by Jennifer Martin Rieck, LPC
Cognitive Behavioral Therapy (CBT) is among the leading Evidenced Based Practices utilized in the field of Mental Health today, particularly for the treatment of depression. Evidenced Based Practice refers to the treatment selected by clinicians to treat specific symptoms or disorders. In order to be considered evidenced based, scientific research must have been conducted and must have demonstrated the effectiveness of the treatment for the specific problem being treated. At the core of CBT is the belief that strategically changing an individual’s thoughts over time will alleviate depressive symptom severity. This is because thoughts, behavior, and feelings cyclically react with one another and each contribute to an individual’s mental state. Much research has demonstrated the effectiveness of this treatment making it one of the primary treatments championed by third party payers for mental health. CBT is often a structured session with much of the work (and homework) having to do with thought replacement and altering the way one thinks. Research has shown that over long periods of time, not only do patient’s symptoms improve, but there are often measurable changes in levels of the neurotransmitters believed to be at the core of long term depression present in Major Depressive Disorder.
Counseling Theories Explained
Many therapists ascribe to other theories of changing and healing, ones that involve more direct emotional engagement like Emotionally Focused Therapy. Some focus primarily on the relational aspect of the client-counselor relationship and the individual’s ability to attach to others and feel secure in their relationships. Yet, still, there are Narrative therapists who believe that the story that individuals tell themselves about their lives is the most important thing to address in counseling. More recent trends in therapy involve a focus on how individuals often believe things about their subjective reality that cause them to manifest unpleasant symptoms. Whether or not the beliefs that a person has are 100% based in reality is irrelevant. The focus is simply on the impact of the belief on the individual.
What is Schema Therapy?
More recently, there has been a new theory of therapy emerging, one that pulls from several previous theories. This theory, called Schema Therapy, was developed by Jeffery Young and colleagues. Schema Therapy focuses on an individual’s pervasive and enduring thought patterns rather than on specific individual thoughts. This theory is currently being researched and is proving itself to be a useful new treatment for individuals who may have failed to find improvement through more traditional treatments. At the heart of Schema Therapy is an understanding that long term, ingrained, and often unconscious, beliefs about ourselves, others, and the world around us are at the core of enduring mental health and relationship distress. Schema Therapy addresses common schemas that have been found to be present in many individuals suffering from mental health concerns.
Some examples of common schemas are Abuse/Mistrust, Emotional Deprivation, and Abandonment/Instability. As a therapist, the schemas named in schema therapy instinctively make sense to me. Each of them represents common themes that commonly manifest during counseling sessions. Often, when hearing clients tell their story/narrative, I can imagine the types of beliefs that they may have and how those beliefs might be impacting their life. Many times, the circumstances that led to schemas occurred during childhood when children were actively interpreting what the behavior or words of parents, caregivers, siblings, or other important figures in their lives, were teaching them about themselves and the expectations that they had of them. However, schemas can also be formed later in life, though less likely, as typically adults have enough information from various sources to combat negative experiences and messages from negative people. The totality of our experiences give us a broader context in which to view information we are receiving from others.
Schema Therapy Treatment
Treatment in Schema Therapy involves assisting individuals in exploring and really taking ownership of their experiences and beliefs. Bringing their unconscious beliefs out into the open, owning them, and being aware of them allows individuals to no longer be driven by the need to repress hurtful past experiences. In many ways, Schema Therapy very closely parallels counseling strategies aimed at integrating past trauma. Research indicates that overcoming and healing from trauma often involves deliberately seeking to connect all of the sensations, feelings, behaviors, and thoughts that encompass a traumatic occurrence. In doing so, individuals learn to be present, to fully integrate all of the aspects of their story, to develop healthy coping skills, as well as to learn to self-soothe and lean on others for support. The same can be said of Schema Therapy. In order for Schema Therapy to work, one must be willing to be vulnerable enough to tell their painful stories, to explore and acknowledge them, to own them and grieve over them, to integrate all aspects of them, and to practice different behavior in life and relationships going forward. Changing our beliefs about ourselves is an ongoing challenge for us all, but the research is clear that what we tell ourselves matters just as much or more than what we tell others.
“Changing our beliefs about ourselves is an ongoing challenge for us all, but the research is clear that what we tell ourselves matters just as much or more than what we tell others.”
It is my belief that our thoughts do often drive our feelings, even more so than our experiences. The messages that we take away from negative experiences (and positive ones) stick with us long after our circumstances change. Cognitive Behavioral Therapy is mind work that helps because it tackles recurring thoughts that are bringing us down. Schema Therapy works because it is heart work and helps us to tell our stories, but more importantly it helps us to recover from our stories.
Tips for Owning Your Story and Schema
Don’t be afraid to tell your story honestly and thoroughly to safe individuals in your life. If you don’t have a friend, partner, or family member to share your heart with then perhaps counseling would be a great place to start. It is crucial that you prioritize safety because, in order to begin healing from your story, you need to be able to share it with someone who can hear your heart and can empathize and understand you without advice giving or judgment.
Work on how you tell yourself your own story. Pay attention to the way you label your behaviors and feelings. Remember that there is no wrong way to feel. A feeling is just a feeling and you are entitled to feel. Similarly, often our past behavior was less ill-intentioned than it was simply ill-advised. We often make decisions that we later regret, but if we didn’t know what we would have needed to know to prevent them then we shouldn’t beat ourselves up for them later.
Steer away from using negative mental health labels that impact your ability to feel empowered. For example, if you feel depressed, try to avoid saying to yourself, “I am depressed,” or worse, “I have depression”. Instead, practice labeling your feelings. “I am feeling sad because ______ happened,” or “I am feeling sad because I am thinking/remembering when ______ happened” are much more helpful ways of talking about your sadness. Connecting your feeling to a specific situation allows you to focus on the temporary nature of your feeling. Feeling sad is a perfectly normal human experience. If you say that you are depressed it implies that there isn’t much that you can do to change it. However, if you can name what happened to cause you to currently feel sad, then you can come up with a game plan for how to address the cause or possibly even prevent it from happening again.
Owning your schema(s) will allow you to take control of your story and to feel empowered to change. Empowered, you can impact your future in the way that you desire instead of being a puppet at the mercy of your past.
To read more about schema, see my blog post Cognitive Consistency and Schema.
To read more about neuroplasticity and how to build up new pathways in your brain, refer to my blog on addiction and change.
To read more about CBT and fighting negative thoughts, see Shoulda, Coulda, Woulda: Fighting Words.
To read more about boundaries and the schema of enmeshment, refer to my previous post Enmeshment and Boundaries.