Schema Therapy vs CBT

Cognitive behavioural therapy (CBT for short in this article) has revolutionised therapy. Once upon a time, before Aaron Beck developed cognitive therapy, psychotherapy was typically long term and based upon Freud's psychodynamic theories. Arguably it was beyond the reach of the masses and only reserved for a very select group of very rich individuals. Whilst I'm not meaning to criticise psychodynamic therapy it's helpful to place CBT in a wider context. CBT then came along and revolutionised psychological therapy. It was shorter term, more focussed, it could be delivered by therapists without any specific qualifications (and indeed it was, and still is in the prison service UK). It could be put into a manual and followed verbatim and the research supporting its efficacy was encouraging.

It was adopted in forensic services as well as helping people with depression, anxiety, panic attacks, phobias and much more. In fact you can find a book or a research paper on virtually any ailment or problem you can think of and CBT will cover it.

But there are some significant problems with CBT. Most importantly the evidence was non-existent for people who suffered from personality disorders or psychopathy. Some of the research conducted found that CBT could make this specific group worse. It was far from a panacea.

The problems with CBT were that it assumed a lot of the client -

It assumed that they knew what the problem was that was affecting them.

But sometimes people just don't know why they feel the way they feel. It's something intangible and hard to pin down. Perhaps they've felt the same way for their whole lives? Perhaps they always choose the wrong partner, or feel that friends seem to let them down all the time. They try to change but can't.

It assumed that clients will comply with the therapy

But some people find it really difficult to do so. There can be many reasons for this, it could be that they feel that it's pointless as nothing even works, or that they don't even believe they have a problem in the first place but are going to therapy because they're not happy in a relationship or at work. Often people's level of mistrust makes it difficult for the therapist to engage with them; these clients then leave the therapy prematurely continuing to feel like nothing will ever change.

It assumes that clients can access their thoughts and feelings

This is the cornerstone of CBT but for some people it's not that easy. Perhaps they have been using a number of unhelpful coping strategies throughout their lives that prevents them from getting in touch with difficult memories, thoughts and feelings.

It assumes that, with practice, patients can change

But some people don't feel that they will ever change. They lack motivation or are resistant to changing in the first place. CBT doesn't explicitly address this barrier. This can often lead to the therapist seeing the client as demotivated and not able to change at the present time; the therapy then breaks down and in fact reinforces the client's feelings of "nothing will ever change". In schema therapy we see this as a mode, or an emotional state and we work with that resistance and try to understand it. We work on the premise that people aren't born with a lack of motivation, or a lack of trust and there's an explanation for it. If we can explain it, then we can help the client change it.

Schema Therapy Approaches

So what is the solution to the above? Well schema therapy doesn't see any of the barriers to engagement as a problem to be worked around, it views them as the problem. What this means is that in the sessions with a schema therapist you'll be able to talk about your lack of trust, or hopelessness, or even what it's been like to feel a certain way for your whole life. We discuss it there and then, in the session, and create a therapeutic relationship that can serve as a partial antidote to those core beliefs and feelings that have been with you throughout your life. So if you've always found it hard to trust we pay really close attention to that in the session; a good schema therapist will be able to notice when your mistrust/abuse schema is triggered and help you slow down the reaction you have when you feel threatened. Ultimately you'll be able to lower your guard and show vulnerability in the sessions with your therapist and this can then become a template you use in every day life so that you can stay strong and assertive, but also let people in so that they can show you care, love and to comfort you when you need it. Then you'll find you don't need to keep your guard up any longer and you'll feel differently to how you have in the past.