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Outline

1 Schema Therapy: Basic Concepts 2 Expansion of Cognitive Therapy for Personality Disorders (1) Cognitions & behaviors are more rigid with PDs

Gap between cognitive & emotive change is much greater with PDs 3 Expansion of Cognitive Therapy for Personality Disorders (2) Intimate relationships are more central to problems of PD patients

Many PD patients will not follow traditional CBT techniques (e.g., thought records, homework assignments) 4 Schema Therapy for Personality Disorders Compared with Cognitive Therapy for Axis I Disorders Greater emphasis on the therapeutic relationship More emphasis on affect (e.g., imagery, role-playing) and mood states More discussion of childhood origins and developmental processes More emphasis on lifelong coping styles (e.g., avoidance and overcompensation)

More emphasis on entrenched core themes (i.e., schemas) 5 Schema Therapy Defined An integrative, unifying theory & treatment Designed to treat a variety of long-standing emotional difficulties, with individuals & couples Presumed to have significant origins in childhood & adolescent development Combines cognitive, behavioral, attachment, object relations, and experiential approaches 6 Core Childhood Needs Safety Stable Base, Predictability Love, Nurturing & Attention Acceptance & Praise Empathy Guidance & Protection

Validation of Feelings & Needs 7 Schemas & Developmental Needs Early Maladaptive Schemas develop when specific, core childhood needs are not

met 8 Broad Goal of Schema Therapy To help patients get their core needs met In an adaptive manner

Through changing maladaptive schemas, coping responses, & modes 9 Definition of an Early Maladaptive Schema A broad, pervasive theme or pattern Comprised of memories, bodily sensations, emotions & cognitions Regarding oneself and one's relationships with others Developed during childhood or adolescence, and elaborated throughout one's lifetime Dysfunctional to a significant degree 10 Characteristics of EMS's A theme, not just a belief Adaptive vs. Maladaptive schemas Many EMSs develop in pre-verbal period (amygdala vs. higher cortex) Deeply entrenched patterns, central to one's sense of self. Usually selfperpetuating. Erupt when triggered by everyday events relevant to the schema 11 Eighteen Early Maladaptive Schemas Abandonment Mistrust & Abuse Emotional Deprivation Dependence Vulnerability Enmeshment Defectiveness Social Isolation

Approval-Seeking 12 Schema Acquisition Toxic frustration of needs Traumatization, victimization, mistreatment Too much of a good thing

Selective internalization or identification 13 Origins of Schemas Negative childhood & adolescent experiences (repisodes) Innate temperament

Cultural influences (ethnicity, SES, religion, etc.) 14 Schema Operations Schema Perpetuation

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Cognitive distortions Self-defeating life patterns Schema coping styles & responses

Schema Healing 15 Schema Coping Styles o o o The ways in which a child adapts to a distressing childhood environment Schema surrender (freeze) Schema avoidance (flight) Schema overcompensation (fight) Many specific, individual coping responses, derived from the three broad styles

16 Common Coping Responses o o o o Aggression, Hostility Manipulation, Exploitation Dominance Overcompensation, Recognition-Seeking

o Stimulation-Seeking, Impulsivity 17 Schema Modes The predominant state that were

in at a given point in time 18 Common Schema Modes Vulnerable Child Angry Child Detached Protector Punitive, Critical Parent Overcompensator Spontaneous Child

Healthy Adult 19 Two Phases of Schema Therapy 20 Goals of Phase One: Assessment and Education Identify and educate patient about central life schemas Link schemas to presenting problems & life history; explore origins of schemas Bring patient in touch with emotions surrounding schemas

Identify dysfunctional coping styles 21 Strategies for Assessment & Education Convergence of Multiple Assessment Methods Pattern identification: Link presenting problems with life history and early origins Educate patients about schemas: Reinventing Your Life Review schema inventories Trigger schemas through imagery, dialogues, and inner child exercises

Observe patterns in the therapy relationship

Integrate with Schema Conceptualization Form 22 Phase Two: Change Concept of Empathic Confrontation or Reality-Testing Cognitive: Restructure thinking related to schemas; develop healthy voice to create distance Experiential: Practice experiential exercises to vent anger & grieve for early pain, to empower patient Therapy Relationship: Focus on therapy relationship to provide limited reparenting, and to heal schemas & coping styles triggered in sessions Behavioral Pattern-Breaking: Assign and rehearse behavioral and interpersonal changes related to presenting problem; break dysfunctional life patterns