INTRODUCTION
Cognitive psychologists are well aware that human beings ‘chunk’ information in order to be able to draw on a network of ideas to a particular context or domain. Generally , the largest ‘chunks’ are called schema and the most powerful schema include the beliefs about self and others. These two domains are the pillars of the mental architecture and across them is the lintel of expectancy, for what I believe about myself and others invariably sets in motion my thoughts about what to expect out of the world. When the cognitive beliefs, values, attitudes and metaphors about self and others is balanced, rational and optimistic, our expectations of life will usually be pretty positive. On the other hand, a negative belief about self and others is likely to lead to problems in living. When people have negative thoughts, they may or may not require change. Depending on the circumstances and the degree of negativity, it may be sufficient to resolve their automatic thoughts using CBT#01 – Perceiving Reflex Thoughts, #02 Altering Limited Thinking Patterns &/or #03 Changing Distressing Thoughts. These techniques essentially outline a Cognitive Process Correction protocol. However, sometimes the schema are so maladaptive that much deeper adaptation of Cognitive Restructuring is necessary and one of the tools for that process is schema focused counseling.
SCHEMA FOCUSED COUNSELING
This is an approach developed by Dr. Jeff Young, who originally worked closely with Dr. Aaron Beck, founder of Cognitive Therapy. Dr. Young and his colleagues found a segment of people who had difficulty in benefiting from the standard approach – people typically with long-standing patterns or themes in thinking and feeling – and consequently in behaving or coping – that required an expanded means of intervention. Dr. Young’s attention turned to ways of helping these clients to address and modify these deeper patterns or themes, also known as ‘schemata’.
The schemata that are targeted are enduring and self-defeating patterns that typically begin early in life. These patterns consist of negative/ dysfunctional thoughts, feelings and behaviors, have been repeated and elaborated upon, and pose obstacles for accomplishing one’s goals and getting one’s needs met. Some automatic thought examples of thematic beliefs are: “I’m unlovable,” “I’m a failure,” “People don’t care about me,” “I’m not important,” “Something bad is going to happen,” “People will leave me,” “I will never get my needs met,” “I will never be good enough,” and so on. These thoughts and beliefs are usually supported imaginally through metaphor and other symbols.
Although schemata are usually developed early in life (during childhood or adolescence), they can also form later, in adulthood. These schemata are perpetuated behaviorally through the coping styles of schema maintenance, schema avoidance, and schema compensation. The Schema Focused model is designed to help the person to break away from negative or maladaptive patterns of thinking, feeling and behaving, which are often very tenacious, and to develop healthier alternatives to replace them. The approach has shown remarkable results in helping people to change patterns which they have lived with for a long time, even when other methods and efforts they have tried before have been unsuccessful.
Eighteen [18] early maladaptive schemata have been identified through clinical observation. Like the list of cognitive errors used in cognitive process correction, they provide a model for what to watch for although individual clients may group their thoughts differently
Emotional Deprivation:
The belief and expectation that your primary needs will never be met. The sense that no one will nurture, care for, guide, protect or empathize with you.
Abandonment:
The belief and expectation that others will leave, that others are unreliable, that relationships are fragile, that loss is inevitable, and that you will ultimately wind up alone.
Mistrust/Abuse:
The belief that others are abusive, manipulative, selfish, or looking to hurt or use you. Others are not to be trusted.
Defectiveness:
The belief that you are flawed, damaged or unlovable, and you will thereby be rejected.
Social Isolation:
The pervasive sense of aloneness, coupled with a feeling of alienation.
Vulnerability:
The sense that the world is a dangerous place, that disaster can happen at any time, and that you will be overwhelmed by the challenges that lie ahead.
Dependence/Incompetence:
The belief that you are unable to effectively make your own decisions, that your judgment is questionable, and that you need to rely on others to help get you through day-to-day responsibilities.
Enmeshment/Undeveloped Self:
The sense that you do not have an identity or “individuated self” that is separate from one or more significant others.
Failure:
The expectation that you will fail, or belief that you cannot perform well enough.
Subjugation:
The belief that you must submit to the control of others, or else punishment or rejection will be forthcoming.
Self-Sacrifice:
The belief that you should voluntarily give up of your own needs for the sake of others, usually to a point that is excessive.
Approval-Seeking/Recognition-Seeking:
The sense that approval, attention and recognition are far more important than genuine self-expression and being true to oneself.
Emotional Inhibition:
The belief that you must control your self-expression or others will reject or criticize you.
Negativity/Pessimism:
The pervasive belief that the negative aspects of life outweigh the positive, along with negative expectations for the future.
Unrelenting Standards:
The belief that you need to be the best, always striving for perfection or to avoid mistakes.
Punitiveness:
The belief that people should be harshly punished for their mistakes or shortcomings.
Entitlement/Grandiosity:
The sense that you are special or more important than others, and that you do not have to follow the rules like other people even though it may have a negative effect on others. Also can manifest in an exaggerated focus on superiority for the purpose of having power or control.
Insufficient Self-Control/Self-Discipline:
The sense that you cannot accomplish your goals, especially if the process contains boring, repetitive, or frustrating aspects. Also, that you cannot resist acting upon impulses that lead to detrimental results.
This cognitive-development model is based on the assumption that many negative cognitions have their roots in past learning experiences. It proposes an integrative systematic model of intervention for a wide spectrum of chronic, difficult and characterological problems.¬ A basic premise is that individuals with more complex problems have one or more early maladaptive schemata.¬
An Early Maladaptive Schema [EMS] has been defined as ‘a broad pervasive theme or pattern regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree’.¬ Schemata are connecting networks of thoughts about self, others and future expectations around a specific domain. The schema tells you what to look for, what to see, and how to interpret these stimuli. Schemata are extremely stable and enduring patterns, comprised of memories, bodily sensations, emotions, and cognitions. When a person has an EMS like abandonment, they have all the memories of early abandonment, the emotions of anxiety or depression, which are attached to abandonment, bodily sensations and thoughts that people are going to leave them.¬ They may even use metaphors such as being adrift alone at sea, to describe the totality of these thoughts and feelings. An EMS, therefore, is the deepest level of cognition that contains memories and intense emotions when activated and provide a way of organizing thoughts, feelings and behaviors.
The three basic origins are thought to be:
- Early childhood experiences.
- The innate temperament of the child.
- Cultural influences.
It is believed that the combination of these three lead to early maladaptive schemata.¬
The child who does not get his/her core needs met.
The child needed affection, empathy and guidance but didn’t get it, etc.
The child who is traumatized or victimized by a very domineering, abusive, or highly critical parent.
The child learns primarily by internalizing the parent’s voice. Every child internalizes or identifies with both parents and absorbs certain characteristics of both parents, so when the child internalizes the punitive punishing voice of the parent and absorbs the characteristics they become part of the schemata.
The child who receives too much of a good thing.
The child who is overprotected, overindulged or given an excessive degree of freedom and autonomy without any limits being set.
Therefore, EMS began with something that was done to the child or perceived by the child to be done by the family or by other children, which damaged them in some way. S/he might have been abandoned, criticized, overprotected, emotionally or physically abused, excluded or deprived and, consequently, the thematic thoughts can becomes part of the schema.
As put by Joseph Santoro in The Angry Heart “…dysfunctional family environment, …psychotraumatizing, creates a person whose heart is wounded by fear and anger and whose mind is often confused and impulsive. This is someone, who, because of his or her family environment, develops a personality disturbance and is at risk for addiction, failure and even self destruction”.
Schemata are essentially an elaborate compendium of representations of early childhood experiences, and serve as templates for processing and defining later behaviors, thoughts, feelings and relationships with others. Early maladaptive schemata include entrenched patterns of distorted thinking, disruptive emotions and dysfunctional behaviors.¬ These schemata become fixed when they are reinforced and/or modeled by parents.
Long after we leaving home , the person with EMS continues to create situations in which they are mistreated, ignored, put down or controlled and in which they fail to reach desired goals.
Schemata are perpetuated throughout one’s lifetime and become activated under conditions relevant to the particular domain.
Changing early maladaptive schemata
It is important to realize that schemata can be functional or dysfunctional and are core cognitive constructs in what is typically referred to as our personality style. For example, someone may have a schema of personal incompetence, from which his or her actions are consistently interpreted as ‘not good enough’. Someone else may have a schema of mistrust, from which all interpersonal actions by others are seen as suspicious. A third person may have a dependency schema and feel unable to function alone without help. Even when presented with evidence that disproves the schema, individuals distort data to maintain its validity. People have a variety of schema, for example, a person probably has a restaurant schema which predicts the behavior in a restaurant. To indicate the impact of a schema on one’s ability to respond, imagine sitting down in a restaurant and being handed a menu by a waitperson who then asks whether you would rather sing?. Such an experience would be disconcerting to most people. In fact, the usual response would be ‘What?’ – for you may not even be able to hear the words since they do not fit into the core of the schema context. Your schema, therefore, have a powerful influence not only on how you behave, but on what you perceive.
The most dominant early maladaptive schemata are the ones developed in the preverbal stage. It is these preverbal schemata that tend to be entrenched and absolute, while the later ones tend to be conditional.¬ Most important to this entrenchment is the fact that the preverbal encoding is symbolic rather than logical, making identifying it cognitively and acting on it consciously much more difficult; which may make it more resistant to cognitive process correction and other approaches. Such embedded schema are self-perpetuating, very resistant to change and usually do not change without specific counseling input. It is because these schema are created so early, that we believe that it would be useful to use these techniques on children and adolescents.
Early maladaptive schemata are unconditional themes (entrenched beliefs and emotions) held by individuals.¬ Because of this and the fact that schemata begin so early in life, people feel secure in knowing who they are and what their world is like even though the reality may contradict. This sense of security and predictability is comfortable and familiar, making it difficult to change, even if the schema is ineffective and distressing. The devil known is less frightening than the devil unknown.
Once a pattern of thought, emotion and behavior is established we tend to repeat it over and over. The universal tendency is for individuals to repeat in their lives distressing or even painful situations without realizing they are doing so, or even understanding they are bringing about the recurrence and repeating in their current situations the worst times from the past. Somehow people manage to create, in adult life, conditions remarkably similar to those that were so destructive in childhood. A schema provides the basis for the re-creation of these patterns because it is the way s/he thinks about him/herself and others that influences his/her emotional status and behavior, let alone what s/he perceives.
This helps to explain why individuals are likely to be drawn to partners where there is a high degree of emotional chemistry that triggers their schemata, even when these people are not objectively healthy for them.¬ People with (EMS) tend to be drawn to partners who trigger their core schemata and maladaptive partner selection is another strong mechanism through which schemata are maintained.
There are three broad coping styles, which ultimately reinforce the schemata through avoiding experiencing painful emotions associated with schema activation. These coping styles are processes that overlap with the psychoanalytical concepts of resistance and defense mechanisms:
Schema surrender is everything the person does to keep the schema going, e.g. if someone has a defectiveness schema and they stay in a relationship with someone who has criticized them, they are surrendering to the schema, allowing themselves to be criticized, thus enhancing the schema. ¬¬But from their perception, they have no choice; they are defective and everyone else knows it so they expect to be criticized. They may not even recognize the person who is not critical, let alone become attracted to them.
Schema avoidance is avoiding the schema either by avoiding situations that trigger the schema or by psychologically removing yourself from the situation so you don’t have to feel the impact. An example of avoidance might be the person with a mistrust schema who avoids making friendships because of the fear of being hurt or taken advantage of.¬ This action only tends to reinforce the belief when others pick up the aloofness of the individual and distance themselves. The avoidance is not actually of the schema, but of the situations in which they believe the schema is played out. Paradoxically, they are giving in to the schema by their very avoidance.
Schema overcompensation is an excessive attempt to fight the schema by trying to do the opposite of what the schema would tell you to do.¬ So if someone has a subjugation schema, they might rebel against the people who are subjugating them. If the overcompensation is too extreme it ultimately backfires and reinforces the schema.¬ A form of overcompensation is externalizing the schema, by blaming others and becoming aggressive. Another way can be achieving at a very high level, whereby, a person who feels defective works 80 hours a week to overcompensate.
The Schema Focused model is designed to help people break these maladaptive coping styles which perpetuate negative patterns of thinking, feeling and behaving, so that individuals can get their core needs met. The process continues on the awareness, attendance, analysis, alternative and adaptation of the cognitive process correction, but is not limited to single automatic thoughts, but expands to cover themes. By switching between past events and current problems, using imagery and role playing, higher levels of affect are activated. Using Interactive Imagery the client is helped to talk to his inner child as s/he experiences early life as remembered, comforts the child, changing the submodalities, and finding alternative meanings in the experience. [See CBT#14 Testing Core Beliefs and CBT#15 Changing Core Beliefs with Visualization.
As a psychoeducational process to enable cognitive change, clients are helped to understand where the dysfunctional schema originated and how it is being maintained. However, because insight rarely leads to change, schema-focused counseling utilizes cognitive, behavioral and interpersonal techniques including empathic reality testing, whereby, the counselor fully acknowledges and validates distressing feelings and beliefs, while pointing out another more balanced and rational view.¬ This process serves to challenge and modify negative thoughts and behaviors, which are rigidly intact.
Schema focused counseling deals with life patterns rather than current situations, which have arisen. ¬Signs include long-term relationship problems – choosing the wrong partners, getting into relationships where you always feel criticized, deprived, controlled, always fighting and feeling angry – displaying repetitive patterns.
The main goals of schema-focused services are:
- identifying early maladaptive schemata that maintain the client’s presenting problem and seeing how they are played out in everyday situations
- changing dysfunctional core beliefs and building alternative beliefs, which can be used to fight the schemata¬
- breaking down maladaptive life patterns into manageable steps and changing the coping styles, which maintain the schemata, one step at a time
- providing clients with the skills and experiences that create adaptive thinking and healthy emotions
- empowering clients and validating their emotional needs that were not met, so that their needs will be met in everyday life.
ANOTHER WAY TO LOOK AT EARLY MALADAPTIVE SCHEMA
Because the themes of early maladaptive schema are often intertwined in individual ways, it is helpful to reorganize the eighteen identified early maladaptive schemata into five themes known as domains. Each of the five domains contain categories of schemata which represents an important component of a child’s core needs. When these needs are not met negative schemata may develop, resulting in unhealthy life patterns:¬
Domain I: DISCONNECTION & REJECTION
Schemata in this domain result from early experiences of a detached, explosive, unpredictable, or abusive family environment. People with these schemata expect that their needs for security, safety, stability, nurturance, and empathy in intimate or family relationships will not be met in a consistent or predictable way.
Abandonment/Instability
This schema refers to the expectation that one will soon lose anyone with whom an emotional attachment is formed. The person believes that one way or another close relationships will end imminently. This schema usually occurs when the parent has been inconsistent in meeting the child’s needs.
Mistrust
This schema refers to the expectation that others will intentionally take advantage in some way. People with this schema expect others to hurt, cheat, or put them down. Often significant others were abusive emotionally or sexually and betrayed the child’s trust.
Emotional Deprivation
This schema refers to the belief that others will never meet ones primary emotional needs.¬ These needs include nurturance, empathy, affection, protection, guidance and caring from others. Often significant others were emotionally depriving to the child.
Social Isolation/ Alienation
This schema refers to the belief that one is isolated from the world, different from others, and/or not part of any community. This belief is usually caused by experiences in which children see that either they, or their families, are different from other people.
Defectiveness/ Shame
This schema refers to the belief that one is internally flawed, and that, if others get close, they will realize this and withdraw from the relationship. This feeling of being flawed and inadequate often leads to a strong sense of shame. Generally, parents were very critical of their children and made them feel not worthy of being loved.
Social Undesirability
This schema refers to the belief that one is outwardly unattractive to others. People with this schema see themselves as physically unattractive, socially inept, or lacking in status. Usually there is a direct link to childhood experiences in which children are made to feel, by family or peers, that they are not attractive.
Failure to Achieve
This schema refers to the belief that one is incapable of performing as well as one’s peers in areas such as career, school, or sports. These clients may feel stupid, inept, untalented, or ignorant. People with this schema often do not try to achieve, because they believe that they will fail. This schema may develop if children are put down and treated as if they are a failure in school or other spheres of accomplishment. Usually the parents did not give enough support, discipline, and encouragement for the child to persist and succeed in areas of achievement such as schoolwork or sports.
Domain II: IMPAIRED AUTONOMY & PERFORMANCE
Schemata in this domain have to do with expectations about oneself and the environment that interfere with one’s ability to separate and function independently and one’s perceived ability to survive alone. The typical family of origin is enmeshed, undermining of the child’s judgement, or overprotective.
Dependence/Incompetence
This schema refers to the belief that one is not capable of handling day-to-day responsibilities competently and independently. People with this schema often rely on others excessively for help in areas such as decision making and initiating new tasks. Usually parents did not encourage these children to act independently and develop confidence in their ability to take care of themselves.
Vulnerability to Harm and Illness
This schema refers to the belief that one is always on the verge of experiencing a major catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive precautions to protect oneself. Usually there was an extremely fearful parent who passed on the idea that the world is a dangerous place.
Enmeshment/Undeveloped Self
This schema refers to the sense that one has too little individual identity or inner direction. There is often a feeling of emptiness or of floundering. This theme is usually developed from parents who are so controlling, abusive, or overprotective that the child is discouraged from developing a separate sense of self.
Failure
This schema refers to the belief that one has failed, will fail, or is fundamentally inadequate compared to others. Parents, who did not give enough support, expected the child to fail, treated him/her as stupid and/or never taught the child the discipline to succeed, usually cause this belief.
Domain III: IMPAIRED LIMITS
Schemata in this domain relate to deficiencies in internal limits, respect and responsibility to others, or meeting realistic personal goals. The typical family origin is permissiveness and indulgence.
Entitlement/Self-Centeredness
This schema refers to the belief that you should be able to do, say, or have whatever you want immediately, regardless of whether that hurts others or seems unreasonable to them. You are not interested in what other people need, nor are you aware of the long-term costs to you of alienating others. Parents who overindulge their children and who do not set limits about what is socially appropriate may promote the development of this schema. Alternatively, some children develop this schema to compensate for feelings of emotional deprivation, defectiveness, or social undesirability.
Insufficient Self-Control/Self-Discipline (Low Frustration Tolerance)
This schema refers to the inability to tolerate any frustration in reaching one’s goals, as well as an inability to restrain expression of one’s impulses or feelings. When lack of self-control is extreme, criminal, or addictive behavior rule your life. Parents who did not model self-control, or who did not adequately discipline their children, may predispose them to have this schema as adults.
Domain IV: OTHER-DIRECTNESS
Schemata in this domain relate to an excessive focus on meeting the needs of others, at the expense of one’s own needs. The typical family origin is based on conditional acceptance, whereby children suppress normal needs and emotions in order to gain attention, approval and love.
Subjugation
This schema refers to the belief that one must submit to the control of others in order to avoid negative consequences. Often these clients fear that, unless they submit, others will get angry or reject them. Clients who subjugate ignore their own desires and feelings. In childhood there was generally a very controlling parent.
Self-Sacrifice
This schema refers to the excessive sacrifice of one’s own needs in order to help others. When these clients pay attention to their own needs, they often feel guilty. To avoid this guilt, they put others’ needs ahead of their own. Often people who self-sacrifice gain a feeling of increased self-esteem or a sense of meaning from helping others. In childhood the person may have been made to feel overly responsible for the well being of one or both parents.
Approval-Seeking
This schema refers to an excessive emphasis on gaining approval and recognition from others at the expense of one’s own ideas. This may involve an overemphasis on status, money, and achievement.¬ Usually parents were concerned with social status, appearance by others, or offered conditional acceptance etc.
Domain V: OVERVIGILANCE & INHIBITION
Schemata in this domain involve an excessive focus on controlling, suppressing, or ignoring of one’s emotions and spontaneous feelings in order to avoid making mistakes, or meeting ridged internalized rules. Typical family origins are domination and suppression of feelings, or a bleak environment where performance standards and self-control take priority over pleasure and playfulness
Negativity/Vulnerability to Error
This schema refers to an exaggerated expectation that things will go wrong at any moment, an inordinate fear of making mistakes that could lead in that direction. “That which can go wrong, will!” This may involve financial loss, humiliation, making mistakes leading to excessive worrying. Parents were pessimistic, worried, or expected the worst outcome.
Overcontrol/Emotional Inhibition
This schema refers to the belief that you must inhibit emotions and impulses, especially anger, because any expression of feelings would harm others, or lead to loss of self-esteem, embarrassment, retaliation, or abandonment. You may lack spontaneity, or be viewed as uptight. Usually parents discourage the expression of feelings bring on this schema.
Unrelenting Standards/Hypocriticalness
This schema refers to two related beliefs. Either you believe that whatever you do is not good enough, that you must always strive harder; and/or there is excessive emphasis on values such as status, wealth, and power, at the expense of other values such as social interaction, health, or happiness. Usually these clients’ parents were never satisfied and gave their children love that was conditional on outstanding achievement.
Punitiveness
This schema refers to the belief that one must be angry and harshly punishing with those people (including oneself) who do not meet one’s (high) expectations or standards. Usually these parents blamed, punished, or were verbally abusive when mistakes were made.
SUMMARY AND CONCLUSIONS
Young has give us a frame of reference to address severe and persistent problems in life and suggested ways of helping clients think about their circumstances and address change. Schema Focused Counseling, like CBT#38 – Dialectical Behavioral Counseling – could potentially be designated a protocol, rather than a technique because it gives a frame of reference for an approach to counseling more than the specific procedures for carrying out the task . In fact, we believe that it is significant to combine the two for addressing the Cognitive Restructuring of very severe but resistant children and adolescents. Within the context of Schema Focused Counseling, the internal logic and symbolism must both be addressed. There are, therefore, a series of techniques that are recommended to be used in tandem to this form of counseling.
From the logic perspective CBT#01 – Perceiving Reflex Thoughts, CBT#02 – Altering Limited Thinking Patterns and/or Changing Distressing Thoughts are the baseline for they set the awareness, attendance, analysis, alternatives and adaptation pattern. However, the counselor will need to be able to link the automatic thoughts to the themes and help the person through a psychoeducation account of the conceptual background and come to an understand the context from which they are viewing the world.
Since Early Maladaptive Schema are formed in the preverbal stages of life, symbolism and imagery must be a major part of the process of change. We have already mentioned CBT#14 Testing Core Beliefs & #15 Changing Core Beliefs with Visualization. We would now suggest that CBT#22 – Six Step Reframing and CBT#37 The Metaphor Model & Clean Language be considered as well.
Finally, CBT#04 – Relaxation should be used with almost any client with emotional difficulties.