Schema therapy is a psychiatric technique used in the treatment of behavioral disorders, usually when the standard therapies like cognitive behavioral therapy have failed. It combines techniques of other behavioral therapies as part of an integrated approach to treatment.
The theory behind the treatment is that everyone has an organized pattern of thoughts and behaviors, each of which is referred to as a "schema". Many of these are classified into typical behaviors that are problematic, such as avoidance of relationships because of fear of abandonment. The patient is then examined for coping behaviors - the behaviors they take on to deal with the issues raised by their schema. These are grouped into "modes" - a group of behaviors that classify groups of schemas. These are then examined to determine why the patient is not meeting their basic emotional needs. The technique assumes that the patient had such unmet needs in childhood and developed their schemas and coping behavior, which continued into adulthood.
Therapy focuses on dealing with the patient's individual behaviors and teaching them to replace their current coping behaviors with more adaptive behaviors.
Schema groupings or "domains" fall into five broad categories - disconnection/rejection, impaired autonomy, impaired behavioral limits, other-directedness and overvigilance/inhibition. Coping behaviors are classified into four categories - Child, Dysfunctional Coping, Dysfunctional Parent, and Healthy Adult. The final one is the goal of therapy.
Depending on the patient, there will be a series of therapies. In many cases, the therapist will act as a surrogate parent for the patient, teaching them new coping behaviors. Imagery is another technique - getting the patient to think about bad experiences and role playing a better solution. Flash Cards are used in collaboration between the patient and therapist and are used by the patient between sessions to refresh the effect of therapy. Patients are often asked to have a two-sided dialogue with themselves to practice new coping behaviors in response to existing behaviors.
Although such therapy can be expensive, it has been shown to be more likely to provide better outcomes that are more cost effective. Patients are also less likely to discontinue therapy.