To understand schema therapy, it’s essential to grasp the concept of schemas. In clinical terms, a schema refers to a disruptive or maladaptive thinking pattern that can lead to unhealthy behaviors and negatively influence relationships. Continue reading to discover how to develop a Schema Therapy Treatment Plan, complete with an example.
Schemas often arise during childhood, particularly when emotional and physical needs are unmet. They can also form in situations where there is excessive pampering or a lack of boundaries. These schemas can later shape your thoughts and actions. In clinical practice, you might encounter behaviors like avoidance, overcompensation, or extreme selflessness.
Schema therapy integrates concepts from various therapeutic methods, such as Cognitive Behavioral Therapy (CBT) and Gestalt therapy. This approach helps clients gain insight into how their underlying thought patterns contribute to their present behaviors. With this newfound understanding, they can manage their emotions and navigate relationship challenges more effectively. Schema therapy is applicable for treating personality disorders, depression, anxiety, PTSD, eating disorders, dissociative conditions, and substance abuse issues.
Because schemas are unique to each individual, they can differ widely from person to person. Most schemas fall into one of five categories: Disconnection and Rejection, Impaired Autonomy and Performance, Impaired Limits, Other-Directedness, and Overvigilance and Inhibition.
Explore our complete collection of Schema Therapy Worksheets
Disconnection and rejection can create difficulties when it comes to trusting others, making it hard for clients to accept emotional support and leading to feelings of isolation. Impaired autonomy and performance can foster beliefs of inadequacy, such as feeling incapable of handling daily responsibilities alone. Impaired limits can instill a sense of entitlement, making individuals feel superior or deserving of special treatment.
Other-directedness may cause clients to prioritize others’ needs over their own, creating unequal dynamics in their relationships. Lastly, overvigilance and inhibition can lead clients to fear expressing their emotions due to potential consequences. This schema can also hinder their ability to acknowledge positive aspects of their lives, as they tend to focus first on negatives or challenges.
Such schemas can foster unhealthy coping mechanisms like surrendering, avoidance, and overcompensation. These coping techniques can produce various difficulties in a client’s life and may contribute to psychological disorders.
Establishing Objectives in a Schema Therapy Treatment Plan
Creating your schema therapy treatment plan begins with a thorough assessment. It’s crucial to adopt a holistic approach during this assessment to identify various schemas that may be influencing your client’s psychological distress.
As you start to craft your schema therapy treatment plan, remember to set specific and realistic goals based on your client’s unique situation. You can adjust the treatment plan in response to the progress your client makes as therapy continues.
In the early stages of therapy, your focus will be on building a strong therapeutic alliance. Clients must feel comfortable and safe in sharing their experiences, schemas, and thoughts without fear of being judged. Depending on your client’s schemas, you may work on helping them fulfill emotional needs that were unmet in their childhood, such as providing validation and support to someone who experienced abandonment or neglect.
While developing your schema therapy treatment plan, consider utilizing resources that can enhance your work. Clinical worksheets are excellent tools for engaging clients during sessions and guiding therapeutic activities. They also serve as a practical reference for clients outside of sessions when they need a reminder. TherapyByPro offers a wealth of professional resources for mental health practitioners, including customizable worksheets. Examples of worksheets that could fit into a schema therapy treatment plan include:
Elements to Incorporate in a Schema Therapy Treatment Plan
In the following sections, we will concentrate on creating a customized schema therapy treatment plan, step by step, using the mental health treatment plan from TherapyByPro. Read on to learn about John’s experience:
John’s Narrative:
John is a 36-year-old police officer who has been facing ongoing mental health issues following an accident while on duty. He reports that he frequently rides a motorcycle during patrols and was struck by an impaired driver eight weeks ago while responding to a call. The accident has resulted in several health problems, such as broken ribs, a punctured lung, and a concussion. After a recent discharge from the hospital, John is undergoing intensive physical therapy for his injuries.
After observing John’s continuous mental health struggles, his wife encouraged him to seek help. He reported experiencing frequent nightmares alongside difficulties sleeping. John has been determined to avoid the accident site, trying to escape reminders of that day. He often feels anxious and irritable, has difficulty enjoying his usual activities, and has distanced himself from family and friends, skipping typical events and gatherings.
John’s childhood was marked by his parents’ divorce, leading to neglect and conflict. In adulthood, he struggles to establish a sense of security in relationships, depend on others, or express his thoughts and feelings. As a result, he faces relationship challenges with his wife and finds it hard to lean on her during his recovery.
John mentioned that he understands PTSD from his military experience, though he has not personally faced it. He stated he does not have a history of mental health issues, has never used substances, and has not previously consulted with mental health professionals. John is willing to participate in one-on-one therapy but currently has no desire for group therapy. However, he may consider group therapy if his symptoms lessen.
Supported Agencies and Care Coordination Plans
Considering the provided details, a psychiatric evaluation might be beneficial for John. This evaluation could help assess if he would benefit from medication. In this case, you could refer him to a psychiatrist at your outpatient treatment center.
Example for John:
Care Coordination: Dr. Smith, (123)456-7890
Clinical Diagnoses
John’s experiences align with the DSM criteria for Post-Traumatic Stress Disorder (PTSD). He has reported symptoms of re-experiencing, avoidance, arousal, reactivity, and mood disturbances. We will designate an acute specifier since his symptoms have been around for less than three months.
Example for John:
Clinical Diagnosis: Post-Traumatic Stress Disorder (PTSD), F43.11 Acute PTSD
Current Medications and Reactions
John is not currently on any medication. If this changes after his psychiatric appointment, this section of his treatment plan should be updated.
Example for John:
Current Medications: None currently
Presenting Issues and Related Symptoms
The presenting problem in your treatment plan allows you to offer a case conceptualization. It’s recommended to include details that back your use of schema therapy and touch on the goals and objectives you plan to include later.
Example for John:
John, a 36-year-old police officer, is facing ongoing mental health symptoms after being involved in a motorcycle accident while on duty. The accident, caused by a driver under the influence, occurred eight weeks ago, resulting in injuries such as broken ribs, a punctured lung, and a concussion. John has recently been released from the hospital and returned home, where he is participating in rigorous physical therapy for recovery.
Encouraged by his wife, John has sought treatment. He mentioned experiencing recurrent nightmares, sleep issues, irritability, hypervigilance, and a decreased interest in activities he once enjoyed. John admitted that he no longer participates in social events with family and friends, leading to feelings of isolation. He also expressed a strong desire to avoid the accident location for fear of how he would react.
John described his upbringing as difficult due to his parents’ divorce, which led to neglect and conflict during his childhood. He suggested that these early experiences may have influenced some of his later difficulties.
Although John is knowledgeable about PTSD from his military service, he denies having a personal history of mental health issues or substance use disorders. He has never undergone any form of mental health treatment or used medications for symptoms. He is open to weekly individual therapy but currently skeptical about group therapy, stating he might be interested if his symptoms improve.
Goals and Objectives
The objectives of your schema therapy treatment plan will be specific to your client and their individual symptoms. It’s important to consider the severity of their symptoms and to focus on what will be most beneficial at this time. Over time, you may adjust the treatment plan to track their progress and set new treatment goals.
Example for John:
Goal 1: Decrease the Intensity and Frequency of PTSD Symptoms
- Objective 1: Identify maladaptive schemas related to safety, vulnerability, and control.
- Objective 2: Employ relaxation strategies such as grounding techniques and deep breathing to manage hypervigilance and irritability.
- Objective 3: Alleviate the impact of nightmares and trauma-related memories through rescripting methods.
Goal 2: Reduce Social Isolation
- Objective 1: Examine schemas that contribute to social withdrawal.
- Objective 2: Gradually participate in social and family gatherings through small, achievable goals.
- Objective 3: Utilize effective communication skills to reconnect with family and friends.
Goal 3: Minimize Avoidance Behaviors Related to Trauma
- Objective 1: Implement gradual exposure techniques to address John’s avoidance of the accident site.
- Objective 2: Recognize and confront maladaptive schemas that fuel avoidance behaviors.
- Objective 3: Apply empathetic confrontation to assist in managing distress during exposure activities.
Specific Interventions Scheduled
This segment of your treatment plan can provide a detailed breakdown of the interventions intended to assist John in achieving his treatment objectives and goals. It can serve as a reference for techniques and exercises to be utilized in future sessions.
Example for John:
Intervention 1:
Imagery Rescripting
Responsible person: Counselor A and John
Intervention 2:
Empathetic Confrontation
Responsible person:Counselor A
Intervention 3:
Behavioral Pattern-Breaking
Responsible person:Counselor A
Intervention 4:
Mindfulness and Grounding Techniques
Responsible person:Counselor A and John
Intervention
5:
Chair Work
Responsible person: Counselor A
Family Involvement
Currently, involving John’s family in his treatment doesn’t seem necessary. However, including his wife in future sessions might be beneficial, depending on their situation and John’s development with the schemas impacting their relationship.
Example for John:
Family Involvement: None at this moment
Additional Services and Interventions
Besides consultations with the psychiatrist in your clinic, John could gain from group therapy, although he currently expressed no interest in participating. If his feelings change later on, it’s important to revisit this part of his treatment plan.
Example for John:
Additional Services: None at this moment
Estimation for Completion
Schema therapy is a prolonged treatment intended to tackle entrenched unhealthy patterns, which can result in treatment lasting between one to two years.
Example for John:
Estimated Time for Completion: Roughly one year of weekly sessions, subject to adjustment as necessary.
Aftercare Plans
This section of your treatment plan should contain recommendations for situations where the client may conclude treatment without achieving their goals. This can happen for various reasons, especially with extended treatments like schema therapy. Adjustments might be needed in this area as your client advances in their treatment to maintain effectiveness.
Example for John:
Aftercare Plans: Schedule appointments with primary care physician for ongoing medication management and potential referrals.
Final Thoughts On Creating a Treatment Plan for Schema Therapy
We appreciate your interest in our guide to developing a customized schema treatment plan! While schema therapy is primarily applied for personality disorders, it can also address underlying issues contributing to symptoms like PTSD. For John, his past experiences are likely exacerbating some of his PTSD symptoms. This therapy allows for individual care and aids in reframing and healing from past traumatic memories.
Schema therapy takes a long-term approach intended to help reshape a client’s emotional and cognitive responses. If you’re keen to explore how this empowering method can fit into your clinical practice, we recommend seeking continuing education and training opportunities.
TherapyByPro is an online resource connecting mental health professionals with clients in need. If you’re in the mental health field, consider joining our community and listing your practice here. We provide assessments, practice documents, and worksheet templates to help streamline your practice. Discover all our mental health worksheets here.
Explore all of our Schema Therapy Worksheets
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