abuse and/or other childhood abuse. When these clients are discussed, they are presented as employing coping behaviors whereby the client (and im paraphrasing here) “unconsciously seeks relationships that reenact the abuse.” Examples of “corrective” therapy involves psycho education whereby the client learns to see their behaviors as understandable re-enactments of the past abuse.

I must say: no amount of assurances by the authors that the client isn’t to blame for this or that the client’s behavior is understandable is enough to remove the stain that these examples imprint. Language that implies that the client is “choosing” (even “unconsciously”) to be abused is now rightly understood as harmful victim-blaming by most modern trauma-informed therapies.

I fear that therapists who rely on Schema Therapy in 2021 won’t understand the nuances of what I trust the authors intend to be teaching, and will instead look at these victim-blaming examples and use them in their own practice.

It is for this reason that I couldn’t recommend this book to anyone in-full. In particular, I would have to cut out the parts on coping styles (parts which, overall, risks simplistically labeling clients’ behaviors rather than approaching them as whole people to be understood and validated). These parts often use the offending victim-blaming language.

That being said, if this book was updated from a trauma-informed lens, it could likely have utility as a text in its own right for many more years.

[Don · Rating 5 out of 5]

Clear, concise, comprehensive.

Clear. The authors use direct, everyday language to explain the basics of schema therapy.

Concise. The case studies don’t go on and on but get right to the point. All helpful, all interesting.

Comprehensive. The authors cover all the major aspects of the therapy — the theories underlying it, the different phases of treatment, all of the techniques used.

After reading this, I’m surprised that schema therapy isn’t more popular. First, it was designed to treat clients who do not benefit from CBT alone, which many therapists would say describes most of their clients. Second, it is essentially an amalgam of two widely used approaches, CBT and emotionally focused therapy. Schema therapy puts these approaches together into a cogent, powerful treatment, and after reading this book, I would love to receive more formal training in it.

[Reza · Rating 5 out of 5]

The book helps one understand themselves better. It’s a psychological book, and written in a way that public can understand and relate. Highly recommend.

[Amanda · Rating 5 out of 5]

A great book about schema therapy from the clinical perspective, informative both in theory and methods! Extremely fascinating

[Gerta Stanionytė · Rating 5 out of 5]

Gal man ne kultūros istorike reikėjo būti šiam gyvenime

[Keith Wilson · Rating 5 out of 5]

One of the nice things about being a reflective eclectic is I have loads of methods I can use to help people who see me for psychotherapy. Sometimes it’s simple. If you come in and say you’re anxious, I can teach you a method of breathing that may make you feel better. If you’re depressed, we can talk about finding something easy and meaningful to accomplish. If you’re early in recovery from an addiction, we’ll devise a relapse prevention plan you can follow. These are all methods of Cognitive Behavioral Therapy (CBT), the most direct and rudimentary approach towards helping someone who’s suffering. 

But what if you’ve tried all that and are still suffering? It’s not like you didn’t know how to breathe, get busy, or do something besides getting high before I told you. What if you can breathe fine when reminded, but can’t remember to breathe on your own when you’re anxious? What if you’ve been to a dozen therapists and nothing has gotten better? Luckily, I have a plan B, and C, and D, and E, etc. Here I’ll tell you about a type of psychotherapy that’s designed to be plan B, schema therapy.

But first, let’s examine the reasons CBT, the usual Plan A, often fails.

CBT requires you to meet with a therapist and share the most personal things about yourself before you know whether you can trust her. Many people need longer to feel comfortable than others. If you’ve been hurt in the past by someone you should have been able to trust, then you might not be so keen on it now. In that case, you won’t take her suggestions. You may need a therapy that strengthens your relationship with the therapist before you can ever get down to the issues that brought you to therapy.

Also, with CBT, you need to know what your problem is. You must be able to identify the issue correctly, so the therapist can give you the right homework. Maybe you’re vaguely, but intensely dissatisfied with your relationships, your work, or your self, but you can’t put your finger on what’s wrong. Or maybe you’re depressed one day, anxious the next, and someone thinks you drink too much, but you aren’t sure. You may have never developed the ability to look within and find the words to describe your feelings. It might be you relapse shortly after treatment is complete or your symptoms change as soon as you address them, like a diabolical game of whack-a-mole. You may have some hidden issues that need to be addressed. Sometimes there’s a deep dark secret that must be brought to light, a grief that you never worked through, or an aspiration that has never been pursued. You won’t get anywhere towards solving your problems the CBT way if you don’t know what they are.

You must be flexible enough to change. It can be impossible if you don’t think you can change, if your anxiety, depression, or addiction have become so much a part of you that changing feels like you’re abandoning yourself. Think about how hard recovery from addiction is, for instance. You must stop doing the very thing that helps you cope, right when you have so much to cope with. CBT has no patience for that. It wants you to get on with it and cut the ties you have with dysfunction.

Nor will CBT work if you need comfort more than challenge. CBT is a challenge. It takes a lot of dedication and consistency to change habits. If you’re so depleted and beaten down from a lifetime of adversity and trauma, it may not be possible to take on anything additional. You may need consolation from a therapist for your suffering before you can do anything to help yourself.

Finally, not everything can be addressed by therapy, any kind of therapy. You might need a lawyer, or a cop, or a doctor more than a shrink. Perhaps moving to a safe environment, getting out of a toxic relationship, or getting a better job, government benefits, or a more equitable society will do you more good than anything I can help you with.

So, what is this plan B and what the heck is a schema? A schema is a pattern imposed on reality that guides your perception and suggests a response. For instance, if something walks like a duck and quacks like a duck, the schema we have of waterfowl says it must be a duck. If you’re out duck hunting, you’ll shoot it. If you’re walking with your grandson, you’ll bring bread to feed it. A schema is an abstract representation of distinctive characteristics, a blueprint of prominent elements, together with a prescribed action. You formed your schemas early in life and superimposed them on later experiences. You do this to be consistent, so you can maintain a stable view of yourself and the world around you.

It can be hard to identify the schemas that guide your thoughts, feelings, and behavior. A fish may not realize it lives in the water because that’s all it knows. A therapist can help, there are tests you can take, and there’s a self-help book you can read. The number of possible schemas is probably infinite, but Jeffrey Young, Janet Klosko, and Marjorie Weishaar, identified eighteen particularly maladaptive schemas in their book, Schema Therapy: A Practitioner’s Guide. These are the schemas therapists most often encounter: Mistrust, Emotional Deprivation, Defectiveness, Alienation, Incompetence, Vulnerability, Enmeshment, Failure, False Entitlement, Insufficient Self-Control, Subjugation, Self-Sacrifice, Approval-Seeking, Pessimism, Emotional Inhibition, Unrelenting Standards, and Punitiveness.

Once you’ve identified your most pesky schema from that list, it’s natural to wonder where you got it from. Personally, I can say I have a bit of an alienation schema. I got it from growing up with no other kids around. When I started school, I didn’t know what to make of them, and they didn’t know what to make of me. Mystified by their ways, I kept my distance and found solitary things to do, like reading lots of books. This, of course made me all the more peculiar to everyone else and reinforced my sense of alienation.

Compared to the awful things that happen in some people’s childhoods, this doesn’t sound all that traumatic, but when you’re a little kid, it doesn’t take much. Childhood experiences become foundational for the person you later become. No, let me rephrase that. They become foundational for your schemas. This is a point I’d like to stress. Contrary to appearances, schemas do not define you. You are not your schemas. I am not permanently alienated. I just sometimes think I am.

If you can trace your schemas back to their sources, you’ll see how these beliefs have recurred throughout your life. But it’s also important to know what your schemas make you do, your response when a schema is activated. My alienation schema is sometimes triggered when I’m alone in a public place, like when I’m at a party and no one is talking to me for a few moments. I see everyone else grouped together and having a good time, but I’m in the middle of the room and no one seems to know I’m there. Either that, or they take one look at me and walk away. Something as ordinary as this can engender some very painful, often unnecessary feelings. Sometimes I can’t just sit with those feelings. I’m compelled to do something about them.

Responses to schemas fall into three categories: surrender, avoidance, and overcompensation (corresponding to freeze, flight, and fight). Surrendering would mean I would just stand there, unable to do anything, or move out of the way and line the walls with all the other wallflowers. My mind would be busy, though. I’d be thinking of all the ways I’m different from everyone. Just the narrative the schema demands. If I were to choose avoidance, I’d leave the party or pull out my phone and spend all my time staring at a little screen. I might also get another drink and numb the feelings that are being triggered.

If I overcompensate for my alienation schema, I might decide to circulate at the party, find a group that’s talking, and join in. Or I’ll locate another solitary individual and bend their ear. This involves some degree of imposition and risk-taking, the very things you wouldn’t think my alienation schema wants me to do. It looks like I’m defying the schema, but they’re tricky. If I feel compelled to become the party animal, then I’ll do it wrong. I’ll be forcing it. I’ll overlook those subtle social cues that would tell me I’m coming on too strong and the other people will not greet me enthusiastically. Overcompensation often ends up strengthening the schema, rather than destroying it.

You know when you’re dealing with a schema when it feels like something is taking you over.  If you go home to see your parents and find yourself behaving like a child, you have a schema to blame. If you’re feeling anxious and crave a drink, then a schema is behind it. If you’ve wanted to get pregnant and can’t get happy for your friend who’s having a baby, then a schema is in the way. Some clients take readily to the idea that they can dialogue with parts of themselves that take over. If they’re open to the idea of an inner child, an addicted side, or a green faced monster, there’s a lot we can do with it. It allows us to utilize my plans C, D, E, F, and G: Voice Dialogue, Gestalt Therapy, Internal Family Systems, Psychodrama, or Jungian, and have a good talk with them.

If we were to go back to the reasons CBT often doesn’t work, we can see that many of those reasons correspond to various schemas. Abandonment, Mistrust, Emotional Deprivation, and Shame schemas would get in the way of establishing trust with a therapist. Clients with Dependence, Vulnerability, Enmeshment, and Failure schemas may not know who they are and what they want. Schemas of Subjugation, Self-Sacrifice, or Approval-Seeking result in someone too intent on pleasing the therapist to look within themselves and know their own feelings. Clients with schemas of False Entitlement or Insufficient Self-Control may be too unmotivated or undisciplined to do the work of change. If you have more than one maladaptive schema, we’ll start on the ones that interfere with therapy first. We’ll remove the barriers to change before attempting change.

A lot of good things happen when you have psychological awareness, when you’re able to observe yourself in a curious, non-judgmental way. You’ll want to know what schemas you use and how they distort reality. Once you identify and decide to work on a schema, go about your day, and try to catch it in action. I did this with my alienation schema and found it popping up all over the place. I can always count on it to visit me whenever I’m alone in public. When you catch it, observe what it prompts you to do. I’ve done lots of stuff with my alienation; everything from studying psychology so I can understand people, to writing, so I can communicate with them. It also causes me to rebel, pretend to be a loner, and to have a book, a podcast, or a laptop with me whenever I’m eating out alone. I’ve been known to avoid some social occasions or leave early, which alleviates it for the moment but, in the long run makes my sense of alienation worse. Try not to beat yourself up when you catch a schema making you do crazy stuff. Your schema is not being bad and you’re not being bad. The schema was trying to help you make sense of the world and give you suggestions about what to do. It’s just out of date.

After watching your schema operate, you may conclude that it needs updating. I took a look at my alienation schema and found a lot wrong with it. Most people I meet are friendly, they include me, and listen to what I have to say. I have no reason to be alienated in the bosom of family, in a safe and vibrant community, a citizen of one of the most consequential nations on earth, belonging to a race that enjoys widespread privilege. It’s ridiculous to conclude on the basis of this misbegotten schema that I’m unlikable and friendless.

When you take a look at facts that undermine your schemas, be sure you can accommodate all the information, rather than explain it away. Schemas operate a lot like conspiracy theories, they don’t permit contradiction. At one point, I was so convinced of my alienation that I was blind to all information to the contrary. The schema had me convinced and there was no arguing with it. Destructive as some can be, schemas provide you with feelings of security and predictability, much like belief in a conspiracy theory gives you an identity. People resist giving up schemas because they’ve mistaken their identity for their schemas.

If you’re open to facts that contradict your schema, you will end up with a debate in your head. On one side will be your schema, telling you things you already thought, and on the other side will be this new information, bearing facts that undermine the schema. We’ll call these two sides the schema side and the healthy side. Now, here’s where you devise your own plan B. Plan A was to use the old schema to guide your behavior. That didn’t work so well, so make a plan to abstain from whatever perpetuates it. Use the healthy side to suggest some new behaviors. Test what the healthy side says and see if it’s true.

When I did that with my alienation schema, my healthy side pointed out all the ways I belong. The next time I went to a party, I assumed I belonged there. Then, I could go up to people and talk to them if they appeared receptive. I didn’t force it. If they weren’t receptive then I behaved as if I was content by myself and watched people. I figured if they didn’t want to talk, it had more to do with them than me. I abstained from looking at my phone, disappearing from the party, or drinking to quiet the voice of my schema.

When I acted as if the healthy side was right, I found out it was; but it’s not always going to happen that way. Sometimes the influence of the schema is so strong that you don’t give it a good test, you give in to the demands of the schema and behave as you always have. Other times, the healthy side, as you constructed it, proves to be wrong. In my case, I don’t belong everywhere. There will be groups of people who systematically exclude people like me, no matter who I am. Maybe I never paid the price for admission, I didn’t get that degree, formally joined, cleaned myself up, or learned to behave in an acceptable manner. If that’s true, then there are steps I can take to belong if I really want to. Then there are the groups that will never accept people like me. They don’t like the color of my skin, the slant of my eyes, or the way I pronounce my vowels. There’s nothing I can do about it then, but I may not want to join their group, anyway.  

If you put the healthy side to the test and find that it’s true, then you are well on the road to recovery. It’ll take some deliberate practice, though. You can’t count on doing it the healthy way once and expect it to stick. In my case, I had to go to a few parties, sit alone in a restaurant many times, and go the places I used to avoid before the healthy way became automatic. However, it won’t be long till you can tell your therapist goodbye and get on with your life.

If you try it the healthy way and find that the schema and your usual responses to it persist, then we need to take what we learned about your schemas and apply them to Plan C. My Plan C is one of the more experiential forms of therapy: Voice Dialogue, Gestalt Therapy, Internal Family Systems, Psychodrama, or Jungian. We’ve given rationality a crack at updating your schema, now you need to see if your emotions can talk to it. Here’s where a willingness to engage with schemas by personifying them is helpful. You basically go back in your memory to whatever trauma caused your schema in the first place, use imagery to pretend it’s happening again, and have a corrective emotional experience.

If it sounds terrifying to go back in memory to trauma and re-experience it, you are wise to be cautious. The memory of trauma will activate the schema involved and set into motion your usual responses. Some can be very self-destructive. We want to first be able to predict what you might do, so we can guard against it. For instance, if the memory of your father beating you up triggers your vulnerability schema, you could easily become violent to defend yourself. You need get past that, so we can contact that inner child who still lives inside, like a set of Russian nesting dolls. You need to take care of him with the healthy, adult side that you developed. Sometimes play and make-believe will help us do what work cannot.

I did this with my alienation schema. I remembered a prototypical incident when no other kid would sit with me on the school bus. I imagined sitting, as I am now, with myself, as a child, on the bus. I talked to that child and asked him if he would like me to take over because I’m an adult. He was happy to let me choose healthy behaviors that he didn’t know how to do.

This is a very different way for me to think, for I used to be ashamed of that little boy. I used to treat that boy in the way that boy imagined everyone was treating him. I would never sit with him. Now, I���m not ashamed of him anymore. I keep him around, along with the schema, for the same reason people keep any memorabilia from their childhood. I’ve got collection of old drawings and a story I wrote during that time, too; all of which are just as embarrassingly inept and childish. It’s important to keep them around to remind myself I haven’t always been as I am now, to demonstrate the reality of change.

Now that I’ve told you about schema therapy, you should know about its limitations. I’ve told you where it fits in, after CBT has failed, and before you try the woo-woo methods like talking to yourself. The other thing I like to say is that the eighteen schemas identified are not enough. People rarely fit neatly into those boxes. Sometimes the creature that walks like a duck and quacks like a duck is a duck-billed platypus and you don’t know where it belongs. The fact is, schema therapy itself is a schema, one that does not correspond perfectly with the actual world and needs to be tailored to fit each person I work with.

However, if this article has done anything at all, I hope it inspires you to identify your own expectations, observe them in action as you go about your day, and consider what they make you do. Do they explain the world the way they’re supposed to, or do they keep you stuck, doing what you’ve always done, and getting what you’ve always got?

Keith R Wilson is a therapist in private practice, who has written widely on mental health and relationships"

[Carla Parreira]

Os traços disfuncionais fazem parte da própria construção da personalidade e da identidade do indivíduo. Os Esquemas Iniciais Desadaptativos (EIDs) estão no centro dos transtornos de personalidade, sendo mais rígidos e difíceis de ser modificados. São basicamente resultantes de necessidades emocionais centrais para a criança que de alguma forma não foram atendidas, como a necessidade de um apego seguro, de afeto, carinho, estabilidade, das noções de autonomia e competência, de liberdade para expressão das emoções, da espontaneidade, do brincar e de limites adequados. A criança desenvolve expectativas resultantes da natureza de suas relações com as figuras de apego. Esses modelos ajudam a interpretar e a manter uma consistência das cognições acerca do mundo interno e externo. Como o comportamento e o caráter do indivíduo são guiados por ele, muitas vezes esse modo de ser é tudo o que ele conhece para se estabelecer nas relações com as mais diversas áreas de sua vida. Os esquemas seriam algo quase in questionável, sendo uma verdade, a priori, natural. Por mais que sejam disfuncionais para os outros, são familiares ao indivíduo, podendo fazer com que sejam recriadas na vida atual condições semelhantes às que foram “nocivas” na infância e participaram da geração desses esquemas. Os EIDs, apesar de serem inicialmente adaptativos, acabam deixando de ter um caráter transitório para se tornarem um padrão de comportamento, envolvendo não apenas as cognições como também as memórias afetivas, corporais e as emoções. As formas de resposta à ameaça, são basicamente de três tipos em todos os organismos: luta, fuga ou congelamento. No contexto da infância, um EID representa também uma ameaça, que é caracterizada pela frustração das necessidades emocionais da criança. Podemos classificar então, três estilos de manejo (coping styles) para lidar com os esquemas: supercompensação, evitação e rendição. O comportamento não é o esquema e, sim, a maneira utilizada pelo paciente para lidar com ele. Há 18 Esquemas Iniciais Desadaptativos (EIDs) que agrupam-se em cinco categorias amplas, chamadas por ele de Domínios de Esquema e que correspondem às necessidades não atendidas da criança em seu período de desenvolvimento.
São eles:
Supervigilância e inibição: em função de uma educação rígida, repressora, na qual não houve possibilidade de expressar suas emoções de maneira livre, os indivíduos com esquemas ligados a esse domínio são geralmente tristes e introvertidos, com regras internalizadas excessivamente rígidas, autocontrole e pessimismo exagerados e uma hipervigilância para possíveis eventos negativos. Os esquemas que aqui se apresentam são: negativismo/pessimismo, inibição emocional, padrões inflexíveis, caráter punitivo.
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Desconexão e rejeição: ligado às falhas de vinculação segura com o outro, de carinho, de estabilidade, da maternagem em geral. Forte dificuldade no estabelecimento de relações afetivas saudáveis. Os esquemas ligados a este domínio são os de abandono/instabilidade, desconfiança/abuso, privação emocional, vergonha, isolamento social/ alienação. Em função de seu desenvolvimento precoce, esses esquemas são bastante difíceis de ser acessados.
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Autonomia e desempenho prejudicados: os indivíduos não conseguem desenvolver um senso de confiança, de se estabelecer no mundo por si mesmo, possuindo geralmente famílias super protetoras que, na tentativa de proteger a criança, acabam não reforçando a sua autonomia. Os esquemas aqui envolvidos são os de dependência/incompetência, vulnerabilidade, emaranhamento/self subdesenvolvido, fracasso.
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Orientação para o outro: com o objetivo de ganhar aprovação e evitar retaliação, os pacientes nesse domínio têm uma ênfase excessiva no atendimento dos desejos e necessidades do outro, às custas das suas próprias necessidades. A família de origem geralmente estabelece uma relação de amor condicional, ou seja, a criança só recebe atenção e aprovação se ela suprime sua livre expressão e se comporta da maneira desejada. Os esquemas aqui envolvidos são os de subjugação, auto-sacrifício, busca de aprovação/reconhecimento.
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Limites prejudicados: ligado às falhas na aplicação de limites realistas, na capacidade de seguir regras e normas, de respeitar os direitos de terceiros e de cumprir as próprias metas pessoais. O egoísmo é a principal característica desses indivíduos, sendo a família geralmente permissiva. Dentro desse domínio estão merecimento/grandiosidade e autocontrole/autodisciplina insuficiente.
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Isolamento Social/Alienação (desconexão e rejeição) Sentimento de que a pessoa está isolada do resto do mundo, é diferente das outras e/ou não faz parte de nenhum grupo ou comunidades. Uma boa terapia oferece recursos para desenvolvimento de novas habilidades sociais. Origem: Crença de que ele ou sua família são diferentes dos outros. Falta de experiências sociais positivas. Crenças básicas: Sou fundamentalmente diferente das outras pessoas. Eu não pertenço a ninguém; sou um/a solitário/a. Sinto-me alienada/o das outras pessoas. Sempre me sinto fora dos grupos. Eu não me encaixo.
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Fracasso/negativismo e pessimismo (autonomia e desempenho prejudicados) Este esquema refere-se a crença que o indivíduo é incapaz de dar-se bem como as outras pessoas em áreas como carreira, escola ou esporte. Estas pessoas podem sentir-se estúpidas, incapazes, pouco talentosas ou ignorantes. Pessoas com este tipo de esquema nem tentam fazer determinadas coisas por acreditarem que com certeza irão fracassar. Crença de ter falhado, de que fracassará ou de ser inadequado em relação aos iguais em áreas de realização (escola, carreira, esportes, etc). Em muitos casos, envolve a crença de ser burra, inapta, sem talento, ignorante, ter menos status e sucesso do que os outros. Origem: Pais que não deram apoio. Foi colocado para baixo, tratado como se fosse um fracasso. Não recebeu encorajamento e disciplina para ter sucesso. Família que abala a confiança. Criança que raramente é ajudada. Criança que não recebe orientação e direção. Criança que foi desprezada. Criança que não aprenderam persistência. Habitualmente os pais não dão suficiente apoio, disciplina ou encorajamento para a criança ter sucesso em áreas de performance como escola ou esporte. Crenças básicas: Quase nada do que eu faço no trabalho (ou na escola) é tão bom quanto o que os outros fazem. Sou incompetente no que se refere a realizações. A maioria das pessoas é mais capaz do que eu no trabalho e em suas realizações. Não tenho tanto talento quanto a maioria das pessoas tem em sua profissão. Não sou tão inteligente quanto a maioria das pessoas no que se refere a trabalho (ou estudo). No negativismo há o foco nos aspectos negativos da vida (dor, morte, perda, desapontamento, conflito, culpa, ressentimentno, problemas não resolvidos, possíveis erros, traição, coisas que podem dar errado, etc.) ao mesmo tempo em que se minimiza os aspectos positivos. Inclui uma expectativa exagerada – em situações profissionais, financeiras ou interpessoais – de que as coisas acabem dando muito errado. Envolve medo de cometer erros que possam levar a um colapso financeiro, perdas, humilhações, ou situações muito desagradáveis. São preocupados, vigilantes, com queixas e indecisões crônicas. Esta pessoa precisa muito do apoio de amigos e familia, pois sozinho não consegue ver que poderia se beneficiar da terapia. Origem: Pais pessimistas. Pais preocupados com as coisas que podem não dar certo. Medo de cometer erros. Pais enfatizam o dever, o perfeccionismo, seguir regras e evitar erros. Criança solicitada a fazer mais do que seria razoável.
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Subjugação (orientação para o outro) Freqüentemente estes indivíduos temem que, a não ser que se submetam, as pessoas ficaram zangadas ou irão rejeita-las. Pessoas que se submetem, ignoram seus próprios desejos e sentimentos. Submissão ao controle dos outros para evitar conseqüências negativas, por sentir-se coagido, para evitar raiva, retaliação ou abandono. Ignoram seus próprios desejos. Subjugação das necessidades: Supressão das preferências, decisões e desejos pessoais. Subjugação das emoções: Supressão da expressão emocional, especialmente a raiva. Envolve o sentimento de que os próprios desejos, opiniões e sentimentos não são válidos ou importantes para os outros. Pode apresentar-se como obediência excessiva combinada com hipersensibilidade a sentir-se encurralado. Pode levar também à escalação da raiva, manifestado em sintomas desadaptativos, por ex.: comportamento passivo-agressivo, explosões de raiva, sintomas psicossomáticos, retiradas de afeição, “atuação”, abuso de substâncias. Esta pessoa só procurará terapia caso alguém o incentive e declare que ele será beneficiado. Origem: Pais controladores. Amor condicionado onde a criança tem que suprimir aspectos importantes de si mesma para ter aprovação. O desejo dos pais é mais importante que os da criança. Ou o status é mais importante do que as necessidades da criança. A criança aprendeu a dar mais ênfase aos desejos dos outros. A criança aprendeu a suprimir a própria raiva. Crenças básicas: Acho que se eu fizer o que quero, só vou arranjar problemas. Sinto que não tenho escolha além de ceder ao desejo das pessoas, ou elas vão me rejeitar ou me retaliar de alguma maneira. Nos meus relacionamentos, deixo a outra pessoa ter o controle. Sempre deixei os outros escolherem por mim, de modo que não sei realmente o que quero. Tenho grande dificuldade em exigir que meus direitos sejam respeitados e que meus sentimentos sejam levados em conta.
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Emaranhamento/Busca de aprovação e reconhecimentos (autonomia e desempenho prejudicados) Este esquema refere-se à crença de que o indivíduo possui um sentido muito pequeno de identidade ou metas internas. Existe freqüentemente um sentimento de vazio ou afogamento. Excessivo envolvimento emocional e proximidade com um ou mais dos pais, à custa da individuação ou do desenvolvimento social normal. Muitas vezes envolve a crença de que, uma das pessoas emaranhadas não pode sobreviver ou ser feliz sem o constante apoio da outra. Também pode incluir sentimentos de ser sufocado ou de estar fundida com os outros, ou de insuficiente identidade individual. Freqüentemente experiênciado como um sentimento de vazio e desajeitamento, de não ter direção ou, em casos extremos, de questionamento da própria existência. Ênfase na obtenção de aprovação, reconhecimento ou atenção das pessoas, ou em se adaptar aos outros à custa de desenvolver um self seguro e verdadeiro. O senso de auto-estima depende principalmente das reações alheias e não das inclinações naturais. Às vezes inclui ênfase em status, aparência, aceitação social, dinheiro ou realização, como um meio de obter aprovação, admiração ou atenção (não por poder ou controle). O psicologo deve tomar muito cuidado com este paciente, pois a terapia não poderá reforçar sua busca de aprovação. Resulta em decisões importantes que não são autenticas ou são insatisfatórias, ou na hipersensibilidade à rejeição. Este paciente deve procurar a terapia, pois a depressão é o quadro mais comum neste esquema. Origem: Pais superprotetores, abusivos ou controladores que desencoraja o desenvolvimento do senso de “eu separado”. Pais que abalam a confiança em si mesmos. Família emaranhada. Pais que não deram responsabilidades à criança. Pais que ensinaram que status é mais importante do que os sentimentos da criança, ou que fizeram a criança sentir que não seria aceita se não atendesse a expectativa dos outros. Aprendeu que precisaria ter status, aparência ou dinheiro para obter aprovação. Crenças básicas: Não consegui me separar de meu pai/minha mãe, ou de ambos, assim como outras pessoas da minha idade parecem conseguir. Meus pais e eu tendemos a nos envolver excessivamente com a vida e com os problemas uns dos outros. É muito difícil para meus pais e eu escondermos detalhes íntimos uns dos outros sem nos sentirmos traídos ou culpados. Muitas vezes me parece que meus pais estão vivendo por intermédio de mim - eu não tenho uma vida própria. Muitas vezes, sinto que não tenho uma identidade separada da de meus pais ou parceiro/a.
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Desconfiança/Abuso (desconexão e rejeição) Este esquema refere-se a expectativa de que as outras pessoas irão intencionalmente tirar vantagem de alguma forma. Pensam em atacar primeiro antes de serem feridos, ou de vingar-se mais cedo ou mais tarde. Expectativa de que os outros vão magoar, abusar, humilhar, trapacear, mentir, enganar, desprezar, manipular ou tirar vantagem. Normalmente envolve a percepção de que o dano é intencional ou resultado de negligencia injustificada e extrema. Pode incluir o sentimento de que a pessoa sempre acaba sendo enganada pelos outros ou a idéia de que “a corda sempre arrebenta do lado mais fraco”. Em terapia o psicologo ajuda a identificar os reais casos de abuso e as situações onde a percepção distocida impera. Origem: Foram abusadas ou tratadas de forma injusta. Pais que mentiam. Abuso sexual ou apanhavam. Falta de empatia e de ambiente seguro. Crenças básicas: Sinto que as pessoas querem tirar vantagem de mim. Sinto que não posso baixar a guarda na presença dos outros, pois eles me prejudicariam intencionalmente. É só uma questão de tempo antes que as pessoas me traiam. Desconfio muito dos motivos dos outros. Eu geralmente fico procurando os motivos escondidos das pessoas.
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Abandono (desconexão e rejeição) Este esquema, quando identificado em terapia, refere-se a expectativa que logo que a pessoa sinta-se ligada emocionalmente alguém, ela acabará sendo abandonada. A pessoa acredita que de uma forma ou de outra relacionamentos próximos terminarão inevitavelmente. Instabilidade ou falta de confiança percebida daqueles dispon��veis para apoio e conexão. Envolve o sentimento de que as pessoas significativas não serão capazes de continuar proporcionando apoio emocional, conexão, força ou proteção prática, por serem emocionalmente instáveis e imprevisíveis (por ex, ataques de raiva), não confiáveis ou erraticamente presentes; porque vão morrer a qualquer momento, ou porque o abandonarão em favor de alguém melhor. Origem: Divorcio ou morte de pessoas próximas. A criança não foi atendida. Ficava só. Pais explosivos ou imprevisíveis. Pais desligados. Brigas em casa. Falta de ambiente seguro. Falta de empatia em casa. Criança foi ignorada, sente que não foi desejada. Pais inconsistentes em atender as necessidades da criança. Crenças básicas: Percebo que me agarro às pessoas com as quais tenho intimidade, por ter medo de que elas me deixem. Preciso tanto das pessoas que tenho medo de perdê-las. Eu me preocupo com a possibilidade de as pessoas de quem eu gosto me deixarem ou me abandonarem. Quando sinto que alguém com quem eu me importo está se afastando, fico desesperada/o. Às vezes, tenho tanto medo de que as pessoas me deixem, que acabo fazendo com que se afastem.
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Privação Emocional (desconexão e rejeição) Este esquema refere-se a crença que as necessidade emocionais primárias nunca serão atendidas. Estas necessidades incluem maternagem, empatia, afeto, proteção, aconselhamento e carinho por parte dos outros. Expectativa de que não receberá apoio emocional, não será adequadamente atendida. Privação de carinho. Ausência de atenção, afeição ou companheirismo. Privação de empatia. Ausência de entendimento, escuta, auto-revelação, ou mutuo compartilhamento dos sentimentos. Privação de proteção. Ausência de força, direção ou orientação por parte dos outros. Quando em terapia o paciente pode achar que o psicologo também o priva emocionalmente, mas será apenas reflexo deste esquema. Origem: Pais emocionalmente distantes, não demonstraram companheirismo, compreensão, proteção, força e orientação. Família rejeitadora. Família refreadora. Brigas em casa. Falta de empatia. Pais privaram emocionalmente. Crenças básicas: na maior parte do tempo, não tenho ninguém para me dar carinho, compartilhar comigo e se importar profundamente com o que me acontece. Na infância, em geral, não havia pessoas para me dar carinho, segurança e afeição. Eu não senti que era especial para alguém, em grande parte da minha vida. Em geral, não tenho ninguém que realmente me escute, me compreenda ou esteja sintonizado com minhas verdadeiras necessidades e sentimentos. Eu raramente tenho alguma pessoa forte para me dar bons conselhos ou orientação quando não tenho certeza do que fazer.
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Dependência/Incompetência (autonomia e desempenho prejudicados) Este esquema refere-se a crença que o indivíduo é incapaz de lidar com responsabilidades do dia a dia de forma competente e independente. Pessoas com este esquema, freqüentemente dependem da ajuda dos outros de forma exagerada em áreas como tomar decisões e iniciar tarefas novas. A crença de ser incapaz de manejar as responsabilidades diárias de maneira competente, sem considerável ajuda dos outros, por ex.: cuidar de si mesmo, resolver os problemas do cotidiano, exercer julgamentos corretos, lidar com as tarefas novas, tomar boas decisões. Muitas vezes apresenta-se como desamparo. A terapia o ensinará a tomar decisões por conta propria. Origem: Pais não encorajaram a criança a ser independente e desenvolver confiança em cuidar de si mesmo. Família emaranhada. Família superprotetora. Criança não recebeu responsabilidades. Pais intervem nas mínimas dificuldades ou nunca ajudaram. Pais que não dão orientação. Crenças básicas: Não me sinto capaz de me arranjar sozinha/o no dia-a-dia. Penso em mim como uma pessoa dependente, no que se refere ao funcionamento cotidiano. Falta-me bom senso. Não se pode confiar em meu julgamento nas situações do dia-a-dia. Não confio em minha capacidade de resolver os problemas que surgem no cotidiano.
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Defectividade/Vergonha/Indesejabilidade Social (desconexão e rejeição) Este esquema refere-se a crença de que o indivíduo é internamente uma farsa, e caso as pessoas dele se aproximem irão descobrir. Este esquema de ser um farsante ou um inadequado, leva uma forte sensação de vergonha. O sentimento de que a pessoa é defeituosa, má, indesejada, inferior ou inválida em aspectos importantes. Ou de que ela não é digna do amor das pessoas significativas, se exposta. Pode envolver hipersensibilidade à críticas, rejeição e culpa, constrangimento, comparações e insegurança perto dos outros, ou um sentimento de vergonha pelas falhas percebidas em si mesmo. Essas falhas podem ser privadas, por ex: egoísmo, impulsos raivosos, desejos sexuais inaceitáveis, etc., ou públicas, por ex.: aparência física indesejável, inabilidade social, etc. A terapia o ajudará a ser mais espontaneo. Na indesejabilidade social há a crença de que o indivíduo é “intrinsecamente” desinteressante para os outros. Pessoas com este esquema vêem a si próprios como fisicamente não atraentes, incapazes socialmente ou que não possuam um status social adequado. Origem: Pais muito críticos que o fizeram sentir que não merece ser amado. Criança foi ignorada e sente que não foi desejada. Pais que o fizeram se sentir pouco atraente. Pais rejeitadores. Falta de experiências sociais positivas. Família muito critica. Crenças básicas: Nenhum/a homem/mulher que eu desejar vai me amar depois de saber dos meus defeitos. Ninguém que eu desejar vai querer ficar perto de mim depois que conhecer meu verdadeiro eu. Não sou digna/o do amor, da atenção e do respeito dos outros. Sinto que não mereço ser amada/o. Sou inaceitável demais, de todas as maneiras possíveis, para me revelar aos outros.
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Inibição Emocional (supervigilância e inibição) Este esquema refere-se a crença que deve-se inibir impulsos e emoções, especialmente raiva, já que esta expressão pode prejudicar outras pessoas ou levar a perda da auto-estima, embaraço, retaliação ou abandono. Estas pessoas podem ser pouco espontâneas ou vistas como contidas. Inibição da ação, dos sentimentos ou das comunicações espontâneas – para evitar a desaprovação dos outros, vergonha ou

[Sippy · Rating 3 out of 5]

3.5 ⭐

Werd naarmate de tijd vorderde voor mij persoonlijk steeds minder interessant, de vele case studies waarin gesprekken worden uitgewerkt, hielpen er ook niet bij. Steeds meer overgeslagen of alleen diagonaal gelezen. Niettemin wel wat van opgestoken, maar ben niet kritiekloos, ook niet in theoretisch opzicht.

[maia · Rating 5 out of 5]

just by reading this book I've gained a lot of introspective understanding of myself and unhealthy schemas I've developed and also an increased awareness of other people and the schemas they exhibit. It's made me a lot more understanding to myself and others, and even though I haven't been to therapy and also did not read this book as a self help book, I found myself being helped by it anyway. it's really interesting and really digestible with no unnecessarily complicated way of explaining things. I'm always referencing this to people, 'they talk about this in the schema book' is something I find myself saying a lot lololol

[Emi Kanter · Rating 4 out of 5]

For the professional therapist of any school of thought, this might help in that it organizes the structure of case formulation, and better thinking the case. It also helps in learning what schema therapy is all about!

It is far from being enough, just a reference and an idea. At least a bit of supervision and technique roleplaying are necessary for puting it to practice, and the whole study to actually be a schema therapist and all that comes with it - I think it should be the standard integrative therapy, for it easily integrates reading from all schools of psychotherapy into a solid model.

Me, as a fan of Winnicott, Thomas Ogden and other psychoanlysts, and as an admirer of Victor Frankl and Jacob Moreno, feel at ease - to say the least - in having a paradigm that let's me be spontaneous, honest with the patient, and integrate many diferent paradigms into my practice, and schema therapy is the "joint", and core.

[Rick Sam · Rating 2 out of 5]

Young and his 18 Schemas: Definitely Worth knowing to fill in gaps in knowledge.
Sometimes, We might not be aware of them. What we cannot define or understand, we are blinded.

Young identified 18 schemas:

Abandonment (instability),

Mistrust‐Abuse,

Emotional Deprivation,

Defectiveness‐Shame,

Social Isolation (alienation),

Dependence Incompetence,

Vulnerability to Harm or Illness,

Enmeshment (undeveloped self),

Failure (to achieve),

Entitlement Grandiosity,

Insufficient Self‐control (or self‐discipline),

Subjugation,

Self‐ Sacrifice,

Approval Seeking (recognition seeking),

Negativity Pessimism,

Emotional Inhibition,

Unrelenting Standards (hyper‐criticalness), and Punitiveness

Maladaptive schemas hinder people from recognizing, experiencing, and fulfilling their own needs.


Deus Vult,
Gottfried

[Gabrielle Monis · Rating 5 out of 5]

Extraordinary!
I recommend this book to anyone who is interest into the making of personalities and behaviours. Young goes deep into the mechanisms and models that forged our minds. And unlike many other books, doesn’t only point out problems, but actually suggests straight forward solutions to solve them. This book helped me understand myself and those around me, a must read.

[Piero · Rating 5 out of 5]

This manual helped me bridge the gap between Cognitive and Behavioural intervention through the Emotional link that was missing before. I think I made a leap in the way I approach treatment and I would recommend this manual to anyone interested in approaching Personality Disorders.

[Lane Willson · Rating 5 out of 5]

Incredibly pragmatic in its application to addiction, this manual is written such that it can be understood by those who have only a basic concept of schemas.

[V · Rating 1 out of 5]

Here's the quick TL DR summary of my review:

There is value here. However, it is encased in a humongous amount of assumptions, presuppositions, implicit statements that detract from the role of the therapist. If you think the role of a therapist is to reinforce societal values, then you need not read any further, we will find no common ground.

This book, is distinctly American in an unexpected way. Following the pattern of declaring war - on mental 'illness', on drugs, homelessness, etc., the authors seem to engage in the same sort of mentality.
The word "fight" finds itself in the book 83 times and "battle" 11 times. I eschewed looking for more synonyms.

In the very first chapter, the DSM is cited as being seriously flawed as a diagnostic system. DSM diagnosis and its criteria are still used throughout the book.
Schema and diagnoses are used interchangeably. While the authors claim schema are supposed to be used solely as models, not a thing in itself, they do not practice what they preach. A lot of incongruence is present.

The good aspects of this work are the exchanges and examples throughout. However they must be enjoyed responsibly in the sense that all the assumptions and claims concerning the role of the therapist, the health, and methods proposed to achieve results, are often shaky at best and downright manipulation at worst.

The most serious reasons as to why I'm rating this so low is the emphasis on coercion and infantilisation of the client, coupled with an abysmally low focus on what the client actually wants. Throughout the book, very little is spoken about what the client wants, or his goals, the therapist perspective is vastly overemphasised and put over the client. The clients goals per se do not exist, only their translation into therapist amtssprache exists, the therapist implicitly determines the goals of therapy, what healthy means, and how all of this will be approached. When I hear the words 'therapeutic alliance' I think of two equals working as a team, this is not present here.

Schemas and modes are used as a coercive tool to circumvent an individual's critical thinking.
Schemas are used interchangeably with diagnosis in the conventional DSM sense, and do not represent added value in this context.

The dynamic of the client/therapist relationship is everything but equal or an alliance. The terminology used is of 'limited reparenting' of 'homework assignment' and of 'abandonded/vulnerable children' representing a core of people's identity. I quote "The patient’s progress in treatment in some respects parallels child development. Psychologically, the patient grows up in therapy. The patient begins as an infant or very young child and—under the influence of the therapist’s reparenting—gradually matures into a healthy adult."

BPD people are classified as children I quote "In our view, the most constructive way to view patients with BPD is as vulnerable children. They may look like adults, but psychologically they are abandoned children searching for their parents." If this is indeed the case, why do the authors not call for the stripping of legal rights of people with so-called BPD? (Sidenote: A personality 'disorder' and mental illness in general is not something you have, but something you do)

Pejorative use of terminology is eschewed on the surface. Clients' parents are denoted as tyrannical, value statements and judgements about behaviour are thrown about liberally. If anything the book left me desperately wanting to give Marshall Rosenberg's Non-Violent Communication re-reads.

Regularly, it is recommended to gaslight and emotionally blackmail the client in the pursuit of keeping the client in therapy and enticing them to change, no emphasis is given on what the client wants. I quote "The therapist finds out what is causing them pain and why they have come to therapy, and uses these as leverage to keep these patients in therapy." Or "The therapist has to find the leverage—the ways it is hurting the patient to be entitled or grandiose. Then, the therapist has to remind the patient continually about the negative consequences of the schema." Or "Keeping the patient in the Abandoned Child mode also helps the patient bond with the therapist. This bond keeps the patient from leaving therapy prematurely and gives the therapist leverage to confront the patient’s other, more problematic modes."

Nevermind the notion of involuntary hospitalisation and proposed form of blackmail. I'll paraphrase the suggested approach for brevity: If you don't go voluntarily, I'll force you and you can no longer count on me when you come back.

And I could keep going and going. The way the authors of this book view clients is abysmal. They truly represent what is wrong the image of therapy from the lens of client rights. They believe coercing, manipulating and forcing people into a mold of a preconceived 'healthy adult' is a right and just pursuit. I personally view it as a crime.

[S.M.Y Kayseri · Rating 4 out of 5]

This book provides a comprehensive guide in conducting schema therapy. Schema therapy incorporates cognitive behavioral therapy with psychodynamics, also employing Gestalt techniques in its imagery techniques.

Schema therapy heavily recruits the attachment theory and childhood adverse events as the primary cause behind patient’s distress. And this assumption is certainly valid, as we are brought up with a framework inherited from our interaction with our immediate families. As I have mentioned in previous posts, psychodynamic theories as such of the Jungian, suggested that every newborn comes with a set of innate images, and first and foremost is the image of the syzygy parent. The newborn superimposed this image to the primary caretaker they depended on daily, and this relation constitutes the sole bridge between the infant inwardness and the world. If this relation is compromised, it will cause severe enduring patterns as we can see in many personality disorders. This maladaptive patterns is what we called as schema.

Schema therapy as the name suggested involves in identifying the schema and tries to loosen the automatic employment of the schema in patient’s daily life. Patients maladaptively equip these schema in the forms of surrender, avoidant or overcompensating the schemas. For an example, a patient with Emotional Deprivation schema might surrender herself to schema by choosing cool, unavailable partners that perpetuates the schema. Or she would avoid the pains of the schema by abstaining from any close relationship at all. Or she would overcompensating by emphasizing her needs above all, even unrealistically.

There’s 18 maladaptive schemas which the patient can employ in 3 coping methods as mentioned above. What I like about the therapy is that it employs objective techniques and rating to accurately diagnose the schemas instead of totally relying on the therapist’s intuition. But the questionnaire is about 200+ questions which realistically cannot be employed in emergent inpatient situations. And I do not believe the rating is to be used in those situations, either. Yet, the objectification of patient’s pathos really helped in relating with the patients. And it really helped that the authors also provided specific treatment strategies against the schemes.

The treatment prong of the therapy employs cognitive, experiential, behavioral and schema mode work. Cognitive and behavioral strategies employed methods as the traditional ones. Cognitive strategies mainly empower the patient to objectify their pathology, into a schematic diagram where the schema can be caught in action and lose its autonomous grip. Experiential strategies mostly involves imagery techniques, where Socratic dialogue held between the conflicting parts within the patients.

The basic framework behing the imagery techniques is to 1) for the patient to face the painful moments in their childhood, as a way of putting a control in the narration, 2) allow catharsis by ventilating to the conflicts, and 3) allowing the therapist to enter into the dialogue as the Healthy Adults, which by the introjection process, the traces of the Healthy Adults can be nurtured within the psyche, and subsequently patient able to integrate the mode into their daily life.

Schema therapy really fascinates me as it provides clear techniques and strategies in the face of the multiple facets of the psyche. While the therapy are designed to proceed long-term even up to years, still the understanding of the schema, the treatment strategies and also the concepts of “empathetic confrontation” and “limited parenting” can be utilized in daily clinical practice.

[Kazza · Rating 5 out of 5]

This is an excellent book for therapists who use schema therapy, which I do. The vast majority of my clients/patients work well with schema therapy. I find it one of the most engaging and practical therapeutic choices. Its foundation lies in CBT with some tweaks, like inner work. Because many people have been negatively impacted by their childhood in unhelpful ways - overbearing parents, abusers, perfectionism, substance overuse - they learn how to 'exist' or survive their home environment. The childhood adaptations that may have served them well once, no longer do so. They are detrimental - like attachment or abandonment issues, people pleasing, social isolation, and so forth.
If you want to read a book that is easy reading and helpful and is about schemas given another name, note that not all the schemas are listed, which is fine because a couple of schemas overlap anyway, then I recommend Reinventing Your Life: The Breakthrough Program to End Negative Behavior...and Feel Great Again. By two of the three authors here, Young and Klosko.

[Paul · Rating 4 out of 5]

It's not a book but I highly extensive guide or manual for conducting schema therapy! And when I say "manual", I mean it both in a positive sense as well as a negative one. On the one hand, the book is super clean written. No unnecessary stories, just pure explanations of theory and technique with appropriate examples. On the other hand, I would appreciate a more critical evaluation of the methodology in terms of its pros and cons. That said, I don't think it would make sense in this particular context. At the end of the day, it is a guide! So, I recommend this guide to any mental health practitioner interested in working with the root causes of various personality disorders as well as hoping to understand the mechanisms of how imagery in particular or therapy in general can be beneficial to clients.

[Euan · Rating 4 out of 5]

This seminal work on Schema Therapy was a good introduction to the core concepts and techniques found within the modality. It focusses more on providing an overview of treatment rather than instructing how to implement certain techniques beyond a case illustrations and brief example dialogues. However, this guide is now two decades old and can be forgiven for not having a fully stocked armoury of schema interventions. Newer manuals seem to do this better.

My main criticism is that this guide repeats itself endlessly. This would be fine if it were based on an 'insertional' model where therapists could open to any chapter and need to be reminded of key concepts. However, this guide really needs to be read from start to finish, and the repetition of key points can become tiresome.

[João Felício · Rating 5 out of 5]

Remarkably well written. This book delivers highly complex information very effectively and to the point. As for schema therapy, it is psychology trying to comprehend the construction of personality, in an evidence based and critical way.

It is a relief to read this, to see that CBT is not neglecting childhood and personality development anymore. This is CBT admitting that it had limitations in dealing with personality structure through classic “cognition changing” technique and diving into a scientific search into human personality development. We are growing to finally have an evidence based way to deal with egosyntonic, yet dysfunctional, behavioral patterns.

[Luiz Fabricio Calland Cerqueira · Rating 5 out of 5]

Essa segunda leitura do livro me encontrou um profissional mais experiente e com mais pacientes onde consigo enxergar os esquemas e modos. É uma abordagem muito abrangente, e certamente encaixa melhor para usuários de TCC. Na primeira vez que li esse livro não era terapeuta cognitivo comportamental e isso fez toda a diferença.

Gostei especialmente do capítulo de Transtorno de Personalidade Borderline, e enxergo com muita facilidade meus pacientes com esse quadro sendo beneficiados pela abordagem. O mesmo não senti com o capítulo de Transtorno de Personalidade Narcisista.