Transcript Schema Therapy Rules - 2014 newest Ray Ban Wayfarer, Ray

The Sex Addict’s Schema
and the Drive to Act Out
Presented By:
Mary L. Deitch, JD, PsyD
and
Tanisha M. Ranger, PsyD, CSAT(4)
Origins of Schema Theory
• Developed to address CBT “treatment failures”
• CBTs fundamental assumptions
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–
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Compliance with treatment
The ability to collaborate with the therapist
A logical basis for change
Accurate self-assessment
Problem specificity
• Schema theory is a unifying theory combining
cognitive, behavioral, attachment, psychodynamic and
gestalt theories and techniques
Schema Theory
•
•
•
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What is a schema?
Where do schemas come from?
How do schemas work?
What are the known schemas?
How do schemas change?
What is the goal of schema therapy?
What is a Schema?
• A dysfunctional assumption about the self, the
world and one’s relationship to others
• Broad and pervasive pattern comprised of
thoughts, feelings, bodily sensations and
memories
• Developed during childhood/adolescence and
elaborated upon throughout the life span –
schemas become the lens through which life is
seen
Where do Schemas come from?
• Toxic frustration of core childhood needs
–
–
–
–
Attention
Affection
Protection
Play
• Victimization, traumatization and/or abuse
during childhood and adolescence
How do schemas work?
• Two primary operations: schema perpetuation and
schema healing
– All thought processes, behaviors and feelings can be seen as
contributing to one of the two operations
• Schema Perpetuation
– The routine processes by which schemas function to
perpetuate themselves
– Includes: cognitive distortions, self-defeating behavior
patterns and maladaptive coping styles
– Schemas tend to highlight and exaggerate environmental
evidence that supports them, while minimizing or ignoring
evidence that refutes
How do schemas work?
• Schema Perpetuation (Cont’d)
– Schemas are made up of thoughts, feelings and
bodily sensations
– It is through the maladaptive coping styles that they
exert influence over behavior and ensure their
survival
– Three maladaptive coping styles: Surrender,
Avoidance, and Overcompensation
How do schemas work?
• Schema Perpetuation (Cont’d)
– Surrender
• Refers to the ways in which people passively give in to the schema
• They accept the schema as fact and then act in ways that confirm
– Avoidance
• Refers to the ways in which people attempt to avoid the schema –
they may avoid activating the schema or avoid experiencing the
painful emotions once the schema has been activated
• Three types of avoidance are: cognitive, emotional and behavioral
– Overcompensation
• Refers to behavior that directly contradicts what the schema suggests
in an attempt to avoid triggering the schema
• They may appear healthy on the surface, but often take behaviors to
the extreme
How do schemas work?
• Schema Healing
– Occurs when therapeutic techniques are used to weaken
maladaptive schemas and coping styles
– Involves an alliance between the therapist and the client’s
healthy side against the schemas
– Therapeutic techniques:
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•
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Challenging, questioning and contradicting schemas
Role playing and real world experiments
Guided imagery
Limited re-parenting
Empathic confrontation
ECU Sample Data
• Total Clients: 50
– Level One: 14 (28%)
– Level Two: 19 (38%)
– Level Three: 17 (34%)
• Attachment Style (ECR Scale)
–
–
–
–
Fearful/Avoidant: 11 (22%)
Preoccupied: 11 (22%)
Dismissing: 7 (14%)
Secure: 21 (42%)
• Clients with more than 1 schema ranked Very High - 36 (72%)
• Client with no schemas High or Very High - 3 (6%) These clients also
described themselves as Securely Attached
What are the known Schemas?
• Disconnection & Rejection Domain
– Focused on the expectation that one’s needs for security,
safety, empathy, belonging and respect will not be met in a
predictable manner
– ABANDONMENT – MISTRUST – EMOTIONAL
DEPRIVATION
– DEFECTIVENESS – SOCIAL ISOLATION
Emotional Deprivation
• This schema is characterized by the expectation that
one’s normal needs for emotional support will not
be met. Typically a result of deprivation of
nurturance, empathy or protection as a child.
Very
High: 16
(32%)
Level
One: 3
(19%)
Level
Two: 9
(56%)
Level
Fearful: 5
Three: 4 (31%)
(25%)
Preoccupied
5 (31%)
Dismissing Secure: 4
: 2 (13%)
(25%)
High: 6
(12%)
Level
One: 3
(50%)
Level
Two: 2
(33%)
Level
Fearful: 3
Three: 1 (50%)
(17%)
Preoccupied:
1 (17%)
Dismissing Secure: 2
:0
(33%)
Total: 22
(44%)
Total: 6
(28%)
Total:
11
(50%)
Total: 5
(23%)
Total: 6 (28%) Total: 2
(9%)
Total: 8
(37%)
Total: 6
(27%)
Abandonment
• This Schema is about the perceived instability or
unreliability of those who are meant to provide support
and connection. Withdrawal of support may be due to
death, imminent illness, emotional instability, or finding
Very
Level
Level
Level
Fearful: Preoccupied: 4 Dismissing Secure: 3 (23%)
someone
new/better.
High:
One: 3 Two:
7 Three: 3 6 (46%) (31%)
:0
13
(26%)
(23%)
(54%)
(23%)
High:
5
(10%)
Level
One: 0
Level
Two: 3
(60%)
Level
Fearful:
Three: 2 0
(40%)
Total:
18
(36%)
Total:
3
(17%)
Total:
10
(56%)
Total: 5
(28%)
Preoccupied: 1
(20%)
Total: 6 Total: 5 (28%)
(33%)
Dismissing: Secure: 2 (40%)
2 (40%)
Total: 2
(40%)
Total: 5 (28%)
Mistrust/Abuse
• Individuals with this schema operate under the
assumption that others will use, hurt, abuse, cheat,
lie to, or otherwise take advantage of them, and that
this harm is typically maliciously intended.
Very
Level
High: 13 One:2
Level
Two: 9
Level
Three: 2
Fearful 4
Preoccupied: 3
Dismissing: Secure: 5
1
High: 10 Level
One:2
Level
Two: 4
Level
Three: 4
Fearful 3
Preoccupied: 3
Dismissing:
1
Secure: 3
Total: 6
Total: 7
Total: 6
Total: 2
Total: 8
Total:
23
Total: 4 Total:
13
Social Isolation
• This Schema is characterized by the belief that one is
isolated from the rest of the world, different from other
people, and/or not part of any group or community. .
Very
High:
13
Level
One:2
Level
Two: 8
Level
Three:
3
Fearful:
3
Preoccupied: Dismissing Secure: 3
5
:2
High: 4 Level
One:1
Level
Two: 2
Level
Three:
1
Fearful:
2
Preoccupied:
0
Dismissing: Secure: 2
0
Total:4
Total: 5
Total: 5
Total: 2
Total:
17
Total: 3 Total:
10
Total: 5
Defectiveness
• This Schema is characterized by the belief that
one is flawed, defective, or inferior. These
individuals believe that if they let anyone get
close enough to see these flaws, they would be
unlovable.
Very
Level
Level
Level
Fearful: 4 Preoccupied: Dismissing: Secure: 5
High: 16 One:3
Two: 7
Three: 6
4
High: 9
Level
Two: 4
Level
Fearful: 2
Three: 3
Preoccupied: 3 Dismissing:
1
Secure: 3
Total: 7
Total: 8
Level
One:2
Total: 25 Total: 5
Total: 11 Total:9
Total: 6
3
Total: 4
What are the known Schemas
• Impaired Autonomy & Performance Domain
– Focused on expectations about the self and one’s
surroundings that interfere with one’s perceived ability to
survive, thrive, separate and function independently
– DEPENDENCE – VULNERABILITY TO HARM
– ENMESHMENT – FAILURE
Failure
• This Schema involves the belief that one will fail or
has failed in major areas of achievement such as
work, school or sports. Individuals generally feel.
inadequate when compared to others.
Very
High: 9
Level
One:2
Level
Two: 5
Level
Three: 2
Fearful: 2 Preoccupied: 2 Dismissing: Secure:
2
3
High: 3
Level
One:2
Level
Two: 0
Level
Three: 1
Fearful:0
Preoccupied: 1 Dismissing: Secure:
1
1
Total:
12
Total: 4
Total: 5
Total:3
Total: 2
Total: 3
Total: 3
Total: 4
Dependence
• This Schema is characterized by the belief that
one is incapable of handling everyday
responsibilities and decisions without
considerable
help
from
others
Very
Level
Level
Level
Fearful: Preoccupied: 4 Dismissing: Secure:
High: 10
One: 2
Two: 4
Three: 4
3
1
High: 4
Level
One: 1
Level
Two: 2
Level
Three: 1
Fearful:2 Preoccupied: 1
Dismissing: Secure:
1
0
Total: 14
Total:
3
Total: 6
Total:5
Total: 5
Total: 2
Total: 5
2
Total: 2
Vulnerability
• This Schema is characterized by fear of
catastrophe and that one will be unable to
prevent harm. These fears can involve medical
issues, emotional crises, or external crises.
Very
High: 6
Level
One:1
Level
Two: 2
Level
Three: 3
Fearful: 0 Preoccupied:
2
Dismissing: Secure: 3
1
High: 5
Level
One:0
Level
Two: 2
Level
Three: 3
Fearful:2
Preoccupied: 2 Dismissing: Secure: 1
0
Total:
11
Total: 1 Total: 4
Total:6
Total: 2
Total: 4
Total: 1
Total: 4
Enmeshment
• Individuals with this schema often have a history of excessive
emotional involvement with significant others (often parents)
that hinders their ability separate/individuate and experience
normal social development. May include feelings of emptiness,
being smothered by others, or being codependent on others.
Very
High: 4
Level
One: 1
Level
Two: 1
Level
Three: 2
Fearful:
1
Preoccupied: 2
High: 6
Level
One:2
Level
Two: 3
Level
Three: 1
Fearful:2 Preoccupied: 1
Dismissing:
1
Secure: 2
Total:
10
Total: 3 Total: 4
Total:3
Total: 3
Total: 1
Total: 3
Total: 3
Dismissing: Secure: 1
0
What are the known Schemas?
• Impaired Limits Domain
– Focused on a deficiency of internal limits, responsibility to
others, or long-term goal-orientation which leads to difficulty
respecting the rights of others, cooperating, committing, and
setting/meeting realistic personal goals
– ENTITLEMENT – INSUFFICIENT SELFCONTROL
Entitlement
• This Schema is characterized by the belief that one is superior to
others, not guided by normal social rules or entitled to special
treatment. These individuals display competiveness towards
others, asserting power and controlling others. Sometimes they
display a lack of empathy towards others.
Very
Level
High: 11 One: 3
Level
Two: 7
Level
Three: 1
Fearful: Preoccupied:4
2
Dismissing: Secure:
0
5
High: 7
Level
One:2
Level
Two: 3
Level
Three: 2
Fearful:
2
Preoccupied: 2
Dismissing: Secure:
1
2
Total:
18
Total: 5
Total:
10
Total:3
Total: 4
Total: 6
Total: 1
Total: 7
Insufficient Self Control
• This Schema is characterized by pervasive difficulty in
exercising self control in order to achieve goals;
impaired limits on emotional expression; or exaggerated
emphasis on avoiding painful or uncomfortable
experiences.
Very
Level
High: 16 One:4
Level
Two:
8
High: 13 Level
One:3
Level Level
Two: 5 Three: 5
Fearful:2
Preoccupied: 4
Dismissing: Secure:
2
5
Total:
29
Total:
13
Total: 7
Total: 8
Total: 3
Total: 7
Level
Three: 4
Total:9
Fearful: 5 Preoccupied: 4 Dismissing Secure:
:1
6
Total:
11
What are the known Schemas?
• Other-Directedness Domain
– Involves an excessive focus on the desires, feelings and
responses of others, at the expenses of one’s own needs in
order to avoid rejection & retaliation or to gain love &
acceptance
– SUBJUGATION – SELF-SACRIFICE – APPROVALSEEKING
Subjugation
• The schema of subjugation involves an excessive surrendering of
control to others out of a fear of anger, retaliation or
abandonment. It takes two major forms: subjugation of needs
(the suppression of one’s preferences, decisions and desires) and
subjugation of emotions (the suppression of emotional
expression, particularly anger)
Very
High: 15
Level
One:4
Level
Two: 8
Level Three:
3
Fearful: 5 Preoccupied: 5
Dismissing: Secure: 3
2
High: 2
Level
One:2
Level
Two: 0
Level Three:
0
Fearful:0
Preoccupied: 1
Dismissing:
1
Secure: 0
Total: 17
Total: 6
Total: 8
Total:3
Total: 5
Total: 6
Total: 3
Total: 3
Self-Sacrifice
• This schema involves an excessive focus on voluntarily meeting
the needs of others, at the expense of one’s own gratification.
The most common reasons are: to prevent causing pain to
others, to avoid the guilt from feeling selfish, or to maintain a
connection with
others
whoFearful:
are perceived
as needy.
Level
Level
Preoccupied: 4 Dismissing
Very
Level
High: 16 One:7
Two: 4
Three: 5
5
:2
High: 13 Level
One:2
Level
Two: 6
Level
Three: 5
Fearful:3 Preoccupied: 4
Dismissing: Secure: 4
2
Total:
29
Total:
10
Total:10
Total: 8
Total: 4
Total: 9
Total: 8
Secure: 5
Total: 9
Approval Seeking
• This Schema is characterized by excessive emphasis on
gaining approval, attention or recognition from others
as the expense of forming one’s personal identity. One
depends on others to provide a sense of self and self
esteem and uses their reactions to gage their decisions
and thoughts.
Very
Level
High: 20 One: 5
Level
Two: 10
Level
Three: 5
Fearful:
6
Preoccupied:
7
High: 6
Level
One:2
Level
Two: 2
Level
Three: 2
Fearful:1 Preoccupied: 1 Dismissing: Secure: 2
2
Total:
26
Total: 7
Total: 12
Total: 7
Total: 7
Total: 8
Dismissing Secure: 6
:1
Total: 3
Total: 8
What are the Known Schemas?
• Overvigilance & Inhibition Domain
– Involves an excessive emphasis on suppression of
spontaneous feelings, impulses or choices OR on meeting
rigid internalized rules and expectations for behavior, often at
the expense of one’s own happiness, self-expression,
relaxation, close relationships or health
– NEGATIVITY – EMOTIONAL INHIBITION
– UNRELENTING STANDARDS – PUNITIVENESS
Negativity
• This Schema is characterized by focusing on negative
aspects of life while ignoring the positive aspects.
These clients believe that things will go wrong or fear
making mistakes.
Very
Level
High: 11 One: 2
Level
Two: 5
Level
Three: 4
Fearful: 4 Preoccupied: 3 Dismissing Secure: 4
:0
High: 10 Level
One:0
Level
Two: 6
Level
Three: 4
Fearful:2
Preoccupied: 2
Dismissing Secure: 4
:2
Total:
21
Total: 11
Total:8
Total: 6
Total: 5
Total: 2
Total: 2
Total: 4
Emotional Inhibition
• This Schema is characterized by the suppression of spontaneous
expressions in order to avoid disapproval, or out of a fear losing
control. Typically involves inhibition of anger, inhibition of
positive impulses, difficulty communicating ones needs or
excessive focus on rationality and disregard for emotions.
Very
Level
High: 15 One:4
Level
Two: 7
Level
Three: 4
Fearful:
7
Preoccupied:
2
High: 8
Level
One:3
Level
Two: 3
Level
Three: 2
Fearful:0 Preoccupied: 4
Dismissing: Secure:
1
3
Total:
23
Total: 7
Total:
10
Total:6
Total: 7
Total: 4
Total: 6
Dismissing: Secure:
3
3
Total: 6
Unrelenting Standards
• Individuals with this schema hold very high standards for
themselves and others towards which they are always striving.
They often feel a great deal of pressure to perform and/or
behave in accordance with these standards, which interfere with
their ability to relax, feel pleasure, or enjoy a sense of
accomplishment.
Very
High:
20
Level
One: 6
Level
Two: 8
Level
Three: 6
Fearful:
4
Preoccupied: 5
Dismissing
:2
Secure
:9
High:
9
Level
Two: 3
Level
Two: 1
Level
Three: 5
Fearful:
0
Preoccupied: 3
Dismissing
:1
Secure
:5
Total:
29
Total: 9
Total: 9
Total: 11
Total: 4
Total: 8
Total: 3
Total:
14
Punitiveness
• This Schema is characterized by the belief that people, including
oneself, should be harshly punished for mistakes. These clients
will be overly punitive towards themselves and others and have
difficulty forgiving.
Very
High: 8
Level
One: 1
Level
Two: 4
Level
Three: 3
Fearful: Preoccupied:
1
2
High: 13 Level
One: 3
Level
Two: 8
Level
Three: 2
Fearful:
6
Preoccupied: 3 Dismissing: Secure:
1
3
Total:
21
Total: 12
Total:5
Total: 7
Total: 5
Total: 4
Dismissing Secure:
:0
5
Total: 1
Total: 8
How do schemas change?
•
Two phases of treatment
1. Assessment and education
•
•
•
Therapist conducts in-depth clinical interview and
assigns Young Schema Questionnaire. May also use
imagery techniques to assess for schemas
Goal is to identify the schemas and coping styles that
are most important in the client’s psychological make up
and link schemas to presenting problem
Therapist educates the client about how schemas form
and helps foster connection to the feelings that
surround each schema
How do schemas change?
•
Two phases of treatment
2.
Change
•
•
Therapist uses cognitive, behavioral and experiential techniques (as
well as the therapeutic relationship) to help the client begin to heal
schemas and alter maladaptive coping behaviors
Cognitive techniques
•
•
Behavioral techniques
•
•
Practice new behaviors and rehearse for interpersonal interactions
Experiential techniques
•
•
Efforts to restructure thinking related to schemas and develop a
healthy voice to challenge maladaptive thoughts
Engage in emotive exercises to vent anger, grieve early pain and
empower the client
Therapeutic relationship
•
Therapy relationship provides limited re-parenting, as well as
opportunities to examine and address schemas triggered in sessions
Suggested Readings and References
• Books
– Schema Therapy: A Practitioner’s Guide by Young, J.,
Klosko, J., and Weishaar (2003)
– Reinventing Your Life by Young, J. & Klosko, J. (1993)
• Articles
– Avoidance and Shame: A Schema-focused Approach to
the Treatment of Sex Addiction by Ranger, T. (2009)
• Websites
– www.schematherapy.com