Archive for Schema Therapy

Mar
6

Healthy and Maladaptive Coping Styles in Schema Therapy

by Laura Johnson

A New Way of Thinking about Coping Styles in Schema Therapy

Cathy Flanagan, one of the original developers of the schema therapy model with its founder, Jeffrey Young, recently published an article in the American Psychological Association’s Journal of Psychotherapy Integration (2014 Vol. 24, No 3, 208-222) where she describes eight modes, or coping styles, that healthy individuals experience. Modes are distinct patterns representing coping strategies to help individuals adapt to situations and to satisfy needs.

In contrast, maladaptive modes or coping styles are extreme forms of normal patterns of adaptation. Each of the eight healthy modes has a corresponding dysfunctional extreme that can become chronically dysfunctional ways of experiencing the self and relating to others.

Healthy and Maladaptive Coping Styles in Schema Therapy

Below are the eight healthy adult modes and the corresponding maladaptive mode that may develop when the strategies are used in excess (the definitions are extracted and summarized from Flanagan’s article).

1. Leader: Behavior, thinking and feelings are all “active.” The Leader is in control, thinking constructively, and openly expressing feelings. Leaders are in touch with both their own needs and the needs of others.

Leader becomes Bully: The Bully operates by demeaning and controlling. Bullies need validation and respect but they elicit hostility and resentment, maintaining a vicious cycle.

2. Caretaker: Caretakers are mentally and physically “on,” and focused on meeting the needs of others. Connection is prioritized and the person’s own needs and feelings come second to those of others.

Caretaker becomes the Martyr: Martyrs do not express their needs but expect that their obvious self-sacrifice will make others respond in kind. The result is a build up of resentment. Martyrs’ excessive need for affirmation induces guilt with the self-defeating effect of making other people pull away.

3. Free Spirit: The Free Spirit actively pursues goals, and reacts in the spirit of the moment. This is a “feel good,” autonomous mode.

Free Spirit becomes Rebel: Rebels have an impulsive, or oppositional style. Rebels’ exaggerated needs for autonomy and change ironically elicit a reaction of correction and control, reinforcing the cycle of rebellion.

Uneven Balance4. Deliberator: Deliberators thoughtfully weigh the possible costs and benefits of different courses of action until a level of certainty is reached. Daydreams and fantasies are entertained for possible action at a later stage.

Deliberator becomes Worrywart: An excessive need for certainty and an intolerance of ambiguity lead to obsessional thinking and behavioral avoidance. Worrywarts avoid acting or taking risks until they are sure of the outcome. Chronic obsessing or indecision can result in procrastination, reassurance seeking, or resentful dependency.

5. Doer: This mode is defined by action and a single-minded focus on getting a job done or project finished. Doers do not think beyond the task at hand. This can be effective in appropriate doses.

Doer becomes Controller: Controllers are closed to feedback from others. When projects are complete, they go straight to the next one, reaching goals with little sense of satisfaction or connection with other people.

6. Strategizer: Here the pros and cons of various strategies are carefully and dispassionately considered. The focus is on thinking over feelings. Action is suspended until it is considered appropriate or timely.

Strategizer becomes Schemer: For Schemers, life is a battle of wits, a game of chess. This is an impersonal, observing mode. Thinking predominates and results in covert manipulations and passive-aggression. This mode precludes authentic connections with others.

7. Emoter: The Emoter openly expresses his or her feelings, either to get urgent needs met or because the context elicits them. Problem-focused thinking and action are secondary to the immediacy of affect.

Emoter becomes Overreactor: Emotional outbursts, which are intended to elicit validation or reassurance, backfire and can produce rejection or ridicule. Frantic efforts to maintain stability and connection are self-defeating in the same way as a child’s temper tantrum.

8. Follower: This is a “low key” mode. The Follower is content to hand over control. This mode may also represent a period of “down time” or rest. Obviously, not everyone can or should be a Leader so Followers contribute greatly in society.

Follower becomes Victim: This is a markedly passive, subjugated mode where affect is flat, detached, or depressed. Victims need connection, stability, and validation but, by shutting down, the likelihood of getting these needs met is decreased even more.

Therapy Implications for Working with Coping Styles

Coping Skills Tool BoxThis model of healthy and maladaptive coping styles provides opportunities for therapists to consider which tools might be used most effectively with different clients, or at different stages of the therapy process. For example, cognitive reframing, emotional regulation, and behavioral skills training might be strategically utilized to modify certain maladaptive modes. Other tools, such as guided imagery or mindfulness meditation, could be used as appropriate. The point is not so much to specify the exact choice of technique but to target specific mode components with whichever tools are likely to be most effective in the individual case. This will help the client to gradually learn to recognize his/her unhelpful coping styles and to consciously decrease the intensity of these maladaptive components or switch to another, more effective, coping style.

How to Get Help to Improve Your Coping Styles

The Cognitive Behavior Therapy Center of Silicon Valley offers schema therapy to help you develop more effective coping styles. We are located in Saratoga on the border of San Jose and Saratoga just a 1/2 mile from Highway 85. With our convenient location near highway 85, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Cupertino and Campbell, CA. In addition, we offer Online Video Therapy for adults in California who are unable to find a qualified schema therapist in your local community. Call us at (408) 384-8404 to learn more about our schema therapy program.

0 Categories : Cognitive Behavior Therapy, Personality, Schema Therapy
Oct
30

Schema Therapy: Basics and Beyond

by Laura Johnson

I just returned from a two-day Schema Therapy Workshop at the New Jersey Institute for Schema Therapy. The training was led by Wendy Behary, the Founder and Director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy and President of the International Society of Schema Therapy. While I have been using Schema Therapy concepts with some clients already, I gained a new appreciation for the complexity, depth and effectiveness of this approach. Starting in March 2015, I am participating in the Advanced Intensive Schema Therapy Training Program. In this article, I will explain some of the basics of schema therapy. Stay tuned for a lot more to come as I work through the intensive training program and get certified!

What is Schema Therapy?

Schema Therapy is an evidence-based approach for long lasting change in the personality dynamics that impact chronic emotional and relationship problems. Schema Therapy was developed by Jeffrey Young while he was at the Beck Institute for Cognitive Behavior Therapy and he eventually branched out on his own. Schema Therapy is considered an integrative model because it draws on cognitive therapy, behaviorism, attachment theory, emotion-focused and relationship-based therapies and other schools of thought. Due to its strong roots in cognitive behavior therapy, I believe it is a natural extension to CBT for helping people who want or need a more depth-oriented approach.

Schema Therapy places emphasis on:

  • Identifying and resolving self-defeating life patterns and deeply rooted emotional themes,
  • Building resiliency and productive responses to life challenges,
  • Drawing out and enabling the strong part of your personality,
  • Employing a variety of cognitive, behavioral and emotional change techniques, and
  • Using the therapeutic relationship as a vehicle for change

What Is the Theory Behind Schema Therapy?

Schema ModelIn Schema Therapy, you will learn which of your schemas are triggered when you notice a strong reaction in yourself. The schema model has identified 18 schemas, typically developed when core emotional needs are not meet in childhood. Some common schemas include abandonment, defectiveness/shame, unrelenting standards, and vulnerability to harm/illness.

In order to cope with the pain when our schemas are triggered, we may develop certain coping styles including:

  • Surrender: giving in to our schemas and repeating them over and over,
  • Avoidance: finding ways to escape or block out our schemas, and/or
  • Overcompensation: doing the opposite of what our schemas make us feel.

When triggered, we may have a strong emotional reaction or mood shift, and we then enter a coping state called a “mode.” There are four categories of schema modes: the innate Child modes (vulnerability, anger, undisciplined/impulsive, contented), the Maladaptive Coping modes (detachment, compliance, overcompensating), the Maladaptive Parent modes (punitive, demanding/critical), and the Healthy Adult mode. The goal of schema therapy is to help you get your core needs met in an adaptive manner by enhancing the Healthy Adult coping mode so your schemas are triggered less frequently and intensely and you can recover more quickly.

Is Schema Therapy Evidence-Based?

I was impressed and pleasantly surprised by the large and growing research base, primarily led by therapists in Europe, where there is support and government funding for longer-term therapies that have been proven effective for deeper and longer-lasting change. In the U.S., most research grants and insurance funding are targeted toward shorter-term therapy approaches for symptom reduction. As a result, schema therapy is not well-known in the U.S. As of this writing, there are no Certified Schema Therapists in California. I hope to change this.

Who Does Schema Therapy Help?

PersonalitySchema Therapy is particularly well suited for adults who:

  • Have recurring depression, anxiety and relationship problems and don’t understand why they stay stuck in the same patterns year after year,
  • Want deeper, more long lasting personality change and relapse prevention after their anxiety, depression and other immediate crises have been resolved,
  • Have chronic anxiety, OCD and depression that does not respond fully to standard CBT, DBT and exposure therapy protocols, or
  • Have successfully completed evidence-based treatment for anxiety, depression, OCD and other problems and want to continue to work on underlying issues in order to improve the quality of their lives and relationships.

Schema Therapy is beginning to be tailored for many populations including children, teens and families. This is an exciting development in Schema Therapy because it will help children and teens develop into healthy adults and prevent them from having chronic anxiety, depression and other problems in adulthood.

What Does Schema Therapy Entail?

Phase 1: Assessment and Education

The assessment phase generally lasts for five to seven sessions and focuses on:

  • Education about the Schema Therapy model.
  • Assessing schemas and coping styles through interviews, inventories and emotional techniques.
  • Scoring and interpreting the results of various schema inventories.
  • Activating schemas using emotional techniques such as imagery.
  • Noticing how schemas show up in the therapy relationship.

Phase 2: Schema Therapy Treatment

As a longer-term, depth-oriented treatment approach for chronic emotional and relationship problems as well as personality change, you can expect the active treatment phase to be about one to two years of weekly therapy. As mentioned earlier, Schema Therapy uses a variety of strategies to contribute to change.

  • Cognitive Techniques: schema diaries, pros and cons of schemas and coping styles, schema dialogues and flashcards.
  • Emotion-Focused Techniques: emotional change through imagery, role plays and two-chair work.
  • Therapy Relationship: empathic confrontation and analyzing schemas when triggered in sessions.
  • Behavioral Techniques: behavioral assignments, skills training and exposure tasks to overcome avoidance of trigger situations.
How to Get Started with Schema Therapy

I hope this article has wet your appetite to learn more about Schema Therapy and perhaps even partake in Schema Therapy yourself. To learn more about Schema Therapy in a self-help format, you can read Reinventing Your Life. If you are interested in starting Schema Therapy, contact the Cognitive Behavior Therapy Center of Silicon Valley at (408) 384-8404 or the Cognitive Behavior Therapy Center of Sacramento Valley at (916) 778-0771 or send us an email.

0 Categories : Cognitive Behavior Therapy, Perfectionism, Personality, Schema Therapy, Uncategorized
May
23

Schemas in Schema Therapy

by Laura Johnson

What is Schema Therapy?

Schema TherapySchema therapy is an extension of cognitive behavior therapy designed to treat a variety of long-standing emotional difficulties with significant origins in childhood and adolescent development. The goal of schema therapy is to help clients get their core needs met in an adaptive manner by enhancing positive schemas and developing healthier coping responses when negative schemas are triggered.

Negative schemas develop when core childhood needs are not met. When parents can more or less meet the child’s core emotional needs in appropriate amounts, the child develops into a healthy adult. Children’s basic needs include:

  • Safety
  • Stable Base, Predictability
  • Love, Nurturing & Attention
  • Acceptance & Praise
  • Empathy
  • Guidance & Protection
  • Validation of Feelings & Needs

Schema Therapy vs. Cognitive Behavior Therapy

Compared to traditional cognitive behavior therapy, schema therapy incorporates:

  • Greater emphasis on the therapeutic relationship
  • More emphasis on affect (e.g., imagery, role-playing) and mood states
  • More discussion of childhood origins and developmental processes
  • More emphasis on lifelong coping styles (e.g., avoidance and overcompensation)
  • More emphasis on entrenched core themes (i.e., core beliefs and schemas)

Schemas — What Are They?

A schema is a stable, enduring negative pattern that develops during childhood or adolescence and is reinforced through thoughts, core beliefs, actions and relationships throughout an individual’s life. We view the world through our schemas. Schemas incorporate core beliefs and feelings about oneself and the environment which the individual accepts without question. They are self-perpetuating, and are very resistant to change.

Even though schemas persist once they are formed, they are not always in our awareness. Usually they operate in subtle ways, out of our awareness. Everyone has schemas since no parent could be a perfect parent and fulfill every emotional need 100% of the time. While the schema descriptions may sound negative, it is normal to have some elements of some schemas within your personality structure. However, when a schema erupts or is triggered by events, our thoughts and feelings are dominated by these schemas. It is at these moments that people tend to experience extreme negative emotions and have dysfunctional thoughts.

18 Common Schema Themes

  1. Emotional Deprivation: This schema refers to the belief that one’s primary emotional needs will never be met by others. These needs can be described in three categories: Nurturance—needs for affection, closeness and love; Empathy—needs to be listened to and understood; Protection—needs for advice, guidance and direction. Generally parents are cold or removed and don’t adequately care for the child in ways that would adequately meet the above needs.
  2. Abandonment/Instability: This schema refers to the expectation that one will soon lose anyone with whom an emotional attachment is formed. The person believes that, one way or another, close relationships will end imminently. As children, these clients may have experienced the divorce or death of parents. This schema can also arise when parents have been inconsistent in attending to the child’s needs; for instance, there may have been frequent occasions on which the child was left alone or unattended to for extended periods.
  3. Mistrust/Abuse: This schema refers to the expectation that others will intentionally take advantage in some way. People with this schema expect others to hurt, cheat, or put them down. They often think in terms of attacking first or getting revenge afterwards. In childhood, these clients were often abused or treated unfairly by parents, siblings, or peers.
  4. Social Isolation/Alienation: This schema refers to the belief that one is isolated from the world, different from other people, and/or not part of any community. This belief is usually caused by early experiences in which children see that either they, or their families, are different from other people.
  5. Defectiveness/Shame: This schema refers to the belief that one is internally flawed, and that, if others get close, they will realize this and withdraw from the relationship. This feeling of being flawed and inadequate often leads to a strong sense of shame. Generally parents were very critical of their children and made them feel as if they were not worthy of being loved.
  6. Failure: This schema refers to the belief that one is incapable of performing as well as one’s peers in areas such as career, school or sports. These clients may feel stupid, inept or untalented. People with this schema often do not try to achieve because they believe that they will fail. This schema may develop if children are put down and treated as if they are a failure in school and other spheres of accomplishment. Usually the parents did not give enough support, discipline, and encouragement for the child to persist and succeed in areas of achievement, such as schoolwork or sport.
  7. Dependence/Incompetence: This schema refers to the belief that one is not capable of handling day-to-day responsibilities competently and independently. People with this schema often rely on others excessively for help in areas such as decision-making and initiating new tasks. Generally, parents did not encourage these children to act independently and develop confidence in their ability to take care of themselves.
  8. Vulnerability to Harm and Illness: This schema refers to the belief that one is always on the verge of experiencing a major catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive precautions to protect oneself. Usually there was an extremely fearful parent who passed on the idea that the world is a dangerous place.
  9. Enmeshment/Undeveloped Self: This schema refers to a pattern in which you experience too much emotional involvement with others – usually parents or romantic partners. It may also include the sense that one has too little individual identity or inner direction, causing a feeling of emptiness or of floundering. This schema is often brought on by parents who are so controlling, abusive, or so overprotective that the child is discouraged from developing a separate sense of self.
  10. Subjugation: This schema refers to the belief that one must submit to the control of others in order to avoid negative consequences. Often these clients fear that, unless they submit, others will get angry or reject them. Clients who subjugate ignore their own desires and feelings. In childhood there was generally a very controlling parent.
  11. Self-Sacrifice: This schema refers to the excessive sacrifice of one’s own needs in order to help others. When these clients pay attention to their own needs, they often feel guilty. To avoid this guilt, they put others’ needs ahead of their own. Often clients who self-sacrifice gain a feeling of increased self-esteem or a sense of meaning from helping others. In childhood the person may have been made to feel overly responsible for the well being of one or both parents.
  12. Emotional Inhibition: This schema refers to the belief that you must suppress spontaneous emotions and impulses, especially anger, because any expression of feelings would harm others or lead to loss of self-esteem, embarrassment, retaliation or abandonment. You may lack spontaneity, or be viewed as uptight. This schema is often brought on by parents who discourage the expression of feelings.
  13. Unrelenting Standards/Hypercriticalness: This schema refers to the belief that whatever you do is not good enough, that you must always strive harder. The motivation for this belief is the desire to meet extremely high internal demands for competence, usually to avoid internal criticism. People with this schema show impairments in important life areas, such as health, pleasure or self- esteem. Usually these clients’ parents were never satisfied and gave their children love that was conditional on outstanding achievement.
  14. Entitlement/Grandiosity: This schema refers to the belief that you should be able to do, say, or have whatever you want immediately regardless of whether that hurts others or seems reasonable to them. You are not interested in what other people need, nor are you aware of the long- term costs to you of alienating others. Parents who overindulge their children and who do not set limits about what is socially appropriate may foster the development of this schema. Alternatively, some children develop this schema to compensate for feelings of emotional deprivation or defectiveness. Positive schema to enhance would be empathy and compassion for others.
  15. Insufficient Self-Control/Self-Discipline: This schema refers to the inability to tolerate any frustration in reaching one’s goals, as well as an inability to restrain expression of one’s impulses or feelings. When lack of self-control is extreme, criminal or addictive behavior rule your life. Parents who did not model self-control, or who did not adequately discipline their children, may predispose them to have this schema as adults.
  16. Approval-Seeking/Recognition-Seeking: This schema refers to the placing of too much emphasis on gaining the approval and recognition of others at the expense of one’s genuine needs and sense of self. It can also include excessive emphasis on status and appearance as a means of gaining recognition and approval. Clients with this schema are generally extremely sensitive to rejections by others and try hard to fit in. Usually they did not have their needs for unconditional love and acceptance met by their parents in their early years.
  17. Negativity/Pessimism: This schema refers to a pervasive pattern of focusing on the negative aspects of life while minimizing the positive aspects. Clients with this schema are unable to enjoy things that are going well in their lives because they are so concerned with negative details or potential future problems. They worry about possible failures no matter how well things are going for them. Usually these clients had a parent who worried excessively.
  18. Punitiveness: This schema refers to the belief that people deserve to be harshly punished for making mistakes. People with this schema are critical and unforgiving of themselves and/or others. They tend to be angry about imperfect behaviors much of the time. In childhood these clients usually had at least one parent who put too much emphasis on performance and had a punitive style of controlling behavior.

At the Cognitive Behavior Therapy Center of Silicon Valley, we have an in-depth interview process and series of questionnaires that can help us identify your primary schemas.

About the Cognitive Behavior Therapy Center of Silicon Valley

The Cognitive Behavior Therapy Center of Silicon Valley offers Schema Therapy for chronic and long standing problems and patterns. With our convenient location just a 1/2 mile from Highway 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us at (408) 384-8404 or send an email for more information on how we can help you with long term schema change.

0 Categories : Anxiety, Schema Therapy, Uncategorized
May
20

OCPD vs. OCD: What’s the Difference?

by Laura Johnson

What is Obsessive Compulsive Personality Disorder (OCPD)?

OCPDObsessive Compulsive Personality Disorder (OCPD) is a type of “personality disorder” with these characteristics:

  • Rigid adherence to rules and regulations
  • An overwhelming need for order
  • Unwillingness to yield or give responsibilities to others
  • A sense of righteousness about the way things “should be done”

What are the symptoms of Obsessive Compulsive Personality Disorder (OCPD)?

  • Excessive devotion to work that impairs social and family activities
  • Excessive fixation with lists, rules and minor details
  • Perfectionism that interferes with finishing tasks
  • Rigid following of moral and ethical codes
  • Unwillingness to assign tasks unless others perform exactly as asked
  • Lack of generosity; extreme frugality without reason
  • Hoarding behaviors

What is the difference between Obsessive Compulsive Personality Disorder (OCPD) and Obsessive Compulsive Disorder (OCD)

  • People with OCD have insight, meaning they are aware that their unwanted thoughts are unreasonable. People with OCPD think their way is the “right and best way” and usually feel comfortable with such self-imposed systems of rules.
  • The thoughts, behaviors and feared consequences common to OCD are typically not relevant to real-life concerns; people with OCPD are fixated with following procedures to manage daily tasks.
  • Often OCD interferes in several areas in the person’s life including work, social and/or family life. OCPD usually interferes with interpersonal relationships, but makes work functioning more efficient. It is not the job itself that is hurt by OCPD traits, but the relationships with co-workers, or even employers can be strained.
  • Typically, people with OCPD don’t believe they require treatment. They believe that if everyone else conformed to their strict rules, things would be fine. The threat of losing a job or a relationship due to interpersonal conflict may be the motivator for therapy. This is in contrast to people with OCD who feel tortured by their unwanted thoughts and rituals, and are more aware of the unreasonable demands that the symptoms place on others, often feeling guilty because of this.
  • Family members of people with OCPD often feel extremely criticized and controlled by people with OCPD. Similar to living with someone with OCD, being ruled under OCPD demands can be very frustrating and upsetting, often leading to conflict.

What causes Obsessive Compulsive Personality Disorder (OCPD)?

There is no single, specific “cause” identified. Several theories suggest that people with OCPD may have been raised by parents who were unavailable and either overly controlling or overly protective. Also, as children they may have been harshly punished. The OCPD traits may have developed as a sort of coping mechanism to avoid punishment, in an effort to be “perfect” and obedient.

Therapy for Obsessive Compulsive Personality Disorder (OCPD)

The goal of therapy is to lessen rigid expectations and learn how to value close relationships, recreation, and fun with less emphasis on work and productivity. Therapy can lead to greater insight into how someone’s OCPD symptoms affect others. It often takes the threat of the loss of a relationship or job to motivate people with OCPD seek treatment because they typically don’t think there is anything “wrong” with the way they are. If motivated to change, cognitive behavior therapy, particularly schema therapy, holds much promise.

Getting Help for Obsessive Compulsive Personality Disorder (OCPD)

The Cognitive Behavior Therapy Center of Silicon Valley specializes in long term personality change using CBT and schema therapy. With our convenient location just a 1/2 mile from highways 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us at (408) 384-8404 for more information on how we can help you overcome the rigid patterns related to an obsessive compulsive personality.

0 Categories : OCD, Perfectionism, Personality, Schema Therapy, Uncategorized