AN INTRODUCTORY GUIDE TO SCHEMA-FOCUSED THERAPY:

Adapted for use with the YSQ-R

Created by Jeffrey Young, edited and revised by Ozgur Yalcin

 TABLE OF CONTENTS

Introduction 2

Early Maladaptive Schemas 2

How Schemas Work 11

Examples of Maladaptive Coping Responses 13

Case Examples 15

Therapeutic Process – Changing Schemas 16

Further Reading and References 18

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 AN INTRODUCTORY GUIDE TO SCHEMA-FOCUSED THERAPY:
Adapted for use with the YSQ-R

Harry is a 45-year-old middle-level manager. He has been married for 16 years, but his marriage has been very
troubled. He and his wife are often resentful of each other, they rarely communicate on an intimate level, and
they have few moments of real pleasure.

Other aspects of Harry’s life have been equally unsatisfying. He doesn’t enjoy his work, primarily because he
doesn’t get along with his co-workers. He is often intimidated by his boss and other people at the office. He
has a few friends outside of work, but none that he considers close.

During the past year, Harry’s mood became increasingly negative. He was getting more irritable, he had trouble
sleeping, and he began to have difficulty concentrating at work. As he became more and more depressed, he
began to eat more and gained 15 pounds. When he thought about taking his own life, he decided it was time
to get help. He consulted a psychologist who practices cognitive therapy.

As a result of short-term cognitive therapy techniques, Harry improved rapidly. His mood lifted, his appetite
returned to normal, and he no longer thought about suicide. In addition, he was able to concentrate well again
and was much less irritable. He also began to feel more in control of his life as he learned how to control his
emotions for the first time. But, in some ways, the short-term techniques were not enough. His relationships
with his wife and others, while they no longer depressed him as much as they had, still failed to give him much
pleasure. He still could not ask for his needs to be met, and he had few experiences he considered truly
enjoyable. The therapist then began schema-focused cognitive therapy to help Harry change his long-term life
patterns.

This guide will present the schema-focused approach, a recent elaboration of cognitive therapy developed by
Dr Jeffrey Young that can help people change long-term patterns, including how they interact with other
people.

EARLY MALADAPTIVE SCHEMAS

A schema is an extremely stable and enduring pattern that develops during childhood and is elaborated
throughout an individual’s life. We view the world through our schemas. Schemas are important beliefs and
feelings about oneself and the environment that the individual accepts without question. They are self-
perpetuating and are very resistant to change. For instance, children who develop a schema that they are
incompetent rarely challenge this belief, even as adults. The schema usually does not go away without therapy.
Overwhelming success in people’s lives is often still not enough to change the schema. The schema fights for
its own survival and, usually, is quite successful.

Even though schemas persist once they are formed, they are not always in our awareness. Usually, they operate
in subtle ways, out of our awareness. However, when a schema erupts or is triggered by events, our thoughts
and feelings are dominated by these schemas. It is at these moments that people tend to experience extreme
negative emotions and have dysfunctional thoughts. Most people will have at least two or three of these
schemas, and often more. A brief description of each of these schemas is provided below.

1. Emotional Deprivation:
The expectation that one's desire for a normal degree of emotional support will not be adequately met by
others. The three major forms of deprivation are:

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 a) Deprivation of nurturance: absence of attention, affection, warmth, or companionship.
b) Deprivation of empathy: absence of understanding, listening, self-disclosure, or mutual sharing
of feelings from others.
c) Deprivation of protection: absence of strength, direction, or guidance from others.

Examples of core beliefs/assumptions:

• I don’t matter
• I can’t rely on others to meet my needs
• I’m not special to anyone

Origins of this schema may have involved early experiences where:

• Caregivers were not really tuned into the child’s needs and emotions. They had difficulty
empathising and connecting with the child’s world.
• Caregivers did not give the child enough time and attention for them to develop a sense of being
loved and valued.
• Caregivers did not soothe the child adequately. The child, then, may not have learned to soothe
themself or to accept soothing from others.
• Caregivers did not adequately guide the child or provide a sense of direction. There was no one
solid for the child to rely upon.

2. Abandonment:
This schema refers to the expectation that one will soon lose anyone with whom an emotional attachment
is formed. The person believes that one way or another, close relationships will end. There is often a
perceived instability or unreliability of those available for support and connection. Involves the sense that
significant others will not be able to continue providing emotional support, connection, strength, or
practical protection because they are emotionally unstable and unpredictable (e.g. angry outbursts),
unreliable, or erratically present; because they will die imminently; or because they will abandon the
patient in favour of someone better.

Examples of core beliefs/assumptions:

• I can’t trust that others will stick by me
• Eventually, people I love will leave me

Origins of this schema may have involved early experiences where:

• A parent or loved one died or left home when the child was young.
• The child was separated from a primary caregiver for a prolonged period of time (e.g. parents
divorced, a parent was hospitalised, the child was sent away to boarding school)
• Caregivers were unstable. They became depressed, angry, drunk, or in some other way withdrawn
from the child regularly.
• The child lost the attention of someone important in a significant way (e.g. a new sibling was
born, a parent remarried, a friend chose somebody else).

3. Mistrust/Abuse:
The expectation is that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage. Usually
involves the perception that the harm is intentional or the result of unjustified and extreme negligence.
May include the sense that one always ends up being cheated relative to others or “getting the short end
of the stick.”

Examples of core beliefs/assumptions:

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 • I can’t trust anyone
• I can’t let my guard down
• People will hurt me

Origins of this schema may have involved early experiences where:

• The child was physically and/or sexually abused or assaulted, or sought out by an adult for
physical affection that was inappropriate or uncomfortable
• The child was repeatedly humiliated, teased/bullied, or put down by caregivers or peers
• People close to the child could not be trusted (e.g., they betrayed confidences, exploited
weaknesses to their advantage, were manipulative, made promises they had no intention of
keeping, and lied often)
• Caregivers were mistrusting and warned the child not to trust people outside of the family

4. Social Isolation:
The feeling that one is isolated from the rest of the world, different from others, and/or not part of any
group or community.

Examples of core beliefs/assumptions:

• I don’t belong
• I’m different to everyone else

Origins of this schema may have involved early experiences where:

• The child was different to others, because of some qualities (e.g., looks, stuttering, personality
feature). They were teased, rejected, humiliated, or ignored by others.
• The child’s family was different from other children’s families.
• The child was made to feel different from others, even within their own family.

5. Defectiveness/Shame:
The feeling that one is defective, bad, unwanted, or inferior, and that one would be unlovable if their
‘flaws’ were exposed. May involve hypersensitivity to criticism, rejection, and blame; self-consciousness,
comparisons, and insecurity around others; or a deep sense of shame regarding one's perceived flaws.
These flaws may be private (e.g., selfishness, angry impulses, unacceptable sexual desires) or public (e.g.,
undesirable physical appearance, social awkwardness).

Examples of core beliefs/assumptions:

• I’m not good enough
• There’s something wrong with me
• I’m worthless

Origins of this schema may have involved early experiences where:

• The child was repeatedly criticised, punished, or demeaned
• The child was made to feel like a disappointment or a burden
• The child was rejected
• There was sexual, physical, or emotional abuse
• The child was repeatedly compared unfavourably with siblings, or their siblings were preferred

6. Failure:
The belief that one has failed, will inevitably fail, or is fundamentally inadequate relative to one's peers
in areas of achievement (school, career, sports, etc.). Often involves beliefs that one is stupid, inept,

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 untalented, ignorant, lower in status, less successful than others, etc.

Examples of core beliefs/assumptions:

• I’m a failure/will inevitably fail
• Nothing I do is as good as other people
• I won’t succeed, no matter how hard I try

Origins of this schema may have involved early experiences where:

• There was a caregiver, teacher, or coach who was very critical of the child’s performance
• Caregivers and peers of the child were extremely successful, and the child came to believe they
could never live up to these high standards or were often compared unfavourably
• The child was not as good as others at school/sports and felt inferior. The child may have had a
disability or condition that was not supported or recognised.

7. Dependence/Incompetence:
The belief is that one is unable to handle one's everyday responsibilities in a competent manner without
considerable help from others (e.g., taking care of oneself, solving daily problems, exercising good
judgment, tackling new tasks, and making good decisions). Often presents as helplessness.

Examples of core beliefs/assumptions:

• I can’t trust my own judgement
• I can’t cope on my own

Origins of this schema may have involved early experiences where:

• The child was overprotected and treated as if they were younger than they were. The child may
never have had a serious rejection or failure until they left home.
• Caregivers made decisions for the child or interfered with their choices by giving excessive
advice, instructions, criticism, or warnings.
• The child was given little or no responsibility.
• The child was criticised for their opinions and competence in everyday tasks.

8. Vulnerability To Harm:
Exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent
it. Fears focus on one or more of the following:
• Medical catastrophes (e.g., heart attacks, AIDS)
• Emotional catastrophes (e.g., going crazy)
• External catastrophes (e.g., elevators collapsing, being victimised by criminals, aeroplane
crashes, earthquakes)

Examples of core beliefs/assumptions:

• I’m not safe
• I can’t protect myself
• I am vulnerable

Origins of this schema may have involved early experiences where:

• There was a caregiver that was phobic or frightened about specific areas of vulnerability (such as
losing control, getting sick, going broke, etc).
• The child was overprotected or continuously warned of specific dangers.
• The home environment did not seem safe physically, emotionally, or financially. Caregivers may

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 • not have adequately protected the child, or the child grew up in a time/place of significant
political, economic, or civil unrest.
• The child or a loved one experienced a serious traumatic event (e.g. a car accident, severe illness,
assault).

9. Enmeshment/Underdeveloped Self:
Excessive emotional involvement and closeness with one or more significant others (often parents) at the
expense of full individuation or normal social development. Often involves the belief that at least one of
the enmeshed individuals cannot survive or be happy without the constant support of the other. May also
include feelings of being smothered by or fused with others or insufficient individual identity. Often
experienced as a feeling of emptiness and floundering, having no direction, or in extreme cases
questioning one’s existence.

Examples of core beliefs/assumptions:

• I can’t survive without the other person
• I don’t know who I am
• I can’t separate myself from others

Origins of this schema may have involved early experiences where:

• The family was extremely close and overinvolved with all aspects of each other’s lives;
boundaries were not respected or established.
• The child was relied upon for emotional support by their parent; their parent was their “best
friend”.
• The child was rarely apart from caregivers and had little opportunity to develop a sense of self as
a separate person.
• Attempts to individuate were met with anger, accusations of betrayal or disloyalty, or other
distress.

10. Subjugation:
Excessive surrendering of control to others because one feels coerced – submitting to avoid anger,
retaliation, or abandonment. The two major forms of subjugation are:
• Subjugation of needs: suppression of one’s preferences, decisions, and desires.
• Subjugation of emotions: suppression of emotions, especially anger. Usually involves the
perception that one’s own desires, opinions, and feelings are not valid or important to others.
Frequently presents as excessive compliance, combined with hypersensitivity to feeling trapped.
Generally, leads to a buildup of anger, manifested in maladaptive symptoms (e.g., passive-
aggressive behaviours, uncontrolled outbursts of temper, psychosomatic symptoms, withdrawal
of affection, “acting out,” substance abuse).

Examples of core beliefs/assumptions:

• I’m not allowed to speak my mind
• I am powerless
• If I expressed what I really felt, I would be punished

Origins of this schema may have involved early experiences where:

• Caregivers or friends punished, threatened, or got angry when the child disagreed
• Caregivers or friends withdrew emotionally or cut off contact when the child disagreed
• The child was dominated or “one-upped” whenever they expressed feelings or needs
• Loved ones tended to become worried, upset, or angry, leaving the child feeling like they had to

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 • walk on eggshells

11. Self-Sacrifice:
Excessive focus on voluntarily meeting the needs of others in daily situations at the expense of one’s own
gratification. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling
selfish; or to maintain the connection with others perceived as needy. Often results from an acute
sensitivity to the pain of others. Sometimes leads to a sense that one’s own needs are not being adequately
met and to resentment toward those who are taken care of.

Examples of core beliefs/assumptions:

• My own needs aren’t important
• I’m responsible for everyone else’s feelings/needs
• It is selfish to do things for myself

Origins of this schema may have involved early experiences where:

• Caregivers were absent, physically/emotionally unwell, or overwhelmed by their demands
requiring the child to help the family by taking on adult responsibilities.
• There was significant emphasis on selflessness and kindness as a virtue (e.g. religious or moral
beliefs).
• The child was made to feel selfish, guilty, or bad if they prioritised their own interests.

12. Emotion Constriction:

The excessive inhibition or disconnection of spontaneous emotion, action, or expression, due to an
underlying shame/embarrassment. It involves inhibition of both negative impulses (e.g. anger, aggression,
sadness) and positive impulses (e.g. joy, affection, sexual excitement, play), difficulty expressing
vulnerability or communicating freely about one’s thoughts, feelings, and needs, or excessive emphasis
on rationality over emotions. There may be a sense of pride in being “a rational person” or hold
moral/ethical values in stoicism.

Examples of core beliefs/assumptions:

• Showing emotions means I am weak/vulnerable
• I am strong because I’m not swayed by my emotions
• It is foolish to be emotional

Origins of this schema may have involved early experiences where:

• The child was expected to suppress spontaneous urges in favour of rigid rules, duty, rationality,
ethics, or keeping up appearances.
• Expression of emotions was met with ridicule, shaming, judgement, abuse, etc., therefore, it was
unsafe to express or experience emotion.
• Expression of emotion or impulsivity was considered a sign of weakness.
• Relationships were enmeshed/co-dependent such that there was no space for the child to express
themselves or develop emotionally.

13. Fear of Losing Control:

The excessive inhibition or disconnection of spontaneous emotion, action, or expression, due to a fear
that one would otherwise lose control of their impulses resulting in dire consequences. This may include
fears of being overwhelmed by emotions (e.g., as in panic/fear or despair), fears of others’ response (e.g.,
abandonment/rejection, ridicule, judgement), fears of harming self/others (e.g. if giving in to aggressive
impulses or intrusive thoughts), fears of ‘overindulging’ (e.g. losing control of spending, eating). There

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 may be an excessive preoccupation with one’s internal state and how one appears to others.

Examples of core beliefs/assumptions:

• If I show how I really feel, it will cause damage
• If I let my emotions go, I won’t be able to stop
• I can’t cope with my emotions

Origins of this schema may have involved early experiences where:

• The child received severe judgement and/or punishment if expressing emotions or following an
impulse.
• Caregivers frequently flipped between being extremely emotional to extremely restrained; they
were emotionally dysregulated.
• Following spontaneous urges was seen to cause harm (e.g. a caregiver was abusive, chaotic, or
suffered an addiction).

14. Unrelenting Standards:

The underlying belief that one must strive to meet very high internalized standards of behavior and
performance, usually to avoid criticism. Typically results in feelings of pressure or difficulty slowing
down and in hyper-criticalness toward oneself and others. Must involve significant impairment in
pleasure, relaxation, health, self-esteem, sense of accomplishment, or satisfying relationships. Unrelenting
standards typically present as:
a) Perfectionism, inordinate attention to detail, or an underestimate of how good one’s own
performance is relative to the norm;
b) Rigid rules and “shoulds” in many areas of life, including unrealistically high moral, ethical,
cultural, or religious precepts;
c) Preoccupation with time and efficiency, the need to accomplish more.

Examples of core beliefs/assumptions:

• I have to be perfect
• I need to do more
• I can’t accept “good enough”

Origins of this schema may have involved early experiences where:

• Caregivers’ love was conditional on the child meeting high standards.
• One or both parents were models of high, unbalanced standards.
• Caregivers used shame or criticism when the child failed to meet high expectations.

15. Entitlement:
The belief that one is superior to other people; entitled to special rights and privileges; or not bound by
the rules of reciprocity that guide normal social interaction. Often involves insistence that one should be
able to do, or have whatever one wants, regardless of what is realistic, what others consider reasonable,
or the cost to others; or an exaggerated focus on superiority (e.g., being among the most successful,
famous, wealthy) in order to achieve power or control (not primarily for attention or approval). Sometimes
includes excessive competitiveness toward or domination of others: asserting one’s power, forcing one’s
point of view, or controlling the behaviour of others in line with one’s desires without empathy or concern
for others’ needs or feelings.

Examples of core beliefs/assumptions:

• I deserve special treatment

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 • I should be able to do whatever I want
• I am superior to others

Origins of this schema may have involved early experiences where:

• The child was overindulged or spoiled by caregivers; the child did not learn to hear or tolerate the
word “no”.
• Caregivers modelled a lack of control over emotions and impulses.
• Caregivers failed to exercise sufficient discipline and boundaries over the child; they did not
impose or follow through on consequences.
• The child was made to feel inferior, unloved, or defective and learned to overcompensate by
becoming demanding, aggressive, or superior.

16. Insufficient Self-Control:

Pervasive difficulty or refusal to exercise sufficient self-control and frustration tolerance to achieve one’s
personal goals or to restrain the excessive expression of one’s emotions and impulses. In its milder form,
the patient presents with an exaggerated emphasis on discomfort avoidance: avoiding pain, conflict,
confrontation, responsibility, or overexertion at the expense of personal fulfilment, commitment, or
integrity.

Examples of core beliefs/assumptions:

• I can’t control my behaviour
• I can’t tolerate discomfort
• I can’t stick to my resolutions

Origins of this schema may have involved early experiences where:

• The child was often left to their own devices and lacked a caregiver to provide guidance and
discipline toward developing persistence or self-regulation skills.
• The child had a learning or neurodevelopmental disorder/condition that was not adequately
treated or supported.

17. Approval Seeking:

Excessive emphasis on gaining approval, recognition, or attention from other people or on fitting in at the
expense of developing a secure and true sense of self. One’s sense of esteem is dependent primarily on
the reactions of others rather than on one’s natural inclinations. Sometimes includes an overemphasis on
status, appearance, social acceptance, money, or achievement as means of gaining approval, admiration,
or attention (not primarily for power or control). Frequently results in major life decisions that are
inauthentic or unsatisfying or in hypersensitivity to rejection.

Examples of core beliefs/assumptions:

• I only have value if others say so/think so
• I am only worthwhile if I am getting attention/praise
• I must be liked by everyone

Origins of this schema may have involved early experiences where:

• The family was heavily concerned about outward appearances, status, or the opinions of others.
• Caregivers’ love and attention were conditional on the child conforming to their preferences.
• The child had difficulty fitting in, so learned to adapt to behave as they believed others
wanted/liked.

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18. Negativity/Pessimism:
A pervasive, lifelong focus on the negative aspects of life (pain, death, loss, disappointment, conflict,
guilt, resentment, unsolved problems, potential mistakes, betrayal, things that could go wrong, etc.) while
minimising or neglecting the positive or optimistic aspects. Usually includes an exaggerated expectation
– in a wide range of work, financial, or interpersonal situations – that things will eventually go seriously
wrong or that aspects of one’s life that seem to be going well will ultimately fall apart. Usually involves
an inordinate fear of making mistakes that might lead to financial collapse, loss, humiliation, or being
trapped in a bad situation. Because they exaggerate potential negative outcomes, these individuals are
frequently characterised by chronic worry, vigilance, complaining, or indecision.

Examples of core beliefs/assumptions:

• Bad things always happen to me
• If things are good, it is only temporary

Origins of this schema may have involved early experiences where:

• There was significant hardship or adversity (e.g., poverty, early loss/grief, traumatic accidents,
abuse).
• Caregivers were highly depressed, pessimistic, or cynical; the child was not sheltered from harsh
realities.
• The child was required to take on adult responsibilities at a young age.

19. Punitiveness (Self):

Self-directed hypercriticalness towards one’s own mistakes, suffering, or imperfections. Involves a belief
that one should be punished or held accountable in some way for failing to meet expectations, a tendency
to ignore extenuating circumstances, and an excessive sense of responsibility leading to self-blame, self-
directed anger, and difficulty forgiving oneself.

Examples of core beliefs/assumptions:

• I deserve to be punished
• It’s all my fault
• I should have known better

Origins of this schema may have involved early experiences where:

• The child was severely punished for making mistakes or committing minor indiscretions.
• There was significant abuse (physical, emotional, psychological) with little/no provocation.
• Mistakes lead to dire/fatal consequences (e.g., war/military contexts, abuse).
• Caregivers were neglectful or abusive unless the child met exceedingly high standards (whether
explicit or implicit) for behaviour/achievement.

20. Punitiveness (Others)

Hypercriticalness towards others’ mistakes, suffering, or imperfections. Involves a belief that others
should be punished or held accountable for their indiscretions, a tendency to ignore extenuating
circumstances and naturally human error, and a preoccupation with concepts of justice. There is often
anger, impatience, and intolerance toward others and difficulties with empathising and forgiveness. This
harsh externalised process may alienate the individual from relationships with others.

Examples of core beliefs/assumptions:

• There’s no excuse for mistakes
• It’s not fair

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 • It’s all their fault

Origins of this schema may have early experiences where:

• There was an excessive emphasis on adherence to rules, procedures, and regulations (e.g., military
families, overly strict parenting style).
• The child was often unfairly blamed (e.g., the child was punished for another’s wrongdoing) or
witnessed injustices (e.g., bad things happening to “good” people and good things happen to
“bad” people).
• Caregivers modelled an externalised coping style (e.g., blamed others, failed to take responsibility
for self) and/or cynical worldview.

HOW SCHEMAS WORK

To understand how schemas work, there are three schema maintenance processes that must be defined. These
processes are schema support, schema avoidance, and schema compensation. It is through these three processes
that schemas exert their influence on our behaviour and work to ensure their survival.

1. Schema Support
Schema maintenance refers to the routine processes by which schemas function and perpetuate
themselves. This is accomplished by cognitive distortions and self-defeating behaviour patterns.

Earlier we mentioned that cognitive distortions are a central part of cognitive therapy. These distortions
consist of negative interpretations and predictions of life events. Many cognitive distortions are part of
the schema maintenance process. The schema will highlight or exaggerate information that confirms it
and will minimise or deny information that contradicts it.

Schema maintenance works behaviourally as well as cognitively. The schema will generate behaviours
that tend to keep the schema intact. For instance, a young man with a Social Isolation schema would have
thoughts and behaviour in line with the schema. At a party he would have thoughts such as: “No one here
likes me” and “I’m not going to succeed at meeting new people”. Behaviourally, he would be more
withdrawn and less outgoing.

2. Schema Avoidance
Schema avoidance refers to how people avoid activating schemas. As mentioned earlier, when schemas
are activated, this causes extreme negative emotion. People develop ways to avoid triggering schemas in
order not to feel this pain. There are three types of schema avoidance: cognitive, emotional, and
behavioural.

Cognitive avoidance refers to people's efforts not to think about upsetting events. These efforts may be
either voluntary or automatic. People may voluntarily choose not to focus on an aspect of their personality
or an event that they find disturbing. There are also unconscious processes that help people shut out
information that would be too upsetting to confront. People often forget particularly painful events. For
instance, children who have been abused sexually often forget their memory completely.

Emotional or affective avoidance is an automatic or voluntary attempt to block painful emotion. Often
when people have painful emotional experiences, they numb themselves to the feelings to minimise the
pain. For instance, a man might talk about how his wife has been acting abusive toward him and say that

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 he feels no anger towards her, only a little annoyance. Some people drink or abuse drugs to numb feelings
generated by schemas.

The third type of avoidance is behavioural avoidance. People often act in such a way as to avoid situations
that trigger schemas and thus avoid psychological pain. For instance, a woman with a Failure schema
might avoid taking a difficult new job that would be very good for her. By avoiding the challenging
situation, she avoids any pain, such as intense anxiety, which could be generated by the schema.

3. Schema Compensation
The third schema process is schema compensation. The individual behaves in a manner that appears to be
the opposite of what the schema suggests avoiding triggering the schema. People with a Dependence
schema may structure aspects of their life so that they don’t have to depend on anyone, even when a more
balanced approach may be better. For instance, a young man may refuse to go out with women because
he fears becoming dependent and will present himself as someone who doesn’t need others in an attempt
to avoid feeling dependent.

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 EXAMPLES OF MALADAPTIVE COPING RESPONSES

Early Maladaptive Schema Examples of Surrender Examples of Avoidance Examples of Overcompensation

Emotional Deprivation Selects emotionally depriving partners Avoids intimate relationships altogether Acts emotionally demanding with
and does not ask them to meet needs partners and close friends
Abandonment/Instability Selects partners who cannot make a Avoids intimate relationships; drinks a Clings to and “smothers” the partner to
commitment and remains in the lot when alone point of pushing partner away;
relationships vehemently attacks partner for even
minor separations
Mistrust/Abuse Selects abusive partners and permits Avoids becoming vulnerable and Uses and abuses others (“get others
abuse trusting anyone; keeps secrets before they get you”)
Social Isolation At social gatherings, focuses exclusively Avoids social situations and groups Becomes a chameleon to fit into groups
on differences from others rather than
similarities
Defectiveness/Shame Selects critical and rejecting friends; puts Avoids expressing true thoughts and Criticizes and rejects others while
self-down feelings and letting others get close seeming to be perfect
Failure Does tasks in a half-hearted or Avoids work challenges completely; Becomes an “overachiever” by
haphazard manner procrastinates on tasks ceaselessly driving him- or herself
Dependence/Incompetence Asks significant others (parents, spouse) Avoids taking on new challenges, such Becomes so self-reliant that he or she
to make all his or her financial decisions as learning to drive does not ask anyone for anything
(“counterdependent”)
Vulnerability to Harm Obsessively reads about catastrophes in Avoids going places that do not seem Acts recklessly, without regard to danger
newspapers and anticipates them in totally “safe” (“counterphobic”)
everyday situations
Enmeshment/Undeveloped Self Tells mother everything, even as an Avoids intimacy; stays independent Tries to become the opposite of
adult; lives through partner significant others in all ways
Subjugation Lets other individuals control situations Avoids situations that might involve Rebels against authority
and make choices conflict with another individual
Self-Sacrifice Gives a lot to others and asks for nothing Avoids situations involving giving or Gives as little to others as possible
in return taking

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Emotion Constriction Maintains a calm, emotionally flat Avoids situations in which people Tries awkwardly to be the “life of the
demeanour discuss or express feelings party” even though it feels forced and
unnatural
Fear of Losing Control Obsessively monitors one’s emotions Avoids situations that might provoke Indulges in emotions and urges
and urges to keep them in check emotional responses indiscriminately
Unrelenting Standards Spends inordinate amounts of time Avoids or procrastinates in situations Does not care about standards at all –
trying to be perfect and tasks in which performance will be does tasks in a hasty, careless manner
judged
Entitlement Bullies’ others into getting own way, Avoids situations in which he or she is Attends excessively to the needs of
brags about own accomplishments average, not superior others
Insufficient Self-Control Gives up easily on routine tasks Avoids employment or accepting Becomes overly self-controlled or self-
responsibility disciplined
Approval-Seeking Acts to impress others Avoids interacting with those whose Goes out of the way to provoke the
approval is coveted disapproval of others; stays in the
background
Negativity/Pessimism Focuses on the negative; ignores the Drinks to blot out pessimistic feelings Is overly optimistic; denies unpleasant
positive; worries constantly; goes to and unhappiness realities
great lengths to avoid any possible
negative outcome
Punitiveness (Self) Treats self in a harsh, punitive manner Avoids others for fear of punishment Behaves in an overly forgiving way
towards self
Punitiveness (Others) Treats others in a harsh, punitive manner Avoids interacting with those whose Behaves in an overly forgiving way
behaviour is disapproved of towards others
(Adapted from Young et al., 2003)

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 CASE EXAMPLES

In this section, six case examples are presented. In each one, the schema processes are demonstrated. By reading
through this section, you will get a better feel for how these processes can operate in real-life situations.

Abby is a young woman whose main schema is Subjugation. She tends to see people as very controlling even
when they are being appropriately assertive. She has thoughts such as “I can’t stand up for myself, or they won’t
like me” and is likely to give in to others (Schema Support). At other times she decides that no one will get the
better of her and becomes very controlling (Schema Compensation). Sometimes when people make
unreasonable demands on her, she minimises the importance of her feelings and has thoughts like “It’s not that
important to me what happens”. At other times she avoids acquaintances with whom she has trouble standing
up for herself (Schema Avoidance).

Stewart’s main schema is Failure. Whenever he is faced with a possible challenge, he tends to think that he is
not capable. Often, he tries half-heartedly, guaranteeing that he will fail and strengthening the belief that he is
not capable (Schema Support). He often makes great efforts to present himself in an unrealistically positive light
by spending excessive amounts of money on items such as clothing and automobiles (Schema Compensation).
Often, he avoids triggering his schema by staying away from challenges altogether and convinces himself that
the challenge was not worth taking (Schema Avoidance).

Rebecca’s core schema is Defectiveness/Shame. She believes that there is something basically wrong with her
and that if anyone gets too close, the person will reject her. She chooses partners who are extremely critical of
her and confirm her view that she is defective (Schema Support). Sometimes she has an excessive defensive
reaction and counterattacks when confronted with even mild criticism (Schema Compensation). She also
ensures that none of her partners gets too close so that she can avoid their seeing her defectiveness and rejecting
her (Schema Avoidance).

Michael is a middle-aged man whose main schema is Dependence/Incompetence. He sees himself as being
incapable of doing daily tasks on his own and generally seeks the support of others. Whenever he can, he chooses
to work with people who help him out to an excessive degree. This keeps him from developing the skills needed
to work alone and confirms his view of himself as someone who needs others to help him out (Schema Support).
At times, when he would be best off taking advice from other people, he refuses to do so (Schema
Compensation). He reduces his anxiety by procrastinating as much as he can get away with (Schema
Avoidance).

Ann's core schema is Social Isolation. She sees herself as being different from other people and not fitting in.
When she does things as part of a group she does not get really involved (Schema Support). At times she gets
very hostile towards group members and can be very critical of the group as a whole (Schema Compensation).
At other times she chooses to avoid group activities altogether (Schema Avoidance).

Sam’s central schema is Emotional Deprivation. He chooses partners who are not very capable of giving to
other people and then acts in a manner that makes it even more difficult for them to give to him (Schema
Support). He will sometimes act in a very demanding, belligerent manner and provoke fights with his partners
(Schema Compensation). Sam avoids getting too close to women yet denies that he has any problems in this
area (Schema Avoidance).

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 THERAPEUTIC PROCESS – CHANGING SCHEMAS

In schema-focused therapy, the goal of the treatment is to weaken the early maladaptive schemas as much as
possible and build up the person’s healthy side. An alliance is formed between the therapist and the healthy part
of the patient against the schemas.

The first step in therapy is to do a comprehensive assessment of the patient. The main goal of this assessment
is to identify the schemas that are most important in the patient’s psychological makeup. There are several steps
to this process. The therapist generally will first want to know about recent events or circumstances in the
patients’ lives that have led them to come for help. The therapist will then discuss the patient’s life history and
look for patterns that may be related to schemas.

There are several other steps the therapist will take in assessing schemas. There is questionnaire that the patient
fills out, listing many of the thoughts related to the different schemas; items on this questionnaire can be rated
as to how relevant to the patient’s life they are.

There are also various imagery techniques that the therapist can use to assess schemas. One specific technique
involves asking patients to close their eyes and create an image of themselves as children with their families.
Often the images that appear will lead to the core schemas.

Jonathan is a 28-year-old executive whose core schema is Mistrust/Abuse. He came to therapy because he was
having bouts of intense anxiety at work, during which he would be overly suspicious and resentful of his co-
workers. When asked to create an image of himself with his family, he had two different images. In the first, he
saw himself being terrorised by his older brother. In the second he saw his alcoholic father coming home and
beating his mother, while he cowered in fear.

There are many techniques that the therapist can use to help patients weaken their schemas. These techniques
can be broken down into four categories: emotive, interpersonal, cognitive, and behavioural. Each of these
categories will be briefly discussed, along with a few examples.

Emotive Techniques
Emotive techniques encourage patients to experience and express the emotional aspects of their problems.
One way this is done is by having patients close their eyes and imagine they are having a conversation with
the person to whom the emotion is directed. They are then encouraged to express their emotions as
completely as possible in the imaginary dialogue. One woman whose core schema was Emotional
Deprivation had several such sessions in which she had an opportunity to express her anger at her parents
for not being there enough for her emotionally. Each time she expressed these feelings, she was able to
distance herself further from the schema. She was able to see that her parents had their own problems which
kept them from providing her with adequate nurturance and that she was not always destined to be deprived.

There are many variations on the above technique. Patients may take on the role of the other person in these
dialogues and express what they imagine their feelings to be. Or they may write a letter to the other person,
which they have no intention of mailing so that they can express their feelings without inhibition.

Interpersonal Techniques
Interpersonal techniques highlight the patient’s interactions with other people so that the role of the
schemas can be exposed. One way is by focusing on the relationship with the therapist. Frequently, patients

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 with a Subjugation schema goes along with everything the therapist wants, even when they do not consider
the assignment or activity relevant. They then feel resentment towards the therapist which they display
indirectly.

This pattern of compliance and indirect expression of resentment can then be explored to the patient’s
benefit. This may lead to a useful exploration of other instances in which the patient complies with others
and later resents it and how the patient might better cope at those times.

Another type of interpersonal technique involves including a patient’s spouse in therapy. A man with a
Self-Sacrifice schema might choose a wife who tends to ignore his wishes. The therapist may wish to
involve the wife in the treatment to help the two of them to explore the patterns in their relationship and
change how they interact.

Cognitive Techniques
Cognitive techniques are those in which schema-driven cognitive distortions are challenged. As in short-
term cognitive therapy, dysfunctional thoughts are identified, and the evidence for and against them is
considered. Then new thoughts and beliefs are substituted. These techniques help the patient see alternative
ways to view situations.

The first step in dealing with schemas cognitively is to examine the evidence for and against the specific
schema which is being examined. This involves looking at the patient’s life and experiences and
considering all the evidence which appears to support or refute the schema. The evidence is then examined
critically to see if it does, in fact, provide support for the schema. Usually, the evidence produced will be
shown to be in error and not really supportive of the schema.

For instance, let’s consider a young man with an Emotional Deprivation schema. When asked for evidence
that his emotional needs will never be met, he brings up instances in which past girlfriends have not met
his needs. However, when these past relationships are looked at carefully, he finds that, as part of the
schema maintenance process, he has chosen women who are not capable of giving emotionally. This
understanding gives him a sense of optimism; if he starts selecting his partners differently, his needs can
probably be met.

Another cognitive technique is to have a structured dialogue between the patient and therapist. First, the
patient takes the side of the schema, and the therapist presents a more constructive view. Then the two
switch sides, giving the patient a chance to verbalise the alternative point of view.

After having several of these dialogues the patient and therapist can then construct a prompt card for the
patient, which contains a concise statement of the evidence against the schema.

A typical prompt card for a patient with a Defectiveness/Shame schema read: “I know that I feel that there
is something wrong with me but the healthy side knows that I’m OK. There have been several people who
have known me very well and stayed with me for a long time. I know that I can pursue friendships with
many people in whom I have an interest”.

The patient is instructed always to keep the prompt card available and to read it whenever the relevant
problem occurs. By persistent practice at this and other cognitive techniques, the patient’s belief in the
schema will gradually weaken.

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Behavioural Techniques
Behavioural techniques are those in which the therapist assists the patient in changing long-term behaviour
patterns so that schema maintenance behaviours are reduced, and healthy coping responses are
strengthened.
One behavioural strategy is to help patients choose partners who are appropriate for them and capable of
engaging in healthy relationships. Patients with the Emotional Deprivation schema tend to choose partners
who are not emotionally giving. A therapist working with such patients would help them through the
process of evaluating and selecting new patterns.

Another behavioural technique consists of teaching patients better communication skills. For instance, a
woman with a Subjugation schema believes that she deserves a raise at work but does not know how to ask
for it. One technique her therapist uses to teach her how to speak to her supervisor is role-playing. First,
the therapist takes the role of the patient, and the patient takes the role of the supervisor. This allows the
therapist to demonstrate how to make the request appropriately. Then the patient gets an opportunity to
practice the new behaviours and to get feedback from the therapist before changing the behaviour in real-
life situations.

In summary, schema-focused therapy can help people understand and change long-term life patterns. The
therapy involves identifying early maladaptive schemas and systematically confronting and challenging them.

FURTHER READING AND REFERENCES

Yalcin, O., Marais, I., Lee, C., & Correia, H. (2022). Revisions to the Young Schema Questionnaire using Rasch
analysis: the YSQ-R. Australian Psychologist, 57(1), 1-13. https://doi.org/10.1080/00050067.2021.1979885

Young, J. E., & Klosko, J. (1993). Reinventing Your Life. New York: Dutton (An Imprint of Penguin USA)

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioners Guide. The Guilford
Press.

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