Schema Therapy

What Is Schema Therapy And How Is It Used In Addiction Treatment ?

Schema Therapy for Addiction Treatment

It’s a word that’s used in casual conversation every day by the clinical staff at Cornerstone of Recovery, but to the uninitiated, the word “schema” sounds like a football play or a get-rich-quick scam.

It’s actually one of the biggest therapeutic tools in the Cornerstone arsenal. Schemas – pronounced “skee-muhs” – are associated with a number of other descriptions: life traps, character defects, maladaptive coping mechanisms and more, but they boil down to one essential definition: unhealthy patterns developed primarily in childhood, which persist into adulthood and shape our decision-making processes. They were developed by Dr. Jeffrey Young and Dr. Janet Klosko out of the cognitive behavioral school of psychology, built on a foundation established by Dr. Aaron Beck; officially, their use in treatment is known as Schema-Focused Cognitive Therapy, and they combine elements of behavioral, experiential, interpersonal and psychoanalytic therapies into a single, unified model.

If that sounds complicated, just know this: In addiction, schemas become both a means of self-protection and a barrier to getting better. In treatment, our clinically trained staff members work within the guidelines laid out by Young, Beck and Klosko to help patients examine these self-defeating patterns of thinking and behavior, which if not addressed will become obstacles in the way of long-term recovery.

Schema therapy consists of three stages, but it all begins with the first step:

Assessment: To tailor a specific treatment path for each patient, counselors and therapists work to discover what their particular schemas might be. Questionnaires may be used to get a clearer picture of various life patterns, and all schemas are categorized as one of 18, broken down by five separate domains.

  • Domain One: Disconnection and rejection, meaning that the patient expects his or her needs for security, safety, stability, nurture, empathy, acceptance and respect will not be met in a predictable manner. Schemas include (a) abandonment/instability, (b) mistrust/abuse, (c) emotional deprivation, (d) defectiveness/shame and (e) social isolation/alienation.


  • Domain Two: Impaired autonomy and performance, meaning that a patient perceives his or her personal value is diminished, that he/she will be unable to function independently or perform successfully due to certain environmental factors. Schemas include (a) dependence/incompetence, (b) vulnerability to harm or illness, (c) enmeshment/undeveloped self and (d) failure


  • Domain Three: Impaired limits, meaning that patients have difficulty respecting the rights of and cooperating with others, making commitments or setting and achieving realistic personal goals. Schemas include (a) entitlement/grandiosity and (b) insufficient self-control/self-discipline


  • Domain Four: Other-Directedness: The patient focuses excessively on the needs, desires, feelings and responses of others at the expense of his or her own needs, often in order to gain love and approval, maintain friendships or avoid retaliation. Schemas include (a) subjugation, (b) self-sacrifice and (c) approval-seeking/recognition seeking


  • Domain Five: Over-Vigilance and Inhibition: The patient either excessively suppresses his or her own emotions and desires or sets rigid internalized rules about their own performance or behavior, often at the expense of happiness, health, close relationships or self-expression. Schemas include (a) negativity/pessimism, (b) emotional inhibition, (c) unrelenting standards/hyper-criticalness and (d) punitiveness.


Where do these schemas originate?

Most of these issues stem from the family of origin, meaning that they’re almost always developed from the age of 0 to 12 years old, and for the rest of an individual’s life, they’re continually reinforced. That does not mean that the family is at fault; this is an especially difficult concept for family members to accept, especially ones who are already feeling guilty and wondering if something they did or didn’t do might have “caused” a loved one’s addiction. Schema therapy addresses the root cause of these coping mechanisms, but it does not assign blame to individuals in the patient’s life.

Schemas develop from two sources: temperament, the core of an individual that’s hard-wired with certain personality traits from birth; and experience, the unique events that occur in a person’s life. Example: An individual’s abandonment/instability schema might stem from anything from being left alone in a grocery store aisle for a few minutes as a 4-year-old to the divorce of parents during childhood. Regardless of how significant or insignificant such an event may seem to the patients themselves or to outside observers, they’ve made an indelible impact on those patients’ psyches, and they impact them in certain ways as they go through life.

Everyone has schema or two (or many), but not everyone develops an addiction. The schemas aren’t necessarily the cause of the addiction, but they can be a stumbling block to the recovery process, as brain changes brought on by heavy drug and alcohol use can exacerbate them or prevent the afflicted from coming to terms with them. And unless they’re examined and addressed during the recovery process, they can certainly stand in the way of the emotional and spiritual recovery process.

Keep in mind that schema therapy is much more complex than this brief description might indicate. Should you want more information about it, our staff members will be more than happy to provide it to you, and in case you’re seeking the Cliff’s Notes version of this page, it’s this: There is emotional trauma in every addict’s life that must be dealt with once the drugs are removed. Schema therapy is a way to do that, and we’ve found it to be an extremely useful and successful part of the therapeutic process at Cornerstone of Recovery.

Alcohol & Drug Addiction Treatment Services

The Path To Recovery Starts At Cornerstone

Medical Detoxification can be a critical time in a patient’s journey toward recovery because the symptoms of withdrawal can be difficult to manage and potentially life-threatening. A team of certified, competent and caring professionals work together to ensure that we provide the best medical care for our patients. The Medical Director prescribes detox medications to keep the patient safe and reasonably comfortable.

While receiving detoxification medications, patients also attend psychoeducational groups and experiential activities. However, detox patients are also given sufficient opportunity to relax and allow their bodies to begin the healing process. Patients on a detox protocol are monitored 24 hours a day and the typical length of detoxification is 3 to 5 days and may be longer depending on the severity of the patient’s withdrawal symptoms.

This unit is designed to support our patients as they enter treatment and begin to invest in their community of peers. An extensive battery of assessments is performed to identify the patient’s bio-psycho-social-spiritual strengths, needs, and barriers to recovery (such as chronic pain, dual diagnosis, trauma, or other co-occurring disorders). This comprehensive assessment process provides our medical and clinical teams with much of the information they need to build a treatment plan that is individualized for each patient.

Our NON-NARCOTIC PAIN MANAGEMENT PROGRAM offers solutions that eliminate and or reduce the dependence on medications to treat pain and improve treatment outcomes. We are able to reduce pain and improve the recovery process. We offer sound information and teach skills that the patient can use to improve coping, relaxation, mindfulness, nutrition, and much more. Some of the modalities we use are Reiki, Rubenfeld Synergy, Acupressure, Mindful Stretching, and Addiction Free Pain Management Education.

We believe healing occurs through direct experience. Experiential activities amplify the traditional therapeutic
modalities that are part of our milieu. Fitness, Meditation, Relaxation Therapy, Yoga, Spirituality Groups, Ropes Course, Mindfulness, Art Therapy, Drumming Circles, and community outings are some components of experiential healing at Cornerstone. Patients who participate in experiential therapies report reductions

Family Therapy is an integral part of all of the clinical programs at Cornerstone. Early on in the treatment process, we conduct a Family Questionnaire which allows family members and close personal friends to have input that impacts the patients treatment plan. When appropriate, there are Family Therapy sessions throughout the treatment process. These sessions are designed to work through relationship issues, enhance communication, educate the family about the disease of addiction and provide them with emotional support while their loved one is in treatment. Through this support, the family will gain knowledge about the treatment process and how they may be unknowingly supporting the addiction through co-dependent and enabling behaviors.

Family members will learn about how to engage in personal growth and change through various 12 step programs, so that the family can heal together trough the recovery process. Cornerstone requires that each patient complete Family Fundamentals, an intensive three-day family program designed to provide intensive education, group therapy, family therapy, 12 step meeting experience, and an opportunity to repair the damage caused by active addiction. Family members are strongly encouraged to attend the Family Fundamentals program along with the patient. Cornerstone also has a weekly family education group for family members and an ongoing support group for parents of young adults who are struggling with addiction or who have recently entered recovery

The Continuous Care Program upholds Cornerstone of Recovery’s treatment philosophy that chemical dependency is a chronic incurable disease that requires the consistent and continued attention of each patient for a lifetime. Recent scientific studies of the disease process have determined that full remission from active addiction does not occur until an individual has experienced at least 18 months of continuous sobriety, long after most intensive treatment programs have concluded.

In response to this knowledge, the Continuous Care Program provides services for a period of at least 18 months following treatment, to ensure that each patient has the opportunity for professional support throughout the early stages of their recovery. During this time, patients are encouraged to practice the skills and tools they learned and developed in treatment as they find their way back
into their home, work, and social environments. They are able to talk with Recovery Coaches and therapeutically
process the ups and downs they experience in sobriety. Active participation in the Continuous Care Program is vital in establishing a lifelong, solid recovery plan.

The Support Living Facility (SLF) provides a safe environment for patients to continue to learn and practice self-management and interpersonal relationship skills while solidifying their recovery program. It can take several months for individuals to become comfortable enough in their recovery to successfully move away from the environment where they got sober. The SLF Program allows men and women to experience some of the freedoms they will experience after treatment while they are supported by thier peers, staff, and a sober environment. Staff monitors the community through regular contact, group therapy, spirituality groups, relapse prevention groups, drug screens, and random checks of the living quarters. Eventually, the patient is allowed to retrieve their cell phone, to leave the premises, operate a vehicle and obtain employment. The minimum length of stay is 2 months (while the individual concurrently is in the IOP Program). Patients often choose to stay in SLF longer while they continue to build their recovery network and become more comfortable with the life changes they’ve made.Typical length of stay varies from 2 to 6 months, depending on the patient’s clinical needs.


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