Young et al. (2006) suggested that many of our negative cognitions are rooted in early childhood experiences, innate temperaments and/or cultural influences.

For example, clients’ psychological wellbeing could have been damaged in their childhood years by not having their needs met, being traumatised or victimised by a controlling adult, absorbing a schema from an influential adult who themselves had a strong schema, or being overprotected and excessively indulged.

The resulting maladaptive cognitions (known as core beliefs or schemas) are often unconditional and very deep-rooted, having become a core part of the person’s self-concept.

Because of their longevity and deep-rootedness – and their being stored in the amygdala (a part of the brain that is not amenable to logical analysis) – they are difficult or even impossible to work with using cognitive restructuring alone.

Many schemas are acquired before the child is fully able to communicate verbally – these are particularly hard to shift. Other schemas (i.e. those acquired later) are sometimes known as conditional schemas, as they are less deep-rooted.

However, whichever their origin and longevity, schemas are stable and enduring patterns, based on an idiosyncratic mix of cognitions (including memories, in both verbal and image forms).

Through 15 years’ clinical observational practice, Young and his colleagues (2006) proposed that there are five domains of such maladaptive early schemas (which relate to childhood needs), containing a total of 18 schemas:

1. disconnection and rejection (comprising the schemas of abandonment, mistrust/abuse, emotional deprivation, defectiveness/shame, and social isolation)
2. impaired autonomy and performance (dependence, vulnerability, enmeshment, and failure)
3. impaired limits (entitlement, and insufficient self-control/self-discipline
4. other-directedness (subjugation, self-sacrifice and approval-seeking)
5. overvigilance and inhibition (negativity, emotional inhibition, unrelenting standards, and punitiveness)

Schemas can be identified in clients through comprehensive assessment, using Young’s schema questionnaire. Another technique involves asking the client to close their eyes and create an image of themselves as children with their parents.

To return to the examples above, a client who had not got their childhood needs met might have acquired an emotional deprivation schema; one who had been victimised could have a mistrust/abuse schema; one who had been influenced by an adult with a punitiveness schema could have adopted the same; and one who was spoilt could have become an adult with an entitlement schema.

Because adults with schemas have become locked into maintenance cycles that keep these going, they tend to live in ways that unconsciously perpetuate them.

Paradoxically, the schemas become so familiar that they are comfortable to stay stuck in, meaning that people may live with them for many years before some precipitating factors triggers an acute problem that leads to therapy – and so the discovery and possibility of treating the schema.

People may live with schemas using any of three possible strategies:

• surrender (giving in to and going with the schema)
• avoidance (avoiding situations that highlights the schema’s existence)
• overcompensation (behaving in an extreme opposite way to what the schema would suggest)

Warning signs that schemas may be present in a client include them feeling pervasively stuck, inadequate, lonely, numb to their emotions or as if life has no meaning – or behaving in a way that involves depending on others or having problems choosing appropriate partners.

Presenting problems such as long-term eating disorders, substance abuse, chronic depression and other repetitive patterns of behaviour may also be clues to the existence of an underlying schema.