Theory

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The Theory Behind Schema Therapy

Early Maladaptive Schemas
The most basic concept in Schema Therapy is an Early Maladaptive Schema. We define schemas as: "broad, pervasive themes regarding oneself and one's relationship with others, developed during childhood and elaborated throughout one's lifetime, and dysfunctional to a significant degree."
Schemas develop in childhood from an interplay between the child's innate temperament, and the child's ongoing damaging experiences with parents, siblings, or peers.
Because they begin early in life, schemas become familiar and thus comfortable. We distort our view of the events in our lives in order to maintain the validity of our schemas. Schemas may remain dormant until they are activated by situations relevant to that particular schema.
We have identified 18 schemas thus far.
Schema Domains 
We have grouped these 18 schemas into 5 broad developmental categories of schemas that we call schema domains. Each of the five domains represents an important component of a child's core needs. Schemas interfere with the child's attempts to get the core needs met within each domain.

DISCONNECTION & REJECTION
(Expectation that one's needs for security, safety, stability, nurturance,  empathy, sharing of feelings, acceptance, and respect will not be met in a predictable manner. Typical family origin is detached, cold, rejecting, withholding, lonely, explosive, unpredictable, or abusive.)

1. ABANDONMENT / INSTABILITY
The perceived instability or unreliability of those available for support and connection.
Involves the sense that significant others will not be able to continue providing emotional support, connection, strength, or practical protection because they are emotionally unstable and unpredictable (e.g., angry outbursts), unreliable, or erratically present; because they will die imminently; or because they will abandon the patient in favor of someone better.


2. MISTRUST / ABUSE
The expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate, or take advantage.  Usually involves the perception that the harm is intentional or the result of unjustified and extreme negligence. May include the sense that one always ends up being cheated relative to others or "getting the short end of the stick."

3. EMOTIONAL DEPRIVATION
Expectation that one's desire for a normal degree of emotional support will not be adequately met by others.  The three major forms of deprivation are:
A. Deprivation of Nurturance: Absence of attention, affection, warmth, or companionship.
B. Deprivation of Empathy: Absence of understanding, listening, self-disclosure, or mutual sharing of feelings from   others.
C. Deprivation of Protection: Absence of strength, direction, or guidance from others.


4. DEFECTIVENESS / SHAME
The feeling that one is defective, bad, unwanted, inferior, or invalid in important respects; or that one would be unlovable to significant others if exposed. May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of shame regarding one's perceived flaws. These flaws may be private (e.g., selfishness, angry impulses, unacceptable sexual desires) or public (e.g., undesirable physical appearance, social awkwardness)

5. SOCIAL ISOLATION / ALIENATION
The feeling that one is isolated from the rest of the world, different from other people, and/or not part of any group or community.
IMPAIRED AUTONOMY & PERFORMANCE
(Expectations about oneself and the environment that interfere with one's perceived ability to separate, survive,  function independently, or perform successfully. Typical family origin is enmeshed, undermining of child's confidence, overprotective, or failing to reinforce child for performing competently outside the family.)

6. DEPENDENCE / INCOMPETENCE

Belief that one is unable to handle one's everyday responsibilities in a competent manner, without considerable help from others (e.g., take care of oneself, solve daily problems, exercise good judgment, tackle new tasks, make good decisions). Often presents as helplessness.


7. VULNERABILITY TO HARM OR ILLNESS
Exaggerated fear that imminent catastrophe will strike at any time and that one will be unable to prevent it. Fears focus on one or more of the following: (A) Medical Catastrophes: e.g., heart attacks, AIDS; (B) Emotional Catastrophes: e.g., going crazy; (C) External Catastrophes: e.g., elevators collapsing, victimized by criminals, airplane crashes, earthquakes.

8. ENMESHMENT / UNDEVELOPED SELF

Excessive emotional involvement and closeness with one or more significant others (often parents), at the expense of full individuation or normal social development. Often involves the belief that at least one of the enmeshed individuals cannot survive or be happy without the constant support of the other. May also include feelings of being smothered by, or fused with, others OR insufficient individual identity. Often experienced as a feeling of emptiness and floundering, having no direction, or in extreme cases questioning one's existence.

9. FAILURE
The belief that one has failed,  will inevitably fail, or is fundamentally inadequate relative to one's peers, in areas of achievement (school, career, sports, etc.). Often involves beliefs that one is stupid, inept, untalented, ignorant, lower in status, less successful than others, etc.
IMPAIRED LIMITS
(Deficiency in internal limits,  responsibility to others, or long-term goal-orientation. Leads to difficulty respecting the rights of others, cooperating with others, making commitments, or setting and meeting realistic personal goals. Typical family origin is characterized by permissiveness, overindulgence, lack of direction, or a sense of superiority -- rather than appropriate confrontation, discipline, and limits in relation to taking responsibility, cooperating in a reciprocal manner, and setting goals. In some cases, child may not have been pushed to tolerate normal levels of discomfort, or may not have been given adequate supervision, direction, or guidance.)

10. ENTITLEMENT / GRANDIOSITY
The belief that one is superior to other people; entitled to special rights and privileges; or not bound by the rules of reciprocity that guide normal social interaction. Often involves insistence that one should be able to do or have whatever one wants, regardless of what is realistic, what others consider reasonable, or the cost to others; OR an exaggerated focus on superiority (e.g., being among the most successful, famous, wealthy) -- in order to achieve power or control (not primarily for attention or approval). Sometimes includes excessive competitiveness toward, or domination of, others: asserting one's power, forcing one's point of view, or controlling the behavior of others in line with one's own desires -- without empathy or concern for others' needs or feelings.

11. INSUFFICIENT SELF-CONTROL / SELF-DISCIPLINE
Pervasive difficulty or refusal to exercise sufficient self-control and frustration tolerance to achieve one's personal goals, or to restrain the excessive expression of one's emotions and impulses. In its milder form, patient presents with an exaggerated emphasis on discomfort-avoidance: avoiding pain, conflict, confrontation, responsibility, or overexertion -- at the expense of personal fulfillment, commitment, or integrity.
OTHER-DIRECTEDNESS
(An excessive focus on the desires, feelings, and responses of others, at the expense of one's own needs -- in order to gain love and approval, maintain one's sense of connection, or avoid retaliation.  Usually involves suppression and lack of awareness regarding one's own anger and natural inclinations. Typical family origin is based on conditional acceptance: children must suppress important aspects of themselves in order to gain love, attention, and approval.  In many such families,  the parents' emotional needs and desires -- or social acceptance and status -- are valued more than the unique needs and feelings of each child.)

12. SUBJUGATION
Excessive surrendering of control to others because one feels coerced -- usually to avoid anger, retaliation, or abandonment. The two major forms of subjugation are:
A. Subjugation of Needs:  Suppression of one's preferences, decisions,  and desires.
B. Subjugation of Emotions: Suppression of emotional expression, especially anger.
Usually involves the perception that one's own desires, opinions, and feelings are not valid or important to others. Frequently presents as excessive compliance, combined with hypersensitivity to feeling trapped. Generally leads to a build up of anger, manifested in maladaptive symptoms (e.g., passive-aggressive behavior, uncontrolled outbursts of temper, psychosomatic symptoms, withdrawal of affection, "acting out", substance abuse).

13. SELF-SACRIFICE
Excessive focus on voluntarily meeting the needs of others in daily situations, at the expense of one's own gratification. The most common reasons are: to prevent causing pain to others; to avoid guilt from feeling selfish; or to maintain the connection with others perceived as needy. Often results from an acute sensitivity to the pain of others. Sometimes leads to a sense that one's own needs are not being adequately met and to resentment of those who are taken care of. (Overlaps with concept of codependency.)


14. APPROVAL-SEEKING / RECOGNITION-SEEKING
Excessive emphasis on gaining approval, recognition, or attention from other people, or fitting in, at the expense of developing a secure and true sense of self. One's sense of esteem is dependent primarily on the reactions of others rather than on one's own natural inclinations.  Sometimes includes an overemphasis on status, appearance, social acceptance, money, or achievement -- as means of gaining approval, admiration, or attention (not primarily for power or control). Frequently results in major life decisions that are inauthentic or unsatisfying;  or in hypersensitivity to rejection.
OVERVIGILANCE & 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 -- often at the expense of happiness, self-expression, relaxation, close relationships, or health. Typical family origin is grim, demanding, and sometimes punitive: performance, duty, perfectionism, following rules, hiding emotions, and avoiding mistakes predominate over pleasure, joy, and relaxation. There is usually an undercurrent of pessimism and worry -- that things could fall apart if one fails to be vigilant and careful at all times.)
 
15. NEGATIVITY / PESSIMISM 
A
pervasive, lifelong focus on the negative aspects of life (pain, death, loss, disappointment, conflict, guilt, resentment, unsolved problems, potential mistakes, betrayal, things that could go wrong, etc.) while minimizing or neglecting the positive or optimistic aspects. Usually includes an exaggerated expectation -- in a wide range of work, financial, or interpersonal situations -- that things will eventually go seriously wrong, or that aspects of one's life that seem to be going well will ultimately fall apart. Usually involves an inordinate fear of making mistakes that might lead to: financial collapse, loss, humiliation, or being trapped in a bad situation. Because potential negative outcomes are exaggerated, these patients are frequently characterized by chronic worry, vigilance, complaining, or indecision.
 
16. EMOTIONAL INHIBITION
The excessive inhibition of spontaneous action, feeling, or communication -- usually to avoid disapproval by others, feelings of shame, or losing control of one's impulses. The most common areas of inhibition involve: (a) inhibition of anger & aggression; (b) inhibition of positive impulses (e.g., joy, affection, sexual excitement, play); (c) difficulty expressing vulnerability or communicating freely about one's feelings, needs, etc.; or (d) excessive emphasis on rationality while disregarding emotions.
 
17. UNRELENTING STANDARDS / HYPERCRITICALNESS
The underlying belief that one must strive to meet very high internalized standards of behavior and performance, usually to avoid criticism. Typically results in feelings of pressure or difficulty slowing down; and in hypercriticalness toward oneself and others. Must involve significant impairment in: pleasure, relaxation, health, self-esteem, sense of accomplishment, or satisfying relationships
Unrelenting standards typically present as: (a) perfectionism, inordinate attention to detail, or an underestimate of how good one's own performance is relative to the norm; (b) rigid rules and &qout;shoulds&qout; in many areas of life, including unrealistically high moral, ethical, cultural, or religious precepts; or (c) preoccupation with time and efficiency, so that more can be accomplished.
 
18. PUNITIVENESS
The belief that people should be harshly punished for making mistakes. Involves the tendency to be angry, intolerant, punitive, and impatient with those people (including oneself) who do not meet one's expectations or standards. Usually includes difficulty forgiving mistakes in oneself or others, because of a reluctance to consider extenuating circumstances, allow for human imperfection, or empathize with feelings.
COPYRIGHT 2003, Jeffrey Young, Ph.D. Unauthorized reproduction without written consent of the author is prohibited. For more information, write: Cognitive Therapy Center of New York, 36 West 44th Street, Suite 1007, New York, NY 10036.
 
Coping styles

We cope with the pain associated with the neglect and abuse that leads to the development of schemas and modes using one or more of three major coping styles:

1. Surrendering by accommodating to the way we are treated and acting as if, and believing, it is the way things should be.

2. Avoiding by disconnecting emotionally or physically from the people who mistreat us and/or by disconnecting from our own emotions.

3. Overcompensating by attempting to fight against the schema and prove it is not true by, for example, trying to do things perfectly so that we don’t feel defective or trying to get control over others so that we don’t get left “at the short end of the stick” or taken advantage of. 
While each of these three ways of coping help to reduce pain in the short run, they become the way we unwittingly, but actively, perpetuate schemas and modes in the long run. Those of us who lean towards surrendering will need help to learn to fight against mistreatment and neglect, those of us who lean towards avoidance will need help to gain the courage to face painful feelings and challenging situations and those of us who lean towards overcompensation will need help to gain the courage to become more vulnerable.

Modes

The original model used early maladaptive schemas as the unifying framework. The most recent development has added the construct of modes. A mode refers to a part of the self that is expressed through the predominant state that we are in at a given point in time. A schema or coping style refers to a trait. A mode consists of our current mood state, as well as behaviors and cognitions. Modes are seen as existing along a continuum of dissociation. On the one end are modes that flexibly shift and blend to appropriate degrees and forms of expression as called for by the situation. Borderline Personality Disorder (BPD) lies along the more dissociated end of the spectrum and is characterized by sudden unmodulated shifts from one mode to another. 
Common schema modes are the Vulnerable Child, Angry Child, Detached Protector, Punitive, Critical Parent, Overcompensator, Spontaneous Child, and Healthy Adult.

Why Modes?

The schema mode concept was originally developed in work with BPD. Many BPD patients identify with most of the 18 early maladaptive schemas. In addition there is often rapid shifting between various schemas and coping strategies. Talking with a BPD patient about all the schemas she has and attempting to track them can be overwhelming for both the patient and unwieldy for the therapist. Modes condense processes related to multiple rapidly shifting schemas and coping strategies into, in the case of BPD, five relatively simple constructs; the Vulnerable Child, Angry Child, Punitive Parent, Detached Protector and Healthy Adult. It then becomes much easier for the therapist and patient to track the rapid shifts among these five modes. It has since been found that various personality disorders are characterized by distinct constellations of modes. This will invariably include modes that serve the function of fleeing from or fighting the treatment process. The mode construct allows the therapist to ally with the healthy adult mode of the patient by joining with her in labeling and responding to problematic modes that threaten to take over the patient and the therapy.

Choosing Between the Mode and Schema Model

When a patient has schema modes which do not overtake her, the schema model allows for greater precision in talking about themes. When modes overpower or disrupt a patient’s experience, the mode model allows for greater flexibility and leverage.