CEU TRAINING: Schema Therapy Interventions – Dependence/Incompetence & Enmeshment/Undeveloped Self Schemas
DATE: 12-05-18
TIME: 11:00-1:00 PM CT
OUTSIDE STUDY: 1 Hour
DIDACTIC PRESENTATION: 2 Hours
EDUCATOR: Shaun Lotter MA, LPC #200631338
SOURCES:
NLT study Bible (2nd ed.). (2008). Carol Stream, Ill.: Tyndale House.
Schema Therapy– Young, Klosko & Weishaar, The Guilford Press, New York 2003
DESCRIPTION:
The training is targeted at assisting mental and behavioral health professionals to grow in their understanding and counseling of Christian clients. Counselors will be taught the Schema Therapy conceptualization and treatment of clients who have dependence/incompetence & enmeshment/undeveloped self schemas. Therapists will also integrate theological/faith components on such matters critical to the Judeo-Christian client population while integrating sound clinical skills.
OUTLINE:
- Introduction
- Review of Impaired Autonomy & Performance Domain
- Dependence/Incompetence Schema Treatment Goals & Interventions
- Enmeshment/Undeveloped Self Schema Treatment Goals & Interventions
IMPAIRED AUTONOMY & PERFORMANCE DOMAIN (a quick review)
Expectations about oneself and the environment that interfere with one’s perceived ability to separate, survive, function independently, or perform successfully. Typical family origin is enmeshed, undermining of the child’s confidence, overprotective, or failing to reinforce child for performing competently outside the family.
DEPENDENCE/INCOMPETENCE SCHEMA:
It is not uncommon to encounter clients in the Impaired Autonomy & Performance Domain. These individuals present as childlike and helpless. They see themselves as unable to take care of themselves on their own and experience life as overwhelming. Life seems so tough and they are inadequate to the challenge. There are 2 components to this particular schema:
- Incompetence – these individuals lack faith in their decisions and judgements about everyday life. They hate fear and facing change alone. They feel unable to face new tasks on their own and believe they need someone to show them what to do. These fears can range in severity from mild to severe, in which case the individual may not even believe they will be able to feed, clothe, and shelter themselves apart from a support figure (this individual is in a kind of parent role for the client).
- Dependence – this feature flows naturally out of the first, incompetence. Since the individual is unable to function on their own, their only options are to find others to take care of them or to not function at all. These caretakers are usually parents or substitute parents such as partners, siblings, friends, bosses, even therapists.
These clients do not typically come into therapy looking to work on this schema. Instead, they present as seeking advice from an expert who can tell them what to do in life. Their symptoms are often anxious or depressive, and they identify these as needing work. Although, these symptoms often stem from the schema, such as a wife who is anxious and depressed because she is unable to consider setting boundaries with or leaving a controlling/abusive spouse. Such clients exhibit behaviors like:
- asking others for help
- constantly asking questions as they work on new tasks
- repeatedly seeking advice about decisions
- having difficulty traveling alone
- having difficulty managing finances on their own
- giving up easily
- refusing additional responsibilities (like a promotion at work)
*Please be aware, a small percentage of these individuals will overcompensate by becoming non-dependent, doing everything on their own and shunning any kind of support as a means of distancing themselves from the struggle.
Treatment Goals:
- Increasing client’s sense of competence and decreasing dependence on other people.
- Build self-confidence via identity work and increasing skill level in managing life challenges.
- Recognition of avoidance behaviors and processing fear & other emotions underneath, which may be connected to childhood.
- Deliberately engaging in life challenges, managing the frustration this creates without giving up.
- Understanding mistakes and failures as an acceptable part of learning.
Cognitive Strategies:
It is the goal of the cognitive strategies to begin to ask the client to challenge their current perceptions of themselves and the benefits of their behaviors. The cognitive portion of work is identified by schema researchers as particularly important with this schema, as the client struggles with deeply entrenched ways of thinking which highlight the benefits and safety of their dependence/incompetence while minimizing the costs. Instead, therapists should challenge this thinking, pointing out the limitations of this way of operating, such as unfulfilled emotional needs, a lack of autonomy, and no self-expression. Additionally, the clients must learn to question their struggle with identifying anxiety as a bad thing, not to be tolerated.
Behavioral:
This intervention is critical if the client is going to gain enough real evidence to refute the schema. They must confront the anxiety producing situations in order to grow. Therapist and patient work to assign managing daily life challenges, starting with the easiest, so anxiety can be brought up and managed, while the client has success in mastering tasks. Role play with the therapist and problem solving are useful. Additionally, the therapist equips the client with anxiety management techniques – such as flash cards, breathing exercises, relaxation techniques, and rational responding. Finally, successes should be celebrated by the therapist, who also encourages the client to reward themselves outside of session.
Experiential:
This kind of work may be more limited with this client. It is valuable to examine origin of the schema and address abuse, trauma, or simply poor parenting which resulted in the struggle. Be aware you may find a significant trauma history, though not always. Be aware, if there is trauma, it is important to begin stabilization work, including DBT, rather than moving strongly into working on the dependence/incompetence schema.
ENMESHMENT/UNDEVELOPED SELF SCHEMA:
These clients are often fused with a significant other, leaving difficulty seeing where the client’s identity begins and the enmeshed other ends. This person is usually a parent or parental figure, such as a partner, sibling, boss, or best friend. Clients feel an extreme emotional involvement and closeness with the parental figure, at the expense of fun individuation and normal social development. There is often the sense that neither the client nor the enmeshed other could survive or function without the other. Additionally, these clients struggle to have a sense of self, which they will often describe as a feeling of emptiness. They have often surrendered their identity in order to maintain their connection to the parental figure. It is possible for a client to have one of the traits, enmeshment or undeveloped self, without the other. For example, a client who had very dominant parents may never have developed a sense of self but is not enmeshed. However, a client with an enmeshed parent almost always lacks a sense of self. Struggles with this schema may present as:
- copying the behaviors of the parental figure
- talking about or thinking about him/her
- staying in constant contact with the parental figure
- suppressing all thoughts, feelings, and behaviors that are discrepant from the parental figure
- feeling overcome with guilt in any attempts to separate from the parental figure, including having boundaries
Cognitive:
These strategies work to challenge the client’s view that it is preferable to be enmeshed with the parent figure than to have an identity of one’s own. Therapist and client explore the advantages and disadvantages of developing a separate sense of self. Clients identify how they are similar and different from the parental figure. Identifying similarities is important, as it is unhelpful for the client to go to the extreme and deny any likeness to the parental figure, creating fantasy preferences which are simply opposition to them. Finally, the client can conduct dialogue between the enmeshed part of self that wants to stay in this kind of relationship with the parental figure and the healthy side who sees value in having a sense of self.
Experiential:
Clients visualize separating from the parental figure in imagery. For example, clients relive moments in childhood when they disagreed with or felt different from the parent. They imagine saying what they truly felt and doing what they truly wanted to do. They imagine telling past and current parental figures how they are different, and how they are alike. They imagine setting boundaries with past and current parental figures, such as refusing to divulge information or to spend more time together. The Healthy Adult, played first by the therapist and then by the patient, helps the enmeshed child accomplish the separation.
Behavioral:
These strategies emphasize the client finding their own preferences and natural inclinations. The client begins to list experiences they find inherently enjoyable. They may be asked to list their favorite music, movies, books, restaurants, etc. Clients list what they like & dislike about the significant others. Behavioral strategies include asserting oneself in the relationship with the parental other. In the case of this person being the spouse, understand that these individuals often choose a very dominant spouse and become immersed in the spouse’s world. As such, learning how to be fully themselves in the relationship, including expressing preferences and setting boundaries is critical.