uopuoy 104 aHY Saud GYOSTING HL & AVVHSIUM 3 SOI ONSOTN 'S LANVE ONNOA “3 AIYIIIE aping sseuoliI01d Y AdVaaHL VWIHDSTo Debbie, Sarah, and Jacob SEY. To my mentor, Dr. David H. Barlow. All these words can't express my gratitude. ASK To my parents —M.EW. Al ight eserved his ook maybe reproduced ranslaed stored in reteal ‘System, or tented any form or by any means, econ, ‘mechanics, photocopying, mlcrofiming, recording, oF ecerwise, without ‘riten persion fom the Publisher Printed inthe Unie: f Americe “This book sprinted on aide pape. Lat digs printmimber 9 87-6 5 4:32 Library of Congress Cataloging Publeation Data Young, elieyB, 1950- ‘Schema therapy: practioner guid Jane. Kloko, Major E. Weiss. fetteyE. Youn, bibographial ST30-809 1 Scheme Treatment. Kost, CASS 4.536 YO 2005 s16ss8—dezt 2002155855 ABOUT THE AUTHORS Jeffrey E. Young, PRD, is on the faculty in the Department of Psychiatry at the Coj as trained thousands of mental health professionals and is widely ac- claimed for his outstanding teaching ski He is the founder of schema therapy, an integrative approach for longer-term disorders and for treatment-resistant patients, and has published widely in the fields of both cognitive and schema therapies, in- cluding two ma 1¢ Therapy for Personality Disorders A Schema-Focused Approach, written for mental health professionals, and Reinventing Your Life (with Janet S. Klosko), a popular self-help book writ: ten for the general public. Dr. Young has also served as a consultant on several cognitive and schema therapy research grants, including the onal Institute of Mental Health Collaborative Study of Depression, and on the editorial boards of the following journals: Cognitive Therapy and Research and Cognitive and Behavioral Practice. Janet S. Klosko, PhD, is Coditector of the Cognitive Therapy Center of Long Island in Great Neck, New York (516-466-8485), and is a senior psy- chologist at the Schema Therapy in and Woodstock Women’s Health in Woodstock, New York (845-679-6699). She received her PhD in (SUNY) at Albany and imterned at Brown University Medical School.Sueur ‘weBamson ‘asouvdef ‘ysuary “ysIng “yax5 “ysteds ont pore -suen n0q Apeagqe sey OSA 31L “PlHom ay punoze staxpseIso1 pure sue “uno 4q (Osx) aureuuonsand warsY>s Sunoy ayp yo asm peardsapis ayy ‘unaq seu Aderarp ewiayps ur sara pouarysiey sip Jo UBIS 2e2p UD ‘spout Buy -astxe Jo sauyuoo ayp puoxog of 01 aauepind pur ,uorsstuns9d, YH0q 20) But “ypreas wa9q 2aey 4 Sioyare9so1 pu suePsTUNP wae e w99q Sey -eraip xoporuo Jo SUOMENUT] ayB yak paysTessIp amor2q ancy su “uouo Saw tox} sxouonnoeid sy Aderoyp eurayps wo red we pet, Py wyeay perso ayy uy soBuey> Aueur ‘sues oT sed ay SuuNG ‘sropiosp Ayfeuosiad usisspueu pue aurpiapiog 20} Adesaqp wuIsy>s redxa sofeu v aquasop 1ey} Siaidey> papuaixa UaNUM dae 24 wuounean sed a4 wHOMy paduone 2aey aui029g [ss adoy 2a eqs uot seuy 90ey 244 ‘TaA9Moy om aatsuanut jo s1¥a4 ¢ IY soafoad 2ofeur ¥ yas uo 281 ey ax uawissexiequia 21105 caep-ordn ue aus 01 Buj08 uno} 10u pey 2a quounean anisuatoudi dvdaad ‘purest aporpy “2249p {yoru ‘sopunoy sty pue Aderoua aantuoa uo %009 & 3924 |] WOIDY Jo 101p ok "a Aaaypl q Aderomp wurzyps yt pue ypag "y wouey Woo Ul pauten sem ays AysIOATU Er Asuuad, pea sox) pause pue wiuealssuudg Jo Ansraatuny ‘wnoug wioy spreme Sut AB0]0y> q Aesop 240 ay woy soaA8ap 2 aun woy parenpesS 18eysI2ny 10 “o% wPOWY AsIaATUN] Wao Te LOLNEYAR [2 St ad “mEYsTany “a aHOLE WY ‘ueumyy pue Aaneiya4s Jo 10ss2}0%4 | ‘Sug uy 2anfap uaiseuv sey ose 24S snorouinu sey ays “29U9I95 © se ABOIOUDAS “sy jeoojoypasg WroUAMY ayp WOH PIEMY to uy 20u9|[90x 10} prvary AuEGTY ay) UO Sey OYSOPY IG “SIOpLostp Ara1eUE ‘Supean puv Sunyareasau ‘mopseg "H PHAECL YU ParGON 34S ‘ANNS 1 THAN, sowiny ayy snogy »Prefoce indicate just a few of the countries that have adopted el Approach is now in its third edition, and sold more than 125,000 copies, is still available at most major bookstores and has been translated into several languages. disorders, couple work, and relapse prevention schema therapy is being used to treat predisposing characterological issues ‘Another important development has beet therapy with spirituality. Three books (Emotional combining of schema ichemy by Tara Bennett- Goleman; Praying Through Our Lifetraps: A Psycho-Spiritual Path to tional religious practices have already been published, ‘One disappointing development, that we hope will change in the de- cade to come, is the impact of managed care and cost containment on the treatment of personality disorders in the United States. It has become in- ‘creasingly difficult for practitioners to get insurance reimbursement and for researchers to obtain federal grants for personality disorders because ‘Axis Il treatment generally takes longer and thus does not fit a short-term, ‘managed care model. As a result, the United States has fallen behind many ‘other countries in supporting work on personality disorders. ‘The result ofthis reduced support has been a paucity of well-designed outcome studies with personality disorders. (The notable exception is, Marsha Linehan’ dialectical behavior therapy approach to borderline per- sonality disorder.) This has made it extremely difficult for us to obtain funding for studies that might demonstrate empirical support for schema therapy. ‘Thus we are turning now to other countries to fund this important re- search area. We are particularly excited about a major outcome study, di- rected by Amnoud Arntz, nearing completion in the Netherlands. This study compares schema therapy with Otto Kernberg’s treating borderline personality disorder. We are eagerly await- lt. For readers who are unfamiliar with schema therapy, we will review what we consider the major advantages of schema therapy over other com- Preface x monly therapies. Compared to most other therapy approaches, schema therapy is more inte smplex ideas, many of which seem convo- ts receiving other forms of therapy, and them in simple and straightforward ways. Thus schema smonsense appeal of cognitive-behavioral therapy (CBT), com- depth of psychodynamic and related approach characteristics of CBT: It is both wed and systematic. The therapist follows a sequence of assessment and treatment procedures. The assessment phase includes the administra- tion of a number of inventories that measure schemas and copi ‘Treatment is active and di ing beyond insight to cognitive, em ‘change. Schema therapy is also valuable Another advantage of the schema model is its spe delineates specific schemas, coping styles, and modes. In addi understanding and working with the therapy relationship. Therapists monitor their own schemas, coping styles, and modes as they work with patient and pethaps most important, we believe thatthe schema ap- proach is unusually compassionate and humane, in comparison with ‘weatment as usual.” Schema therapy normalizes rather than pathologizes psychological disorders. Everyone has schemas, coping styles, and rodes—they are just more extreme and rigid in the patients we reat. The coward the most se- disorder, who are ic confrontation” and "limited reparent toward patients. The use of modes allowing the therapist to aggressively id, maladaptive behaviors, while still retaining an alliance with pies. The concepts of “empa ‘ground therapists in a caring attitu the patient In closing, we highlight some of the new developments in schemano] Sumuteisns put ‘usando sowing ssoyp 10}—suower9ue8 ano} ye—Aqray At UE “doy ayqeropistio> ayaqp 30) swuapnas ue sonieaqioo Aun ue [9 pale wopsi saya 40) GIN 990 "| Uorey Ajpeoadso ‘sioypesy kur ue sppysions “3 8H0l0 ssaze> un ing 2aey | yrs uodn aseq aun 25 amp Sumpiaoad 20}—KyoW pue peeypU Ajjepads>—spuaysy pue 4| ux yueys 01 29 Osfe PIBOM [WWD “YaMUs eUUAL pu "wosrapLES uN "ag “aypug paea aq “wnegaddy wy rq "ysAy audef ug Apemads dns saya 10) sonBea[jo> Aus yueyp 01 a Plnow | '9Aoge yp oF uO oysoy “sg 1oUDL spa Kur noyBaouyp aprns w pue putoyay ouosiad v ypoq uaaq sex oy Sfoaq ‘Sunuareday pur Supuawd 105 epou ays we au paptaoid ano] jruonrpuosun asowp ‘iaye} Aw! Of ‘ys0q, Agep v wo syzinb Sua ypu dn Sumnd apyan woaford Arana ype oun Burd ay ‘ut uonoaap J9q 40} ‘iorensTuUpY aannsexg Aut “ouregny AOWeN, Of spiliaquig plaeg pue say wua[9 “WosrapURS [I “WERUEYO TYNOUEA “ISM [PEyOH ‘PID TPIOf ‘utes “AMY pnowly ;peosge puv SOEs Pau ayp uF YIOG ‘sKEA. 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The therapy blends clements from cognitive-behavioral, attachment, Gestalt, object relations, ‘constructivist, and psychoanalytic schools into a rich, unifying conceptual and treatment model. Schema therapy provides a new system of psychotherapy that is espe cially well suited to patients with entrenched, chronic psychological disor- ders who have heretofore been considered dilfic ‘experience, patients wit Lown persor ‘with significant characterological issues that under orders, typically respond extremely well to schema-focused treatment Gometimes in combination with other treatment approaches) THE EVOLUTION FROM COGNITIVE TO SCHEMA THERAPY A look at the reason Young f Jd of cognitive-behavioral therapy! helps to explain the ‘that the development of schema therapy was so impor~ 1jo mo woes uoyo ayy “0s op 01 2jqeun uayjo axe surajgoud jorBojouaioe reyp pos stuaned “Tax2K0K, ‘ayBaoqn spp pi0o01 pue aaizsqo 01 parsadxa are siuoned uy dey asidesoxp 2tp 02 wot $iodas pue suonows pre suopttoo warp ss9998 ue shamed ujuren joug ‘sein 5} Advsoep oso}seyaq-aanmaoo ur uondunsse yons soqpouy soajosuaip Suiday 205 soayens ume3y or uewp isideoyp a4p two3} -ejosuoo ujige 01 pateaiows auou seadde Sout faq “soHBowens jomuo>y.95 ‘urva 01 2outionpal Teai8 arensuowp Aru doy “siuauTUstsse yZ0%2W0y diajdaioo iow Aew dayy “saanpa2oid Aderoyp jexowseyoq-aapmuoo pHs {daio9 01 2qqeun 20 Siqusun ayo ax dom pue ‘pareoyduio> axe Ade “oy 04 soypecidde pue suomeanowt stay ‘siuoned jeoZojoroivereyp uve 20} ‘iasaaioH ‘semmpaood usunean Aress200u 9qp YALA on ‘uomanuoyujau aanisod pur Susppord awos wp re SUD], nq ‘suioxduxés 2onpar 03 pareaniout B09 puepueis Jooo10%d yduunsse yons 240 sien, | Adpiey) joso1nnyog-@nilsB0D [OU 1OUD Aq paIojorA, pl] Jo suouduinssy cup 01 Add on 959 Ader esoqseyaq-2ano euonpe ‘sng yo Aue os ane 1 stl “dus sity nue a 34 op yp Say S999 HOM HAH WI Sampo lucas tu sdigsuonas a wt smo Sean Supjeas aud faqy.suoygend [eHo[Om IE deuopard og suaned wa n somn & Sr es Surpouos ny [py Aq siunydoard ea 9H PU 250) Sova mloyjoud fener o satin sv ao on side aos od 20) zoo oe swe Ja HS pr depo 43 25040 Ut Pesta. 01 [pos Sproat Aq sda on tg ee tuned yo Atos aanysuas Aqpinde 05 st Jo souasqe 212jduo> wsousye ayy 998} sn 3 ‘sontaioe rao auinsal 0 aun Sey 2y pue“oxamoy ‘pareqe ancy staodnss spey sty 29ug 2p} Suppose sty Jo 3sou pauunsuod pey reyp stem aatsind -unoo pure siysnoyp aayssasqo ayp soveurun AaB ay "wonuasaid asuodsax ‘unt patriquioo aunsodxa jo urea8oud resoraeyaq wiai-noys © YBnomyy, wp c jPpaw jondeaven -kdeang proeyey id -sosqp aaystnduro>—satssasqo sty 10) Avra [Bsorsey>q-2anuifoo ssofiapun, jeu & ‘apdurexa 104 uaunean Jo sn2os v at009q staqgord jeo180y ‘pasjosar uzaq aaey stuordwixs aso sayy “susoiduaAs | stay Jo tuounvan yezorseyeq-2antu809 10} pen auto> siuatted 12410) siajaid ays “suoneunsep radord 3 cms 124 Sunefivew ‘Suaup se : 2m eyaA—291 ‘Suoye ‘souapuadap, out y>eq sosd up ‘Beaamoy ‘spua) aoug ‘stonemis snozauinu jo 25u} soutoarano pue swroidaxs o1ued yo 1eaj 104 soonpax ttusis ays ‘st sens aiqoyd 01 amnsodxe panpesd pue ‘sigSnoy) orydonsee> Su8u9] -eyp ‘Buuren Sunpwaig Jo Sunsisuos wesfoud v ysnomyy “wiqoydeso8e Jo 1uunean jeioraeyaq-aantudo> 105 stuasaxd waned opeuia v ‘ojdurexa Jo4 “UmexpYpe st wwatuNEIN 2ouO asdeyat 10 WEuNEAN WT ssaxBoud 01 je] saipi pue ‘uorssazdap 20 frapaate se yous ‘surordunés | stxy jo 1uaun¥aN 10}, autos ‘sem yo sequinu e ut Adezaup jexoteyaq;2anruiZ0> Teuonpen jo ssauaansaye ayn aonpar ue> surajgoud jeo1Bojorar>eze4) St 3181 sso0ons ons yty oda: ino IuoueaLL, "TOU are siaypo s QZ A{yBno1) UOT os uaaq Sqjeuonmpen aaey stuaunvan asoy“srapsosip asnqe 2oueisqns ‘pe ‘uuojoxewos ‘Sunea “Jenxas “aapxue “pout Aueur urpnypuT “s19pr0sIp [spy 40} stuaunean je>tBojoyaésd aano0y72 Suidojaaap uy ssoxBoud 1u3] /pox2 apeu aaey siauonnioeid pur sioqauvases jesolaeyoq-aaniusor) Ue AdWaaHL YW3HOS z4 SCHEMA THERAPY touch with their cognitions or emotions. Many of these patients engage in cognitive and affective avoidance. They block disturbing thoughts and im- ages. They avoid looking deeply into themselves. They avoid their own disturbing memories and negative feelings. They also avoid many of the behaviors and situations that are essential to their progress. Ths pattern of avoidance probably develops as an instrumental response, learned because itis reinforced by the reduction of negative affect. Negative emotions such as anxiety or depression are triggered by stimuli associated with childhood memories, prompting avoidance of the stimuli in order to avoid the emo- tions. Avoidance becomes a habitual and exceedingly difficult to change strategy for coping with negative affect. Cognitive-behavioral therapy also assumes that patients can change their problematic cognitions and behaviors through such practices as em- pirical analysis, logical discourse, experimentation, gradual steps, and rep- jon, However, for characterological patients, this is often not the case. In our experience, their distorted thoughts and self-defeating behaviors are extremely resistant 10 modification solely through cognitive-behavioral techniques. Even after months of therapy, there is often no sustained im- provement. Because characterological patients usually lack psychological flexibil- ity, they are much less responsive to cognitive-behavioral techniques and frequently do not make meaningful changes in a short period of time. Rather, they are psychologically rigid. Rigidity isa hallmark of personality disorders (American Psychiatric Association, 1994, p. 633). These patients tend to express hopelessness about changing. Their characterological problems are ego-syntonic: Their self-destructive patterns seem to be so rmuch a part of who they are that they cannot imagine altering them, Their problems are central to their sense of identity, and to give them up can ‘seem like a form of death—a death of a part of the self, When challenged, these patients rigidly, rellexively, and sometimes aggressively cling to what they already believe to be true about themselves and the world apy also assumes that patients can engage in culties in the therapeutic rel cognitive-behavioral treatments. Rather, such difficulties are viewed as ob- stacles to be overcome in order to attain the patients compliance with treatment procedures. The therapist-patient relationship is not gene regarded as an “active ingredient” of the treatment. However, patients characterological disorders often have difficulty forming a therapeu ance, thus mirroring their difficulties in relating to others outside of ther- apy. Many diffcult-to-treat patients have had dysfunctional interpersonal relationships that began early in life. Lifelong disturbances in relationships with significant others are another hallmark of personality disorders (Millon, 1981). These patients often find it difficult to form secure thera- Concepivel Model 5 peutic relationships, Some of these patients, such as those with bord or dependent personality disorders, frequently become so absorbed in ti ‘meet their emotional needs that they are unal to focus on their own lives outside of therapy. Others, such as narcissist drs, are frequent the therapist. Because interpersonal issues are often the c relationship is one of the best areas for assessing isa focus that is most often neglected in tradi- have problems that are rea case of patients with char not met. These patients commonly have ie, and pervasive. They are unhappy in major life areas and isfied for as long as they can remember. Pethaps they have ‘been unable to establish a long-term romantic relationship, have failed to their work, or experience their lives as empry. They se-behavioral treatment. Later we look at how specific schemas can make it difficult for pa tients to benefit from standard cognitive-behavioral therapy. THE DEVELOPMENT OF SCHEMA THERAPY For the many reasons just described, Young (1990, 1999) developed ‘schema therapy to treat patients with chronic characterological problems who were not being adequately helped by traditional cognitive-behavioral therapy: tment failures." He developed schema therapy as a sys- tematic appro: expands on cognitive-behavioral therapy by inte- grating techniques drawn from several diferent schools of therapy. Schema intermediate, or longer term, depending on the pa- raditional cognitive-behavioral therapy by placing such greater emphasis on exploring the childhood and adolescent origins of psychological problems, on emotive techniques, on the therapist-pa- tient relationship, and on maladaptive coping styles. Once acute symptoms have abated, schema therapy is appropriate for the teatment of many Axis Iand Axis Tl disorders that have a significant basis in lfelong characterological themes. Therapy is often undertaken in conjunction with other modalities, such as cognitive-behavioral therapy and psychotropic medication. Schema therapy is designed to treat the characterological aspects of disorders, not acute psychiatric symp-srandeyo sup uy soe] sopdts Surdoo ssn sip a1 uoqpa a1ou idaow09 sw azoydxa any ‘Seuraqos jo wed roUr a7e ang ‘sewayps Aq wasup axe sxoraeyaq smu “ea sosuodso1 sv doppsap suowavysq aandepejeur a Bun0K | sj so1seypg spenp' -uSnoayp wadau pur wuowidoppaap ino uy dp: ue euonows Suneayap-jes axe seuIay9S pur au ‘souansafope 10 pooypyiy> Buump pedoyana sroqo apa sdiystonepal $2u0 pu sosouo Buyprea1 « -vsuas Aqypoq. pu ‘stopyufoo ‘suonoura ‘saxtowau jo pastadu turaned so auiayp aiseasad “peoig & « ‘sy ewoyps aandeperey 4jzeg ue jo uonmuyap aaysuaxasdus0> “pasira1mO seurajas aandepeyeyy Sse Pajaqe] a4 2eMp seuIANDS Jo 19sqNs ' pauyop 24 ‘eapt stp azojdxa oy, “Sraprostp | spcy tuoxy> Auer pues “oud jeaBojoxsioexeyo sap ‘siapaostp Aaxjeuostod jo aloo ayp we aq WySHUL —ssouattadxs pooupityp 2}x01 Jo nsaz e se Aqueunad doyeaap rexp sewoy>s ‘qeradso—seuiayps asaqn jo amos wy pozisompodéy (6661 "O66T) uno} Wed s,5un0, ‘ouia4yag 0 jo Uo! ‘ays ut sme] x0 POOUPHND wt pauLi0} 9q_ueo seurayps ‘aandepeyeur 10 oandepe ‘saneFou 10 aanisod 2q we _ruioyps e womuyap peoig sip Aq pautorsip 40 aweandoeut Maq]eOu USEF tuoA2 \pHiom 2ypt PUP JpsoU0 Jo ata a]gEIS © BuTUTEIUTENA J0} , SoumsisuoD aanidoa, 20) pau 3up se o) pauiayar soumnotios st sy “9]geox|dde 198U0] fou ame Aatp ways waa ‘s2ouauadxo 2p 1218] uo pasoduadns uoqp PU paresoqeye aq 01 anupiwo> “2p ut seo pouuioy are yptyas jo Atretr‘SeUAePS ow uonow aun st Adesaypoypssd soy aoueaaqax yates xdaouo> ywenoduar uy -aouayedxa apy gauo Jo suas Supjeut 20} a}djound SurzturBiO peo1g, ‘Aue se Aqjeroua8 jo 1ySnotp aq we ruIDYDs e adesoypoypsd pus ABojoy> isd yo 1xaitoD ain uy saAIMOH “SeuYPS O1 Bun wosj BUUOW ryan Burrandzaquy 40} wurayps jesmpn & 20 2ouadUEs v BupueIs crapun 10) eurayps anstndiuy 8 asvy Ava am sny “sur2;qoud Sursjos pur uoneuroja Sunazdzaiuy 10j apins & se saaias veIp weyd 2% qe uv se yo 1yBnoxp 9q osye ued vuuayps e “Bojoyodsd aaquuBo> UIIDIAA WH sdojaaap aantuBoo pooyplry> jo saBeis warayp ut eremayps moqe “ap ur a10un OW Iaderg Ips paremosse StuounMod sous éyqegoud st wor Z reP0Hy jorideoue Avoisty you Aqjersadso ue sey 2249s, ‘pasmt st ,ew24>s, v JO rdadu09 a4 YDIYAK Ut SPI ‘SIMIONNS B Sf BUIYPS B PUIaHps, plo% 24 ‘puLayps, ws uioq any 1094p wUIEYDS We oo] poyeap FOr uM mo 3K, tauar atp jo ddn ayeur weyp sionnsued 21seq 2Kp anysuo owe49g 94) 40 AOISIH SWW3HOS 3AldVOVIVW ATEVS yBnoryy “a8uey> 40; suoswar aq) wp idexoyp ay) “Seurays aratp uo paseq solSawns jeuosiods ‘sewioyps stomp Bunysiy ut swuoned ‘pur surayqord aatsearad spay Aderayp euayps : vl Poe — -peue pue uorssardap stuonyp Swan ur [ojesn wa4osd sey Adesatp eMayDS (pene oqued Sustmnoar 10 uorssardap 2ofeu uao44-jf6y se YoRs) suiOr AdW¥aHL YW3HOS 9e SCHEMA THERAPY CHARACTERISTICS OF EARLY MALADAPTIVE SCHEMAS Let us now examine some of the main characteristics of schemas. (From this point on, we use the terms “schema” and "Early Maladaptive Schema” ly interchangeably.) Consider patients who have one of the four ‘most powerful and damaging schemas from our list of 18 (see on pl privation, and Defectiveness/Shame. were abandoned, abused, negle: rejected. In adulthoo schemas are triggered by life even they perceive (unconsciously) as similar to the traumatic experiences of their childhood. When one of these riggered, they experience a strong negative emotion, such as , fear, or rage. ‘schemas are based in childhood trauma or mistreatment. individual can develop a Dependence/Incompetence schema without exper individual might have been comple throughout childhood. However, altho as their origin, all of them are destructive, a ious experiences that are repeated on a regular basis hood and adolescence. The effect of ive for consistency: The schema is ws. Although it causes suffering, itis comfortable and familia, 1t feels “right.” People feel drawn to events that trigger their schemas. This is one reason schemas are so hard to change. Patients regard schemas as a priori truths, and thus these ing of later experiences. They play a major ers and paradoxically lead them to inadvertently rec- es the conditions in childhood that were most barm- early environ- ls us that his family was cold and tunaffectionate when he was young, he is usually correct, even though he may not understand why his parents had difficulty showing affection or expressing feelings. His attributions for their behavior may be wrong, but his basic sense of the emotional climate and how he was treated is almost always vali, The dysfunctional nature of schemas usually becomes most apparent later in lf, when patients continue to perpetuate their schemas in their Conceptual Model ° er people even though their perceptions are no longer accurate. Early Maladaptive Schemas and the maladaptive ways in which patients learn to cope with them often underlie chronic Axis I symptoms, such as anxiety, depression, substance abuse, and psychosomatic disor- ders ‘Schemas are dimensional, meaning they have different levels of sever- ty and pervasiveness. The more severe the schema, the greater the number So, for example, ifan individual experiences to trigger a Defectiveness schema, If a that comes later in life a parent, then that individual is less parent’ gender. Furthermore, in general, the more se~ tense the negative affect when the schema is sts, ve schemas, as as early and Maladaptive Schemas, so we do not spel sge leads to a maladaptive schema. Nevertheless, our con- cern in is the population of psychotherapy patients with chronic disorders rather than normal population; therefore, we focus primarily con the early maladaptive schemas that we believe underlie personal thology. THE ORIGINS OF SCHEMAS Core Emotional Needs from unmet core emotional needs in core emotional needs for human be-woud v sj au, 2atssoufBe azo are awos ys asour are aw * rout 248 UaNpityp 9uv0s “ying Woy u>umezadutay 10 ,AayeUos!A, Due anbjun v seq pgp ypro ‘22201 woos suazed sour sy uenzodast ‘dso st iuouaesoduia) jeaonoura spyiyp ayy, “sewray9s jo wowdoyeasp 242 Ut sofon sofeu ded ose wuautuostat pooupyp Ayres weys wyRO sxOWe juawosedwey jouoyowy -se youue> py 241 18 donsod squoied a4 “umi0}stun un Bareap Joa “uj tou Ajqegord ts. wouresodurar ausypsKp © Wy “oxpo iueoyUaIs v Jo soNsuaneTeyD ayy sazeUADIE] pure [enprarpuy ue sorpoqas sourunsoiap dputed zwatesaduan veyp 23194 2A ‘s9pout 10 s9[41s Burdoo aumovaq autos put 'seuIaYDS awoveq stonezieussiut pue SWOR>YHUDpY 2soxp. Jo aos “sayto He “jus jo stoadse ureuao azreurauy pue yi AmnwEpE Sa paaasgo aaey am ‘iatper ‘op stiaied soup Bumypdrong azy ‘Agouapt uaxpjyp verp aumsse 10u Soop japou mo “Pap nus B -puewiap Sunwuo20q Aq adoo nyu fay fesneusayp ‘0 ‘Sup Burw09 2q Aq toneatdap jo sBuyoay zayp yu adoo 1ystu stuaned ‘siased pjoa aoip ini SuLdjuapt jo pearsuy ‘sis Burdos uo wonoas axp ut save ssn “stp 2a sy soa[osussip poo éessooou iow are Aap ‘ssaupfoo jo swuardr>=124 ‘on sueam trey nowy sttamed qroq yBNOYRY XqHESSID.U ION Ep]o> A(feUoR outa at009q py y04 ‘SIIMpe Se YI IUAMSse dm PINOYS "UEAPTHYD $e PAAo] sun pat &jauo] 323 yiog ‘stoned proo pey yiog ‘wauprry> sy “seutaq2s won eatidag yeuonourg yaya. uasoud qiog siuaned ox ‘jdunexe zexpoue sy ‘Camnpe 21x01 axp Jo Sioqseyoq 20 ‘supa ‘siynotp axp yo 2tU0s Ho aE uw winota v Buraq jo aousyadxa am quosqe Ylog waNpTTYD sous nyeo1 ny suana st ojdutexo sty) ‘Jasuuny aatsnqe sume>9q Aqpemuand pe 20} -aeyaq puv ‘su poynuspr ap uoupe) aaisnge sty isuneBe yD"q FTO} "HA2 341] Yasnqe we Fujaq Jo Buraay xp azyfeusaTUT OU PIP ys Ng" “aq Jo Suyoay axp paouauiadxa ays “1 azyeusowur 10u pIp 24s Inq ‘OLAELE faronge samye)s94 Jo wNDLA ay Sea a4 "BaSsTENGNS pute ayssed 9uIED2q aus soqneg 969 148 10u prp ys 194 WH saKpE) Tay Hay “3fou WNITA IH 1 poquunsons “yam ‘3uo 1st 2tp “PIP w sy "asNgw POOUPIGD Jo Sioa ‘ns yog "Waunean 103 yu2sard syuaned oa ‘aydurexa 104 ‘storaeyoq put “sooustrdxo ‘suyaay‘syinorp stuaied oxp sozreurara pee ps sayNE=pY Apannapes Prep 31 S940 nunDyfuBis ye uoRB2YfaUap 40 uosEZEAUAT i ang2apas st seus savea19 wp aouatiadxs apt jo ad ypanO} aL ‘su uv owes Auouorne pue WOp2e4 Jo aaiBop aatssaox ue pyiy> v aai8 Keun 20 ‘pyr ¥ 190.0xdraA0 dex “PIN © Jo a aun ut panjoaur éuzan0-2q Aews suaied sng 22u! you ate si _ +110 Awjouotne 40} spat [euonowD a10> SPRY 24 ‘PABPUT 20 PayPpO2 uw |epow fondenuen 205) “jnHamod Se 10 iaua ate sare] padojaaap sPurSy>s ‘asomoH “SeULDYDS yea Aout pus pe UI saajasuioyp PU, 9 aaniia sph teyp yo sotareudp oyp ane Aqpure} sojueudp aup ‘iuarxa afi oy ‘swouIny (2oueidaose pur ‘oueamana “yes ‘apes sopnfout) s1ax0 01 siuoumTpeMe asn29S AdWaaHL YWaHOS ou12 SCHEMA THERAPY deal of research supporting the importance ofthe biological underpinnings Shy © Sociable individuals unique mix of poi aspects of temperament that, ample, a safe and loving home ent quite friendly in many rejecting enough, ev an extreme emotion: ‘and produce psychopathology without apparent justification in the pa- tients history. ‘SCHEMA DOMAINS AND EARLY MALADAPTIVE SCHEMAS In our model, the 18 schemas are grouped ‘met emotional needs that we call "Schema domains." We review the empir- Soe weniger Conceptual Model 13 ical support for these 18 schemas later in the chapter. In this section we ate on the five domains an¢ themas they contain. In Figure LiL, the five schema domains are centered, in italics, without numbers . “Disconnection and Reject 1 18 schemas are aligned to the left and numbered (e.g., “1. Abandonment/Instability”). Domain I; Disconnection and Rejection ts with schemas in this domain are unable to form secure, Jhments to others. They believe that their needs for stabi ot be met. Typical families abusive (Mist ‘cold (Emo- seness/Shame), or isolated from the atients with schemas in the the first four schemas) childhoods, and as jonship to srapy relationship perceived instability of with this schema have the continue to be there they are only present the patient for someone they are emotional ly, they will die, or manipul: ‘The Emotional Deprivation schema is the expectation that one’s desire sd. We identify three ‘The Defectiveness/Shame ‘or worthless and posed, The schema usually involves a sense of shame regarding one’s per ceived defects, Flaws may be private ( fishness, aggressive impulses, ‘unacceptable sexual desires) or public (e-., unattractive appearance, so- cial awkwardness)(2002) ono save wont aston a uensa 010 508 uosod 5,20 aH (2002) sueyo aohesst ue jonueor ais arcane ees 0 Ao onseNng sa eiaicanl Id1DsC-JPS/oawO NES WSIS “LL soueuuoyiog pue Awouorny pagent {sino 0} oD a 0 2}geU0sea! PISO Sh 20 sae SX 9 oP 01 2 “yunauiso> 10 daost Aue Jago wou wasp “ppow ayy Jo 91 a4p wos} peor sys ou nqsvodsos ‘su PURI UF A2UeDH2q) 1s pdojtapun pao 2 csyerues oy.9 ua he woner UNA ‘Bus 1ysonsee fevonous Layo (uo1s909p poo8 aye ‘yse OU Py o> aye "3) sods) Aepaine $3 puey 01 24geun 5} 40 Souatadwoouyaouapuedag 9 (003) “FE aN Suewop elWay>s payeosse wpm seuioyas enndepeyew Ave} “VL 3UNDL waRdu0> © U! on22oy pue wonseuu0ssig a repo jorudeoues AdW¥aHL YW3HOS ve16 SCHEMA THERAPY Conceptual Model 7 FIGURE 1.1. (cont) (An excessive focus on the desires, feelings, and responses of others, atthe expense of nee i gain love and appr ‘ones sense of| ‘own nat Conditional acceptance: Children must. ‘order to gain love, atention, and ‘emotional needs and desires —or vance and satus—are valued more than the unique needs and feelings of i rendering of control to others because one feels coerced—submitng in ‘order to avoid ange 3n, oF abandonment. The two major forms of subjugation |A. Subjugation of needs: Supore 3. Subjugation of emotions: Suppression o 5) perfection, inordinate atertion i perormance | the nom ing adequately met snd se wo are taken care of. (Overlap with concept of codependency.) power requenty that are inauthentic or unsatistying oF in hypersensitivity to ree Overiglance and Inhibition (excessive emphasis on suppressing one's spontaneous feelings, impulses, and choices ‘or on meeting rigid, internalized rules and expectations about performance and ethical behavior offen atthe expense of happiness, self-expression, relaxation, close (cont)Saya] on Kamisuasradsy, uno 2aissa0x se stuasazcd ‘pur spaou uo sau0 rey uoridaniad arp sa sare Aijepadsa ‘sosuodsau jeuonoura sau0 Sutssaiddns ‘suorowa fo worn “ais (2) pu ‘saxisap 40 saouaiajoad sgu0 Surssaiddns ‘spoon fo wosvinfqns sane suo} role om) ay] "WauuopuEge 10 “uOREYEYAL ‘oA snsn s} WonwEn{qns Jo UonUNy IY "po21209 sj2aj a0 asneI2q S19 po 01 fosnto2 yo Buuapusims aatssa>x9 We St euraYDS UoHPB/Qns aL mp a jo spaau anbjun up anpea Koy weyp 2xour ,soouezeadde, yeto0s 10 spat Teuonows wio sjoqp anes siuared 2p ‘somtumey ypns Aueur ul [eaordde Jo aAo] ureiqo ot z9pio Uy seagpsurayp Jo sioadse qwevodun wyensax asnur uaupyiy ‘soueidaooe [euommpuos uo paseq st uyBtu0 Arum peordAa ay, “S19 jo Jo Saujsap aqp xo][oy pue Aqjewrarxe parsaatp axe Aaxp ‘eI2IUT [eos yeuLIOU apmn END Say poudyaa2 yo $9104 ayp Aq puunog [295 10U op eUTEUDs sip ype siuaTIEg 'S283] “tad pub siysu yepads o1 papinus axojaiain pu ‘ajdoad sayto 02 souad ns sj 340 wYp UONdumasse ayp S| EUIDY>S Atso_punLo/maWOTIAI IHL, ‘syyauag amniny jo 3388 24p 404 uonesynEsS Aejep 01 pue sosind unt meqp uyensor oy Apsedea aq ape] Xo signpe sy “TomUO-}[9s dojaa ‘ap 01 10 “sza40 sapisuon 01 ‘as]9 aUOIDAD 02 Apdde rey sepnA D4 A04I0}, ‘oy pazmnbar tou ara stuonied asetn “uaupyty> sy (‘OT sardeyD ur ssnostp 248 se ‘ufo Areonad ayp 10u Aensn st 2ou28jnpuano ‘saseo asayp Uo dag jeuonourg Se ypns “Buray9s 1oMouE 10) uoHEstiadUiO219A0 Jo WLIO} 3q sohiowos we> qwaurEpAUg) TaB|npur pue aaisstuad {r9A0 ax9a eID Al [pew onideoue> ‘sipo jo siy8u axp Sunsadsax Aayn> 40 Aaygordisat 0 pavor ut syyery jeu ~omut aenbape padoqaaap tou 2aey urewop snmp Uy SeMIOXPS YUM siuaneg 1H] pastoduy i] uoWog yss00 St U0 exp Spaaq s9ajoat ‘euiatps ayy “si2ad souo o1 aanejar avenbapeut UNy 10U P]noD Stenprarput poysouu> ayp Jo auo iseaj ve rey anataq | ced aso -ruatdojaaap aqp 01 (siuazed uayjo) sie%pi0 1ueayUsis azoUt 30 2UO tLe Pealoau 4 ayo aze euiayps {las padojaxapupmuauysouugy axp (soydonsew> jeameu ‘own ‘sitappoe 9) pusixe (¢) ue :(jonuo> Bujsoj See19 Bujo8 “3'2) jouonowa (2) (SaLY se Yans saseo sip ‘sppene ueay “3'2) ppoipat (1) saydonsewy jo sad Suum0} snD9y s1vag “2doo ov aydonsereo 1eyy 295 ayy. ‘storst22p pook ‘sq861 au a5euBpUN, ‘sura|goud yeonseid 94jos Xouows afeueut op ayqeun 429} Aaxp day uodsax Avpduasa nay ap \qvtmn [pay euroyps 2ouaradwoouyo2uapuadag ax ya UaNpyD wrwasas x {pia “SPAS ausimbas ay soaseur luoup dazoyutan 01 payrey pue 2019p} (pear Autouomne ayy uy suraygoud ae Jo sauoqp parsarosds940 pu Wt 1d ‘uaapytgp aroas siuaped asaep 3 wuared oxy soaypsursty ayqesedmo épuapuad ige ayp s} Atmouorny e2uDWoyay puo Awouoiny pasioduy :j| uiDWog AdW4aHL YWaHOS aL20 SCHEMA THERAPY trapped. Subjugation generally leads to a buildup of anger, mani maladaptive symptoms (eg. passive-aggressive behavior, tempter outbursts, psychosomatic symptoms, or withdra Patients with the SelfSacrifice schema voluntarily meet the needs of others atthe expense of their own gr spare others pain, avoid guilt, gain se connection with someone they ee as an acute sensitivity to the suffering of others. It inv one’ own needs are not being adequately met and may lead to fe resentment. This schema overlaps dependency” Patients wi gaining approval or recognition from other pe cure and genuine sense of tem is dependent on the reac- tions of others rather than on their own reactions. The schema often in- cludes an excessive preoccupation with socal status, appearance or success asa means of gaining approval or recognition I frequen sults in major life decisions that are inauthentic and unsatisfying ilance and Inhibition : Overvi Patients in this domain suppress their spontaneous feelings and ‘They often strive to meet rigid, internalized rules about rerformance at the expense of happiness, self-expression, . close relationships, or good health, The typi Domain predominated over spontaneity and pleasure. As children, these patients were not encouraged to play and pursue hi they learned to be hypervigilant to negative life events an imism schema is a pervasive, lifelong focus on the (eg., pain, death, loss, disappointment, conflict, betrayal) while minimizing the p cludes an exaggerated expectation t wrong in a wide range of work, financial, Jin their spontaneous ac- id communication. They usually do this to prevent being criticized or losing control of their impulses, The most common areas of Conceptual Model 2 one must strive to meet very high to avoid disapproval or shame. The in the patient’. The schema typi because one is for human imperfection, or to take a person's intentions into account Case Illustration Let us consider a brief case vign young woman named Natalie comes for treatment. Nat tional Deprivation schema: Her predominant experience of jonal needs are not met. This has bee emot her depression persists. Natalie has generally been attracted to emotional ving men. Her husband, Paul, fits this pattern ‘When Natalie goes to Paul for holding or sympathy, he becomes irritated and pushes her away. This triggers her Emotional Deprivation schema, and she becomes angry. Her anger is partially justified but also partially an overreac- tion to a husband who loves her but does not know how to show it. Natalie's anger further alienates her husband, and he distances himself from her even more, thus perpetuating her schema of deprivation. The marriage is caught in a vicious cycle, driven by her schema, In her mar- riage, Natalie continues to live out her childhood deprivation. Before mar--qeaouddly ‘2oqu206 395 ‘uoneBalqy 1op ssoUparsaIG-IAHO ‘Seurayps tpt sitated Aduiayp wr wtp 2zqeq¥aa pute suonours pure suo! “S09 ssooo8 wea syuaped 1eyp soumsse Adesoxp TexoTAeY>g-2 qwounvan 24ads vas 01 ajqeun aq Arua smu pute wea, Aap U4 P orp owe sous ou deur (anny “os padopsaapurypuammysousu 4 “aun, ‘2ouaptiadag) urewop soueuoyiag pue Aurouoiny posed ‘ay sewoyps tpi siuaped ‘seanoafgo iwounean jo wona9|9s 2p ‘sqe08 ay 4€9)9 pur Anuapy jo asuas Buoms e aaey sivaped wey we sd amp Jo sia ut poy aun jo pousd woys © powoydatooun jo pany st. ystiqeis> 01 age 2q You eur (aunPyS/ssouDAR ‘}9q‘woneatidag [euonoW ‘ssnqyASsNNSIY YuaMUOpUEGY) wreOP uopoofoy pure vontauuodsiq 3y! UI SeUIDYDS axey oy siuaned ‘para aoueyfe Shnadeiayp sanisod v wo} weD swuoned wey uoRduNSs dup 0) preBar uy ‘ajdurexs 104 aideyp stip uy Ajsnoward poiow Ades Teiojseyaq-aanqufoo yeuompen jo suondumsse ax jo suru you! ned 20} yJoougip 21 ayer semayos Xdexoyp jexoraeyaq-2. “pen aBeioges 01 jenuatod axp ancy sewayos aandepereny Adpsey) osoinnyeq-2niuS0> ou Cpoptoae aq tayo uso ssouanbasuos pareay ‘parnadxa st yey soap pre 2y ‘sus 24) W suo fEUONIPUOD a1e SEUIIYDS 25a} soo zaqjie2 01 paxuF] 24 WED SeUIYDS [EUOTPUOD [TE ION) “wIEBe a0 ‘euiapps az09 ayn Jo Yn 2tp 298} 02 aay snip PuE WOH -pupur at “seuroyps 2109 ayp [[eISa10} WED SeULaYDS [eUOMpuOD aU SOU 2V “spaou sjenpiapty s2y0 aqp Jo [[e199Ur 01 YBRoW FuroyDeS-9s 10 YoU fe 398 on ynoud Supuews9p aq o7 prey s} 2] s [eoNpUod Jo spuvUIap ay) }9aWH o1 2yqyssodust Aensn sy -ajqeaoqun os {99) 10U [[H8 1 pue ‘suey Aur aedsap ‘ann adaooe pfs [emparpuy ap uot “wao Aus ax0U8t pur spaau sen 1Bout | JL, ssauaanz2foqr 0} asuodsax wa anfuans-fias | 3WE yp Avis [es wosred ayy WOH noge AiSue 198 sos0u puv Siuea Uosiad x24p0 ayp JeAaTeyNS OP Tenpipuy ay Tw2uuopungy 0) asuodsar ut uopwSniqns 4980] Jo Ao 2g qe | wat "WD9piad aq WED | fly 'S242H] oq yenptatpuy ax ssauaan22foq 0) asuodsax wi spanpunis Sunuaj2nun ssojduuexa amos are 232} 08 -puooas, azv seuayps [euoppuod “asuDs siKp UI ‘seUaYPs euoRIPUdDLN au wor, rae 1H 01 sidurone se doaxsp way seulayps [eUOMPLOD ez 1PPOW fsdeauen qu feuonowT upypas -uomuBoory urjaas-teaoidd asngyasnaisiy iqeisuyuauiuopueqy smuay2s pouoypuosu7, souoy9s youonypued, x{uesoduo1 iseaj ve ‘surostno aaneSou aup uaae sdeqiod “Sujop os uy “pur spiepuers ysiy 120Ut 01 ans 10 ‘SuoHow HqIYUT‘PACId es.) ‘areinigns weo fenpraypuy ayy “suiosmo axp aBueyD ayia empraspur 9 “adoy Jo 10 poy SeuIay>s [euoN|pUOD jus ewayps 24 “sonveus ay t a9t0y> Aue pey Suracy pry? P ayp 01 auop sexi rey sareyusdeoua eurayps ay "1 aBUEyD lueo Surquou pue—peq ‘paxaSuepus iaroduio> tu, 9q 6 jenpratpus ay “suLes aq 9q [La aeHODMNO a4p“s2op feNPLARpU 3x wy ote oN UaHed axp 01 adoy ow no Ploy seuIay>s [euoTIPUODUN, wuoRpuoD aie 2aie] padofaaap are yet seuIaYDS ayp seaxayje “S19 -tpo put jjas 941 mnoge sjatfaq JeUONNpuodHN are 2109 ay) W asoU axe puE asoijes padoranop axe reip seuiayps ap “Afjexous9 “TeUoH )UOD Se SELUDHDS INOS ALA AOU 2A [BLORIPLIDD axe sto! dumsse Suydjopun svaxoyaa “|euonIpuoIUN axe SEUNIY|IS WY sem (GET Yau 2 imeys “ysmy x99g) suondumsse SutKpopun sag pure seuIaKIS aandepeeyy / swords | sxy Dtworyp pur sdiysuoneasyeuonounysip ov Spey‘ a0 ut pend ad pue io padryd sunt wah s ng ealayos «yo tsk 2p 01 spray uomeaudap pooupyiy> ax 240 st etlayas 2109 ¥ 49934 oy siamued 02 poise 1sou ag 01 Aouapuas snp] "ssaUApUD jo suOTS -sardxa yeuuiow 4q_,pore20yns, 1/2} pur wry o» paoeme dijensas tou sem ays ing "ue aanensuowap AjjeuorlourD axom B paep pey axpereNg “Buds AdW8aHL YWAHOS zw24 SCHEMA THERAPY EMPIRICAL SUPPORT FOR EARLY MALADAPTIVE SCHEMAS A considerable amount of research has been done on Young’ Early Mal- ive Schemas, Most research conducted thus far has been done using Young Schema Questionnaire (Young & Brown, igh studies with the short form are in progress. The Young hhas been translated into many languages, including French, Spanish, Dutch, Turkish, Japanese, Finnish, and Norwegian. The first comprehensive investigation of its psychometric properties ‘was conducted by Schmidt, Joiner, Young, and Telch (1995). Results from this study produced alpha coefficients for each Early Maladaptive Schema that ranged from .83 (Enmeshment/Undeveloped Self) to .96 (Defe ness/Shame) and test-retest coefficients from .50 to 82 in a nonclini population. The primary subscales demonstrated high test-retest relibil ity and internal consistency. The questionnaire also demonstrated good convergent and discriminant ‘on measures of psychological dis- tress, selfesteem, cognitive vulnerability to depression, and personality disorder symptomatology rs conducted a factor analysis using both clinical and sets of primary factors developed schemas and their hy- relationships, Within one sample of undergraduate college students, 17 factors emerged, including 15 of the 16 originally pro- posed by Young (1990). One original schema, Social Undesiral not emerge, whereas two other unaccounted factors did. In an effort to is factor structure, Schmidt et al. (1995) gave the Young, onnaire to a second sample of undergraduates taken from the same population, Using the same factoranalytic technique, the investi- gators found that, ofthe 17 factors produced in the first analysis, 13 were clearly replicated in the second sample. The investigators also found three distinct higher order factors. Within a sample of patients, 15 factors emerged, including 15 of the 16 originally proposed by Young (1990). These 15 factors accounted for 54% of the total variance (Schmidt et a., 1995). In this study, the Young Schema Questionnaire demonstrated conver- gent validity with atest of personality disorder symptomatology (Personal- ity Diagnostic Questionnaire—Revised; Hyler, Rieder, Spitzer, & Williams, Conceptual Model 25 id discriminant val th measures of depres- wwentory; Beck, fendelson, Mock, & id self-esteem (Rosenberg Self-Esteem Qu inical undergraduate population. and Dunn (1999) using an ‘The investigators conducted a factor an: ings, 16 factors emerged as nall naire possesses very good that its primary factor structure i different countries and f Lee and his colleagus produced somewhat samples probably had range effects, as it was unlikely t dents were suffering from extreme forms of psychopathology. The a state that factor structure replication depends on the assumption that the schemas underlying psychopathology in clinical populations are also pres- ent in a random sample of college students. Young suggests that Early Mal- adaptive Schemas are indeed present in normal populations but that they become exaggerated and extreme in c ‘Other studies have examined the validity of the individual schemas .ow well they support Youngs model. Freeman (1999) explored use of Young’s schema theory as an explanatory model for nonrational cognitive processing, Using normal participants, Freeman found that weaker endorsement of Early Maladaptive Schemas was predictive of greater interpersonal adjustment. This finding is consisteht with Young’s tenet that Early Maladapive Schemas ae by def egative and dys- Rittenmeyer (1997) examined the convergent validity of Young's the Maslach Burnout Inventory (Maslach & Jack- xepor inventoy designed In a sample of C: ‘meyer (1997) found that wo schema domains, Overconnection and Exag- gerated Standards, correlated strongly with the Emotional Exhaustion scale of the Maslach Burnout Inventory. The Overconnection schema do- main also correlated, although not as strongly, with two other inventory , Depersonalization and Personal Accomplishment. ine (1997) investigated the utility of Young’s schema theory in ‘the treatment of personality disorders by using Early Maladaptivebe ano9 soe 01 e219 aney 24 ‘wopuBo> axey 2% 29u0 “Burpuodsas jo AyGHOY St ‘anuioo jo aumea; SuyysmBunsip ay “sostiodsox 2pewHOIE 0 fos tow aie Buyssoooud aanufoo ur panjoaut surrsAs “Ises1t09 Up -rurome anoo0 ssuodsor ypoq pe soya ayy eBuep J estexdde Ue jeur ais wyepBAute 249 29U0) “HPWOIND sf wsIsés wymPBKiUD 2, ee “suonon at asixa ue suopow ‘panels os[e (4861) uOleZ sy waBuep amp O» SuIpuods ‘ar paners Apeaiye seq vjepSAtme ayy ‘yeus sa8uep yp pazTuBor2t sey Souoo 2p aumn ayp dq xav09 amp soyoeou 1 Hexp Appia zou wep Aue yp soupead [eusis ayp ‘ioxomoH “xoU0D 94p puE FyEpRAure xp. yloq oF ‘snueerp ax els S908 eu saBuep y aays0f 1 worst sun 2 a, 1s 1sixo 8D suoRoUlD “oBe apEdap € 9A0 PALEIE]D (HBT) DUOLEZ SV IRushs axp Jo uonenstSax snojosuo> Aue nowt epepAuTe at wy PeUtZO} 9 wea suojioear Jeuonomy “snopsuo>im s1 suoysKs PIPRAue 24 ‘soxanoo saufrq pue waists yeduresoddry ayy woyy 1 ysinanstp jetp samgume jo saqumnev sey wiarsis ejepBAure auf “emo 01 BuIpIO9y wejshs ojopBkuy ays Jo s24S1s0420/04 ‘ssqusnopssuoo pue paajonuy asoqp—utesg axp jo suiasés Burssao01d ured auf mnoypem an990 WE sesuodsar jeuonowTy fBo> ay arois xouod0am pue sndueooddiy ay pue S10 “uuaut jeuonoue ayn s3o1s eepBAue ay "WaAD auTes aH ‘snotosto9 ssaoaud yp SuISTUEYIOU Up waa awumtEs Jo aoueoYTUsIS yeuoNOU a ‘Suovs sonsiBan veep stasqueypour upesq 2up “xnogsT o» Buyps099e ‘SMI pte saBuep 10) axedaud 4p aun wists eepsAure ap jo yo spiny wwakapTp ago UE PATE asa, -uraas(Spaseq-eqepBAwwe we sos Set odo sustuerpou Buuojspuc> 263} q pays|geisestouaM! sNOPsOO “am pu soe yonaoo pars pa sudo yp Boa aes Aq uusop pie ae sououraus snorsu "uc sayaney specimen eSouNC z pow fenideou0> ‘sans (9661) XROG™ Jor aqp wo yaueosar axp yo davunuins syy uy "uHeIg 34) so Juauruopaege se Yans sit9s9 pooypEY? 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They are deeply entrenched beliefs about the self and the wmed at a very young age. They are often al knows. , Schemas provide patients with fee of selipreservation, an attempt to hold onto a sense of control and inner coherence. To give up a schema is to relinquish knowledge of who one is and frequent practice. Patients must system- ema and work every day to change. Unless itis cor- schema. The ther schema realizable ideal, however: Most schemas never complet cannot eradicate the memories associated with them. Schemas never disappear altogether. Rather, when they heal, they be- come activated less frequently, and the associated affect becomes less in- tense and does not last as long. Patients respond to the triggering of their schemas in a healthy manner. They select more loving partners and friends, and they view themselves in more positive ways. We give an over- view of how we go about healing schemas in a later section of this chapter. MALADAPTIVE COPING STYLES AND RESPONSES Patients develop maladaptive coping styles and responses early in life in order to adapt to schemas, so that they do not have to experience the in- tense, overwhelming emotions that schemas usually engender. I is impor- tant to remember, however, that, although coping styles sometimes help the patient to avoid a schema, they do not heal it. Thus all maladaptive coping styles still serve as elements in the schema perpetuation process. Schema therapy differentiates between the schema itself and the strat- ‘egies an individual utilizes to cope with the schema. Thus, in our model, the schema itself contains memories, emotions, bodily sensations, and cognitions, but not the individual’ behavioral responses. Behavior is not ‘part of the schema; itis part ofthe coping response. The schema drives the Conceptual Medel 33 close to anyone, and one adopts ac snd. superior attitu others, Thus the coping behavior is not intrinsic to the schema Three Maladaplive Coping Styles flight, and These correspond to the three schema coping styles of overcompen: avoidance, and surrende) f childhood, an Early Maladapt the presence of a thre core emotional needs (for secure yy and play, or reali tense emotions the schema unleashes. Faced wi id can respond through some combination of these three coping responses: the child can surrender, avoid, or overcompensate. All sciously: In any gh them, but the child can exhil tions or with different schemas, (We provide examples of these three styles below.) ‘Thus the triggering of a schema is a threat emotional need and the concomitant emotion: responds with a coping style. These coping styles are usti childhood and can be viewed as healthy survival mechanisms. But they be- come maladaptive as the child grows older because the coping styles con- tinue to perpetuate the schema, even when conditions change and thi dividual has more promising options. Maladaptive coping styles ulti keep patients imprisoned in their schemas,swuaped Sunummatop ur ajor snwai8 v s4ejd Aqqeqosd yusuresaduar 9%) 1 ‘siatno werp rayres 59,4 Bujdoo urew2o dojasap sjenpratpur Aya Suu “ianap ur sio19e] urea a4p Jo 3u0 st ywouEIaduray wep azIsotPOdKY 2A rows snowlous “p8u pus sanpasuzayp rassean seurayos Surdpapen 2up ‘st uy “passaxdap Ayjeoqury> Surwo29q Aq srestadutooap wa ‘sosdeyjoo aresuadusoarano o1 Ape stay) “sypeqres jnpromod ouauodya Koy way ‘soyeistas s1241 wos} FuNUseD] IQ) ue suon jaya 38p2}aousppe 40 Soun|re} sT2Xp 10} 1 ajqeun ae Aoyy, Xfoationnsuoa reayap aypury oF soy sou} AarEs Kay pure ‘dqeniuaaa Burypauios 2 [fej 02 punog 242 (02 An orp a22pd ‘not neu ow Toy “ew anu 2720} “ae ur parsoatt 0s axe fou, “sxaqTO yee Ada9p rooutoD o» KTgE 2H) ‘aug ‘Surop os uy -2jdoad saypo Aeave sontsp 11 ypu soy AINE OU “a1ES ~ioduonaso oy anupuoo foqy ‘sodden up sug spew po mn 101 4 ‘sn are siuaqed sissanet “plsoss 2prsino 2up ‘nowp “anamoy soodns pur peroods [oj ued 5 Potoust Buypoy ueys saypey “ssoUIANDVP pue uoneatidap TeuoNoU Jo $Buys9} azoo wpa adoo stuaned diay 01 aq2s 4ie>id4 suonesuadiaoa1240 Snatspueu ‘ajdurex9 104 ‘dn Suisox8 yo} woned ayy wu Anges ssoussojdyoy Jo 2suas ayp oxy adeaso jo Sued © Sip 01 aaneurayye ue siayo 1 asne29q sdoqaaop wonesuadioar24 ‘papa sia pue Surpuewsap ‘001 s208 uorteatidap jeuonou9 yay idan patesuadwo> Shao ue ing ‘oddns euonowsa 105 s1aq2o se ov waned pasudap éqfeu0R Zouua ue 1ojAueat st 1 Suwa “0s Op oF Axpeay 3q PHOS Ua ‘prot au ayer of sioqio sojfe owe uoneFnfqas pI waned paresuad ‘uoni4o uy Aen siaqio Sutaup da pus puw Su2eurwop pur Furjonuo> jo} auroseq Kaxy ‘srestadwuoaraao ayn Lys “ing ‘Sy OR Siow woxo o} swuaped pawnigns 40} Aypyeay st “3d 204 sanonpordun 10 “2apysuasuy"2ntsooxe Aiqensn sf JO1seKq soggy Bupppeneioiano> ons} payor 18 Ayeordéa stowsuaduson980 Ing Sruosino a|qeisap # 02 peat 0} p2129dx9 2q qeuoseas ue pu “x2tR0 JO Baan) a tano2.e oIuy ser “UonenNs tp 01 axeuonsodond st o1seYeq dip se Bao] os euioqos v sufeBe y>eq my OF Axpyeay st "suowesuodto9 “ao tayo axe—su0096ssoutsng ‘siopea|yeoryjd ‘sues wpaU—Lar005 tty aydoad pautupe iso agp jo 210s oe} Uy supe aeadde ,ssorestod “uosieno, Aueyy ‘payeoy UWI soyPED paremiodiod s] ways ayn wep os suew ap stooysiaa sjpweurarozun ep wus ayp sure y>eq IS or aduone AesdAqfensed # se pawo1s 2q teD uopestod001240 drs of Barua euoy>s aap yo ssaxd ayn [29} xp yeousapun ing ‘pamsse pue yuAPYUO> Js ae feqy-aoeuns ayn UO Penesa NOD Anup "euLDYDS yp HL pare “SHO somo20q pur se pew fonideouos 8 paqjoau0s asm Aaqp se pareinfgns arom Kou oe seat eugps i UHI 9 0 soup SL se Sunes paw “Fuse yy Aays ‘sresuaduoa1940 a 0 Seare ajoym unys stuaned 9{e1 9} ploae AOU] “spumUs s}ayA Jo Ino Way Ind ip days “woo} saBeu 10 sAYBRoY Yons Ua, st 128 7 soBeun pue siunop yooyq fay, euIayDS 2xp INOgE AY] ISIxXO 10 S2op eULDYDs ayP YSRoWP se “ssoUaIEAE duane Aayy.“paweatioe 1942U st EUIaYDS 3Up WHA O§ sant, (Kis Suidoo & se aoueproae azyqan stuated HoH e2upplony Dweyog pee ener bata UM, Jepueung oweyog AdWaaHL YWaHOS ve36 SCHEMA THERAPY coping styles than it do viduals who have passive render or determining their schemas. For example, indi- a given coping style is selective " Children often model the coping behavior of a parent with whom they identify We elaborate further on these coping styles in Chapter 5. Coping Responses Coping responses are the specific behaviors or strategies through which the three broad coping styles are expressed. They include all the responses to threat in the individuals behavioral repertoire—all the unique, idiosyn- cratic ways in which patients manifest overcompensation, avoidance, and surrender. When the individual habitually adopts certain coping te- sponses, then coping responses adhere into “coping styles." Thus a coping style isa trait, whereas a coping response isa state, A coping style is a col- lection of coping responses that an individual characterstically utilizes to avoid, surrender, or overcompensate. A coping response is the specific behavior (or strategy) thatthe individual is exhibiting ata given point in time. For example, consider a male patient who uses some form of avoid- ance in almost any sit gered. When his gilfriend threatened to break up with him, he went back to his apartment and drank beer until he passed out. In this example, avoidance isthe patients coping syle for abandonment; drinking beer was his coping response in this one situation with his girlfriend. (We discuss this distinction further in the following section on schema modes.) Table 1.1 lists some examples of maladaptive coping responses for cach schema, Most patients use a combination of coping responses and styles, Sometimes they surrender, sometimes they aveid, and sometimes they overcompensate, Schemas, Coping Responses, and Axis iagnoses We believe that the Axis Il diagnos flawed. Elsewhere (Young & Gluhoski, 1996) we have reviewed its many limitations, i yy and validity for many categories and the unacceptable level of overlap among the categories. In this chapter, hhowever, we emphasize what we see as more fundamental conceptval flaws in the Axis I system. We believe that in an attempt to establish crite- tia based on observable behaviors, the developers have lost the essence of both what distinguishes Axis I ftom Axis Il disorders and what males chronic disorders hard to treat, system in DSM-IV is seriously Conceptual Mode! Ea According to our model, the core of person~ yy disorders and the' behat marily re- sponses to the core schemas. As we have stressed, healing schemas central goal in working wit patients at a charateolo jinating maladaptive coping responses permanently is almost changing the schemas that drive them. Also, because ble as schemas—they change depend- ig behaviors are the personality orders. Many diagnostic criteria are lists of coping responses. In com- the schema model accounts for chronic, pervasive characterological il coping responses, it relates the origins in early sment, Furthermore, ead dng several schemas and rent levels of strength (dimensional) category rather than as one single Axis SCHEMA MODES fof schema theory to explait (our actively interested in working w dap In fact, we try to help patients fip from a dysfunctional mode toa healthy mode as part of the schema healing process. ‘Atay given point in time, some of our schemas or schema o (including our coping responses) are inactive, or dormant, wh have become activated by life events and predomi moods and behavior The predominant stat in time is called our “schema mode.” We switching of modes, As we have said, adaptive. All of us flip from mode to mod answers the question, “At this moment schema operations is the Our revised definition ; operations—adaptive or maladaptive—that are currently active for anit radual” A dbguncional schema mode i acivated when specific mal adaptive schemas or coping responses have erupted into distressing emo- those schemas or schtynund sso pu ssomnaang rnopod 2901 Juin 9a yo sumone Dreupou spuods soaraeap orga twuonou Sea srs ‘soo jo onde and se sooo 0305 aeynessps enprspur pone fie zouadns tow ‘Beinn 3 osama suonems SPIONY Sa peer BPRS oT aS sandepeen Sue aay TT aa oe Iepept fesdeoue> por on S80 ToesuREOSAT 7 edaerg Daud ons owe pes “Mom ua, So pees “InP om spon vate So san aapuadoper sine “Gowan Spx 19s pedoqeopug pao, Gras sasdpnae a seunapa voneandaa Teopowy ssnqynsnnsy vndepey eg RTE Banda Sone Fo MNT TT TTL AdwaaHL YWaHOS ae40 SCHEMA THERAPY ‘schemas or coping responses, previously dormant, become active. Dysfunctional Schema Modes as Dissociated States iving spe integrated wit modes can be characterized by the degree inctional schema mode, therefore, isa part of the self that is, ‘cut off to some degree from other aspects of the nal schema mode can be described in terms of the point jon at which this particular mode lies. To the de- is simultaneously able to experience or blend more rood or an angry mood. At the highest level of dissociation isa pat disorder (or multiple personality disorder). In and, in extreme cases, a patient with dissociative ident order (DID) may even have a different name for each mode. We discuss this concept of modes as dissociative states in more depth later. ‘We have curently identified 10 schema modes, although more modes ‘will undoubtedly be identified in the furare. The modes are grouped into four general categories: Child modes, Dysfunctional Coping modes, Dys- functional Parent modes, and the Healthy Adult mode. Some modes are healthy for an individual, whereas others are maladaptive. We elaborate further on these 10 modes in a subsequent section. One important goal of schema therapy is to teach patients how to strengthen their Healthy Adult modes, so that they can learn to navigate, negotiate with, nurture, or neutralize dyst The Development of the Mode Concept ‘The concept of schema modes originated ‘our work hough now we apply it to One of the problems we were ‘having applying the schema model to patients with BPD was thatthe num- ber of schemas and coping responses they had was overwhelming for both the patient and the therapist to deal with all at one time. For example, we Conceptual Medal 41 that, when we give patients with BPD the Young Schema Question- not unusual for them to score high on almost all of the 16 ssessed. We found that we needed a different unit of analysis, sd fone that would group schemas together and make them more manageable, Patients ith BPD were also problematic for the original schema shift from one extreme alfective state or 1e moment they are angry; the ne? ified, impulsive, or filled ing responses tend to group together into parts ‘of schemas or coping responses are triggered to- the Vulnerable Child mode, the affect is that frightened, and sad. When a tion, Abandonm yy may be simul presents with the affect of an enraged child having a temper tantrum. ‘The Detached Protector mode is characterized by the absence of emo- tion, combined with high Ievels of avoidance. Thus some of the modes fare composed primarily of schemas, whereas others primarily represent ‘coping responses. hibits certain characteristic schema modes, ‘groupings of schemas or coping responses. ir typical the Abandoned Child mode, experiencing the pain of her schemas, the Angry Child mode, expressing rage; she may the Abandoned Clhem auras uy Sumwwyag Aq 10 siompo Buneanstun dq s2qp >Y9eq siyiy rowesuadwoa9sQ 24, ‘2de>se jo suo} soyj0 Suzan 30 “ajdoad Surproae “Bunemmuns.yjas “saounsqns 5 Aq euaxps ayp jo ured sy woy AqjeoxBoyoyisd PAPPEI 2Y1 “Sao O1 UL sal asnUs os PIEYP s5>k luye3e aot Sujuooag ‘wuayas ayp o7 siuuqns Jzapuatn Jo stoqseyaq pur sBury22y 24 Jo] 248 “upeSy) "uonesuadwioaz940 pur “2oueproAe ‘01 puodsa1ieo sopoum aarp 254, ‘rarapuouing ue idtuo> axp :sopout Buidoo jeuonounysAp 2anp poyRUapr aaey 294, ‘yy “ssaxpo ‘Apuauino ave sp2au feuonowia 210> asoys 240 st ssod poSesuo st 1 poaudag ay 2p Jo 1s0u saouatiodxa ssewayps 2109, Sq aL, ‘way 9pnrT se apour PHD atqes=UITA ‘quand ypta épaarie10qe]j09 59p sme Uf “SULT yeraUad ale paurdiosipuryoaisinduyy 2up asoytuet HD seuO8a1eD dep sapour eUIDyDs OT PERUAPY eH a, sepow Oway2s O| -4eg ypuonounyséq ‘sopow Su ‘peoug anos owt podnos aq tn ‘pari st apoum pIyD AiBuy ayy way TEM dram Aa anny SqpodG ag yas swuaned ao Hs toy stojaryaq pur suonow ue daoy Lumpy Ampyeay © asey Koy) “Bue amor2q aydoad Ayspeay dpeoFTojoyaKsd {oyat “2jdunexa 204 ‘sapout euonaunjsdP yeay pue axezapour ueD spout aunpy Atpyean ay aqdoad Aqyeay,AtjeoiBojoypssd uy pareanse 4 234 azo pue Zaftions sq pour 31 « {nowpry 2pounynpY Ayyjedgyaxp Jo ssauaanoay pue yTua.s axp Ut Sm, sjenpuapur posediat axour pu Ayppeou w2exuoq 2ouarayrp soKoUy ev [PP2H fendenue) pepuaig © aing 2IqB2Ld © prBRL © suang ndepy « aandepsjey PaBpamoupy ¢ paspapaourpsean paresfioy «> paweioossiq, suojsuaunp [219 #08 Buoye sa\poue 01 jenprapuy 240 wroN} Aten sopout ‘ozLeUMUINS OF, (e961 "2BEd) 2 0} asuodsa1 ut uonepoumtios9® 01 uado aiout axe sey “suiD) Beg uy “sua|goud jeorBopossigexey> snouss yin siuaned Jo sapour p aBuey> 01 wado pue ajqrxay azour pue prBiz $59] aue sdpour jeu ‘Puooas ‘pods éjaiajduio> 20 pouanysty A(Sunupatseio90 st jenpia a I "w9} asuanMt pue aind e ur sued impo axa Woy Yo mds st eH) gps 3 ed au0 01 Butzi3}a1 axe am ‘apous auy}29pi0q ¥ InOge ¥]E 2 ays isentioo uy ,vaamsiamig, Jo uonesuas ay) FuF>npoad snus “it9a2 UE anoge déey pue pes yioq 2q ue ays ‘aydumex 404 sjsnoauey nuts 2poul 2uo erp azo aouatads9 wed sfenprarpun Atpyesqy‘sepou suyapiog Ue Doreroossip ss3j aze sapou jeuiou ‘pres aany aa se "sity “sizadsou wueod 98 UT SOpOUE IUTEaPOG WI} J2IIP [a Sopour Isaxp ng ‘s2o4EIS indu}> SuyBueyD © asuodsaz ut pow pes 20 :UBue ‘payeiap e OM ys Tenpupur eppeay y rDeNUY suYeUar AINuapY payzun e jo Isu9s 247 Tenpupur Aipyeoy épeatBojoyaAsd y (2Be quasapp & yea “sapom pry Ina aap $2) 244 yes Jo apout auo wey! zou ancy Spiuanbayy arp asnesaq aq yita siuaried ueya sspou aiour aaey Aensn si rd soup Jo sonnuapt aaneposstp 24] “suonouny pure “souoUou ‘sien Aqpuosied ‘srpus8 ‘sae ‘souu waryrp asey sem wey pue smo ype jo azeswwun uayo are exp sarmeuosiod axexedas omy yo yds ancy 2qp jo sued wazayiq “sopour Jeuonounyssp yo stuso} sua yim siuaned jo sanyeuosiad iuaiyyp yp Mata 24 “[eIs:2A0NUOD atOD -9q sey stsoutierp axp ep azypeaz am YSNoWPTY ‘UoREI0ssIp Jo uMDads © 01 sawjax apowr vuray9s © jo idaouos ano wp dyarlq pouonuaM ayy S2)015 pajoi20s81q so sepoy, AdW¥3HL VW3HOS wa4 SCHEMA THERAPY spt to disprove the schema in a manner that iysfunctional (see the previous discussion of overcot examples). All three maladaptive coping modes schemas ‘We have ides tive Parent and comes like the parent who has been int ishes one of the child modes for being “bad,” and the Demanding Parent continually pushes and pressures the child to meet excessively high stan- dards. The 10th mode, as described eat rode we try to strengthen in therapy by nurture, or heal the other modes. the Healthy Adult. This is the ching the patient to moderate, ‘SCHEMA ASSESSMENT AND CHANGE ‘This brief overview of the treatment process presents the steps in assessing ‘and changing schemas. Each of these procedures is described in detail in later chapters. The two phases of treatment are the Assessment and Educa- tion Phase and the Change Phase. Assessment and Education Phase st phase, the schema therapist helps patients to identify their ‘9 understand the origins of the schemas in childhood and adolescence. Inthe course of the assessment, the therapist educates the pa- tient about the schema model. Patients learn to recognize their maladap- tive coping styles (surrender, avoidance, and overeompensation) and to see how their coping responses serve to perpetuate their schemas. We also teach more severely impaired patients about their primary schema modes and help them observe how they ip from one mode to another. We want patients both to understand their schema operations intellectual experience these processes emotionally. The assessment is multifaceted, including a ie history intervie eral schema questionnaires, self-monitoring assignments, and imagery ex- cercises that tigger schemas emotionally and help patients make emotional links between current problems and related childhood experiences. By the end of this phase ind patient have developed a complete schema case concep: |, and behavioral strae- erapist-patient relation- ‘Conceptual Model 45 Change Phase Throughout the Change Phase, the therapist blends cognitive, experien- til, behavioral, and interpersonal strategies in a flexible manner, depend ing on the needs of the patient week by week. The schema therapist does rot adhere 10 a rigid protocol or set of procedures fe Techniques . As long as patients able to change; they wi fs taught to the populace. But sometimes the st to disprove the schema. For example, pa- might in fact be failures at work or at school. As a result of procrast- have not developed the relevant work skills. If there is not enough existing evidence to challenge the schema, then pa- tients evaluate what they can do to change this aspect 1s. For ex- ample, the therapist can guide them to fight expectations of failure so they catn learn effective work skill. exercise, the therapist and patent summarize the case against the schema on a flash card that they compose together. Patients carry these flash cards with them and read them frequently, espec when they are facing schema triggers. Experiential Techniques Jht the schema on an emotional level. Using such experiential and sadness y stand up t0 they were children, They link childhood images with images of upsetting situations in their current ‘They confront the schema and its message directly, opposing the schema and fighting back. Patients practice talking back to significant people in their current lives through imagery and role-playing. This em--ap 51 Aayuosiag staprosip “al aneyy (L661 9 39 PLOY “O66T "Te 2 yoaq) sereIDOSSE STE PUP IE [POW ,Pa1ojnMuo}ey, 5,Peq Adesogy vmayps ypu shew werodust ‘uy derano rey soypeardde Adesomp soqio awos uo APG ITO OSye AN, “kdesaxp oanruio9 jo suonyjnunio) 1u2201 §390q pue Aderaxp eaIaT|PS U3aNT aq saouauayp pe sop |zeunts Any 910s 1YBHYBIY aa "WONDAS STD o> Adeso4p euayes yaa sdeyas0 Jooy>s 2uo ou “sjooyps jeoBO[o49 isd &ueus ut asorp 01 seyyuns suégoU09 suFeIUoD zoamp eUIayDS YNOURTY ‘soadsor yueliodut ty si2}ffp os[e [aPoul BUIEGDS xp 'sfaPoUT aX 9591f. gus depaso Adesap wurayps jo sivadse yBnompry “soypeoidde 359 pue ‘suonejax 9a{qo “arureucpoypdsd ‘stanonnsto> “Txo}Aey>q $Siurpnypur Xdezaypoy>sd pur ABojoyredoyAsd jo sjapour zaypo Aueur usta, 0 japour eway>s axp Xydosoyyd anisnyout simp jo ryNs9 ¥ Sy jepout snewoiss ‘paausnzis v oTut ueaom ApYsH axe sayfovens pur Aroayy at “aoatp BuLGjun w uo paseg st 7, Zo1I9 pur peu Aq Sumpaad0rd jo asuss ap uy Adesatp sno9pp9 ue “Tanamoy “10U st Adexay EUINYS 2pfes yeuosiad sasidesoyy axp saweiodsoout éqppear ppou: aun ‘raxoai0yy “suopuaaiotur asamp mtawiajdusy dap oy pur ‘asm Aap suonuaaraiuy yoy ‘Suorssos ut ssnastp Aaxp ryan BuEI2IU0D ISTE ‘eiaup pue siuaned yi0q 40} Wopaayj Jo asurs e 01 perngquued sey apmINre Su, "sem wueoqrudts ty Suysueyo aze Stuaned soyHOyM Uo st snd0} Axe sud ay mareudpoysd “xorsryoq-aantuoo se payssey> 24 fm som aToy saMTOTLA nOgE UI2oUOD IN] LA suoNyOs 40} Burros ‘nau apts 8 1se9 Ay, "worsnpur pur ssauuado jo Aydosoyyd ¥ dope siside -ratp warsyps "ypeordae waunean pur yenid2ou0> v yo wauidoppaap ay UL S13GOW a3HLO GNY AdV83HL WHOS N33M138 NOSIYWAWOD sore] ypSuay sare ae sidaouo9 asoyp ssaasip aq ‘pooupHyD uF siuaned stay wosy 2ato0—r 1ou prp inq papaau swuanied veya “diysuoneyar onmaderayp ays Jo spunog sieudordde ogi ungis ‘Fui | | | i 23] SumY]EY Aypeuonows we sonsind pue sewraqps isupse siyiiy oy aimpy AqppeoqL, v se asideraqp ayp soztpeusaret juaned ayy sewioyas siuaned aq ov avopnue qenmed v se saarns days suonyjas qusned-isideiop ayy “drysuonejss annaderayp ayp wy astse Aaty se sopout puv ‘sapfas Bujdon ‘sewoyps siean pue sossasse asiderayp 3u1] diysuoyojey wwoung-sidoveys oyy ssouanbosto> aaneou wia.-Bu0] 24) HE S95pas -watp. woyuo> 01 pus uoywoasip ampus o» Bunya. 9q st swuaned ‘uns woys 2x ut Suypremar st souepione asneaag “apts Sutdoo © 8 2oueproae autoaiea0 0} uoneamow SOyE1 1} OY Tp 30 suorOLN 1) yo mmo doy ‘suioned ayy apoyn 20 ‘sony sq) ‘ssed sap 'suaygoud Saqp Uo soy 0% seajasuiayp OWE 10U Op Sau. “SeUIRYDS sy Jo ted 210 wos Buideoso dooy Aoqr asneraq ssarford 07 jy Sew sioprony SuiBuey> or saapasurap Ade pe seurays soxp Anup djvapp 01—siayno Bulssaudu‘s26}asu21 Sumoiduy ropiey Bupom Aq—Bunesuodwwoa1940 ypts poidnao0axd oot 2q deus Aoxp 40 “sixpo aume|gAayp ‘suzaoud stays Jo} odsor upg UE sewigos atoqn Supa mouyoe ueyy soyper “>smeDaq wowEeIN UI SsO1 oud ayeut 01 pe} Meu stovesuadwonrag “deioyp ut ssasload rweoKUsts 2yeUr of a1ge 10u are pue ewayDs ayp avenradsad= soul] yom 40 feuOstOd 2B mi2s 10U Aq 40 sdrysuoneyar aanonuisap wy HueUNaL 44 —ouraqps 217 01 Suuapuauins anunuos oyss stusned ‘3jduexs 404 "28uey> 0 sepio uy soyaas Buidoo aandepeyeur xy) dn 94i8 or Bue 2q SME siaoneg Sayeoy wuryps or sapomsqo yews oop woxjo are dawn pue ‘seurayps 01 sasuodsa1 Bujdoo '19¢j ut ‘ae sioraeyag euoNIURYSAP 2891p Jo 80} Susmied axdepe 04 J 200 1 ss Budo> aandopeeus do soa Ayenperdiooned aL pou Sen ey Sunenjeas sidesoyp ayp qpL syjnsay ayp sassnosip ware axp =utise mo Bunks oy aBuy9 Ho|anjoq or sFsHO aHOD2Ao ap Senbmuyoor Aner pu spas yoy os deny ain ut Buuafor pus Gade sijaegoq sou Beno fe huss “Se lonoutoy 1 aeded pu und aoned on soy tae me Pr on eg so seyyeoy ayeut of suiboq pus “wurnpe ip senraed suotsm9p at 30 seo. found urea> no 9s of ston waned aq owe jo soe Dendape ato au ii satuodea:Sydoo sandepefea seen, oop StuoutBise onary eowryaq uAhop woned ap saloy Beth aa, Buryooig-woyog joso1nnyag 94aq euonowa ue ve 3yo49 wonemiadiad euroy>s ayp yeaiq or squaped szomod AdW¥SHL YW3HOS ov48 SCHEMA THERAPY the schema concept may “provide a common language to fa- integration of certain paychotherapewie approaches” (p. 2) to Beck’ model, a “core belie” represents the meaning, or cog- nitive content, of a schema. Beck has also elaborated his own concept of a mode (Beck, 1996). A mode is an integrated network of cognitive, affective, motivational, and behavioral components. A mode may comprise many cogni ‘These modes mobilize individuals in intense psychological reactions, and schemas, which contain memor and language. Modes acti sic categories of survival s , problem-solving “programmed strategies for carryi Is, such as defense from predator al and social beliefs ins that a corresponding mode is not riggered, Even though the cogni- sponding affective, motivational, or behavioral components In treatment, a patient learns to utilize the conscious control system After an extensive review of the cognitive thera elude that Bec has not elaboated~-exept in very ge Jhniques for changing schemas and standard cognitive therapy. medium, mainly fantasy]” (p. 70). But we cannot find detailed and dis tive change strategies for schemas or modes. on Finally, Beck et al. (1990) discuss patients’ cognitive and behavioral strategies. These s ent to the schema therapy né of coping styles. Psychologically heal viduals cope with life si tions with adaptive cognitive and behavioral strategies, whereas psycho- Conceptual Model 0 logically impaired people utilize inflexible, maladaptive responses within Beck’ revised cognitive model and Young’ latest state- ‘chema model presented in this chapter have many points of ‘Both emphasize two broad central structures—schemas and modes—in understanding personality, Both theories include cogni n wn, emotion, genetic makeup, coping mechanisms, and cul influences as important aspects of personality. Both models acknowle the need to focus on both conscious and unconscious aspects of person: ity. ‘The differences between the two theoretical models are subtle and of- ten reflect differences in emphasis, not fu ments. Young’ concept of an Early Maladaptive Schema incorporates ele~ ments of both schemas and modes, as defined by Beck (1996). Young defines schema activation as incorporating affective, mot behavioral components. Both Beck discusses jode a 10 Young’ concept of schema activa: Tris unclear why Beck (1996) needs to differentiate schemas from nodes, based on his definitions of these terms. In our opinion, his mode Concept could easily be broadened to encompass the elements of a schema {or vice versa) Pethaps Beck wants to diflerentiate schemas from modes to temphasize that modes are evolutionary mechanisms for survival. The con- cept of a schema, in Beck’ revised model, remains closer to his original Cognitive model (Beck, 1976) and as such is mote closely related to other cognitive constructs such as automatic thoughts and core beliefs, ‘Youngs concept ofa schema mode is only marginally related to Becks tse of the term *mode.” Beck (1996) developed his mode co count for intense psychological reactions that are survival oriented. Young developed ‘concept (0 schemas and coping styles a portant conceptual difference is the relative emphasis ‘iyles, Although Beck etal. (1990) refer to maladaptive fot include them as major constructs in his re- ‘Alford & Beck, 1997). Young’ model, in con- trast, assigns a central role to coping styles in perpetuating schemas. This emphasis and elaboration on schema surrender, avoidance, and overcom- petsation isin sharp contrast with Becks limited discussion. “Another major difference is the greater importance placed on corejo auo sp sanbjuysay yenuauadxs mata osavayas peioravyaq 10} proud AraBeu} asa pue aU se sqip 295 100 op Aauofeur amp *(666T “nouEG syadxa aqerodioou 01 uniaq avy sisidesaup e yBnowpyy ‘sonfoperp pue AaZeun se yons szoduy ayp uy sj soupeoidde om yp U2: ‘uuu [eiayduad e uy ssauatadxa poo -eraqp aanyuBo9 “IsenueD uy sioIseYaq BuIdoo pu 'suonOD ‘su aandepepeu suo2iaso swuaped djay sasiaioxe asay ‘s22uauiadx2 poo =pyiy> Bumasdn o1 paar sastaraxa enuauiadxe yo Aaya e yBnowtn ced apinB ssiderayp euroyps ‘seur2y9s 2121 Supeonpa pur Fuyssosse 01 uonppe uy owed yp Joy wn asf 342 tuo SeUIDYDS 9ADy>IYI IIA suIBT20 Pood] are spoou asoip way suaddey eqn ureydxo 01 pue pltqp v Jo ay mnoge warp ateanpa 01 stuoned o1 suas uo asa4p suTE|AxD 1 ‘arayn ssosse 01 padoyasap u99q Sey 1uoUITINSU We PUE “SEUIEYDS QT 2 _ypea roy suff\x0 uourtz09 isout a4 Paynnuopr ney sisidesoqp PUNT “09 ty] *j2q]3q 2409 SuIpappUr ‘suopTUo> Jo suo ayp noqe spay Adeiogp sano Aderayp euroyss ur sojéas Sunuazed pu suifti0 ooupnp uo pooed syd ayy us} ower yoda J>qnouy -se Bunsprapun Buzo|dxa 20 syySnowp aneworne 10} Sunyse Aq a7rao3—r fon ano Aiaa yng io8eu pasnoo}-eurzyas Buys saaooun oy Asea Afoan separ st yotyat eurayps wopestdag feuonowry ayp st ajdurexa H21]99x9 uy ‘sonbruyjgor quowissasse aanjuBo> [vuuiou ysnoxp passat aq astazaypo ajar weep sxoraeyaq Suidos pu seuioyps Asnuept dyeq 02 soon ayqenes sey sideiarp eurayos 2g) snqy uated yeapuapur y>e> ry snag ov Ade ‘rat sayy] pauyas soypuny 2x pur passasse are stustueypaue Hujdoo pue Sewioyps as0U)] TuaueaN 94} Jo You 10} syseq 2Up WLIO} eM Sapsas Buydoo prog aarp pue seuyas Avo aytoads gt pareiogepe sey Sunog,‘apour ay (0 yestuao isow aze sa[dts Bujdo> pue seuayps asne>2q ‘axowoyAN ponqas savy Aaxp trun ysidesom axp £q Ayuais}suo9 pons and are strorduids Jo s198 10 suraigord waxino payuuaps Sseap “iseNu0) hq desoxy anqu6> uj “Suo|ssas uoasug pue UOISSIS ¥ URL ‘IaqOuE ‘1 euaqps ao woyy"yussaxd pur 1sed uoaaniag dipiny axows 02 wopaay} ay spoou stdexoyp eurayps a4, ‘Suo|ssas uo epudse [euLioy ss9q © pue aumanns sso] asoduat 1 sstdesay) EuaYDs spea} oste snoop ul yTYS SHEL desN ‘2aanuiioo uf Kaxpuooas Ajpensn aue asaup seai2yas ‘spout pue‘s9[4as Bardoo ‘seuay9s 03 payoaap st atm jo Aiofew ayn Xdesoq) ewoyps uy “axoNLII -mg ‘summed Suopyy 1 sonssy masaid wiosy wwounvan ut Spze9 sn90) UE ays Sneurep v or spea] yeoudde dn-wonog sip ‘Adezaqp warY>S Uy pparersoqje uaaq any staoiduds 24 2040 juounean ur sureutos quaped au Jf s91e SJoqq 2109 ssaxppe pure swysnowy Is Jepow yorudeou0> wr9us8 Ade 01 ouper ‘auueut sotdesomp tog wt 204 jen1429 & ‘ypeoadde yova ed amp snyy“sjepou Adeioyp jo soueuiodun ayp aziseydura yioq suaned 2x wosy aouap ‘uy aiour 2q o1—seurayps Sumpnyput yed aBeinoous srrsuneaN Yi0q "310} dura rey 224° pag pue Bumog au pe uv ced asideaayp 2up jooape pue ysidesoq pue waned w9asKI3q ‘uoneroqeijo> jo 22122p yBiq e aBemmoou ypog “susunean aya tH dep940 jo svare Auvut are auoup “ypeordde aamuoo sysaq sem Adeioyp euayps Budojassp 01 soud aouangur Arewud sfuno4 se “<(Sursudins 10N pow pure seuIay>s Jo itaLUdoT=x2p amp 01 peal sasuauedxa poopy nds sxoy uo 40 axe spaat ar0D ay 1eYa UO purdxa 10u op aU) sad ut 2jor ueuodunt ue Keyd soouaNyU pooypLyD pu¥ sp2ou [eU0} seanour 1p [e12Ua8 uy 2o18e sorepOssE st puw y>Deq YHow]Y Adeia4p aanrugoo ut ueyp Adesoy) eurayps uy sassaoord yeruouidojeaap pue sp2ou AdWuaHL YW3HOS os52 SCHEMA THERAPY four equal components of treatment and devote considerabl therapy ‘most cognitive therapists is generally accepted in can be changed more ms (when the patients affect is techniques can sometimes be the only way to cognitions in the session. Another primary difference is inthe role of the therapy relationship. Both therapies acknowledge the importance of the relationship for eff tive therapy, yet they utiiz view the therapy re to comply with imulate hot shen the relationship appears to be impeding progress, ionship is not generally considered to be a In schema therapy, the therapy relationship is one of the four primary ‘components of change. As mentioned earlier in the chapter, schema thera- pists utilize the relationship in two ways. The first involves observing schemas as they are activated in the session and then using a variety of procedures to assess and modify these schemas within the therapy rela- tlonshi second function involves limited reparenting. This process rience” (Alexander & French, 1946). Within the appropriate I therapy, the therapist acts toward the patient in ways that serve as an anti dote to early deficits in the patient’s parenting. our experience that characterological patients cannot typic tic, healthy alternative to their schemas without direct instruction from the Schemas are so deeply ingrained and implicit that questioning and empirical investigation alone are not enough to allow these patients to see their own cognitive distortions. Thus the schema therapist teaches the healthy perspective by empathizing with the schema view while confront- ing the patient with the realty that the schema view is not working and is not in line with realty as others see it. The schema therapist must con- stanly confront the patient in this way oF the patient slips back into the unhealthy schema perspective. As we tll patients, “the schema fights for Conceptual Medel 53 This concept of doing battle with the schema is not central 10 changes, or core unmet needs, such as nurturance 1s, cognitive therapists generally do not exactly these coping mechanisms—not simpl schemas—that often make patients with personali ‘We alluded earlier in this section to the concept of modes. Although ‘cognitive and schema therapies both incorporate the concept of a mode, ‘cognitive therapists have not yet elaborated techniques for altering them, Schema therapists have already identified 10 common schema mode states (based on Young’ definition noted earlier in the chapter) and have deve ‘oped a full range of treatment strategies, such as mode dialogues, to tre cach individual mode, Mode work forms the basis of schema therapy patients with borderline and narcissistic personality disorders, disorders so difficult Psychodynamic Approaches ; Schema therapy has many parallels to psychodynamic models of therapy. shared by both approaches are the exploration of the focus on the therapy rms of the therapy relationship, the modem psychodynam joward expressing empathy and establishing a genuine relationship (cf., Kohut, 1984; Shane, Shane, & Gales, 1997) is compatible with our ited reparenting and empathic confrontation. Both psycho- dynamic and schema approaches value intellectual insight. Both stress the need for the emotional processing of traumatic material. Both alert thera- pists to transference and countertransference issues. Both affirm the im-Luopewuojur pure uonUaNe DaNp sjapow Supjiom ‘seus AT “s2yOs yanypene oO} sesuodsar onsuaDeRE SUDIP jounysip 248 seuauDs 2andepe sayy axv roninsuo> Aaxp spout jyes 2p jo Japour Suppiom peuraruy we NSU | ‘uadapur 10 wonsaioid drome suey Aum se 25 2xf Jo [apous Sup “ ouspuodoput 10} jaoud 40} paoU smu Sy IuounjaeNe uwUE ayo 10) z2your axp pwe wUEFU yo suzaried uo paseg ja8zr] st fppour Bupyrom yeu IptaTpUr we ‘seUaYDS 2{F] seUIIYDS 2andepeyeyy Ajweg Jo oO i sdejzaa0 sjapou Bup|L0% Jeuro1U Jo wonoU (EJ6T) SAqlAog, ‘Buypeay, Pusy>s Sunow aaoudstp veyp seouauiadse sou 2yppouuuo22” yenradrad purayps jo ado owp Tetp 08 aousplsa tou Sununodsip pur aaoidsip pinoo 3saup Woy) wars 1eyR SU yaidiaruystar seuoyss aroun jo du8 2 auapammy seuyps aandeperew 4263, “Boo Bunspxo Suiue 30 ort induy mau 3 fo} paveaniou: st JenpIArpuy ayp ‘sua (zopT “iHeig) weNEBeIZ UL “sou Supjaas pue Aer; Suurssaid woesurq aoueje omTeUsP v UIE “uyeu 01 pareanows aue sfufoq uewny rem pasodord (¢261) Aquiog suanbayy 001 st saan -8y rwausypene jo ruawa>e(dax amp uy ansuD AouE s19Tp open doap wuoy 01 Aaysqeur uy “ument jo uotssaidur ‘001 aq eo Aatkue wonreredas'sase aos tu “ep INO por "yuared v Aq wuauuopuege jo steaitp parwadar 10 yuaxed & jo ssoj se Ypns rare} anqsiaae yo 2ouanbasuod v s} AEXUE Uo} q siuaied wroyy won juypuoaoy ‘3ouspuadaput saiour ord puv sapaoaud qeip p2ou jeuonouta ywUNDeNe teu spipo 20) Aampour op IusUIDENE aIqEIs & rey Sondre (BET ‘LET “696T) Aqiwog ‘uonenpiarpuy pue Auouorne 03 quetUyeNE Woy] sps920.d WIL -doyanap jeuonows pooypryp quaog Suoyse ‘japous PUISq>S 24 UL “950g unas v 3uio3eq 01 sidezaqp axp anmnbar (eU24>s ‘uonejost qe0g axp jo uondsoxo aup UA) urewop uoN2a{ay pur LoNsIu ss repew jonideoue> sjemue 19410 pue) Aqeuvoyadsd pure ‘suaisks rulayps quaWuopUEGY desaqp eurayps to r9edut Swota J2POU! EUIOYDS uf] “spas juido> Jo sopAas 29s sisidesaip Buys “sousta séyeuwoypsd 2194.44 “[apOuL ‘pu pur pjiom, “ut O1 paieanout aie apd 1ud ap uo sisox osm waIaY>s “spastt iduy 2atssause pu yen 12} 24up w 20U st Japout UIDYDS 2ouaraytp rofeut iayouy jours yourun squaped 2p) asideaayy varayps ‘sayseoud ip Pue aative aq 01 soaeapud ureuras 01 pardwone 4qjeuon pen 9avy sissqeuvoy>dsd reyp st aouaxpp Ay 90 "s|apoul aIuLELKPOYD -Aed pue ddviarp emayps waaaueg soouai9jtp [eAUdSs ospe axe 2294. Adeayp asn29y9 y stuasaid wuaped ayy amionns sad Jo pudy ax 1p Sunudsse “aamaMNs AeUostad yo soutexIod AdV¥BHL YW3HOS: vs.56 SCHEMA THERAPY processing, Defensive distortions of working models occur when the indi- vidual blocks information from awareness, impeding mo sponse to change. In a process similar to schema perpettation, internal ‘working models tend to become more rigid over time, Patterns of interact ing become habitual and automatic. In time, working models become less available to consciousness and more resistant to change as a result of recip- rocal expectancies. Bowlby (1988) addressed the application of attachment theory to psy- chotherapy. He noted that a large number of psychotherapy patients play patterns of insecure or disorganized attachment. One primary goal of, psychotherapy is the reappraisal of inadequate, obsolete internal working ‘models of relationships with attachment figures. Patients are likely to im- pose rigid working models of attachment relationships onto interactions With the therapist. The therapist and patient focus first on understanding the origin of the patients dysfunctional internal working models; then the therapist serves asa secure base from which the patient explores the world and reworks internal working models. Schema therapists incorporate this same principle into their work with many patients Ryle’s Cognitive-Analytic Therapy Anthony Ryle (1991) has developed “cognitive-analytic therapy.” a brief, intensive therapy that integrates the active, educational aspects of cogni- approaches, especially object ns, Ryle proposes a conceptual framework that systematically com- bines the theories and techniques derived from these approaches. As such, cognitive-analytic therapy overlaps considerably with schema ther- apy Ryles (1991) formulation is called the “procedural sequence model.” He uses “aim-directed activity” rather than schemas as his core conceptual construct. Ryle considers neurosis to be the persistent use of and failure modify procedures that are i fe or harmful. Three categories of pro- cedures account for most neurotic repetition: traps, dilemmas, and snags. terns Ryle describes overlap with schemas and coping {In terms of treatment strategies, Ryle encourages an active and collab- esapeutic relationship that includes a comprehensive and dept oriented conceptualization of the pa apy does, The therapist shares the con cluding an understanding of how the and a listing of the various m: lures the patient ws cope with these problems, In co ic therapy, the main ‘ment strategies ate transference work to clarify themes and diary-keeping Conceptual Mede! 7 about maladaptive procedures. Schema therapy includes both of these components but adds many other treatment strategies. Cognitive-analytic therapy utilizes a threefold change method: new understanding, new experience, and new acts. However, new understand ing is Ryles main focus, what he considers the most powerful agent of change. In cognitive-analytic therapy, the Change Phase primarily involves helping patients become aware of negative patterns in their lives. Ryle’ ‘CAT the therapeutic emphasis is put most levels (of cognition), in particular s appraisal processes and promotes p. 200) ‘necessary, but not sufficient, compo- vard treatment of more severe pathology. 1e and narcissistic disorders, we relative to the new experience approaches. Ryle (1991) views ad refers are intended erapy in several ‘move beyond ial techniques, such as imagery )proach, patients wi to attach securely to the therapist ly systems approaches. His is based on “person schemas theory’-app ¥ wy afup ssidsoin‘poysygese Aoanoos 5 9498 5 Due Ayes yo astos vaeas iy isn ssidesayy “anSoqsip sy RU ous squared 2yp 01 spuane pu S9sT20) ‘SH moo} Ajeuon oun ue dojeaap 01 20x Adeioq past2oy (€8 “1661 ‘OH 1 appuo wy ** aouanadxa yeu ont s8unaq Adesoyy,‘souaqps uor Aqqeaonowra jo we 218 sauzaaa o1 astiodsos pte J0 u se ares dau) ‘pareanioe wayyy wourEadwian aww) pue Asorsty Bu 1n0 Aqpav3y $94 Got nea 3 tioquain) Roguoin yonga eouayor HonOwD 3 ‘STpuw usuaapr co pom gS seen ra ip ao sss ord de Poston : ‘ypuvasa ssaooid Advert Aduons dung posto) euonon 2s entre wo sae rpuysene 4q pound ‘UDYs 297 “SppoU 9a (4661 ‘otateg 29 Rioquassy ‘¢ : 2309 sty pur Bioquaais ays Aq padojaxop “desorp pasnoo; Ajeuonourg Adoseyy pesnooy Ajouoyoug pot pind atqwiauyan sutaned ay Him aM. Tey pue—,sonns antssoifan, sum (Z661) AIMOIOH Wey SASSO" 1s1deI9y) uisyps aq sproxdde smusouoy] s9op wey aye BuTEANo" uo siseyd 20 sombre stn aeonsss 10 payap 9pta ¢ s90P (L661) AUAOIOH daa waIDyDS yr uostEdIOD Wy souo sandepeyet pur aumeuuay 210 Guoqd wpe or seunay>s ,swuspiowidns, moe 4 S18 10> aasuajap pur sjapoun diysuone|i-ax Uo asINe> “Sip pue susnota saioned ayp Fujen2o}‘saidioww pue sage wider SL “ounvan jo ied yea vs0ta qn s isu SoM (1661) SHAE UE SV otaryaq sot jo sjetn ued auaned ay sdjay pu ‘owesisoz pue sopmamme [euonsuysip soxtony wonuone sntoned agp Bunpanpay 44 souepioxe SHowiaiunoo woned oq suodns widesoyy2fp “wuaunean axp BatNG twonesuadizoazaa0 pur ‘roptasins sourpiose wurayps 4a passeduaen -uo wuoaiouoyd ap yo duet si2400 (1661) zimoroH H8oq0d4 SH EN, 6s repoW orudenuey a Joss 9) 2oueplone aajoaur wy Soy °Z codu Surzyuruyus 40 Keane uot Ye JO 1uaIUOD a4 YBINOxIp $9} (09 aaysuayaq *] soxuapr zusor0y 914 ~tuasorospe,s2ss2p0ud Jonuo> asisua}9p 58> (L661) anbraypon ut sa Burdo> sBunog 219 sores asaya qupsaud you IMOIOH (LE “d “£661 “ALMOIOH) ,sHoNOUTD PUE svepr Jo uo|ssaxd -X9 [eqiasuiow pur fequaa apnyour a1is w Se paztufe3az st we wioned ayp luuoj ov amquio> wexp siuswia,> ay “suorssaxdxa feuostadioiyy pue s2ou9 -uodxa sno1osuos jo wioned v, st pura Jo ates ¥ “sapots jo 1dsoU09 ano ‘pun Jo sais, souyap osfe (1661) ztmo10K SO}De) LOMO pure TuSUEZdMN ae uuadap 'say4as Sudo aanout jpesuen 40} sidtu9s sapny “HP 9[ou # wep suretdxo (2667) ZAMMoL04{ 's[415 Tutdod pur * ~depeqewy Ajaea ‘spaau euonowrs 2109 01 4[2s00 ptiodsaiso> asoqp to>uy buray>s Jo sum ut ‘ppout drysuoneja: 2]o1 papeaup axp asurede puojap exp sjepour diysuonejas ajor (¢) pur “(,.apou drysuoneax a[or papeaip,, 2up) 482} 2109 w (Z) [pour diysuone|s >Jor pasisap, yp) PaaU 10 Ystin ‘Suudyapun we (1) ypios drysuoneyar ajor yped sareoosse zHMOIOH > -pout diysuonyjar 9f01, suts91 24 ress Mo sares0qeT> (L661) ZHMOIOL, susaived ap aatieSau isou Suydqrap sun seurayps oyoads sawauyjap Suunoy sea.aqye "seura49s [fe jo aMoNAIS eeu’ axp uo sosno0j zuMoIOH “eMDNPS aandepe|eW Aled ue jo uon “ou Amo oF wonuDpI AjTEMANA st LORTUNEP SHYT “(LET -uodxa poorpyyp jo sanpisay A1owou wos pottz0} 43195 JO sara Sato Butstudwio9 ‘snorsuooum Ajpensh ‘anejdiuar e st eWayos uosiad ¥ (9661 “THEIqUY 39 ‘UosuNS “ZUMOIOH ![66T ‘ZENOIOH) AdV¥aHL YW3HOS 8s60 SCHEMA THERAPY cate dialectic balance of “following” and “leading,” accepting and f ing change. This process is similar to the schema model ideal, confrontation, Like schema therapy, emotionally focused therapy recognizes ‘mere activation of emotion is not sufficient to engender change. tionally focused therapy, change requires a gradual process of em: ised therapy from the sche! ce is the primacy emotionally focused therapy gives to af schemes compared with the schema model’ more egalitar- iew of the roles played by affect, cognition, and beh \ai- are an “infinite amount of unique ‘emotional schemes” (Greenberg & Paivio, 1997, p. 3), whereas the schema model defines a finite set of schemas and coping styles and provides appro- priate interventions for each one. ‘The emotionally focused th plex, hierarchical organization, and instrumental emotions, a adaptive, complex, and social tion scheme suggests specific whether the em anger) and whether Compared with the more parsimonious schema model, «1 cused therapy places a considerable burden on the therapist to analyze emotions accurately and The assessment process in organizes schemes in a com- attunement to the therapy relationship, ‘SUMMARY Conceptual Mode! él oneself and one relationships wi icant degree. Schemas comprise mer and bodily sensations. They develop during childhood or adolescence an are elaborated throughout 01 we. Schemas begin as ad snse negative affect. LeDoux’s ed with Tear conditioning and trauma suggests domains. A great deal of empirical support exists for these schemas and some of the ‘We define two fundamental schema operat and schema healing. Schema healing is the goal of sche adaptive coping styles are the mechanisms patients develo} schema perpetuation, We have ident surrender, avoidance, and overcom- 1¢ specific behaviors through which pensation. Coping responses are these three broad coping styles are expressed. There are common coping responses for each schema, Modes are states, or facets of the self, involving9 yeworduds pare wordy jou Sunemiadiod-y am surepdxs isiderayp yt 436 emp 30m ve pue sdiysuonep ut Ayensn suzanied 9s9u, ‘5 yupaaud vein sured 9 1 YDS 203 AayqerINs siuaned ayp sovenqeas pue 1 s[v08 pu suraqqord Supuasaid siuaned amp sassasse isidesoyy yw suldaq asidesayp aq. “ss0201d uoneonpa Jo mayaraao jauiq e aptaoid mow 2A, szyyemdaoui09 ase) pasn0}-vurayps poy jun e out s2nsoqeo9 diqenpesB muowissosse axp “aIe] paquDsep sanjTepout suawssosse snoqes ayp Surzynn ‘waueradura pure ‘s9]4as Buydoo ‘seuroxps ‘sazaned aj sossosse asideaayp ap sy ‘soreyuNa2e sasaxpod{y asayn sisnipe pue wep wo paseg sesaqpody sdojeaap yp ‘aye “2Vo| MULL} OU st ‘PauMaNAS st waTIssasse ayp YNOt uopezypmadaouo9 aseo ayp aay quatuesadwn 30 sasuodsar pur sojdas Burdoo jo uc -sojope pu pooypyy> WI seuayps yo suo ay Supunsiapun “¢ seuraups aandepeveyy Ape jo Buuo8un pre uw id ay euoniounysép Jo ws seo aofeu xs sey Adezayp euayps Jo aseyg UoREONpy pue iuduissessy yy NOLLVINGI GNV LNJWSS3SSV VWIH)S z 4aadvyD OIAEEG Jo SULIO] LONTEDY PLA S9p4as aoyidar pu sewiayps [eau o1 saves jeaostadsorut \uaqredxa ‘aanuoo spu: p aq ‘aseyg 28484 [24 pue “20u2989[0pe teisiopun ‘seus aan Aj jay isidesoep aya ‘aseqd asiy axp uy -aseyg a8uey> >xp puE asviq Uoneonpy pure auissassy aya :saseyd 0 ieibgy wus AdWaaHL YW3HOS 29Scheme Assessment and Education 65 64 SCHEMA THERAPY ‘SCHEMA-FOCUSED CASE CONCEPTUALIZATION naires for homework, and the therapist and p: the sessions. Next, the therapist uses experi imagery, to access and trigger schemas and to link schemas hood origins and to the presenting problems, The therapi patient’ schemas and coping styles as they ship. Finally, the therapist assesses the patients emotional temperame In the course of the assessment, patients come to recognize schemas and to understand the origins of these schemas in childhood. They analyze how these self-destructive pattems have recurred throughout their lives, Patients identify the coping styles they have developed to deal with their schemas—surrender, avoidance, or overcompensation—and elucidate how their individual temperaments and early life experiences predisposed them to develop those styles. They link their schemas presenting problems, so tl patterns, early develop- Shemas. Thus each patient ih the patient’ Early Maladap- ping styles. By the end of the Assessment Phase, the therapist completes the Schema Therapy Case Conceptualization Form (see Figure 2.1)! The form incides the patients schemas, links to the presenting problems, schema triggers, hypothesized temperamental factors, developmental origins, core memories, core cognitive distortions, coping behaviors, modes, the elects of schemas on the therapeutic relationship, and change strategies. The Importance of Accurate Identification of Schemas We have found that using multiple methods of assessment the accuracy of schema identification, For example, some patients dorse a schema on the Young Pa ‘Schema Questionnaire, Itis easier fc cents’ attitudes and beh: and Coping Styles To develop an 1em to access their own emo- are likely to be less sal ‘The Assessment Phase has both an pect. Patients identify their schemas rat ing the Change Phase. 1e therapist not jump to conch schemas are operating based sol sponses to a single assessment modal be the outward manifestation of di schemas emot Imagery: The decision about whether a hypothesis about a schema “ the patient is based in large part on what “feels right” ‘identified schema usually resonates emotionally for the patient. During the Assessment Phase, the therapist utilizes cognitive, experi- schemas in different people. Al- in depression, anxiety, substance abuse, ic symptoms, or sexual dysfunction. Even in a specific per- psychosom diagnosis stich as BPD, patients may share some schemas and not tionship. The assessment is thus a mul therapist and rm and refine hypotheses as they g Core schemas emerge as these multiple methods the patent’ life. The assessment grad cd case conceptualization. required to complete the assessment is var ard cases might require as few as five assessm whereas patients who are more overcompensated or avoidant usualy re- quire more time assume the presence of a schema of a patients childhood experi- lar painful childhood circumstances, yet 10 female patients botho 9 ides) v annus Jo UeSioR a S. ‘pou srazuuy pojods, oya u) sioWa0 404 wi29H00 pue euydizeip 40 308 404 Kq poezeny 2eynaui0e 296 | diyouoryejas Rdesoya pood Rion e ancy ‘Om Julia Pue Yay 310M 09 Bulbebue aatauNy Puy | ‘swalgoud aay aaidoad ey 02 Bulageedn 20 Gutiog aifaug shes aye osneoeg equauublese yomawoy uazauM uo yenaiyy Nol} auuscop ure aug wauera 40 suonouto mysed anoae Wea oa 346200 pile soojaine Kaboul! pon’ o2 saua aug "peazouuod pue pobeouo suieos us ybrowa wana “au: pubvoa Rajjqesoulna io eeoulpoou ‘guouyoesae Ouosas aluipe 02 auexonjes 5} ug "uo}s6a9 u uA 24a 40 Yoni Yona Same eazey (eouaiajsueaiunoo 4o/pue suze leuosiad ‘uoveyea uoIsses.u! uo sapou pue seuiaLps jo 3>edu) ysuonetey AdeoyL .orauuy peyods, °¢ (PiI4d peuaqybuy ev07) aqaouwy ajaany °Z (103999044 Pausered) sasauuiy YenoL "| Ginoy Augeey 24) 6} Lonppe u) sepony ewaYpS weAajay ‘Rosou pug aygeuouinn eo} 24s Yonoua wend ‘o.su09 ul puE YBnOa s49y svoyneyog Bupesuadwwo>s0N9 uous yan Kaew Sptony “y “sbujeay pue saufnous jyuted uo bulsno0y plone 09 204 ‘slowoula plone 03 Raerou pue uonemuias 23906 2 “ebujoay jguted no 204 04 loyoaye eeendy ‘| sioyseyeg 20uepiony -adoad seygo yam sbuyze) aigesauyna anoge a63 204 s90a “e ‘naa u 274! 6968 PUe s0uROU Loy Jo alk Gaye oy 42eq01d 10 ainaun 04 e10ys0 4s 304 2200 ‘| siojneyeg sopuuns Gunsasoquun 40 Gusoq aie aeya sdisuoraeras 10 ‘sonnase ‘exse1 yam Jon9 09 aney auPINOUS |'S "en | sanonsyne ney pule OP 1 2146 24 PINOUS |“ -ensoidee pue Mbue ‘ageraipaidun axe uous 260/1 “S ‘Rooau os Buiea pur swolgoud jeuomowe ‘Aueui 06 Guney 40} ou yaya Buon Reauauiepuny oulyaowios oar94s °2 ‘ug aya je 240 Guowas aus 04 01 ancy | spoou Kus Jo azo aye2 o% aioya 2q 1679 IM HO ON “| suons0isiq anniubo> 2105 304 10p vornenoud 20 ‘Rygedwo ‘aioddns Aue sexo zou pip ang diey Joy sxazuuy 03 pouina JeURoM "Paueaybiy dion seyaols 124 pue axgouuiy Aibue Kian oem wouae ‘se6el| 10 SeuowiaW poouPIYD 2103 -swoygoad ya possnoeip 40 abuso paieys saAcu eioqusous Kes peau ai W ou ey aaaauly “e steamy sam pie op pen a # 98 salon say ou maz Gurscosaid jo ojos ova ui and sem oxsouuy ‘ansoidxe pue Kibue sem souged Z (2402) sus6u0 jewwauidorenag yowasve Tuo ‘yo e oe eez0u jeuorsowo seiseuuy pojiying ausued Jouaen ‘Rvoats pul eeaidioy som sou0p4 “| suyBuo rewoudojonog 03 suo.e4 jeyBojoa/swuowieredua ajisoy vojseusdwnoae 10 ys nor uorseop lepine oN “ouazas ion aie eapoui pus Sosuodes! buldo) uasse Roseidpou aie Nevioioe uonesuoduleneq Jo sd S9pOM UE “esuodsoy Guido ‘seus Jo KONos Guassieuun so ‘autano4 “Gusiog Gunrgowios op 02 parse Guled “G Adesoys 10} yosu sy pue susoygoid soy anoge Bupjuiys “p ouole Oulsey “o (A) puaiyhog @ 04 25099 220 03 Busi, Z (WH) Puouyhog w GuIscou (vauor 40 vau 01 pau 9 3-14 Apacs) s1966u1 eWaES fueoipueig /Avowieriug “oudioeig-yasjeraued-si96 quotes ewaws Gof 02 gof wow sano ‘4804 exeidutoa 40u 620p suua|goud 10) ty wolqo1d Poyuoes eulays Pyewinu: Guaioreg Ayrowyp sey ‘vow sqeudesddew seep : suioyjoud diyouoneiey :€ woyqoid 196 ‘Seeuenogj0q ‘ssnayasnusiy\ "uolaendag jeuoroug 23M ssauannaejeq ‘aenay srsnenein ‘uonenudeg \euomoug .0y aovodses Gude ss4uH eUON>y Penge \Ou02Iy 7% WaIGOs 224086426 ‘esouaNacejeg ‘UorsEAideg jeuonOU sy eWEYDS vojseaideg 2 wagon swijgosg wu2sin auidesia-sesnonucn. ses aueryneul “9 Rajsoipusprauaworyaus “G suisysyesouannioneg "y aen4yjsn2eIA 2 eoyuceSules 2 (uorseqaud pue ysediuo ‘coueunaunu 4o) uoigerudag jeuorou *| Sewowps wersieu 100426 ub poze -woneonp3 usteeane9 ‘punosbppeq mug aeioyideary onedhs>d eUoN -s9by) Lay aybug ‘sn 92 "36y 0 oxtouuy ‘oweu spuoneg Mm jouoey “sweU onewzoy4 pu (09) "Ve RAND ‘snaUUy 10) WHO mdaau0D ase Adwioy] BLASS “Pe RIND68 SCHEMA THERAPY ‘grew up with fathers who wei tients mother) was a warm and loving parent who compensated for her f- thers coldness by providing affect ibuted her fathers rejection to limitations in her fathers capacity to a he was equally cold to her and to her siblings. She came to believe at Some men would not love her but that others would—she had to find the right ones. She later sought out loving men who further healed the damage done by her father. Although this patient had an Abandonment yw to moderate severity, she did not develop a Defe schema, Thus two patients with rejecting fathers ended up with qui ferent schemas and coping styles as a result of more complex elements in their childhood experiences. Other factors also influence which schemas a patient develops and the strength of those schemas. Many patients, such as the second woman just described, have other people in their lives who counteract a schema by providing what the patient needs, thereby preventing the schema from de- veloping or weakening it. Patients might also have subsequent life experi- rmodify or heal the schema, For example, patients might form healthy love relationships or establish close friendships and thereby par- tally heal schemas in the Disconnection and Rejection realm. Sometimes patient temperament works against the formation ofa schema, Some peo- ple appear to be more psychologically resilient and do not develop strong Early Maladaptive Schemas, even under conditions of considerable adver- ‘whereas other people seem more psycholo velop maladaptive schemas with relat ‘Accurate identiflation of schemas is important because there are spe- individualized treatment interventions for each schema, For exati- le, a patent repeatedly asks her therapist to give her advice about prob- lems with her boyfriend. On the basis ofthese and similar statements, her therapist mistakenly concludes that the patient has a Dependence schema. Because the treatment strategy for the Dependence schema is to increase the patients self-reliance by having her make her own decisions, the thera- Pist declines to give her advice. Infact, however, the patient has an Emo- tional Deprivation schema, She has never had someone strong to whor she could go for guidance. The treatment strategy for Emotional Depriva- tion i to reparent the patient by providing nurturance, empathy, and guid- Schema Assessment and Education cs A patient with »Defectveness schema might ove Workplace by overachieving and competing but sO is nd esa Shyles ae not sthemaspecifi: They generally cove as coping mechanisms for dsessing emotions generated by many diferent schemas. For example order to escape emotional upeet might do so beerse the Abused ejected, ov subjugated. They could gamble to a fering for them, coping ‘good reason, in order to cope 1 coping style is probably. ‘a barrier to schema work, One purpose the schema from awareness, and the schema in order to fi (0 recognize coping fact, represent a maladaptive coping style. The calm de- an avoidant coping style might resemble the de- ‘but it actually indicates a dysfunctional ap- proach to emotions. ‘Viewing problematic behaviors as coping styles helps us understand why patients persist in self-defeating behaviors. The resistance of these pa- mnge indi ed reliance on responses that have least 10 the past. ‘THE ASSESSMENT AND EDUCATION PROCESS IN DETAIL ‘We now discuss the specific steps in the assessment and education process in greater detail.Aqpaveadas worssaudap 20y Adesonp yesoineysq-240 ‘plowwod-Te B ‘2jduexa 104 “paweorpur uayo st Aderayp euyps wat YopIOSIP 1 SIXY Ue 20} Adexaip snowo1d oF anode ‘ua9q sey 10 19pios|p | SKY 289p> OU ancy 01 suas uae e Moy Heesa Sipe Hoy sien otedead «saadop pur Aropcue Sutsde] -a4 10 we - se siapuosip guony xeut 109 paz ‘Ayfeuosrad 20} tuaunean e se Adesaqp et ‘suoqssas Suxznp [oyoo|e 10 sBnup jo avant qepadso 5 sty “ssaiBloud 01 s2p30 ina sBnup axp asne22q Sooueisqns Suisnge Day yroHs eUsaY>s Op 01 a|q}SSOM AqaxE sioanp wig yides9qp 3y) Uaup ‘Tasnge souEIsqns ‘sno}as e Apiuazmo sj uuaped ayp J] os euUDx}s SuPpEHAPUN 210}24 19pI0 “sip ainoe axp sassouppe asideaayp auf wadp “equINNg 10 “erEIOSUE "NOyssaxd ‘ap sofeuu ‘sypene ayued arenas sey ruaned ap 1 ‘ajdutexe x04 "wone>ypaut ugnonp joyar worduds a) uaqn Toprosip | sixy pean ROB UE Se -adexatp puayps Buruutoq 210}2q sewayps 10 waned at ¥ 01 pare] an aq 01 29s 10U s90p 10 JouoneMIS st wiajqoad BupUasesd oyL °C 9aa] 219495 02 31 -ropou ee sSnap s2%po 20 joyorye Bussnqe Apuaxino st uaned 941 3 a ipouod PurBYPS ve -asod 2q 01 pau Ae 10 2Iqh x ‘suopeorpur 2tp jo auios saat 1st] fea ou Inq “pasoudutt avy staordusds pu s9su9 2 udoxdde 210229, [Tus stuajed awios 20 ‘stuaned Te 20) ayeudozdde rou st Aderaup euIRYDS Adoioys oweyog 10} jueyog ey} Jo Ayiqoung ays Buissessy ‘sis Sujdoo pur seurayps spueqsny s94 jo SUED) UY PUE 59 seumayps #94 Jo suum uF suiz|gord jexueul ray] pueisiopun or seratp ay TuaUISSaSse 2up1 5q 2280] ow [es 3yS Ie) OF PAE PaysNeS [22f [IMA ays WHA os drysuon i Uuoyoonpg pue woussesry OwoYDS “var peeur ayp jo Aaxjenb ayy anciduat o1 st yusunwan 10) peo8 19} “2 age sjpequaa st puegsny 294 eu) pue Your Buf9q OU axe sp29U [PUO! 8ioua yp uoununs OULD ays PU p1om paddors 2avy aBeueu soy aaorduny on pain sey exszEpy Shem 2 sea | "2atsnge oy 3eq aouNOq PLR ‘staauvo (sng pur uwe> nf, ox ‘s12are onoue. ee peasy A "UIP IY 8 ae ve pouzen | siwad 7 10) Sool on PaLLEW W994 21, ‘soutef ‘pueq -snyj 194 spun diysuonejas soy soquosap eysseyy “idaa9x9 S24 OUD Uy ey Eye 28a =u ayn jo aun aya ay “Bunox qq paronpuo> 14 YAP sa}ADN xoyer aze sidiooxa fuysoyoj ay, ‘Suey stays swagoud 10y Adesaxp afin sey ays “Plo ste94 ch 51 EYURIA "u0 ‘yeo8 Adeso sryp uy suaygoud 3 nya sxounied s2s00y> 180) pue ay8nea auovaq sisidezamp soumauios ‘se wiaip Wo pasn30} ders 01 pur nuapr o} isjdesoip ay 40} wweniedun $13] seuiayps siuaned axp Sunoydx> quouissosse aqp yon secu Aqueopp sirayqoad Sunuasoud 24 sjpog Adosoyy puo suisjqolg Buyvasaiy ay) Busssorsy Adesoyp warayps 5 aUN Ssasse 01 pue speo8 Adwsowp pur swajqard f9Pl O1 St UOHTENjEAa jeNIU aYp Jo ¥Se2 YE ‘uoyor}ong jouuy yy AdWuaHL YW3HOS oz toy waned amp jo Bunuasaid siuaned ay 47 SCHEMA THERAPY homework assignments, The therapist frames the problem in terms of the patients Subjugation schema, The homework assignments remind the pa- tient of his school years, when he resented being controlled by parents and teachers and rebelled against authority, Just as he did then, the patient is ‘overcompensating for his schema by not doing his homework. Because the patient wants to make progress, the therapist can ally with the patient in fighting the schema in order to complete the cogni Other difficulties in therapy that might benefit from a schema ap- proach include attendance problems and problems in the therapy relation- ship. When there are blocks to change, a schema approach can as Focused Life History ‘The therapist tres to determine whether the year-old man enters He is deeply depressed and has chological treatment. Does his depression ods of schema Did the patient experience any traumatic losses in childhood? Patterns emerge asthe same triggering events, cognitions, emo repeat over time and across situations. Relationship hi work dificulties, and periods of strong affect provide clues to schemas 4 patient is having trouble managing her anger at her boss, that her boss is triggering one of her schemas. Further in- shed light on the mater. ‘The therapist also works to identify the patients coping styles of sur- tender, avoidance, and overcompensation. The therapist explores how pa- tients have coped with their schemas in the past. ‘When patients surrender to a schema, they reenact i,j pened in childhood, with themselves in perience the same thoughts and feelings they did as children, and they be- hhave the same way as they did then. In contrast schema avoidance looks like fight from the schema, entailing the use’of cognitive, emotir or behavioral strategies to deny, escape, minimize, or detach from the as it hap- same childhood role. They ex- Scheme Assessment ond Education 73 schema, With schema overcompensa ing back: He or she uses cognitive, © counterattack, compensate fr oF ex The therapist introduces ihe tea of coping styles to patients by ex- planing that fdapt to dstressing evens The Both repre ei es have become generalized ways o Ete are especially vsble when schemas are rggeed. The therapist. potent tha coping styles can prevent acess o schemas and block {py progress. in alton, some coping sles, such as substance abuse oF totional detache te coping spls provides a tionalves and prompts patents to volunter information about how they coped during ficult umes in the pas The Case of Marika In his erview with Marika ry to determine whether her their relationship or part of a larger Young takes a focused life bi with James are jonship like prior to James? ‘one with James. Both mere James aban /—he stayed out at said they loved me a Chris abandoned me phy night. Both men were generous with money a lot Atthispoincapsttem appens tobe emerging in Marta romantic lationships. Spot partners “verbally abused” and “abandoned” her. Both were generous natrally, The therapist hypothesizes that she has schemas Ir the Disconnection and Rejection realaperhaps Abuse or Abandon” ment-and ingutes about her feactions fo men who tated her we ‘THERAPIST: What were you like with someone who was nice to you? What about the nice guys? There must have been some who treated you wel [MARIKA: They didn’t last long, I ended it. They were just awful. THERAPIST: Were they too nice?saospe spa soe 9 aq soypmsyoresat oj pangs pana so} Hoys au PauNsEa 2G to seaayps gr pe 3) OF Jam se aloo sun uoN|PpEBUIPPE a TH a GET TE {> ptapy skews abe pour se eanj Boj 2 oy} eugDs Yeo oy Sa But yo pasado 5 pu uot 1 SUEUOD QA 2 Jo quauissasse aatsuayaiditod e apraoid suti0} yuawssasse soy uowssassy Ar S3¥OLN3ANI YW3HOS PE PIPPE AAEM ey a seuaqos aandepeey A Dy uojsaa voy Huo stag} Noys pu Si St ap sero pas vu geese amesrronD 2 joqe 910m 2 ue, Bubjse Aq euroyps 1ueaapar yea moqe ‘on taped 2yp aduroad op sway Supoos- Sty amp sasn wsidesaqp aq ‘ewayps passin 128 0) wes rep’ seuay>s ‘uone 2iE SeUIRYIS aWIOS soyAyM ssIOU Isidesde -odx2 jo Aqpiom pur waned ayp 1 ueaoos Aen st wuBayDS WHA "PUIDYDS Burdoo pur seurayps rnoqe 5980 ndopesap aya 1d 8 wo (9 40 ¢ pared) sa109s UBIy axOU 10 9 dv. eUIDEDS 2 emiadind st won -esuiadutos1240 pu aoueproae wusay2s jo atu00100 -1e 1sowye st sig "ewoyps sy aeMadiad o1 saai9s éqane ‘ase at sea sd 0} uonwane Sumvesp pur yeredas wuroy>s y>ea 40} suiatt 24 ‘axciatuy 0) 29p10 Ur EWES tf ip amdunoo Ajpensn rou sep ‘uy Aaistmayp jo aouasqe axp 10} uonezfeuoRwA v ay az0WH Suta98 nq woneuy|dx9 AzoioejsnVs v se ann Fay YoU s9op Ans 29 em ays dss Jo uonPuydxe smquEyy “sdryst axp saye aoqduioo pue autoy aye ayp 01 DSA 3MH Soa Jstdeoip ay 3298 u2yF7 wuIOd-9 uo wo SOqUDsOp UE uo sanju (Toor ‘9661 “uous 39 BunEg *77-DSA) sHEUUORSOND eUTaHDS BuTNoy aH jayne Waaup-euioy>s axe soe yu suajgoud 194 wy sisoyodAy ayy suoddns asuodsax Seyteyy «PROM uradoing sea 21 :yauvIN, Adiysuonejar veyp yas Boom sea WYNN STEVE ‘suonesiaauoD [B01 pet ay, ~spiom Aur s940 [Te paddup 24 ‘ON AAV gqeonuo 94 Sey STAVES ea, ay ‘2014 A194 seat An 3D “VARIA 10,001 Sea pr WA waned ayp se onaaun ayp‘aydusexa 40g oun Aeon -sord 2ur anf pjnom pu sno ce Uoyoonpa pup woussessy DUOY>S AdW¥3HL YW3HOS ve7% SCHEMA THERAPY of each high-scoring schema and the meaning of the schema in everyday words and encourages the patent to read more about the schema n Rei venting Your Life (Young & Klosko, 1994) By this point in the assessment, the therapist knows the patients pre- senting problems and has explored the focused life history. The therapist has formed hypotheses about the pat on the Young Schema Questionnaire may support or refute these hypothe- ses, and they may contradict previous information. The therapist asks identifica Some patients find that ju schemas. Fragile pat iy. The therapist can ask these pa- dent can may respond to upsetting questions by a “forgetting” order to avoid facing coping style of schema avoidance. If ing the questionnaire, the this as a sign that the ps icant avoidance problems rely more on other facets of the assessment process to determine spend one or two sessions going over the completed the patient, depending on the number of high-scoring hemas. Because patients are permitted to change the wording lems and life history Young Parenting Inventory ‘The Young Parenting Inventory (YPI; Young, 1994) is one ofthe reans of identifying the childhood origins of schemas. The YPL separately on a variety of behaviors that we hypothesize contribute to the Schema Assessment and Education 7 and the items are grouped by schemas. We gener tients as homework a few weeks after the YSQ—*t or sixth session when we discuss the origins of ‘grandparents, or adding columns for additional parents o par they lived as children or adolescents, For examp! hher mother and father, then, after her father died when she was 5 years old, ‘with her mother and stepfather. She added a column and rated the items fon the YPI for her mother, father, and stepfather. “The inventory is a measure of the most common origins we have ob- served for each Early Maladaptive Schema. It reflects childhood environ- ments that, from our observation, are . shape the development of Specific schemas. However, itis possible that the patient experienced the childhood environment commonly associated with a particular schema bbut nevertheless did not develop the expected schema, This could happen for a number of reasons: (1) the ps ‘temperament prevented schema from developing; (2) one parent or a significant other in the child's life compensated for the other; or a significant person, or fan event later in life healed the schema. The therapist scores the YP in a similar fashi apist citcles all items rated 5 or 6 for i sssume that scores (of 5 or 6 have a high chance of being lly significant as origins for a particular schema.) The only exceptions are items 1 through’5, which as~ fess the origins of Emotional Deprivation and are scored in reverse: low Scores signify the relevance of that origin for Emotional Deprivation. Un- ke the YSQ, itis not necessary to have more than one high score on a parr icular schema iy significant. Although it is true the mote high scores there are for a can be that the schema is relevant for the patient, any high-scoring item on the YSQ. The ther- the YPI can be meaningful as a schema origin. For example, ent in- es on a YPI item that she was sexually abused by a parent, it is very ly that the patient has a MistrusvAbuse schema, even if the patient ied the other origins for that schema very low. Tn the ne: the therapist has reviewed the patients scores, the patient and the therapist together discuss any high-scoring items. The therapist encourages the patient to expand on each origin by ng examples from childhood or adolescence that illustrate how the ‘ed the behavior. This discussion continues until the thera- ind accurate picture of how each parent contributed to the evelopment of the patient schemas. The therapist explains to the pat the relationship between each origin and the corresponding schema, and also how the childhood origin and schema may be linked to the patient’(S68 “Sunog) Adesamp eurayps uo sdoysiom Supuane sisidesarp 10} padoyasap am aspuoxa Sururen dno v wo paseg st gst 1 Sropeat rey) A1aBewy or uonIoApoul ue st asfaioxe Sutaoqfo) ML wad Aqjeonowa pur prata a} axe wT day ay -2suon aasoud atp uy pie pro ino ‘sn 0) 3 aqUasap 01 way Se 29698 “uit uv aanioid stuotied 29 "waNo Sit UO 2uL09 1 12] 0} Ing aBeu axP 20104 Now warp se agg “spurue sjayp jo dor axp ov weoy aBeuNt ue 19] pue S262 np asof2 01 wot} Se Bm “2]EUONE FHA, ned Suyai8 YY ‘surajqoad wan soup 01 sewcoups say poutuo> pute ‘setuayssfmp Jo suiBu0 PooYPTD AP ‘purisiopum ‘seuiayps stomp pa] oF ayy djay Es AzaBeuN we [OM Aro eeu 20} ajeuonex Suroutauoo © yn stared Sumpracad Aq wr8aq 29 seuyps Sup pu pawosse suonows souanadxa waned ox doy of ‘suojgord Sunuasard o1 seurayos UIT OL, sewayps 2p jo suffizo pooupnyp au pueisiapun OL seuoyps siuaned ayp s0881n paw AINUEPY OL, ae qamnssasse 10} AroBeunt Jo s[po8 24 7UDtHSs9$ se oy AaoSeum yo 290 2up Jo mazAz990 jug w 1uasead a9 aH “f Jd Gr uae st stuaied usta 32044 AzaBeuny op 01 soy Jo woNdH9s3p PaqtEIaP V fe [njomod est AroBeuy Arateur ws sip soysydauo.oe Ae idexaup a4, “woyp [29j ue> auaried ayp pu asidexarp ayp Wog rep OS ‘iossas Adesayp aya ty sewatps Syuoned ayy 1988 1 st dans wou 2yL Surdoo pu sewia4ps 510 -ed ayp jo Surpueisiapun jen123} Suz waned ayp yaya sarreuuonsonb paraydiuo> panaiaas pur pasnoo} 8 uayer sey asidesaqy up ‘ssaaoud aawssasse 2qp UL uO” STEN IY ANaWSS3SSV ANZOWW! -sotzonraauy ona asaup to parynuapr s9[cas Surdos axp yo asn atoxp rowwoUt uaned ‘sessaisoud Adesoyp sy ,{uonenas 91p ur aureys jo Bur ‘amo mod ya feop 09 nok 105 Kew w sea Suqurelg vem aqqissod 1 SL ayia isidezayp ay, ‘suneys yo sBanj2y sdeysod—sBunoay njured 2100: 10 10} saresuadwioataso SuraTE|g otf zo\pay soxojdxa rsidesoqp HL ‘duexa ue 10) ise istdezarp agp ‘3/48 Suydoo e se Buyureyg saszopua wan ‘aidurexo 20 uoned ap ypia stout Sutzo>s-ySty sossnostp Pur ‘ese {uoiuaaut tonesuaduionoao aun sesn Isidesaqp 3H 6 Lvoyoonpa puo woussessy OWOLPS ‘9s 1ujod-g sosn Aiovuaaur ayy. wom Supjearq wroyy 108 SuOISt> “se syuout juaduso21a40 PuUay>s S2ssasse ey axIeU 9 ¥ 51 (C661 “Bumo,) Aso1uaauy uoNesUaduIoD BuMO, a4 -ap 19n0 221008 ties ysns 2pny -uonsanb w: Arojueau uoyosuedwor Buno, ‘pups dup prose on pazyn 9q wee searad Busy st 9,kis But e uy oytoads-eurayps 10U st Gowaatt ;9uo8 v anPaqpU S90p 21095 uM 1aA 34) Uo $83095 "DSK sofpuaisisuoauy ‘seuayps ‘aueuuonsanb soy10 yp UO 2u0 uo seuiayas BuU09s-y8ty sdsax sazeduioo ysidexoyy 24 nt SUUUDy>S Bundy 2 1d 209 ‘sng “suonow umo 12y y aro stuated stomp rey Afareanooe Ayn aun spa sy ain jo 2048 Semoqps Bus005- IL-DSA 24 Wo aso4p -spuapt 10} amseoun somaq v 29 01 2aoud s: puts ys yar stusned x Jo ino axe Sayp yBnowp waAD sco] euey2s sures amp pared qusned axp jt uaa “euayDs wey y axiasqo Apuanbayy am ‘eurayrs x jo suo ead 247 1pojjar yp [dA au Uo suIaN s2siopue ABuons quoned e J] ‘seuIaYDs Jo a1ns woul j22upul 2|genyea v ag 01 uaaosd ss>[oy2AgU SEY LGA aYp ‘DSA 24 UO {Bly aiops wy seuiayps 40} surBt10 joy] AJnuapy 01 Joyped nq aABy sIUOA ved seuiayps yotyse ainseau 01 pouBisap 10U sem Jax ayp ySNOYDTY AdWuaHL YW3HDS 880 SCHEMA THERAPY 1. Close your eyes. Picture yoursel words or thoughts a sale place. Use pictures, not ywn, Notice the details. Tell s there someone with you, ‘or are you alone? Enjoy the relaxing, secure feeling in your safe place, 2. Keep your eyes closed and wipe out that image, Now picture your- self as a child with one of your parents in an upsetting situation. What do you see? Where are you? Notice the details. How old are you? What’ hap- pening in the image? 3. What do you feel? What are you thinking? What does your parent feel? What is your parent thinking? 4. Carry on a dialogue between you and your parent. What do you say? What does your parent say? (Continue until dialogue reaches a natu- ral conclusion.) 5. Consider how you would like your parent to change or be different in the image, even if it seems impossible. For example, do you wish your parent would give you more freedom? More affection? More understand- ing? More acknowledgment? Less criticism? Be a better role model? Now tell your parent in the image how you would like him or her to change, in the words of ac 6. How does your parent react? What happens next in the image? Keep the image going until the scene ends. How do you feel at the end of, the scene? 7. Keep your eyes closed. Now intensify the feeling you have in this image as a child. Make the emotion stronger. Now, keeping the emotion in your body, wipe out the image of yourself asa child and picture an image in your current life in which you have the same or a similar ing, Don't try to force the image? What are you there is someone else in the image, hhim or her to change. How does the person react? 8, Wipe out the image and return to your safe place. Enjoy the re- laxed feeling. Open your eyes. “The imagery assessment we conduct with patients is similar to this €x- cercise. We start and end with a safe place. We ask patients to picture sep rate images of upsetting childhood situations with each parent and any ‘other significant figures from their childhoods or adolescences. Then we {instruct patients to speak to these people in their images, expressing what they are thinking and feeling and what they wish they could get from the ‘other person. We then ask patients to switch to an image from their current lives that feels the same as the childhood situation. Once again, patients carry on a dialogue with the person from their adult life, saying aloud what they are thinking and feeling and what they want from the other, We re- ‘peat this process until we have covered all the significant others in child- Scheme Assessment and Education 8) hood who contributed to the formation of the patients schemas. (Chapter techniques, provides an extended transcript of Dr. Young conducting this exercise with a patient.) ‘When doing imagery work with p: important for the thera- pist to begin early in the session so that there is enough time to discuss ‘what happens afterward. In this discussion, the therapist helps patients ex- plore the images in order to identify schemas, understand their origins in childhood, and link them to the presenting problems. In addition, the tegrate the imagery work with information i assessment modalities. es patients are distraught after an imagery session. Starting session helps ensure that there is fore they have to leave. When patients are cemapts to set them at ease. The thera yes. Some request s. The therapist ms. After the exercise, the therapist the present moment before the ses- imagery exercises at the therapist makes the necessary accommodat may need to sion ends, 1d by linking this image to an ups However, imagery exercises may proceed in the patient comes into the session already up- set about a current as the symptom i right say, look like? What is the pain saying?” We can use strong ei it experiences but does not understand as the starting place. Imagery of Childhood Nadine is 25 years old. She has sought therapy for depression. Nadine ‘works as an office manager in a large company. She has been consistently promoted at work because she is an excellent mediator of office disputesspe sty tus diysuoneax pooypyy> sty uy euyDs ayp jo stmBtLo ay puestapun pue wordus snetos sy Suikyapun euIoy>s atp ss202~ [neg Say AIaBe ayy “ewoyps sparpuris Sunuaparuy syneg Sorpoqus soxae) 24) ow >yoat isn q]eyp pu 2jgendaoocun axe saps yooups sy wen ‘othe StH Toye) SuNDHNA sty IPI PIP e se PSU 0 eur ue soumoed peg ‘PLND v Sea. 94 MOK Kee ates am [29j WKY 2pEL ‘oy suoauios jo aBeuy ue ammoid ot neg syse uacp asidesoyp aL ap wy apes ys Jour wuatosuo> a4ou yom 1. pey eg "HY Ys 03 XO, SUL "eq A198 i pu sl0%8 2894 sty BUIOp U2aq roU sey 2 HEY se Bunjeadg saxsue pu rouum axp jo ajor ay 24 es ov wy sonans ty sy een 3paysiow yu, ® $04 3 eq 303 aroun wads sey 24 21h “Aqrapun atp. Ajauapt 01 19pi0 ur 2aueprone jeuonows autoarano waKp day uayo ue AsaBeun ‘swords oneuos 201 sed way “224epIOAP wUIDGDS Jo suBis Ajruonbayy axe surorduass onewIOS swojdudg 2youog of peyury As060W) nuzapln Lapp! 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Schema avoidance may manifest itself a number of ways. Patient ‘might refuse to do the exercise, stating disda response from a narciss dons or bring up unrelat only see a “blank screen.” Their images may be too vague to make out, or they may see only “stick figures.” There are many possible causes for schema avoidance. Some can be easily overcome: The patient may be self-conscious about “performing,” worried about doing the exercise “right,” or too nervous to concentrate Often the therapist can resolve these difficulties simply by resta tionale for the imagery work and reassuring the can be overcome, The therapist can also begin wit rial: For example, the therapist might begin ages and then gradually introduce more upsetting images. We have several methods for overcoming schema avoidance of imag ‘ery work. We describe them more fully in the chapter on experiential tech- niques (Chapter 4), but we list them briefly here. They include: 1. Educate the patient about the rationale for imagery work. 2. Examine the pros and cons of doing the exercise. 5. Start with soothing imagery and gradually introduce more anxiety provoking material 4. Conduct a dialogue with the avoidant side of the patie work) 5. Use affect regulation techniques such as mindfulness or relaxation ining, te psychotropic medication ode. Some patients have trouble visualizing themselves as children, When this happens, it can be helpful to have patients picture themselves in the present, then work backward to early adulthood, adolescence, and then fix nally to childhood. It can also be helpful to ask patients to picture their parents or siblings as they were when the patients were children, Some- times patients cannot visualize themselves, but they can visualize other people and places from childhood, In addition, patients can bring in pho- tographs of themselves as children to stimulate imagery: The therapist and patient can look at the photographs together, and the therapist can ask questions such as, “What might the child be thinking? What is the child feeling? What does the child want? What happens next in the picture?” Schema Assessment end Educotion 85 Another method for overcoming schema avoidance is conducting a di- logue with the avoidant side of the patient. We call this sic c xde (see Chapter 8). The Detached Pro regotiates with the De~ patient where dea with chem aotlace Perstent scheme avoanee may there ona ients who have been abused etna Very to may be to righened to experience 7 of decompensation. Severe schema exy work tionship grows ove something othe extreme, ftmosphere was empty and at these aes the therapist ms 0b oer acne mets: Howse, posse Seman For cxample pens may fel trapped when they closet ing alone These sensations and emations can Assessing the Therapeutic Relationship ‘The patients schemas also appear in the therapy (Of course, this is tra schemas as well: The ‘own schemas are triggered. We the therapeutic re The triggering therapy relationship represents an opportunity for the mn acne ends seis euneing bah the cuentcwcersnce and related events nthe (ear rata ay pacts to remember suber people who have Premped them els sae a. wy Naludapve Schonas produce characterise beh any For eumple's pent wis Dependence schema might pea ee Be eip ah qeestonnaes and homework ssigments + patentde os are seuyps ‘suo1ssos jenprsypur 10} yousteu aygenyes apracid uw possnostp sowdor ay ox pu stoqurom dnoiS soypo 01 spuodsar zuaned 1p MoH, waplad aq Ava seuraYDS SauoMed axp YOIs UI IxOIUOD 12yIOUr sy Aderoyn dnoup “uoss9s amp juauin> ¥ 07 HOR ue yeu paren uayyo axe seuti9495 SGOHI3W IN3WSSISSV ¥3HIO suourersduray squoned axp moge peop 1ai8 v yeaaat ue sSunaau amp jo auor ret st2p wraureradwiay aveuuy amp ‘ueBoq Aayp seqpiea ou pu axe sBurja9y ay ub aout a4 2 spoud wren 10), red ay 20] 9701 u99q sdeme sey sp soyPays 84S nok 04, ‘.ex2du192 sn0K 980] NOX OP U>H}O MOH. 'a Se JPnsn nok Op MOH, ‘ise isidesorp ay, ‘spoour Sumpesaad 10 auraseq z12y0 ned auios ‘sores aanoaye 03 paw suonsanb Jo souas e Bunjse Aq rwowresaduay squaped aqp azijemdsou0d o1 surfog asidezarp 24. ‘veut 319m pue Adeiampoypésd yBnonp af "saay atop Jo 1S0ur 10) warp jo wed 20 ayeuur s} a1E5 pour ‘anamoy ‘sasodind erm 204 “aorsny payrerap & Buruteigo Aq ssan8 poweonpa we afew 01 st op wed 2m, 4s0q 2411 TWaurezaduray apeut sauoatHOS ATUTEa9 ypTas AUTUAETaP OF saAns vou tuouiss2sse avenbape aaey 124 10U Op am TeYA a10u PINOYS 2 dnaxqew pouonows 2 me pure sxurezoduion ath 8 3 wey areUoIssed 9q fqqoud seas Ansara aq) Bnowp se passaippe 2q ue> smi on jueisison Afoursnx> Ayjensn a uowoonp puo sy OwOKDS wed joy usyo uv soann doy em ayn snl awouwladur eu s1Oq a1 PE sey uaUIeradar suosied Y>rg “si sjpeqawsp aos s9sod mueueraduin yous yo ppuodsa1 waned ay Moy jo ued WeDqUsIs © 9q s es pu wioqur st 4 "Tuauresaduray ssasse 0} suoSwD! [89A9S 92 31311] ‘Seway>s 1 atp seouanyjuy uoureuadwiay ouvioduiat dzipenadoouo> 2x arpuey or adope spenprarpan od jo 126 v se Suorsuowp as9q) Uo ayqeos © dys 2 snopeuy ndg € ormdmpscq, nDeALUON «© aTeT ‘suomealosqo [PORK] UALO Ano WLOX} ‘unexp ‘iuaurtedwiay yeuonowr jo suas apt ancy am “T zdey> uy parou am sy suouup pazisaypodcy woos LINaWvdadW3L TYNOLOWG ONISSISS¥ ‘suo BUIDyDS UI atp (pa womeuoyUr sp saxeys 2 nypedura 1 mnoge Buy jexaqp ay “drysuoneyas aqp rmoge jsnojaidsns yse aysiu ewoy>s asnqyasnnstyy v ypu TuaHed !pauasop Buraq jo 329} jo ano ysidexaup a4p wo Burdfau As}s94 MYST eUIDYDS uuoptegy we Yt Uaned e ‘aw wnxD 20 saSuey> BuyApayDs se yns junvan jetbeds soy sisonbou ajeur dtpaveadas wfStaa wuoy9s 1u9U uw quaned v ‘poout 10 yreay sisidexayp yp moge axinbut 4 Due asidesomn ayp Jo snoxoqjos éqzaa0 aq ays BUIaY|Ds 2OyTA9"S-95 ¥ YEN AdV¥3HL YW3HOS 9888 SCHEMA THERAPY pparent in dreams. Pat ring dreams and dreams the therapist in subsequent sessions. Dream ey can be a starting place for imagery work. Books and schemas. Therapists can assign specific books or mov- for this purpose, based on the therapists hypotheses schemas, The patient’ reactions can support or dis- hypotheses. ‘can record their dreams—especially recut EDUCATING PATIENTS ABOUT SCHEMAS ‘Throughout the assessment process, the therapist educates the patient about the schema model. Patients become educated primarily through di |. assigned readings, and self-observation, As they learn about the ‘model, patients can participate more fully in the formation of their case conceptualizations, Reinventing Your life We asign Reinv them learn about: book presents exte ir schemas, referred to as ive case examples. We hay {in these examples and thus engage emotional ietraps” and describes the overcompensation (called ‘he book next presents chap- tets on each of 11 lifetraps. These chapters provide their own question- naires, which patients can take to ascertain whether they are likely to have that lifetrap. The chapters then describes the typical childhood origins of strap; danger signals in potential partners (who perpetuate rather elf in relationships, change. particularly romantic ones; and specific strate ‘We recommend that patients read the short introductory chapters and then one or two chapters about their primary schemas. Even tient has many more schemas, we work on only the primary one or recommend other chapters later, as the topies arise natu- ient everyday life or in therapy sessions, Self Observation of Schemas and Coping Styles ‘As patients learn about their schemas, they begin to observe the activity of their schemas in their current lives. They self-monitor their schemas and coping styles using the Schema Diary form. We say more about the self- Schema Assessment ond Education 89 monitoring of schemas and coping styles in Chapter 3. Self-observation iy their schemas are triggered and how res. Patients can observe what is happening recognize that they ate behaving in self-destructive ways, ven if they ate not yet able to change their behavior patterns, THE COMPLETED SCHEMAFOCUSED CASE FORMULATION ‘SUMMARY “This chapter discusses the Assessment and Education Phase of schema apy. This phase has six major goals: (1) identification of dysfunction- pattern lentification and triggering of Early Maladaptive remas, (3) understanding of the origins of schemas in childhood and adolescence and responses; (5) assess- ‘ment of temperatnen he case concepi ‘The assessment ism behavioral, and interpersonal measures. and goals for therapy, and evaluates the patient apy, Next, the therapist takes a life histor and coping styles. The patient gr Young-Rygh Avoidance Inventory; nt dis the therapist uses experiential iy imagery, to access and trigger the patient schemas and to their origins in childhood and to current problems. Through- he therapist observes the patients schemas and coping styles as they appear in the therapy relationship. Final assesses the pa- tients emotional temperament. As the therapist and pa reline hypotheses, the assessment gradually adheres into a case conceptt- alization. ‘Schema avoidance is the most common obstacle to the imagery assess- ‘ment work. We present methods for overcoming schema avoidance of im-le ‘say possi 5 TUL en ag yaoa antes ii aq ou js puog aig» Sais uo feo a de Mo sto Hey P idura pue aanpafqo sxou sey YANN e YBN f pu ewayps 2up Jo apisino yin e st axaKp jenqeaa pu eUIDYDS aIp aprsino dais siuan ced dyay sovfarens uons ou 032q sey au, 2pou NPY Spt Hp 09408 p99 #3 lexoyp ayy 2seyg WoNONpa pue WaIssDssy ep JO 4 aaadeyp 5 uyoon aariufoo qi ssaaoud a8ueq ayp as Suydoo ‘seursqps Appour 01 saiBore “uy pu “Je10\seyaq ‘Tenuauads “aannBo9 sore0dz00 a8uey ap uiSoq 01 spear are waned pure asidesamp at a su 250d seadey> snowsaid dup Uy paquasep aseyd womeONPA PUL mDUSsessy axp Suna|dM09 ZY SHIDALVYLS JALLINDOD ¢saidvy wonojpouta¥onoyoKed Sunennu pur ‘Buren uomeReas 40 ssou -rypuju se yons sonbraypn wont oye utsn“Quom 9poey Weed 249 Jo api auspione ap tum andoyp v utionpuos“euonepadeeys ie -vojoue aiour Surmnpon denpead pue cae Suoos aa Bee ‘2amio oy Sop sormapesp pa soficape a Sues pom {oun 40} auoties aq moqe Mand on Zueonpe Sutpmuy eke AdWaaHL YWaHOS 08.92 SCHEMA THERAPY Cognitive Srotogies 93 ‘OVERVIEW OF COGNITIVE STRATEGIES to them because they have lived entre lives that seem to verify their schemas fnd that they adopted certain coping styles because it was the only way to jerse childhood circumstances. Consistent with constru alidates patients’ schemas and coping styles as und histories. Ar the same ti rap nts about the negative consequences oftheir schemas maladaptive coping styles. Their schemas and coping styles were adap- \dhood but now are maladaptive. A therapeutic stance of distinguishing the re- ‘supports the patients the patient first recognizes that greatly exaggerated. The thera- regard the schema as open to ques- is a hypothesis to be tested. They the evidence supporting and ref go through the they find alter bates between the “schema side” and the “healthy advantages and disadvantages of the patients current coping on this work, the patient and therapist generate healthy responses to the mn acknowledges the past requires constant shifting between empathy err in one direction or the other. Et lo not push patients to face rea cause patients t0 feel defensive and mis- change. With empal ‘imal balance between empa- to progress. When the ther- feel truly understood and af- ves. Feeling understood, they ge, and they are more recep- fe perspectives offered by the therapist. Further, ing with them against the schema. who they are, they begin flash cards whenever the schema is triggered. sponding to sche ‘When the cog appreciation of how more psychological distance from the schema and no longer truth, They have some insight into how the sche ms. They begin to wonder whether the schema really has to run— ‘might have a choice. lized the cognitive work as part of Healthy Adult mode that atively nal arguments and empirical evidence. component of schema therapy, patients are usually no longer dependent ‘explains to patients that, given thei life histories, it they see things as they do and behave as they do, How. « ways in which they see and behave have only served mas. The therapist builds a case in favor of fighting h new ways of behaving rather than persisting in the fg patterns. The material gathered in the Assessment therapist to substantiate the destructiveness of the cognitive techniques. Even thot though the schema is true, they know es, The therapist encourages patients so doing, they can ir basic emotional needs. The f empathic confrontation and ka, a patient ige. Marika and her husband, James, are stu tyele in which she becomes more and mote aggress tention and affection, and he becomes more and more witha exploring her childhood rel jents must change in order to im- prove. The therapist acknowledges to patients that their schemas seem right Dr. Young speaks to Marika about her approse