A Client’s Guide to Schema Therapy
作者: Jeffrey E. Young / 6291次阅读 时间: 2010年11月20日
来源: Schema Therapy Institute 标签: SchemaTherapy
www.psychspace.com心理学空间网

.HV0|g/Fa/k0A Client’s Guide to Schema Therapy心理学空间-^&I8i f S
David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D.心理学空间(j P&S&D~*a,E%O
Schema Therapy Institute心理学空间!g4l!~A5c8T IsZ&w
HARRY is a 45-year old middle-level manager. He has been married for 16 years, but his心理学空间u"Wc%O3h L
marriage has been very troubled. He and his wife are often resentful of each other, they心理学空间 WxSK)SQ1V y!?|
rarely communicate on an intimate level, and they have few moments of real pleasure.心理学空间6Aj4Ia.k9R*m R
Other aspects of Harry’s life have been equally unsatisfying. He doesn’t enjoy his work,
\`Vq/S~1G4W3j0primarily because he doesn’t get along with his co-workers. He is often intimidated by心理学空间,M1H`z{*A2e.i
his boss and other people at the office. He has a few friends outside of work, but none心理学空间x!YTc?ae~
that he considers close.心理学空间\:Fg XP*Ms
During the past year Harry’s mood became increasingly negative. He was getting more
*NN]"L)M6S0irritable, he had trouble sleeping and he began to have difficulty concentrating at work.
;[d!vSwg%UN4E3E0As he became more and more depressed, he began to eat more and gained 15 pounds.心理学空间)p8b rA]yU.yg u+J
When he found himself thinking about taking his own life, he decided it was time to get心理学空间p%} d:R}X2}
help. He consulted a psychologist who practices cognitive therapy.
(Rmh%N6m7hX Jp0As a result of short-term cognitive therapy techniques, Harry improved rapidly. His mood
H| oDBj$?9O\0lifted, his appetite returned to normal, and he no longer thought about suicide. In
I%N2z(Fo T$~yf0addition he was able to concentrate well again and was much less irritable. He also
A#N(z`5W p3}sd0began to feel more in control of his life as he learned how to control his emotions for
*S%w4~:O|$fl0the first time.心理学空间mO|5g0K/V B\p+vb
But, in some ways, the short-term techniques were not enough. His relationships with心理学空间D$Jqt!r6}9Gf+u[O
his wife and others, while they no longer depressed him as much as they had, still failed心理学空间%R'{\|:C;Q+P
to give him much pleasure. He still could not ask to have his needs met, and he had few
a!T~%sQm!Q'yz+t0experiences he considered truly enjoyable. The therapist then began schema therapy to
T,`:WpUZ8V0help Harry change his long-term life patterns.心理学空间 Yn ZDTph$m
This guide will present the schema therapy approach, developed by Dr. Jeffrey Young to
2F,Z\l'yWKT0expand cognitive therapy for clients with more difficult long-term problems. Schema
o-zWTHc Ee/F.`+Y.p0therapy can help people change long-term patterns, including the ways in which they心理学空间im"yS2?t R]
interact with other people. This overview of schema therapy consists of six parts:心理学空间eli2]&nL/j9H*u
1) A brief explanation of short-term cognitive therapy心理学空间-p\_3uim!bM
2) An explanation of what a schema is and examples of schemas;
+r\ w8x&I m9l03) An explanation of the processes by which schemas function;心理学空间NZO5[iz
4) An explanation of modes and how they function within schema therapy;
7aGN-E]E| S#\+}05) Several case examples; and
1R {+R+C2]&m06) A brief description of the therapeutic process心理学空间+v t&`,^|m]H0b
Short-Term Cognitive Therapy
;]q"l,u ?I3@0Cognitive therapy is a system of psychotherapy developed by Aaron Beck and his
tZ{xiL'E^0colleagues to help people overcome emotional problems. This system emphasizes心理学空间 iU!Bg ok
changing the ways in which people think in order to improve their moods, such as
xH#|"N7h\-n"}"YA0depression, anxiety and anger.
{'J OnD;Y0Emotional disturbance is influenced by the cognitive distortions that people make in
oP8u*lQ5i0dealing with their life experiences. These distortions take the form of negative
5T aj-P]8O0interpretations and predictions of everyday events. For instance, a male college student心理学空间'u&[f _L-IUN3k
preparing for a test might make himself feel discouraged by thinking: “This material is心理学空间Y_ `p,z+T/C+U
impossible” (Negative Interpretation) and “I’ll never pass this test” (Negative Prediction).
2MMi ]AH*g!J#B0The therapy consists of helping clients to restructure their thinking. An important step in
;k%Xi-Q)G0this process is examining the evidence concerning the maladaptive thoughts. In the心理学空间5i+NWe#~!Wn z
example above, the therapist would help the student to look at his past experiences and心理学空间4q(M~Zy7J&b'G q*I
determine if the material was in fact impossible to learn, and if he knew for sure that he心理学空间Sio&Q/eM7e
couldn’t pass the test. In all probability, the student would decide that these two
(m&IE(|O`*[$F0thoughts lacked validity.
W_%voZ I1T0More accurate alternative thoughts are then substituted. For instance, the student might心理学空间;xt*\ cR%c,B
be encouraged to think: “This material is difficult, but not impossible. I’ve learned
*v2y(DZh6l J3jS0difficult material before” and “I’ve never failed a test before, so long as I’ve done
9v1N1wo2k1L J0enough preparation.” These thoughts would probably lead him to feel better and cope
|dWCsnb0better.心理学空间ot*QVb|!e9p ~
Often short-term cognitive therapy is enough to help people overcome emotional
5g_,l8Y,CF2{| H[0problems, especially depression and anxiety. Recent research has shown this to be so.
voH ic&s(`nl0However, sometimes this approach is not enough. Some clients in short-term cognitive心理学空间 _U5Tkr9h
therapy find that they don’t get all the benefits they want. This has led us, as well as心理学空间 xM\&r0H
various other researchers (Beck, xxxx) to look at deeper and more permanent cognitive心理学空间 kwoX M
structures as a means to understand and treat problem moods and behaviors. Schema
j._mo6cok0therapy was created as a result of these efforts.心理学空间 }yf'h R rT"~)P(^ O1C
Schemas - What They Are心理学空间9HK4sS$M3~7@
A schema is an extremely stable, enduring negative pattern that develops during
FKt1aP$u~~R#L0childhood or adolescence and is elaborated throughout an individual’s life. We view the心理学空间&Mzv*@5L%LS
world through our schemas.心理学空间 x6AWfK;e
Schemas are important beliefs and feelings about oneself and the environment which心理学空间)u.`c8^7u
the individual accepts without question. They are self -perpetuating, and are very心理学空间nE4v1wL-v8x5Mk iZ
resistant to change. For instance, children who develop a schema that they are
m,b3|u/]cK3} _0incompetent rarely challenge this belief, even as adults. The schema usually does not go心理学空间v/yu"_\~%B]
away without therapy. Overwhelming success in people’s lives is often still not enough心理学空间+l:sL2Z/X8~
to change the schema. The schema fights for its own survival, and, usually, quite
Fr0Vx8?0successfully.心理学空间"o UkCB] BA l
It’s also important to mention the importance of needs in schema formation and心理学空间J;F&r V.DFC5h\
perpetuation. Schemas are formed when needs are not met during childhood and then
1B#H/O3i@I0the schema prevents similar needs from being fulfilled in adulthood. For instance a child
ymRvLnzf(HM0whose need for secure attachments is not fulfilled by his parents may go for many years心理学空间.m*UE\ rB5H%Zq
in later life without secure relationships.
-xdD||6f)k"V0Even though schemas persist once they are formed, they are not always in our心理学空间2N4U)bT$H}
awareness. Usually they operate in subtle ways, out of our awareness. However, when a心理学空间:si]5I]3RG e
schema erupts or is triggered by events, our thoughts and feelings are dominated by
~2e3lH[[b(R8@EY0these schemas. It is at these moments that people tend to experience extreme negative
~7CC"PL {;\0h]0emotions and have dysfunctional thoughts.心理学空间G%?"[}$j+f}5KK
In our work with many patients, we have found eighteen specific schemas. Most clients
|0I.Cr p^K hHA'cu0have at least two or three of these schemas, and often more. A brief description of each心理学空间-B%T2n S9I~
of these schemas is provided below.心理学空间 m"b.g'M6X'{7} K
Emotional Deprivation心理学空间OB:@.Wq2u ]
This schema refers to the belief that one’s primary emotional needs will never be met by心理学空间a:k8P)Wc3u'zv|0? c
others. These needs can be described in three categories: Nurturance – needs for心理学空间1h b:N'Ag
affection, closeness and love; Empathy – needs to be listened to and understood;
'p8|phh CjQ&Z3Y0Protection – needs for advice, guidance and direction. Generally parents are cold or
Q e;})e^&p0removed and don’t adequately care for the child in ways that would adequately meet心理学空间3|$k%F}n
the above needs.心理学空间!P'{b} _r9W
Abandonment/Instability心理学空间6CQ EYc
This schema refers to the expectation that one will soon lose anyone with whom an
!?!Sdrw} q1D o&x;I0emotional attachment is formed. The person believes that, one way or another, close心理学空间3wR:r H g1O R%Z
relationships will end imminently. As children, these clients may have experienced the
!cG(|se$XT0divorce or death of parents. This schema can also arise when parents have been心理学空间ne$R5aE@CQ
inconsistent in attending to the child’s needs; for instance, there may have been
P;I{k `2Qs0frequent occasions on which the child was left alone or unattended to for extended
ep/afF0periods.
TH?:{${L%s0Mistrust/Abuse
9[g F C V ~l9YAyr0This schema refers to the expectation that others will intentionally take advantage in心理学空间r ^U-U'N4x)N
some way. People with this schema expect others to hurt, cheat, or put them down.
rP,ZRSk0They often think in terms of attacking first or getting revenge afterwards. In childhood,心理学空间*i@}e r`/w ~|9YAFH
these clients were often abused or treated unfairly by parents, siblings, or peers.
Q9?4b({*A l*xG0Defectiveness/Shame心理学空间v_:w;nCvX^
This schema refers to the belief that one is internally flawed, and that, if others get
wz&Jg;L;q0close, they will realize this and withdraw from the relationship. This feeling of being心理学空间 tuRu [I+X;Nl:Id
flawed and inadequate often leads to a strong sens e of shame. Generally parents were心理学空间-sLH8TR2d]
very critical of their children and made them feel as if they were not worthy of being
A{&b!L.\+i P0loved.
^iT}urs0Social Isolation/Alienation心理学空间`(C"o9I8f?
This schema refers to the belief that one is isolated from the world, different from other
2?9\G$fE5N|0people, and/or not part of any community. This belief is usually caused by early
Y7s;z~s0experiences in which children see that either they, or their families, are different from
UD-_q"U C q0other people.心理学空间&rJd&H{w.i'@etO
Dependence/Incompetence心理学空间&} B5A4c"n
This schema refers to the belief that one is not capable of handling day-to-day心理学空间3HZ/Z\B @2\
responsibilities competently and independently. People with this schema often rely on
R c9~u T `G@p0others excessively for help in areas such as decision-making and initiating new tasks.
$w.y1^z!E8]#K_0Generally, parents did not encourage these children to act independently and develop心理学空间5]F&sl2E Cv
confidence in their ability to take care of themselves.
f%?3I)x;C+p0Vulnerability to Harm and Illness心理学空间9X-]:Z3^(R
This schema refers to the belief that one is always on the verge of experiencing a major
l|,d&qs0catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive心理学空间2ow(O WBG%W?
precautions to protect oneself. Usually there was an extremely fearful parent who
u!c*g#h2XE)k0passed on the idea that the world is a dangerous place.
5fO2h%W`['b/q/In0Enmeshment/Undeveloped Self
&B{z;ew&d0This schema refers to a pattern in which you experience too much emotional心理学空间(SK$f`%Q2F3p
involvement with others – usually parents or romantic partners. It may also include the心理学空间9_q'L)@N
sense that one has too little individual identity or inner direction, causing a feeling of
9__oJ L_2b+qO0emptiness or of floundering. This schema is often brought on by parents who are so心理学空间H u-IG8H,|g8u;Oj)Q
controlling, abusive, or overprotective that the child is discouraged from developing a
!H9L V4M:p`GIex0separate sense of self.心理学空间x.W4t Rh
Failure
:~:n-?zYK&K0This schema refers to the belief that one is incapable of performing as well as one’s
]%_"@s3\ ]^0peers in areas such as career, school or sports. These clients may feel stupid, inept or心理学空间-~6UsVIt$w
untalented. People with this schema often do not try to achieve because they believe心理学空间z#h,Gd9NX
that they will fail. This schema may develop if children are put down and treated as if心理学空间&x)^yKK]G*t
they are a failure in school and other spheres of accomplishment. Usually the parents心理学空间m0T9i cFA2dd
did not give enough support, discipline, and encouragement for the child to persist and心理学空间#pPL w:s5E J
succeed in areas of achievement, such as schoolwork or sport
viun4N't6Q0Subjugation
Qn`7{ P8^u(u0This schema refers to the belief that one must submit to the control of others in order to心理学空间1AJ$d$M/yN
avoid negative consequences. Often these clients fear that, unless they submit, others
&PQp{m9va{0will get angry or reject them. Clients who subjugate ignore their own desires and
7s$xyX+w1E;E0feelings. In childhood there was generally a very controlling parent.心理学空间?M\;U2w'k+r3e2u j5A]
Self-Sacrifice心理学空间cF9s!AB7l I
This schema refers to the excessive sacrifice of one’s own needs in order to help others.
]CH&P Q]/eT3g0When these clients pay attention to their own needs, they often feel guilty. To avoid this
-tvy0p M;Ut0guilt, they put others’ needs ahead of their own. Often clients who self -sacrifice gain a
u+q;? ^fc6ewp9j0feeling of increased self -esteem or a sense of meaning from helping others. In childhood
`sU$t]p/~$T0the person may have been made to feel overly responsible for the well being of one or
:Wf Wn/[P Kx0both parents.
4uHI"vk0Emotional Inhibition
6L/KTF7m*l U/b0This schema refers to the belief that you must suppress spontaneous emotions and心理学空间/C7yt(E uI,}2C
impulses, especially anger, because any expression of feelings would harm others or心理学空间 t#?*c[^)Ot+E2k
lead to loss of self -esteem, embarrassment, retaliation or abandonment. You may lack
EmY)t D]U0spontaneity, or be viewed as uptight. This schema is often brought on by parents who
#~@*e.T.v4c h0discourage the expression of feelings.心理学空间Ua6Y7Ti{
Approval-Seeking/Recognition-Seeking心理学空间 VmO+Ty+jA
This schema refers to the placing of too much emphasis on gaining the approval and心理学空间9?)v:A_~
recognition of others at the expense of one’s genuine needs and sense of self. It can心理学空间3pBu:W b*U,\
also include excessive emphasis on status and appearance as a means of gaining心理学空间{ y:Ck5~
recognition and approval. Clients with this schema are generally extremely sensitive to心理学空间.Q(P HK r&xcc
rejections by others and try hard to fit in. Usually they did not have their needs for心理学空间!p WS W Erw-gqAq
unconditional love and acceptance met by their parents in their early years.心理学空间![(?;_W!\,S5h A:XT
Unrelenting Standards/Hypercriticalness心理学空间5I_U;Sc(y
This schema refers to the belief that whatever you do is not good enough, that you心理学空间J%e_5s3O9G~
must always strive harder. The motivation for this belief is the desire to meet extremely
2[#{#E)Gs1o4CRM0high internal demands for competence, usually to avoid internal criticism. People with
!m G3|e M:t w0this schema show impairments in important life areas, such as health, pleasure or self -心理学空间h*D.yl)ND,L
esteem. Usually these clients’ parents were never satisfied and gave their children love
5Aq'f7ug0that was conditional on outstanding achievement.
@ h:MS?9[4~[:`0Entitlement/Grandiosity
)T V1zY K"u+_/[%S0`0This schema refers to the belief that you should be able to do, say, or have whatever
Q/k0H J&HD2~Y.P&yd0you want immediately regardless of whether that hurts others or seems reasonable to
5z$WQ8z,Mp*GT0them. You are not interested in what other people need, nor are you aware of the longterm
@r:|w)Z qj0costs to you of alienating others. Parents who overindulge their children and who
$VQ8s)MC0do not set limits about what is socially appropriate may foster the development of this心理学空间3A'Q0Z7u,g)iM:Em
schema. Alternatively, some children develop this schema to compensate for feelings of心理学空间P@I%Ljh8Eoa
emotional deprivation or defectiveness.
x+[ GC(jJNj0Insufficient Self-Control/Self-Discipline
o Roo?q/p0This schema refers to the inability to tolerate any frustration in reaching one’s goals, as心理学空间Fxy q/q f(e
well as an inability to restrain expression of one’s impulses or feelings. When lack of
!G D/M9?h!X0self-control is extreme, criminal or addictive behavior rule your life. Parents who did not
&CR nBf0model self-control, or who did not adequately discipline their children, may predispose心理学空间D6h)m,eE4a6f {
them to have this schema as adults.心理学空间'Hb"Wp}.wiO
Negativity/Pessimism心理学空间&@4H SB? b K7c9YqB,S j
This schema refers to a pervasive pattern of focusing on the negative aspects of life
h!].`7G x0while minimizing the positive aspects. Clients with this schema are unable to enjoy
N'f'QH;rgt-` Gz4N0things that are going well in their lives because they are so concerned with negative
M bX3N I ~ u0j?/B0details or potential future problems. They worry about possible failures no matter how心理学空间 Q6Y@/Ka
well things are going for them. Usually these clients had a parent who worried
-B#^6k3v1q0excessively.
/J^0v2TY TNM0Punitiveness
;zO/I2FP E w0This schema refers to the belief that people deserve to be harshly punished for making心理学空间%PP#bg4y3B
mistakes. People with this schema are critical and unforgiving of both themselves and心理学空间PH.u XJ |
others. They tend to be angry about imperfect behaviors much of the time. In
1BX$vKL0childhood these clients usually had at least one parent who put too much emphasis on
Y3m-yBn7K0performance and had a punitive style of controlling behavior.心理学空间M?4ABB
How Schemas Work
eBwM*_8j7`0There are two primary schema operations: Schema healing and schema perpetuation.
W8S2U.wxy9eV0All thoughts, behaviors and feelings may be seen as being part of one of these心理学空间 }"E;N7b B
operations. Either they perpetuate the schema or they heal the schema. In a later心理学空间O'BhM2mo8c
section on the therapy process we will explain more about schema healing.
9Zgi$cCv'F8j3|5@q0Schema perpetuation refers to the routine processes by which schemas function and
/t&r6}7r&["Kf+R(A*sv0perpetuate themselves. This is accomplished by cognitive distortions, self -defeating心理学空间%P/I sNAralgf
behavior patterns and schema coping styles.心理学空间/Q&g#k;uR6E%N
Earlier we mentioned that cognitive distortions are a central part of cognitive therapy.心理学空间6Y-| f.~}G8_l9T(b%Z
These distortions consist of negative interpretations and predictions of life events. The
LOD _(Tylv7J0schema will highlight or exaggerate information that confirms the schema and will
)A4g[#`D*D0minimize or deny information that contradicts it. Likewise, unhealthy behavior patterns心理学空间NO nSyH q/`,g{
will perpetuate the schema’s existence. Someone who was abused in childhood and心理学空间p f9} V7gt3D eVU
developed a Mistrust/Abuse schema may seek out abusive relationships in adulthood心理学空间'i Ky1[ e
and remain in them, providing a constant stream of evidence for the schema.
]\wy+J0In order to understand how schemas work, there are three schema coping styles that心理学空间 dS#^&?.@{
must be defined. These styles are schema surrender, schema avoidance, and schema
KV^fx1Pq0overcompensation. It is through these three styles that schemas exert their influence on心理学空间k/d.U2Ux
our behavior and work to insure their own survival.
!o*g8A)tv1S0Schema surrender refers to ways in which people passively give in to the schema.心理学空间-EF4A"X OAj
They accept the schema as truth and then act in ways that confirm the schema. For心理学空间;OC P kg7I ]T
instance, a young man with an Abandonment/Instability schema might choose
v,q)w#R~q0partners who are unable to commit to long-term relationships. He might then react to
R\-A,rk+e Yo0even minor signs indications of abandonment, such as spending short times without his
NH"w:_am-P1J&bE"x:b0partner, in an exaggerated way and feel excessive negative emotion. Despite the心理学空间2P7DT&~m q!rA)}U0M4n
emotional pain of the situation, he might also passively remain in the relationship心理学空间n3@5?S:P/k
because he sees no other possible way to connect with women.
`%c!i"?Xh xJ0Schema avoidance refers to the ways in which people avoid activating schemas. As心理学空间*YLUyI,b X
mentioned earlier, when schemas are activated, this causes extreme negative emotion.
L?-Z[$R{,S'{ V0People develop ways to avoid triggering schemas in order not to feel this pain. There are心理学空间x'Ma"^ gSL2O
three types of schema avoidance: cognitive, emotional and behavioral.
;ic7@Z~` |9m4S4t#Ef0Cognitive avoidance refers to efforts that people make not to think about upsetting
@ Sy)EnRBVh0events. These efforts may be either voluntary or automatic. People may voluntarily心理学空间:Zl,i'ZIR,gf-g8gF+H
choose not to focus on an aspect of their personality or an event, which they find
3Ub%vV0uwQ0disturbing. There are also unconscious processes which help people to shut out心理学空间vz1it[7V"Re?
information which would be too upsetting to confront. People often forget particularly心理学空间N@K'^Jq
painful events. For instance, children who have been abused sexually often forget the心理学空间|!Qqu7^
memory completely.
O u T u_P-C0Emotional or affective avoidance refers to automatic or voluntary attempts to block
}Q Z.AK0painful emotion. Often when people have painful emotional experiences, they numb
-lzbw1}|R g{0themselves to the feelings in order to minimize the pain. For instance, a man might talk
X#]%}9aYkD0|0about how his wife has been acting in an abusive manner toward him and say that he
xPt}b7?(q)I(y0feels no anger towards her, only a little annoyance. Some people drink or abuse drugs心理学空间*h7Oz0C}v6Jt?
to numb feelings generated by schemas.心理学空间~^n&`w"Mu_
The third type of avoidance is behavioral avoidance. People often act in such a way as
$P7c/F*C2P1ub3e\(|j,Y2k0to avoid situations that trigger schemas, and thus avoid psychological pain. For instance,心理学空间P@5m a&h/]3w
a woman with a Failure schema might avoid taking a difficult new job which would be
#m ?%P[O_^sY%v0very good for her. By avoiding the challenging situation, she avoids any pain, such as心理学空间 l!\#Sj2VPc0?'T4?Z,F
intense anxiety, which could be generated by the schema.心理学空间g-W"q:d8sy
The third schema process is Schema overcompensation. The individual behaves in a心理学空间F9KV:JD,qa
manner which appears to be the opposite of what the schema suggests in order to avoid心理学空间6w,e#M#T g
triggering the schema. On the surface, it may appear that the overcompensators are心理学空间2Yx h;}TbD/K
behaving in a healthy manner, by standing up for themselves. But when they overshoot心理学空间`J8Zm T C r3x
the mark they cause more problem patterns, which then perpetuate the schema. For心理学空间!qP7~T%g9y8R `Qn
instance, a young man with a Defectiveness schema might overcompensate by
aq|0m5l W {ux0presenting himself as perfect and being critical of others. This would likely lead others心理学空间0}"A Oql
to criticize him in turn, thereby confirming his belief that he is defective.心理学空间"{B"j$]$L
Working With Modes
ih"Ojpt:N0When treating clients with schema therapy one of the most important innovations is the心理学空间 @&d9` r2r9m/XA
concept of mode. For our purposes we will define a mode as the set of schemas or心理学空间B-cA0Fo!l
schema operations that are currently active for an individual. Or you might think of a心理学空间G m3v2F^dB#w3|
mode simply as a mindset or state that you might be in temporarily. Most people can心理学空间 euC ?/rV5GG_
relate to the idea that we all have these different parts of ourselves and we go in and心理学空间qFq fmC&k F5_P#`
out of them all the time. For instance, if a friend tells you she had a bad day because心理学空间&bZ4S;q#@!qEU
her boss (or her toddler) was in his raging bull mode, you’d know exactly what she
ad]&s{2E uj0means.心理学空间 {/v&~,HR!UI
There are often occasions when a therapist will choose to work with a client’s modes in
$y6U$uM#V2hL:Mhde0therapy. If a client is extremely upset at the beginning of a session, the therapist may心理学空间*hZ2D9x8us.f!};W
inquire about what part of the person is feeling the emotional pain and attempt to心理学空间&MRY,y7j8B_/J"b
recognize it and deal with it directly. For instance, for several sessions, Myra was very
q[L{[R%Y0sad and hurt because she was unable to talk out some problems with her husband. In
WB|L2m-A^x!~1N0talking with her therapist they focused on a mode, or part of her, that she called Lonely
w.LY]L9GSF0Myra, that seemed to be active after these failed attempts. By engaging this part of
O9B|#q#n&ef0K0Myra in this manner the therapist was able to give her an opportunity to express the心理学空间-x3F!f pq(UxKE
feelings and thoughts connected with her pattern of loneliness.心理学空间 Y6F#I'~uqKMQ B
The exact pattern of work with modes will vary from session to session. But some of
'kFGCQ0the more common activities in mode work can be described. The history of the mode is
Ph1Lb0B A0often discussed; the client will speak about when the mode started and what was going
)_/N^o0[5W0on at the time. Connections are made between modes and current problems.心理学空间*Zhl8Kg;L#vB \
Dialogues can be conducted between different modes when there is a conflict. For心理学空间.dCb%s:Kpe5k
instance, a miser mode and a playboy mode might have it out over what type of car to心理学空间 m fs f5I ~)P
buy. And there is always an effort to link mode work with other aspects of the therapy.
NA+CR/x#UH(gg%fvd0Case Examples
E~g&t6^0In this section six case examples are presented. In each one, the schema coping styles心理学空间N\"L3ec X+zr
are demonstrated. By reading through this section, you will get a better feel for how
8V.EH/]n/Rc0these processes can operate in real life situations.
0_ ZdQo1`u,v0Abby is a young woman whose main schema is Subjugation. She tends to see people
PaL,x}@)a0as very controlling even when they are being appropriately assertive. She has thoughts心理学空间Ci6e"CJErF
such as “I can’t stand up for myself or they won’t like me’ and is likely to give in to心理学空间$cJ(k/uSr.[(g'`
others (Schema surrender). At other times she decides that no one will get the better
:bv5MZ{/y0of her and becomes very controlling (Schema overcompensation). Sometimes when心理学空间"e W U%{/U i
people make unreasonable demands on her she minimizes the importance of her own
y+gY4Qu/w0feelings and has thoughts like “It’s not that important to me what happens.’ At other心理学空间|li9`c[L7N
times she avoids acquaintances with whom she has trouble standing up for herself
l7W b|h/?$j]#p7e0(Schema avoidance).心理学空间.R8gUG]P
Stewart’s main schema is Failure. Whenever he is faced with a possible challenge, he心理学空间/m3yqi Pp
tends to think that he is not capable. Often he tries half -heartedly, guaranteeing that he
U n#j f3JRa,B0^A.h0will fail, and strengthening the belief that he is not capable (Schema surrender). At心理学空间"KG9[&n ykbT7f)n$O
times, he makes great efforts to present himself in an unrealistically positive light by心理学空间9X r"^6[y8t@-L5d
spending excessive amounts of money on items such as clothing and automobiles
0TYj,p ` Y6??0(Schema overcompensation). Often he avoids triggering his schema by staying away
i H\ ]*{u0from challenges altogether and convinces himself that the challenge was not worth心理学空间vAyI:g;M
taking (Schema avoidance).
*ov@*mk0Rebecca’s core schema is Defectiveness/Shame. She believes that there is
j~(^be(k P0something basically wrong with her and that if anyone gets too close, they will reject
KKGl*H)O/J0her. She chooses partners who are extremely critical of her and confirm her view that心理学空间i9I oHg
she is defective (Schema surrender). Sometimes she has an excessive defensive心理学空间d o,h"jGW
reaction and counterattacks when confronted with even mild criticism (Schema
8xq2qwB&aaB$yh0overcompensation). She also makes sure that none of her partners get too close, so心理学空间'TZ g:|x'u
that she can avoid their seeing her defectiveness and rejecting her (Schema
h4e f#B SP T4?0avoidance).心理学空间+a"s n\.Ht1r
Michael is a middle-aged man whose main schema is Dependence/Incompetence.心理学空间"O9u;uX vbcj
He sees himself as being incapable of doing daily tasks on his own and generally seeks心理学空间:a-q4r4c!w u.`
the support of others. Whenever he can, he chooses to work with people who help him
"z0?/Te0j8K)QV1}-M~0out to an excessive degree. This keeps him from developing skills needed to work alone
tx3G/i/n{?H;nn0and confirms his view of himself as someone who needs others to help him out心理学空间wzRd[*V
(Schema surrender). At times, when he would be best off taking advice from other
#m?0a%Ft uFa8[0people, he refuses to do so (Schema overcompensation). He reduces his anxiety by
~)a `&d)RY{ Bv0procrastinating as much as he can get away with (Schema avoidance).
Fx.X1Mx*H/g0Ann’s core schema is Social Isolation/Alienation. She sees herself as being different
q7}0wn2lH'h'}/Vg}0from other people and not fitting in. When she does things as part of a group she does
oDZ#i V"s;G0not get really involved (Schema surrender). At times she gets very hostile towards心理学空间$m0a8|S8A
group members and can be very critical of the group as a whole (Schema心理学空间gOsl;CX
overcompensation). At other times she chooses to avoid group activities altogether
9msnv'PC/a2IJ0v0(Schema avoidance).
a[3gej0P5B9t#m0Sam’s central schema is Emotional Deprivation. He chooses partners who are not心理学空间aMu8v.A0V
very capable of giving to other people and then acts in a manner which makes it even
7N)b i9W3{N0more difficult for them to give to him (Schema surrender). At times he will act in a心理学空间Nr N rkb!D5HY+c
very demanding, belligerent manner and provoke fights with his partners (Schema
%y{x5qo^0overcompensation). Sam avoids getting too close to women, yet denies that he has
?T\E3LE"Mm1p/}h0any problems in this area (Schema avoidance).
4[J*D1C:B Pj,[0Therapeutic Process - Changing Schemas
F'c]Q'L0In schema therapy the goal of the treatment is to engage in schema healing processes.
.x A'@'lq2w0These processes are intended to weaken the early maladaptive schemas and coping心理学空间x&fJ@S3`3~%E
styles as much as possible, and build up the person’s healthy side. An alliance is formed
y%q#L yD)@ t`3i8fEL0between the therapist and the healthy part of the client against the schemas. Any of心理学空间bq ]!TmKymC
the therapy activities described below may be seen as examples of schema healing.
3L6FE7F7G9}H2xJ0Z0The first step in therapy is to do a comprehensive assessment of the client. The main
1F.Iwa*R.uR"Q0goal of this assessment is to identify the schemas and coping styles that are most
s-AnG-JH?'E0important in the client’s psychological makeup. There are several steps to this process.心理学空间{`$g!` {Tj IIdy
The therapist generally will first want to know about recent events or circumstances in
aa7~J*vwk;x0the clients’ lives which have led them to come for help. The therapist will then discuss
^2V0G(R@?Vx3O0the client’s life history and look for patterns which may be related to schemas.
)G.X!nNC's/J:A0There are several other steps the therapist will take in assessing schemas. We use the
@m3g?R+\w%I#t0Young Schema Questionnaire, which the client fills out, listing many of the thoughts,
W Pk#CWeU0feeling and behaviors related to the different schemas; items on this questionnaire can心理学空间 bL{W5`;Y
be rated as to how relevant to the client’s life they are.心理学空间Vo@^s,@:Al&M*[
There are also various imagery techniques which the therapist can use to assess心理学空间 dsHy1V!u.}c8d
schemas. One specific technique involves asking clients to close their eyes and create an
f0_~Zqp"N0image of themselves as children with their parents. Often the images that appear will心理学空间 sg X f,J-d%K
lead to the core schemas.
%MAGZ9c}fia0Jonathan is a 28 year old executive whose core schema is Mistrust/Abuse. He came
l"Y#cHnqm!|0to therapy because he was having bouts of intense anxiety at work, during which he心理学空间f$OLr"I*wV3v
would be overly suspicious and resentful of his co-workers. When asked to create an心理学空间9j(z.|/iw zS
image of himself with his family, he had two different images. In the first he saw himself心理学空间dfp+UWe
being terrorized by his older brother. In the second he saw his alcoholic father coming
.S2^;g"Q}%tF0home and beating his mother, while he cowered in fear.
f1`@Do~0There are many techniques that the therapist can use to help clients weaken their
m2xHRh:h'c0schemas. These techniques can be broken down into four categories: emotive,心理学空间^N7Z(pIuHy7VP
interpersonal, cognitive and behavioral. Each of these categories will be briefly心理学空间 sD"FTgno+u
discussed, along with a few examples.心理学空间Z.yj$P(L|r
Emotive techniques encourage clients to experience and express the emotional aspects
x3N,QnM N0of their problem. One way this is done is by having clients close their eyes and imagine心理学空间3t+^/sIM
they are having a conversation with the person to whom the emotion is directed. They心理学空间0p2z \}'G6r
are then encouraged to express the emotions as completely as possible in the imaginary心理学空间f:EKw&E;caa}
dialogue. One woman whose core schema was Emotional Deprivation had several
$?*X,_2sO0such sessions in which she had an opportunity to express her anger at her parents for心理学空间&yEc#wm;h-^
not being there enough for her emotionally. Each time she expressed these feelings, she心理学空间l0D6NWm
was able to distance herself further from the schema. She was able to see that her心理学空间'h"I&t%K @ d r
parents had their own problems which kept them from providing her with adequate
3j?9S{Z"Op0nurturance, and that she was not always destined to be deprived.心理学空间 D3Dt1G5n(h
There are many variations on the above technique. Clients may take on the role of the心理学空间+Z'v*g%h*{O(G%] z%r
other person in these dialogues, and express what they imagine their feelings to be. Or
HF2] q~kbkkc0they may write a letter to the other person, which they have no intention of mailing, so心理学空间_H$]E%E/t? \Z0N
that they can express their feelings without inhibition.
'N1EH&P6Z:EX0Mode work can be invaluable as an emotive technique. A client may be feeling a vague心理学空间H"oph.^
sense of sadness which he can’t clarify. By looking at modes with his therapist he may
-wa2F7h7AR S~:~}0VW0connect with a mode that he labels as Unimportant. By dialoging with the therapist心理学空间 Q(A p"N+l{6AtxJ
from the mode’s point of view many feelings can come out which can be worked on
7\ lj4aE!aZ0further. In this case the client might get in touch not only with the sadness, but also
4JZqT6n#] X\/~0with anger at being ignored.
C/I"gPT?"I*sW0Interpersonal techniques highlight the client’s interactions with other people so that the
g"{@ D~u[T0role of the schemas can be exposed. One way is by focusing on the relationship with the
9v w {"_ V W2l0therapist. Frequently, clients with a Subjugation schema go along with everything the
Gr.|1xa8z0therapist wants, even when they do not consider the assignment or activity relevant.心理学空间|/sm8fP6W4Ly
They then feel resentment towards the therapist which they display indirectly. This
;l3{`4E1z9c ^[:o){0u0pattern of compliance and indirect expression of resentment can then be explored to the
XfX/F\Pa'H0client’s benefit. This may lead to a useful exploration of other instances in which the
LSi/_oF:hF0client complies with others and later resents it, and how they might better cope at those心理学空间'h6k oMm VU
times.心理学空间2aQ PV%\r6B#V
Another type of interpersonal technique involves including a client’s spouse in therapy. A心理学空间g:Qq.c5Y}H
man with a Self-Sacrifice schema might choose a wife who tends to ignore his wishes.心理学空间Z-{r.K`{i)a
The therapist may wish to involve the wife in the treatment in order to help the two of
'[5@!AnXV:]0them to explore the patterns in their relationship and change the ways in which they
^\X8^ P/ONTo0interact.心理学空间8sx&}5l^b
Cognitive techniques are those in which the schema-driven cognitive distortions are心理学空间5S*P/U$? g;mr
challenged. As in short-term cognitive therapy, the dysfunctional thoughts are identified心理学空间G}Q#Nc)`6D6C
and the evidence for and against them is considered. Then new thoughts and beliefs are心理学空间,R0o[,}'zKo(|K
substituted. These techniques help the client see alternative ways to view situations.心理学空间c \+T6O/y:Nh:nb
The first step in dealing with schemas cognitively is to examine the evidence for and
5HyfXC v*q0against the specific schema which is being examined. This involves looking at the client’s心理学空间,e8{wk4a+SsP4S7j
life and experiences and considering all the evidence which appears to support or refute心理学空间w0z g\9r6Bfj
the schema. The evidence is then examined critically to see if it does, in fact, provide
.B5?O7gV L'e,CY0support for the schema. Usually the evidence produced will be shown to be in error, and心理学空间#}(S)VNLu+ir
not really supportive of the schema.心理学空间K ` Ys$IrC)Q `*n
For instance, let’s consider a young man with an Emotional Deprivation schema.心理学空间EHC?Ij#\?3J
When asked for evidence that his emotional needs will never be met, he brings up
v3@Y-jG'O0instances in which past girlfriends have not met his needs. However, when these past
-`el0?p+P1j0relationships are looked at carefully, he finds that, as part of the schema surrender心理学空间 K0RA}(l
process, he has chosen women who are not capable of giving emotionally. This
Z4O)j5k8u,^)v0understanding gives him a sense of optimism; if he starts selecting his partners心理学空间s?lU4Z,l O6oz
differently, his needs can probably be met心理学空间,O7iCbOD L e$s
Another cognitive technique is to have a structured dialogue between the client and
OoB^0c`-xClm0therapist. First, the client takes the side of the schema, and the therapist presents a心理学空间#R a c"y)N e E0K
more constructive view. Then the two switch sides, giving the client a chance to
4DDMLqU0verbalize the alternative point of view.
Y m+{]%C@o9o&J0After having several of these dialogues the client and therapist can then construct a心理学空间j:K;sh#?7b:R
flashcard for the client, which contains a concise statement of the evidence against the
@/Qd"LBxuQ0schema.心理学空间N)C2h \hB E wi c
A typical flashcard for a client with a Defectiveness/Shame schema reads: “I know心理学空间 IZi].~kK5Hzb*c
that I feel that there is something wrong with me but the healthy side of me knows that
wa(G#z pU2l0I’m OK. There have been several people who have known me very well and stayed with
d$Lj.ka9@/~0me for a long time. I know that I can pursue friendships with many people in whom I
D&{l b \9Y!?0have an interest.”心理学空间8y!bjOSK3I
The client is instructed to keep the flashcard available at all times and to read it
4cRT c8G},X!H-d0whenever the relevant problem starts to occur. By persistent practice at this, and other心理学空间2CY-G t5j3? M:k u1L
cognitive techniques, the client’s belief in the schema will gradually weaken.心理学空间*T1_;f\0c z:e
Behavioral techniques are those in which the therapist assists the client in changing心理学空间;RjA-W9~${$k-C!@$N
long-term behavior patterns, so that schema surrender behaviors are reduced and
fI*F)P Lk#Lq0healthy coping responses are strengthened.
9A#Rnr;WZ8_g/TY0One behavioral strategy is to help clients choose partners who are appropriate for them
W'o@@'`0and capable of engaging in healthy relationships. Clients with the Emotional
i2odC.B(~7Y4_0Deprivation schema tend to choose partners who are not emotionally giving. A
2x P D,of5Q6W0P0therapist working with such clients would help them through the process of evaluating
}2G&G3iY7H E0and selecting new partners.
\2ZbQi+lV4t)i j0Another behavioral technique consists of teaching clients better communication skills.心理学空间z3o4XY @t4z
For instance, a woman with a Subjugation schema believes that she deserves a raise心理学空间{y$XkR*aRT\Z@!ez
at work but does not know how to ask for it. One technique her therapist uses to teach
R v$aDO$O2q0her how to speak to her supervisor is role -playing. First, the therapist takes the role of
bUad)?o6H:Y2L0the client and the client takes the role of the supervisor. This allows the therapist to
j%yR}t6I0demonstrate how to make the request appropriately. Then the client gets an opportunity心理学空间%{0i*m;};Z@
to practice the new behaviors, and to get feedback from the therapist before changing心理学空间(C#A a!V [Y-EX+?k;b9z
the behavior in real life situations.心理学空间#M1t5~!l,[8O8C4s/N
IN SUMMARY, schema therapy can help people understand and change long-term life心理学空间x oG!i[0[F
patterns. The therapy consists of identifying early maladaptive schemas, coping styles心理学空间;[O\5aBE
and modes, and systematically confronting and challenging them.心理学空间 Myw'p0B&z
References:
b2p+?,W+| k|$[M0Young, J.E., and Klosko, J.S. (1993). Reinventing your life. New York:心理学空间0R*lrJUr$`*d
Dutton, 1993.心理学空间zL mo,E c'Y1{r/l
Young, J.E., Klosko, J.S., and Weishaar, M.E. Schema therapy: A
n'{MW,YM3pOX c0practitioner’s guide. New York: Guilford, 2003.心理学空间]})B3v.LJ
Copyright 2004, Cognitive Therapy Center of New York
/w6\n:n3LbS0For more information contact:心理学空间t |?B:ZJv5c
David Bricker, Ph.D.心理学空间.~5n'ern;V@
160 Broadway心理学空间S&g#`*K6a:g,].t
New York, NY 10038心理学空间 {"^"lL5u!S^k
(212) 406-3520

I[T3~%E/p,z2f0www.psychspace.com心理学空间网
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