Therapy overview
Schema Therapy
Schema Therapy is an integrative psychotherapy that draws on CBT, Attachment Theory, Psychodynamic Theory and Humanistic/Experiential approaches including Gestalt Therapy. Schema Therapy focuses on self-defeating life patterns which have their roots in early unmet emotional needs. These self-defeating patterns can show up at home, in work and in relationships and often cause significant distress and suffering. However, whilst Schema Therapy aims to explore early origins of current difficulties, it remains structured with a focus on the present and on life goals.
Who does it help?
Schema therapy was originally developed to address complex and long-standing psychological problems and has good outcomes with people whose difficulties have previously seemed hard to treat. It is now used to support people with all sorts of difficulties, including but not limited to low mood/ depression, self-harm, anxiety, OCD, relationship problems, trauma and difficulties with self-confidence, eating or addictions.
What does it consist of?
If we were to work together using a schema therapy approach, the first step would normally be to work out your schemas. Schemas are a bit like a lens through which we interpret the world that are developed in childhood and influence how we behave in ways that tend to be self-fulfilling. For example someone who has early experiences of being abandoned might (unconsciously) fear future abandonment and therefore be very sensitive to or easily upset by their partner buying busy or late home. They may then cut off emotionally, get very angry or become very clingy, all attempts to protect themselves from possible abandonment, but all of which make it more likely that their partner eventually gets fed up and leaves them.
This is just one example of a schema. There are many schemas, which as you can imagine play out in all sorts of unhelpful and self-fulfilling ways. It is important to say that we all have schemas, and that they can be worked on and changed, but often we need to learn to recognise and understand them first. It is also important to say that schemas can develop from a whole range of early life experiences, from very obviously traumatic experiences such as abuse or the loss of a parent, to much more subtle experiences. Most often I work with people whose parents did their best, but some of their own emotional difficulties, stress or parenting practices got in the way of them meeting all of their children’s needs.
acceptance and commitment Therapy
Acceptance and Commitment Therapy (ACT) is an action-oriented approach developed from cognitive behavioural therapy (CBT). In traditional CBT, people are supported to notice how their thoughts and interpretations are contributing to their distress and then to challenge these thoughts and develop more helpful and realistic alternatives. This approach (which I also draw on) can be very helpful for many people, particularly some sorts of anxiety disorders. However, Steven Hayes, who developed ACT noticed that for some people, this approach of challenging thoughts was not helping. Firstly, it’s not always that easy to change our thoughts. And secondly, we often find that however much we challenge our thoughts, our minds will always produce more unhelpful thoughts and so we can get trapped in a losing battle. And what’s more, the process of trying to challenge thoughts and suppress feelings is exhausting in itself, so often makes us feel even worse. In ACT, this is referred to as secondary distress - the distress we generate trying to challenge our thoughts and suppress our feelings.
A key difference between ACT and CBT is that in ACT, rather than challenging thoughts (with the aim of changing feelings), people are encouraged to accept their thoughts and feelings as they are. Although it might sound counter-intuitive, many people find that through this accepting approach, their feelings and thoughts become less distressing and overwhelming. This frees up space for them to identify and work towards their values, another cornerstone of ACT.
Compassion focussed Therapy
Compassion-Focused Therapy (CFT) is a particularly useful approach for people who struggle with shame and self-criticism. CFT draws on evolutionary science and neuroscience to explain how we can become hyper-focussed on threat and lack the skills required for self-soothing. In CFT, people learn to develop the skills of self-compassion and mindfulness, which can help with mood regulation and lead to feelings of self-acceptance and safety. If we draw on this approach, we will typically do guided exercises such as visualizations and meditations and you will be asked to practice these exercises between sessions. Like ACT, CFT fits well with and can be incorporated into Schema Therapy.
Dialectical Behaviour Therapy
Dialectical Behaviour Therapy (DBT) is a structured approach aimed to help people manage intense emotions and relationship difficulties. Like schema therapy, it was originally developed for people with complex and chronic difficulties, such as personality disorders and self-harming behaviours but it is now used for a range of presentations. The core concepts in DBT are:
Mindfulness – accepting and brining attention to the present moment
Distress tolerance – sitting with negative emotions rather than trying to escape in ways that often make the situation worse
Emotion regulation – managing intense emotions
Interpersonal effectiveness – strengthening relationships though assertive and clear communication
DBT is typically delivered in a group format. However, each of the skills can be learned in isolation or in one-to-one therapy. I typically draw on the DBT skills alongside other approaches. For example, after making sense of someone’s difficulties using a Schema Therapy framework, I may draw on DBT skills to help the person think about how to change some of their schema-driven behaviours.
“Hannah created a calm and welcoming environment in which I felt I could bring my whole self to therapy. Her empathy and warmth made me feel safe and understood during each our sessions. Hannah is clearly an expert in her profession. Her knowledge, support, and guidance have helped me reach a point with my anxiety that I had previously thought was out of reach. My quality of life has vastly improved through my sessions with Hannah, and it is something I will always be grateful for”.