Archive for Personality

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
Feb
21

Radically-Open Dialectical Behavior Therapy (RO-DBT)

by Laura Johnson

RO-DBT: Your Path to a More Flexible Life and Joyful Experiences

Laura Johnson, LMFT, LPCC, Center Director, attended a two-day workshop on Radically-Open Dialectical Behavior Therapy (RO-DBT) led by its founder, Thomas Lynch, PhD, Professor of Clinical Psychology at the University of Southampton, UK. RO-DBT is an evidence-based approach to help individuals become more flexible in their thinking and responding, more open to life experiences that create joy and happiness, and build intimacy and social connections. RO-DBT can be particularly helpful for individuals with inflexible, rigid personality styles who are susceptible to certain types of anxiety disorders, depression, OCD, perfectionism, anorexia and autism. RO-DBT includes many of the skills taught in traditional DBT but also teaches an entirely new set of skills to increase flexibility and reduce rigidity.

RO-DBT Theory

The theory behind RO-DBT is that children with an “over controlled” temperament are more likely to develop internalizing disorders such as anxiety and depression and become socially isolated as adults. “Overcontrol” is defined as an emotionally constricted, shy and risk averse temperament. In appropriate amounts, overcontrol is a positive trait. You may desire to exceed expectations and perform well, value rules and fairness, delay gratification to achieve goals, and have a high sense of duty, obligation and self-sacrifice.

On the other hand, individuals who develop a excessively overcontrolled style may have a need to appear perfect (planning ahead, being right, stressing orderliness and structure), follow rules (always doing the right thing, being prepared, smiling even when unhappy) and have high pain tolerance (able to work really hard and delay or minimize joy and fun).

Goals of RO-DBT

The goal in RO-DBT is to help individuals develop optimal control that is neither over- or under-controlled.

RO-DBT starts with defining what’s healthy and what’s not. Its interventions strive to build these positive traits including:

  • Receptivity and Openness to new experiences (as opposed to high risk aversion, hypervigilance for threat, avoidance of novelty and discounting of constructive feedback)
  • Flexible Responding to adapt to changes in the environment (instead of compulsive needs for structure and order, hyper-perfectionism, compulsive planning/rehearsal, and rigid rule-governed behavior)
  • Emotional Expression and Awareness to have genuine emotional experiences (as opposed to inhibited expressions or fake expressions and low self-awareness or minimizing of feelings)
  • Intimacy and Connection to form long-lasting bonds (instead of aloof/distant relationships, excessive social comparison, envy and bitterness, and low empathy and validation skills)

Ways to Build Flexibility, Openness and Social Connection

In addition to most of the traditional DBT skills, RO-DBT also teaches additional new skills  to build the qualities of flexibility, openness and social connection including:

Radical Oppenness Skills LegosRadical Openness Skills Module is a completely new skills module where you will learn to change your physiology, engage in new behaviors, learn from constructive feedback, validation skills, build compassion and forgiveness, stimulate positive emotions toward yourself and social connectedness with others through loving kindness meditation,verbal and non-verbal skills to signal openness and friendliness, and communication of emotions to increase social connection and reduce social isolation and loneliness.

Mindfulness Skills to recognize when you are in fixed mind vs. fatalistic mind and how to get to flexible mind and to teach self inquiry.

Emotion Regulation Skills to reduce envy, bitterness, resentment and revenge.

Some Examples of RO-DBT Skills

There are three steps involved in building the skill of Radical Openness:

  1. Acknowledge the presence of unwanted or uncomfortable feelings such as irritation, tension in the body, negative emotions or feelings of uncertainty
  2. Turn toward the discomfort and use Self-Inquiry to ask yourself, “What do I need to learn from this?” instead of automatically distracting or accepting
  3. Flexibly Respond by doing what’s needed in the moment

Practicing being open to feedback from others includes the following steps:

  1. Acknowledge the feedback
  2. Describe your emotions, sensations, thoughts and images
  3. Be Open to new information by cheerleading yourself, adopting an open body stance, and fully listening to the feedback
  4. Pinpoint what the new behavior is and confirm
  5. Try out the new behavior
  6. Self-soothe and reward yourself
How To Get Help in Building Flexibility and Other Positive Traits

The Cognitive Behavior Therapy Center of Silicon Valley specializes in helping individuals change unhelpful thinking and coping styles and build flexibility, openness and social connection. With our convenient location just a half 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, Cupertino and Campbell, CA. We also have a CBT Online Video Therapy Program for clients in California who live to far away to drive for our specialized therapy in person. Contact us at (408) 384-8404 for more information on how we can help you manage you become more flexible, open and joyful.

0 Categories : Anxiety, Cognitive Behavior Therapy, Depression, Mindfulness, OCD, Perfectionism, Personality, Social Anxiety, Uncategorized
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
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