- Introduction – Diagnosis & Treatment of Any Associated Mental Disorder
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SCHEMA THERAPY – THE CORRECTIVE CYCLE, COPING RESPONSES, MODES & QUESTIONS
Let’s continue our discussion of the Schema Therapy Model by introducing the client corrective cycle, coping responses, modes and questions.
THE CORRECTIVE CYCLE: Once an individual is wounded (think back to our discussion of core emotional needs & these needs not being met), there is a tendency to engage in a behavioral cycle which is maladaptive. In other words, the person attempts to deal with the pain they have been through using ineffective ways. This is particularly true of individuals who have “just tried to move forward” or “let the past go.”
The original wound was likely created in childhood or adolescence and not effectively dealt with. However, from that point forward, the individual makes decisions, creates relationships, and behaves in such a way as to recreate the circumstances of the original wound on a continuing basis. In other words, without even intending to, the client self-sabotages.
The person will also interpret all incoming information in such a way as to confirm the faulty belief system created by the wound. Their unresolved past wounds become the lens through which they interpret life. As Christian counselors, we can clearly see here the reason why God places such a high value on the truth, as ongoing lies are devastating. As Jesus said, “32 And you will know the truth, and the truth will set you free.” – John 8:32 (NLT).
This troubling cycle serves two purposes. The first is to maintain a kind of cognitive and emotional equilibrium. In other words, while beliefs & behaviors may be maladaptive, they are congruent, and thus, in line with the individual’s belief system. The second purpose is to correct the mistakes which occurred the first time around. The person will “get it right” this time.
How does this look? Here we will transition into Coping Responses.
Coping Responses: these are specific behaviors or strategies (fueled consciously or unconsciously by faulty beliefs) through which coping styles of avoidance, overcompensation, and surrender are expressed in response to a threat. They are unique, idiosyncratic ways in which clients manifest their coping styles. When the individual habitually adopts certain coping responses, these adhere over time into “coping styles.” Thus, coping style is a trait, whereas a coping response is a state. A coping style is a collection of coping responses that an individual characteristically utilizes to avoid, surrender, or overcompensate. A coping response is a specific behavior (or strategy) that the individual is exhibiting at a given point in time.
A word on Temperament: it is very likely that temperament plays a significantly greater role in determining a client’s coping response than in the actual schema manifested. For example: a more passive client is likely to utilize avoidance as a response, where a more aggressive client will overcompensate.
Defining 3 Types of Coping Styles:
Avoidance: When patients utilize avoidance, they attempt to arrange their lives, so the schema is never activated. They attempt to live without awareness, as though the schema does not exist. They avoid thinking about the schema. They block thoughts and images that are likely to trigger it. When such thoughts or images loom, they distract themselves or put them out of their minds. They avoid feeling the schema. When feelings do surface, they reflexively push them back down. They may drink excessively, take drugs, have promiscuous sex, overeat, compulsively clean, seek stimulation, or become workaholics. When they interact with others, they may appear perfectly normal. They usually avoid situations that might trigger the schema, such as intimate relationships or work challenges. Many patients shun whole areas of life in which they feel vulnerable. Often, they avoid engaging in therapy. For example, these patients might “forget” to complete homework assignments, refrain from expressing affect, raise only superficial issues, come late to sessions, or terminate prematurely.
Example: A college student presents for counseling, reporting dissatisfaction with life, including feelings of anxiety and loneliness. Throughout counseling, the client expresses a desire for change and closeness. However, the client often comes to session reporting instances of promiscuous sexual encounters with destructive other persons, with whom there is no chance of actual connection.
Surrender: Yielding to the schema. The patient does not try to avoid or fight it. They accept the schema is true. They feel the emotional pain of the schema directly. They act in ways that confirm the schema. Without realizing what they are doing, they repeat schema-driven patterns so, as adults, they continue to relive the childhood experiences that created the schema. When they encounter schema triggers, their emotional responses are disproportionate, and the experience their emotions fully and consciously. Behaviorally, they choose partners who are most likely to treat them as the “offending parent” did. They frequently relate to these parents in passive, compliant ways that perpetuate the schema. In the therapy relationship, these parents may also play out the schema with themselves in the “child” role and the therapist in the role of “offending parent.”
Example: A woman is abused emotionally by a critical and controlling father as a child. She grows-up and seeks out men who are critical and controlling. She then actively seeks to gain the approval she could never get from her father, from men, like him, who are incapable or unwilling to give it. When she is in yet another abusive relationship, she seeks the help of a male counselor. The counselor is upset by what he hears regarding the way the client has been treated and quickly sets about trying to help the client by directing what she needs to do. The client is drawn to this and begins responding to the therapist as an obedient child.)
Overcompensation: Patients fight the schema by thinking, feeling, behaving, and relating as though the opposite of the schema were true. They endeavor to be as different as possible from the children they were when the schema was acquired. Overcompensation can be viewed as a partially healthy attempt to fight back against the schema that unfortunately overshoots the mark, so the schema is perpetuated rather than healed. It is healthy to fight back against a schema so long as the response is proportionate to the situation, taking into account the feelings of others, and can reasonably be expected to lead to the desired outcome. But over-compensators typically get locked into counterattacking. Their behaviors is usually excessive, insensitive, or unproductive. Overcompensation develops because it offers an alternative to the pain of the schema. It is a means of escape from the sense of helplessness and vulnerability that the patient felt growing up.
Example: A couple presents for marriage therapy, on the verge of possible divorce. The husband is a very accomplished physician who is excelling in his career. His wife complains of a lack of sensitivity to the needs of the family and his not having any energy for the marriage. What has brought the two into counseling is “the last straw” as the husband has been considering the position of “chief medical officer” at his hospital. He thought his wife would be thrilled that he had been approached for the position. It was an honor, and, after all, they were on this “adventure” together.
Narcissism (a sub-set of overcompensation): These overcompensations typically serve to help patients cope with core feelings of emotional deprivation and defectiveness. Rather than feeling ignored and inferior, these patients can feel special and superior. However, though they may be successful in the outside world, narcissistic patients are not usually at peace with themselves. Their overcompensation isolates them and ultimately brings them unhappiness. They continue to overcompensate, no matter how much it drives away other people. In doing so, they lose their ability to connect deeply with others. They are so invested in appearing to be perfect they forfeit true intimacy. Further, no matter how perfect they try to be, they are bound to fail at something eventually, and they rarely know how to handle defeat constructively. They are unable to take responsibility for their failures or acknowledge their limitations and therefore have trouble learning from their mistakes. When the experience sufficiently powerful setbacks, their ability to overcompensate collapses, and the often decompensate by becoming clinically depressed. When their overcompensation fails, the underlying schemas reassert themselves with enormous emotional strength. Thus, incentivizing the patient for continued overcompensation in future: “I can’t ever let myself feel that way again.”
Schema Modes: Parts of self, existing on a spectrum of dissociation. The extent to which multiple modes are able to be experienced simultaneously, the level of dissociation is lower. Healthy individuals experience modes shifts as a part of any given day and may experience multiple modes at once (ex: a bittersweet event). A patient’s schemas and coping responses tend to group together into “parts of self.”
- Mode Dimensions: Dissociated vs. Integrated, Unacknowledged vs. Acknowledged, Maladaptive vs. Adaptive, Extreme vs. Mild, Rigid vs. Flexible, Pure vs. Blended.
- Think of each of these as a continuum, with one descriptive word on one end and the other on the opposite end. A client can be placed somewhere along this line.
- Unacknowledged ————————————————————Acknowledged
- Mode Types: Child Modes, Dysfunctional Parent Modes, Dysfunctional Coping Modes & Healthy Adult Modes.
- Child Modes:
- Vulnerable Child: experiences most of the core schemas (abandoned, abused, deprived, rejected child).
- Angry Child: enraged about unmet emotional needs and acts in anger without regard to consequences. Often, protects vulnerable child & is a teenager.
- Impulsive/Undisciplined Child: expresses emotions, acts on desires, and follows natural inclinations from moment to moment in a reckless manner, without regard for possible consequences for self or others.
- Happy Child: the one whose core emotional needs are currently met.
- Dysfunctional Parent Modes:
- Punitive Parent: punishes the various child modes for being “bad.” The patient becomes like the parent who has been internalized.
- Demanding Parent: continually pushes and pressures the child to meet excessively high standards.
- Dysfunctional Coping Modes:
- Compliant Surrenderer: submits to the schema, becoming, once again, the passive, helpless child who must give in to others.
- Detached Protector: withdrawals psychologically from the pain of the schema by emotionally detaching, abusing substances, self-stimulating, avoiding people, or utilizing various other forms of escape.
- Overcompensator: fights back either my mistreating others or by behaving in extreme ways in an attempt to disprove the schema in a manner that ultimately proves dysfunctional.
- Healthy Adult Mode:
- Healthy Adult: works to heal the schemas, modeled and bolstered by therapist.
- Child Modes:
Finally, let’s take a look at questions counselors can ask in session with clients to help zero in on possible schema wounds. These questions are conversational and engaging to the client while being diagnostically significant to the clinician. CLICK HERE to read some of the YSQ-L2 questionnaire.
Sources:
Schema Therapy– Young, Klosko & Weishaar, The Guilford Press, New York 2003