Schema therapy is an innovative, integrative therapeutic approach, originally developed by Dr. Jeffrey Young (and colleagues) as an expansion of traditional cognitive-behavioral treatments, to more effectively treat clients with personality disorders and those who fail to respond to or relapsed after traditional cognitive therapy (Young, 1990; Young, Klosko & Weishar, 2003; Arntz, 1994; Farrell & Shaw, 1994, 2012; Behary, 2013; Farrell, Reiss & Shaw, 2014).
The schema therapy approach to treatment draws 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 and adaptive re-parenting.
Young developed the conceptual model of Schema Therapy with a focus on individual therapy (Young, 1990; Young, et al., 2003). Farrell & Shaw (1994, 2012, 2014) developed a group model, initially focused on treating borderline personality disorder (BPD). They carefully addressed the need for experiential interventions to fill gaps in emotional learning and provide corrective temotional experiences related to attachment and emotional regulation. Like Young they used a limited reparenting therapist style expanded to meet the group’s needs including limited corrective re-family experiences. This model is recognized as a group version of Schema Therapy. Recently, adaptations of ST for children and adolescents (Loose, Graf and Zarbock 2013 and Romanova, Galimzyanova & Kasyanik, 2014) and couples (Simone-DiFranscesco, Roediger, and Stevens, 2015) have been developed.
Schema therapy is particularly well-suited for difficult, resistant clients with entrenched, chronic psychological disorders, including personality disorders (such as BPD and narcissism), eating disorders, intractable relationship problems, and criminal offenders. It is also effective for relapse prevention in depression, anxiety, and substance abuse. The results of a major comparative outcome study have shown schema therapy to be highly effective with a large percentage of outpatients with Borderline Personality Disorder, with a low dropout rate (Giessen-Bloo, et al., 2006); (Nadort, et al., 2009). 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.
ST is consistent with the research of attachment theory, developmental psychology (e.g. Bowlby’s Attachment Theory, summarized Cassidy & Shaver, 1999) and interpersonal neurobiology (Siegel, D., 1999). One of the unique aspects of ST is its full integration of experiential, cognitive, and behavioral pattern breaking interventions to accomplish the goals of treatment. All three types of intervention are necessary for adherence to the ST model.
The large positive treatment effect sizes for both individual, group and combination ST described below are likely due, in part, to this integrative approach that facilitates improved functioning as well as reduced symptoms, and accomplishes long lasting personality change.
The Empirical Validation of Schema Therapy
The effectiveness of ST for BPD has been validated empirically in several large-scale studies of individual ST: Giessen-Bloo, et al., (2006); Nadort, et al., 2009); one randomized controlled trial (RCT) of Group ST (Farrell, Shaw & Webber, 2009) and several pilot studies (Reiss, Lieb, Arntz, Shaw & Farrell, 2013; Dickhaut & Arntz, 2014). ST has demonstrated effectiveness in a large multisite trial for Cluster C (Bamelis, Arntz, et al., 2014), a study for PTSD (Cockram, Drummond & Lee, 2010) and one for forensic patients with personality disorders (Bernstein, Nijman, Karos, Keulen-de Vos, de Vogel, & Lucker, 2012). The effectiveness of ST reported in these studies includes improved function and quality of life as well as reductions in key symptoms and global severity of psychopathology.
These findings have led to growing use of ST and additional studies worldwide to evaluate its effectiveness with other disorders. Group ST studies underway include: BPD (Wetselaer, Farrell, Evars, Jacob, Brand, et al. 2015), Avoidant personality disorder and social phobia (Baljé, Greeven, van Giezen, Korrelboom, Arntz and Spinhoven, 2016), mixed personality disorder groups (Muste, 2012; Simpson, Skewes, van Vreeswijk & Samson, 2015), complex trauma (Younan, May & Farrell, 2017) and Individual ST studies for: depression (Renner, Arntz, Peeters, Lobbestael, & Huibers, 2016, Malogiannis, Arntz, Spyropoulou, Tsartsara, Aggeli, et al., 2014), geriatric clients (Videler, Rossi, Schoevaars, van der Feltz-Cornelis and van Alphen, 2014) and Dissociative Identity Disorder (Shaw, Farrell, Rijkeboer, Huntjens and Arntz, 2015). The ST treatment programs being evaluated vary in length from 20 sessions to a tapering schedule over two years and are conducted in a variety of levels of care (inpatient, day hospitals, weekly outpatient) and treatment settings – public and private hospitals and outpatient clinics as well as forensic settings.
ST is an approach that is rated positively by both clients and therapists (de Klerk, Abma, Bamelis, & Arntz, 2016; Spinhoven, Giesen-Bloo, van Dyck, Kooiman & Arntz, 2006). In addition, ST has growing evidence for its cost effectiveness for the individual modality (Van Asselt, Dirksen, Arntz, Giesen-Bloo, van Dyck, Spinhoven, et al., 2008; Bamelis, Arntz, Wetzelaer, & Evers, 2015).
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