A Client’s Guide to Schema Therapy
作者: Jeffrey E. Young / 6286次阅读 时间: 2010年11月20日
来源: Schema Therapy Institute 标签: SchemaTherapy
www.psychspace.com心理学空间网心理学空间j?v]-uKf4r

A Client’s Guide to Schema Therapy心理学空间+P wO;e7nP9s!e*P
David C. Bricker, Ph.D. and Jeffrey E. Young, Ph.D.心理学空间k2?,` Dd)s#j
Schema Therapy Institute心理学空间r C _J^ KG:r]
HARRY is a 45-year old middle-level manager. He has been married for 16 years, but his
%ha:Sl"{%FlE2X0marriage has been very troubled. He and his wife are often resentful of each other, they
{/BMxB6N!Zg0rarely communicate on an intimate level, and they have few moments of real pleasure.心理学空间*o4N8_}/Y
Other aspects of Harry’s life have been equally unsatisfying. He doesn’t enjoy his work,
I*W s.CL4Kw0primarily because he doesn’t get along with his co-workers. He is often intimidated by心理学空间J!K+F#U9H
his boss and other people at the office. He has a few friends outside of work, but none心理学空间 c8d6he2H |!~8E
that he considers close.心理学空间c$o F.U8ER
During the past year Harry’s mood became increasingly negative. He was getting more心理学空间~LN'nrT
irritable, he had trouble sleeping and he began to have difficulty concentrating at work.
yXl(oq HbcZ0As he became more and more depressed, he began to eat more and gained 15 pounds.
#{r4yn ]B0When he found himself thinking about taking his own life, he decided it was time to get心理学空间}GG~Zon.?
help. He consulted a psychologist who practices cognitive therapy.
dxD'fI0As a result of short-term cognitive therapy techniques, Harry improved rapidly. His mood
#[,Iu9|E/zS5B.K0lifted, his appetite returned to normal, and he no longer thought about suicide. In心理学空间6T8RfB8K T9Q'O/F-~X
addition he was able to concentrate well again and was much less irritable. He also心理学空间"O:x,\o J
began to feel more in control of his life as he learned how to control his emotions for
pdT.?in0the first time.心理学空间6@7M;B._@"X|6~\
But, in some ways, the short-term techniques were not enough. His relationships with心理学空间E.h:x;mi
his wife and others, while they no longer depressed him as much as they had, still failed心理学空间1{'f8`{vq?
to give him much pleasure. He still could not ask to have his needs met, and he had few心理学空间7d7Wa;x$g/V
experiences he considered truly enjoyable. The therapist then began schema therapy to
+cc4{XPV%Y1K:Y4_0help Harry change his long-term life patterns.心理学空间Q6o1rU#b/p~1}
This guide will present the schema therapy approach, developed by Dr. Jeffrey Young to心理学空间x5qcfMI_ \
expand cognitive therapy for clients with more difficult long-term problems. Schema
T_ bYK:w8HI0therapy can help people change long-term patterns, including the ways in which they
`NKK,P p7Eg z f0interact with other people. This overview of schema therapy consists of six parts:心理学空间!YvW$Xl*uEA
1) A brief explanation of short-term cognitive therapy
1ouMp|$A1hU|02) An explanation of what a schema is and examples of schemas;
b*F4VM8I?{-[E#f03) An explanation of the processes by which schemas function;心理学空间d#M9}1u[ },mTu nz
4) An explanation of modes and how they function within schema therapy;
,}+T-b B^l05) Several case examples; and心理学空间&Z{'mQ-NP;k4OD
6) A brief description of the therapeutic process
uO,L ^$q0Short-Term Cognitive Therapy心理学空间,R'WV Mp
Cognitive therapy is a system of psychotherapy developed by Aaron Beck and his
Aa;m ~]!UjL0colleagues to help people overcome emotional problems. This system emphasizes
7@8NH$EBD0changing the ways in which people think in order to improve their moods, such as
!M H LCZ*M5{I0depression, anxiety and anger.
"H*Gc&m$q2I0Emotional disturbance is influenced by the cognitive distortions that people make in
8|_7WPU2Z1U0dealing with their life experiences. These distortions take the form of negative心理学空间;_7r y,y!My%N/m mu8t
interpretations and predictions of everyday events. For instance, a male college student心理学空间3pBU8nh
preparing for a test might make himself feel discouraged by thinking: “This material is
!dHH}[$F7?C0impossible” (Negative Interpretation) and “I’ll never pass this test” (Negative Prediction).
}H }tw orD,x0The therapy consists of helping clients to restructure their thinking. An important step in
w:^5j3s)Xff({.Dl1[v0this process is examining the evidence concerning the maladaptive thoughts. In the
G T:_&C,Y {"_$Da3Xq0example above, the therapist would help the student to look at his past experiences and心理学空间Qoz8]F+U"|6zP'q
determine if the material was in fact impossible to learn, and if he knew for sure that he心理学空间WKS V Q%uM^F J
couldn’t pass the test. In all probability, the student would decide that these two
#| aHn*GD/k'}-X8b0thoughts lacked validity.心理学空间-v#P]nf2},S VO&j
More accurate alternative thoughts are then substituted. For instance, the student might
X"M~?&i0be encouraged to think: “This material is difficult, but not impossible. I’ve learned心理学空间*UnyK-iV$X!jm
difficult material before” and “I’ve never failed a test before, so long as I’ve done
(ZW3IW]8i0enough preparation.” These thoughts would probably lead him to feel better and cope心理学空间.Z#F:UJ)}
better.心理学空间&C'[.I!]eS
Often short-term cognitive therapy is enough to help people overcome emotional
3SDRAj7et'N0problems, especially depression and anxiety. Recent research has shown this to be so.
9V,z*S lWBf#nl0]0However, sometimes this approach is not enough. Some clients in short-term cognitive心理学空间~D y$i.n
therapy find that they don’t get all the benefits they want. This has led us, as well as心理学空间s!SyzeLf9y*T
various other researchers (Beck, xxxx) to look at deeper and more permanent cognitive
3W"|O.`{cM0structures as a means to understand and treat problem moods and behaviors. Schema
;B ~ i"[&N0therapy was created as a result of these efforts.
Sgf$@"rc|+r)K0Schemas - What They Are
O!W? HqI|-j^0A schema is an extremely stable, enduring negative pattern that develops during
X9g#y|h@K0childhood or adolescence and is elaborated throughout an individual’s life. We view the心理学空间&cBG[AG5y
world through our schemas.心理学空间(Q5u!` H+W5XU(k ejjY
Schemas are important beliefs and feelings about oneself and the environment which
zM]uv0the individual accepts without question. They are self -perpetuating, and are very
g)lYt4nv#By0resistant to change. For instance, children who develop a schema that they are心理学空间^/j%G,|n?Z
incompetent rarely challenge this belief, even as adults. The schema usually does not go
n4RgO8J*m&~0away without therapy. Overwhelming success in people’s lives is often still not enough心理学空间(]\d'P0W2m!m|x
to change the schema. The schema fights for its own survival, and, usually, quite
o,d0O.Br @&BY2yM;E0successfully.心理学空间r Cc|8|
It’s also important to mention the importance of needs in schema formation and
R*C,~5W Y0perpetuation. Schemas are formed when needs are not met during childhood and then心理学空间bmd)?7C0JU~Iak
the schema prevents similar needs from being fulfilled in adulthood. For instance a child心理学空间 H9t3G!VBdd*N/]
whose need for secure attachments is not fulfilled by his parents may go for many years
Z|.wF*vBBtNKu n0in later life without secure relationships.
(n*dtj*I6zPz0Even though schemas persist once they are formed, they are not always in our
QhO6jk&y0awareness. Usually they operate in subtle ways, out of our awareness. However, when a
%{.P1po^D\0schema erupts or is triggered by events, our thoughts and feelings are dominated by心理学空间2`0m N!E$Bu
these schemas. It is at these moments that people tend to experience extreme negative心理学空间)KO+~0e8n4RS]2J
emotions and have dysfunctional thoughts.
N!v#P&~)n;@Y:x5O)e0In our work with many patients, we have found eighteen specific schemas. Most clients心理学空间 SJ9v(Tnq4i|
have at least two or three of these schemas, and often more. A brief description of each
k0Q$b%^'s0of these schemas is provided below.
ZWp@,t7jv0Emotional Deprivation
:E+_S$w|0I0This schema refers to the belief that one’s primary emotional needs will never be met by心理学空间%[s6C^{%]c
others. These needs can be described in three categories: Nurturance – needs for心理学空间)}jD#c DC3Xs
affection, closeness and love; Empathy – needs to be listened to and understood;心理学空间D{/R t]"db
Protection – needs for advice, guidance and direction. Generally parents are cold or心理学空间;y,t'rF9Hz
removed and don’t adequately care for the child in ways that would adequately meet
8L"n9Z3U jI4TSy0the above needs.
;z1EV$_%Rt U3e0Abandonment/Instability心理学空间"S/]K W3vx9N
This schema refers to the expectation that one will soon lose anyone with whom an心理学空间0U bL%ot:FJ:D
emotional attachment is formed. The person believes that, one way or another, close心理学空间n,tx'A r"o
relationships will end imminently. As children, these clients may have experienced the心理学空间,f3^ vx#w:m
divorce or death of parents. This schema can also arise when parents have been
e5}[Gt0inconsistent in attending to the child’s needs; for instance, there may have been
Nm[.]&k)qv0frequent occasions on which the child was left alone or unattended to for extended心理学空间SNb'NM1{`-l@
periods.心理学空间1RsEZ"A{ Q)[PY
Mistrust/Abuse
@ WXDlxi0This schema refers to the expectation that others will intentionally take advantage in
!Bms5@6l*w p\ iW,O0some way. People with this schema expect others to hurt, cheat, or put them down.
{^e0t] \f0They often think in terms of attacking first or getting revenge afterwards. In childhood,心理学空间 k9iAfvC
these clients were often abused or treated unfairly by parents, siblings, or peers.心理学空间 C;]/~xDxl
Defectiveness/Shame心理学空间{(f-Z+jirwd` J
This schema refers to the belief that one is internally flawed, and that, if others get心理学空间4Zv NAqq*B
close, they will realize this and withdraw from the relationship. This feeling of being
a+T7z9AaW(w#JjK5P0flawed and inadequate often leads to a strong sens e of shame. Generally parents were心理学空间Ynw!m6BDLB
very critical of their children and made them feel as if they were not worthy of being
V2Vj7w-z2M0loved.心理学空间Nm+f;|#rj,s9Gs
Social Isolation/Alienation心理学空间l&B6?6bX~ L
This schema refers to the belief that one is isolated from the world, different from other
S@ L8g'^`U W0people, and/or not part of any community. This belief is usually caused by early心理学空间)ktZo,Q
experiences in which children see that either they, or their families, are different from
4\'v$]}AMm$T!@ Ij0other people.
I2ZQ5V+w ?7D0Dependence/Incompetence心理学空间 Ip!h%QS6v"O#D
This schema refers to the belief that one is not capable of handling day-to-day心理学空间'CB-e5yP
responsibilities competently and independently. People with this schema often rely on心理学空间 @#PX[5H:k$d1b\d E
others excessively for help in areas such as decision-making and initiating new tasks.心理学空间!lv&OVIT3V
Generally, parents did not encourage these children to act independently and develop心理学空间H o`b^-de
confidence in their ability to take care of themselves.
BtaYk;@-V rI0Vulnerability to Harm and Illness心理学空间"yK%y J s{(I
This schema refers to the belief that one is always on the verge of experiencing a major
q tDNW0u9}S0catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking excessive
E Wu$?U/Y^o R0precautions to protect oneself. Usually there was an extremely fearful parent who
.M Cs9|c0passed on the idea that the world is a dangerous place.心理学空间PTum xe
Enmeshment/Undeveloped Self心理学空间A l+~!{1n?
This schema refers to a pattern in which you experience too much emotional
I T(o)J)d?FRN0involvement with others – usually parents or romantic partners. It may also include the心理学空间$z\'nnw]&[(k8d
sense that one has too little individual identity or inner direction, causing a feeling of
6b2o0NO%U!w|0emptiness or of floundering. This schema is often brought on by parents who are so心理学空间1q&KHpGW$`)S
controlling, abusive, or overprotective that the child is discouraged from developing a心理学空间7y6jQI6{A Cm"h
separate sense of self.心理学空间 Nt*N&j"SC,]l0J?3f
Failure
:s}~yF)y,Q`iopx0This schema refers to the belief that one is incapable of performing as well as one’s心理学空间mu7_$l(B
peers in areas such as career, school or sports. These clients may feel stupid, inept or
nP]m6~!Q0untalented. People with this schema often do not try to achieve because they believe
HJo2^'Kx0q*{f!l)As0that they will fail. This schema may develop if children are put down and treated as if
"f7W4T{%Z:RR0they are a failure in school and other spheres of accomplishment. Usually the parents
3j r9Gg&Y7B I&v0did not give enough support, discipline, and encouragement for the child to persist and
+Xf ]E| h%O0succeed in areas of achievement, such as schoolwork or sport
M:l*v};k;{*Mk0Subjugation
9a1Ay8Z5N;KU~0This schema refers to the belief that one must submit to the control of others in order to
9Ww3Z@ M?0Av0avoid negative consequences. Often these clients fear that, unless they submit, others心理学空间a0H(wK-V$q
will get angry or reject them. Clients who subjugate ignore their own desires and
Pj-k AX:N P`$e0feelings. In childhood there was generally a very controlling parent.
%th"Uc+C0Self-Sacrifice心理学空间(Q n:BT,Q#d+Ow
This schema refers to the excessive sacrifice of one’s own needs in order to help others.
$nh!rwx'd0When these clients pay attention to their own needs, they often feel guilty. To avoid this心理学空间3m]EZp$ob
guilt, they put others’ needs ahead of their own. Often clients who self -sacrifice gain a
2yZb\-cN2\`;yR r0feeling of increased self -esteem or a sense of meaning from helping others. In childhood
&C!Oa"VnKf0the person may have been made to feel overly responsible for the well being of one or心理学空间[:n)\b4]@4F
both parents.
D] g F l0r'G0Emotional Inhibition心理学空间K*o\%~e;v{
This schema refers to the belief that you must suppress spontaneous emotions and
M_O%]ohP0impulses, especially anger, because any expression of feelings would harm others or
r)K5[1VA7yJ1{0lead to loss of self -esteem, embarrassment, retaliation or abandonment. You may lack心理学空间2hR3_3~0Q f L1u
spontaneity, or be viewed as uptight. This schema is often brought on by parents who
w%Dh h7Z0discourage the expression of feelings.心理学空间9X3YK$o8b([a
Approval-Seeking/Recognition-Seeking
6T4J \%sA7P0This schema refers to the placing of too much emphasis on gaining the approval and
Qs#U0?:NEq0recognition of others at the expense of one’s genuine needs and sense of self. It can
%t-daS*c0also include excessive emphasis on status and appearance as a means of gaining心理学空间Z0j d{b3g1m1W#l
recognition and approval. Clients with this schema are generally extremely sensitive to
z,XZ\7E w&E0rejections by others and try hard to fit in. Usually they did not have their needs for
4a3fU(`V jw0unconditional love and acceptance met by their parents in their early years.心理学空间b.N[jAcj
Unrelenting Standards/Hypercriticalness
'@ e4bj"`P:kO,a0This schema refers to the belief that whatever you do is not good enough, that you
vir%se!aD;Yf2O0must always strive harder. The motivation for this belief is the desire to meet extremely心理学空间:{ mF$H8B+qh
high internal demands for competence, usually to avoid internal criticism. People with心理学空间R"TY"D5px
this schema show impairments in important life areas, such as health, pleasure or self -
TOr4mK!L3G5Y p#jL;\0esteem. Usually these clients’ parents were never satisfied and gave their children love
I)kH6IFn| mQ0that was conditional on outstanding achievement.
H {~$BU+K I7@'H@0Entitlement/Grandiosity心理学空间p%B/WKTb@*s7K
This schema refers to the belief that you should be able to do, say, or have whatever心理学空间O-E%hd-D/jt
you want immediately regardless of whether that hurts others or seems reasonable to
+gV_Ej)m!H'k n I0them. You are not interested in what other people need, nor are you aware of the longterm心理学空间 u0jX'V*|9bi
costs to you of alienating others. Parents who overindulge their children and who
G r6aNp+`M9R0do not set limits about what is socially appropriate may foster the development of this
y@C+A/k\e0schema. Alternatively, some children develop this schema to compensate for feelings of
Gr`4z2a \+T?4u+e0emotional deprivation or defectiveness.
'Wpc0@4y#Mc0Insufficient Self-Control/Self-Discipline心理学空间vyI h[M].l+|#k
This schema refers to the inability to tolerate any frustration in reaching one’s goals, as
XD+?gSbY7T0well as an inability to restrain expression of one’s impulses or feelings. When lack of心理学空间.^y)a n}0_
self-control is extreme, criminal or addictive behavior rule your life. Parents who did not心理学空间 A5Lr3Sp8L2oD
model self-control, or who did not adequately discipline their children, may predispose
to]L |] r0them to have this schema as adults.心理学空间"V!a|5q;g1MF'A
Negativity/Pessimism
P:o#uik0This schema refers to a pervasive pattern of focusing on the negative aspects of life心理学空间"`SZP1t{!h
while minimizing the positive aspects. Clients with this schema are unable to enjoy心理学空间 W5cg'a&uJ
things that are going well in their lives because they are so concerned with negative心理学空间#p)j6S I;D*Ix"}2cL&j
details or potential future problems. They worry about possible failures no matter how心理学空间8v-[.nu5[v[
well things are going for them. Usually these clients had a parent who worried
6K#tr]wM2n4g1h0excessively.心理学空间R] n:q9cg+m
Punitiveness
,{1_.P:Us&hO0This schema refers to the belief that people deserve to be harshly punished for making心理学空间)r5h:k:cZ7q ^(@zQ
mistakes. People with this schema are critical and unforgiving of both themselves and心理学空间+s3LM&x1X@
others. They tend to be angry about imperfect behaviors much of the time. In心理学空间 nze1k'R|1F
childhood these clients usually had at least one parent who put too much emphasis on心理学空间}U9rnXYH
performance and had a punitive style of controlling behavior.
9z)k AK#|0How Schemas Work心理学空间g#q!T'tGR@,X
There are two primary schema operations: Schema healing and schema perpetuation.心理学空间7J9iQ/wZ7f V%[y
All thoughts, behaviors and feelings may be seen as being part of one of these
lO&~s|}\i0operations. Either they perpetuate the schema or they heal the schema. In a later心理学空间9[d*^8v!Xv.W*f7_3V
section on the therapy process we will explain more about schema healing.心理学空间K ~G NR&u3J)E \
Schema perpetuation refers to the routine processes by which schemas function and
C.VQ.{QY0perpetuate themselves. This is accomplished by cognitive distortions, self -defeating心理学空间9p+~&lliZV)C
behavior patterns and schema coping styles.心理学空间#]2ajo0LVv sm
Earlier we mentioned that cognitive distortions are a central part of cognitive therapy.
wJW&g9}g)VSg)i0These distortions consist of negative interpretations and predictions of life events. The
!KV-bD]6yoP0schema will highlight or exaggerate information that confirms the schema and will心理学空间7u.cg-o?t
minimize or deny information that contradicts it. Likewise, unhealthy behavior patterns
6U8Kxm#b&_rE0will perpetuate the schema’s existence. Someone who was abused in childhood and心理学空间"B|sg r
developed a Mistrust/Abuse schema may seek out abusive relationships in adulthood心理学空间:f0}+DvuA/?D NS \
and remain in them, providing a constant stream of evidence for the schema.
$w:rG._p0QD0In order to understand how schemas work, there are three schema coping styles that心理学空间\j*ev/x1Esn
must be defined. These styles are schema surrender, schema avoidance, and schema
}g)~o9|'k"M,n0overcompensation. It is through these three styles that schemas exert their influence on
s*y.D8IGS0our behavior and work to insure their own survival.
G[1HmFl2oE0Schema surrender refers to ways in which people passively give in to the schema.
M p}5`R lv)S-Es0They accept the schema as truth and then act in ways that confirm the schema. For心理学空间 x5m`#d?+E9{7L*A6^
instance, a young man with an Abandonment/Instability schema might choose
jb4Q ZZan0partners who are unable to commit to long-term relationships. He might then react to心理学空间4U'Y4H5w;ne&^q
even minor signs indications of abandonment, such as spending short times without his心理学空间@8yPK5W b f
partner, in an exaggerated way and feel excessive negative emotion. Despite the
W-am'? z6o.T F,Z(q0emotional pain of the situation, he might also passively remain in the relationship心理学空间%l6uE-`t
because he sees no other possible way to connect with women.心理学空间!Cq{jG?
Schema avoidance refers to the ways in which people avoid activating schemas. As心理学空间 J['` r%Q_4I G$p
mentioned earlier, when schemas are activated, this causes extreme negative emotion.
$fy| WD%Iu%Fkih0People develop ways to avoid triggering schemas in order not to feel this pain. There are心理学空间&C6|!S&y OD,B#mZ uJ
three types of schema avoidance: cognitive, emotional and behavioral.心理学空间 mDxVR2AF\
Cognitive avoidance refers to efforts that people make not to think about upsetting
.Z0].vr$nr$a&^0events. These efforts may be either voluntary or automatic. People may voluntarily心理学空间4g Kk$Fep
choose not to focus on an aspect of their personality or an event, which they find心理学空间1`0d.oH8[
disturbing. There are also unconscious processes which help people to shut out
D9xU!Yeq0information which would be too upsetting to confront. People often forget particularly
W3nfgp]0painful events. For instance, children who have been abused sexually often forget the心理学空间[X6b } H"`'@;d
memory completely.
x\}rE7ge~-C0Emotional or affective avoidance refers to automatic or voluntary attempts to block
z4\ I}[4@ \0painful emotion. Often when people have painful emotional experiences, they numb心理学空间5T[1N,SxaK5]
themselves to the feelings in order to minimize the pain. For instance, a man might talk
n$cwKe c4Vo O ]0about how his wife has been acting in an abusive manner toward him and say that he心理学空间z~7K\(iH
feels no anger towards her, only a little annoyance. Some people drink or abuse drugs心理学空间axafzh"BJ
to numb feelings generated by schemas.
D*@6c`Kd8l:S%_0The third type of avoidance is behavioral avoidance. People often act in such a way as心理学空间:m7h }t1R+MbN0x%a$[
to avoid situations that trigger schemas, and thus avoid psychological pain. For instance,
$l3J.l^^t0a woman with a Failure schema might avoid taking a difficult new job which would be
:Bi2Z[+w,l0very good for her. By avoiding the challenging situation, she avoids any pain, such as
XqW_ @WE^0intense anxiety, which could be generated by the schema.
P;_\7QR5t0The third schema process is Schema overcompensation. The individual behaves in a
6ij.Jb }h0manner which appears to be the opposite of what the schema suggests in order to avoid心理学空间+} @)k:WZI(]`g
triggering the schema. On the surface, it may appear that the overcompensators are心理学空间ReH~E.Z
behaving in a healthy manner, by standing up for themselves. But when they overshoot心理学空间D7@eH%[V'c?
the mark they cause more problem patterns, which then perpetuate the schema. For
s0o3Cfr@9W0instance, a young man with a Defectiveness schema might overcompensate by心理学空间 S}8Y5aL n
presenting himself as perfect and being critical of others. This would likely lead others
o;Pm#wOb0to criticize him in turn, thereby confirming his belief that he is defective.心理学空间HXs`Si&W
Working With Modes心理学空间qM IQ-rs
When treating clients with schema therapy one of the most important innovations is the心理学空间lNck^pr9n%g
concept of mode. For our purposes we will define a mode as the set of schemas or心理学空间]K1FQ k"O
schema operations that are currently active for an individual. Or you might think of a心理学空间{aT2`VS3N;N
mode simply as a mindset or state that you might be in temporarily. Most people can心理学空间u7v{ ZN2Zx[
relate to the idea that we all have these different parts of ourselves and we go in and
+DVB;{8XA{Ps+N0out of them all the time. For instance, if a friend tells you she had a bad day because
4_4[qF!ID_l0her boss (or her toddler) was in his raging bull mode, you’d know exactly what she
1dB[dh6k+fw9l6H0means.心理学空间}DQPZ/lQM
There are often occasions when a therapist will choose to work with a client’s modes in
Wbu Yv U g?0therapy. If a client is extremely upset at the beginning of a session, the therapist may心理学空间N;] XY `b}&x,Z
inquire about what part of the person is feeling the emotional pain and attempt to
}~"hMC o`]o0recognize it and deal with it directly. For instance, for several sessions, Myra was very心理学空间K-Is/q4K&i/zb
sad and hurt because she was unable to talk out some problems with her husband. In
9yc,sQ6H'f0talking with her therapist they focused on a mode, or part of her, that she called Lonely心理学空间cu!j GOOK
Myra, that seemed to be active after these failed attempts. By engaging this part of心理学空间"g8uI M(D0R
Myra in this manner the therapist was able to give her an opportunity to express the心理学空间|7EK e@ x
feelings and thoughts connected with her pattern of loneliness.
~W?^j2]0The exact pattern of work with modes will vary from session to session. But some of心理学空间^ ~p'|\?
the more common activities in mode work can be described. The history of the mode is心理学空间K%[~ Y;?FP
often discussed; the client will speak about when the mode started and what was going
P r+L[1l"O:tC0on at the time. Connections are made between modes and current problems.
7bE)t]_M0g.?0Dialogues can be conducted between different modes when there is a conflict. For心理学空间9Ogrc5`TC HXY
instance, a miser mode and a playboy mode might have it out over what type of car to心理学空间~W5Tj#_-_a
buy. And there is always an effort to link mode work with other aspects of the therapy.心理学空间9Xu }-E^&ckPt"F6h
Case Examples心理学空间:f'p[ D @ Pdz3@
In this section six case examples are presented. In each one, the schema coping styles
m(Gq\*D2J!g|0are demonstrated. By reading through this section, you will get a better feel for how心理学空间 H-Ow%qmD
these processes can operate in real life situations.心理学空间iS t(rr1H#y CD
Abby is a young woman whose main schema is Subjugation. She tends to see people
R%o{#pSu/v5S7\:o0as very controlling even when they are being appropriately assertive. She has thoughts
0D Z5i/_*nd F0such 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W/L9ev9~V)Q
others (Schema surrender). At other times she decides that no one will get the better心理学空间b?{n^$pI
of her and becomes very controlling (Schema overcompensation). Sometimes when心理学空间%T5zSt$|"nP
people make unreasonable demands on her she minimizes the importance of her own心理学空间 FG\P2?aA2H r
feelings and has thoughts like “It’s not that important to me what happens.’ At other心理学空间R'Xl~$}h![
times she avoids acquaintances with whom she has trouble standing up for herself心理学空间Bb[8R'F2S
(Schema avoidance).
:qh#OLmX0Stewart’s main schema is Failure. Whenever he is faced with a possible challenge, he心理学空间*o%@q"OJu
tends to think that he is not capable. Often he tries half -heartedly, guaranteeing that he心理学空间P'SX~3Y,v
will fail, and strengthening the belief that he is not capable (Schema surrender). At
,FRR`Lui0times, he makes great efforts to present himself in an unrealistically positive light by
Y!LF\}]j#`0spending excessive amounts of money on items such as clothing and automobiles心理学空间 KzaT!z(_(j'X
(Schema overcompensation). Often he avoids triggering his schema by staying away心理学空间"{2Z2Uu4y H7K
from challenges altogether and convinces himself that the challenge was not worth心理学空间_!@\)Mt{G
taking (Schema avoidance).
)W*NcNA1_j0Rebecca’s core schema is Defectiveness/Shame. She believes that there is
K.laX%C"kT!Hy CS C0something basically wrong with her and that if anyone gets too close, they will reject心理学空间 _f!p:dNQ%[
her. She chooses partners who are extremely critical of her and confirm her view that心理学空间sfTS7V2K{6G
she is defective (Schema surrender). Sometimes she has an excessive defensive
&rB4a#OS(^^t r0reaction and counterattacks when confronted with even mild criticism (Schema心理学空间)}!y R,a1z0V
overcompensation). She also makes sure that none of her partners get too close, so心理学空间r` d5sES[
that she can avoid their seeing her defectiveness and rejecting her (Schema心理学空间8C)@of,g|_)g:U
avoidance).
o3c'mt'j$iY#f0Michael is a middle-aged man whose main schema is Dependence/Incompetence.心理学空间g:dH}%|L5O
He sees himself as being incapable of doing daily tasks on his own and generally seeks心理学空间o y%]2X7d FT^
the support of others. Whenever he can, he chooses to work with people who help him心理学空间'w.ma)@]+J
out to an excessive degree. This keeps him from developing skills needed to work alone
zQR;? v u0and confirms his view of himself as someone who needs others to help him out
dm X$J2I ]$k"wN0(Schema surrender). At times, when he would be best off taking advice from other心理学空间R c"lPE6T.A(Ne
people, he refuses to do so (Schema overcompensation). He reduces his anxiety by心理学空间~8}/p%xa jES9b;bt
procrastinating as much as he can get away with (Schema avoidance).心理学空间 cZ:f9jn&PI8`
Ann’s core schema is Social Isolation/Alienation. She sees herself as being different心理学空间't X s7N p2Nnz]|9Rdp
from other people and not fitting in. When she does things as part of a group she does
J!SyK@.`H"fH0not get really involved (Schema surrender). At times she gets very hostile towards
|!HX%l{,g0group members and can be very critical of the group as a whole (Schema
c9]D}W+b0overcompensation). At other times she chooses to avoid group activities altogether
A"qI~?v0(Schema avoidance).心理学空间(DK6yc@4yWVG%L
Sam’s central schema is Emotional Deprivation. He chooses partners who are not
)]Z1e\?nM-B(~k-JL0very capable of giving to other people and then acts in a manner which makes it even心理学空间9X3|2j,x/tCT3S$g
more difficult for them to give to him (Schema surrender). At times he will act in a心理学空间$D:^Rpy_ D&F+o1B
very demanding, belligerent manner and provoke fights with his partners (Schema
&G"o8Ma }WJ0^0overcompensation). Sam avoids getting too close to women, yet denies that he has心理学空间7m'l3{(m] b``s
any problems in this area (Schema avoidance).心理学空间]8mH5N3Z hk
Therapeutic Process - Changing Schemas
[2s;jv ~d9Q0In schema therapy the goal of the treatment is to engage in schema healing processes.
.Dz+[8^ I:r5E0These processes are intended to weaken the early maladaptive schemas and coping
#Y!s!_1H"E,|8^0styles as much as possible, and build up the person’s healthy side. An alliance is formed心理学空间8CB [?Pk
between the therapist and the healthy part of the client against the schemas. Any of
7y"Wr)xp(E q0the therapy activities described below may be seen as examples of schema healing.心理学空间qR&Ne.T/k
The first step in therapy is to do a comprehensive assessment of the client. The main
z gNU%a6q|D0goal of this assessment is to identify the schemas and coping styles that are most
D(JOPu'^3VQ%]0important in the client’s psychological makeup. There are several steps to this process.
7k5C"Y9Z6O:}s:l z0The therapist generally will first want to know about recent events or circumstances in
)JA%O#h#`1oA&of0the clients’ lives which have led them to come for help. The therapist will then discuss心理学空间.OF P1SgiO#pI
the client’s life history and look for patterns which may be related to schemas.
3]:D2e^.YV+l Y0There are several other steps the therapist will take in assessing schemas. We use the
j|7C ^ x$~ ]fV7y0Young Schema Questionnaire, which the client fills out, listing many of the thoughts,心理学空间g+z/~}"Y3u|8D
feeling and behaviors related to the different schemas; items on this questionnaire can
,Ag(l rL3Ik'd0be rated as to how relevant to the client’s life they are.
9z4UZ|x+W0There are also various imagery techniques which the therapist can use to assess
2B&f3|oFu0schemas. One specific technique involves asking clients to close their eyes and create an心理学空间5WA7p$p"pq|0a9i.w
image of themselves as children with their parents. Often the images that appear will
Hog1n!SN.Um,|0lead to the core schemas.心理学空间 tv4Uj&@`Z)B
Jonathan is a 28 year old executive whose core schema is Mistrust/Abuse. He came心理学空间_ pUSG'K
to therapy because he was having bouts of intense anxiety at work, during which he
+VXm!`_(K/Z0would be overly suspicious and resentful of his co-workers. When asked to create an心理学空间$Br8u;YD S
image of himself with his family, he had two different images. In the first he saw himself心理学空间A+Z8J1j8L3k
being terrorized by his older brother. In the second he saw his alcoholic father coming
)fSNI ~:P8JG4p0home and beating his mother, while he cowered in fear.心理学空间 | z[mw&st
There are many techniques that the therapist can use to help clients weaken their
#G&z(}#I9T;N0schemas. These techniques can be broken down into four categories: emotive,
%F PmWH(g*~Jfu0interpersonal, cognitive and behavioral. Each of these categories will be briefly心理学空间jvB"w2c(O7h
discussed, along with a few examples.心理学空间 G8FOma9OKe
Emotive techniques encourage clients to experience and express the emotional aspects心理学空间t"M;^9g2]q\
of their problem. One way this is done is by having clients close their eyes and imagine
G?zI/QvO!|0they are having a conversation with the person to whom the emotion is directed. They
(b1OJFltv0are then encouraged to express the emotions as completely as possible in the imaginary
xu/qnX0Fa)r4qr0dialogue. One woman whose core schema was Emotional Deprivation had several
O5w0S:} UNa0such sessions in which she had an opportunity to express her anger at her parents for
*R'\\1_4f6^0not being there enough for her emotionally. Each time she expressed these feelings, she心理学空间Nr"od;IB J6m
was able to distance herself further from the schema. She was able to see that her
~MWY)IM0parents had their own problems which kept them from providing her with adequate心理学空间$z~~p"x j L
nurturance, and that she was not always destined to be deprived.心理学空间j1I4h$OqI2E
There are many variations on the above technique. Clients may take on the role of the
/]5ON] B3th;k%U.G^4Y0other person in these dialogues, and express what they imagine their feelings to be. Or心理学空间8r2i8I5d!i&xN
they may write a letter to the other person, which they have no intention of mailing, so心理学空间FQg:}4n%E
that they can express their feelings without inhibition.
.g(|3C au.~jt$`g0Mode work can be invaluable as an emotive technique. A client may be feeling a vague
x X/xYx L6Jz k0sense of sadness which he can’t clarify. By looking at modes with his therapist he may
-{9j WD7C0_7vo-ZN?I j0connect with a mode that he labels as Unimportant. By dialoging with the therapist心理学空间7Zg {-_;nX~,^4D+So2e
from the mode’s point of view many feelings can come out which can be worked on心理学空间:sM)kJ^
further. In this case the client might get in touch not only with the sadness, but also
0Z3huc \ Yl2J g0with anger at being ignored.心理学空间ILNAD%yzC
Interpersonal techniques highlight the client’s interactions with other people so that the
!x\-]bHT"W0role of the schemas can be exposed. One way is by focusing on the relationship with the心理学空间'WDE,NTuSz Z7O
therapist. Frequently, clients with a Subjugation schema go along with everything the心理学空间{,yTsH;\
therapist wants, even when they do not consider the assignment or activity relevant.
3NWr:z&^9jS%W8G0They then feel resentment towards the therapist which they display indirectly. This心理学空间a0gV&h9u&E l@
pattern of compliance and indirect expression of resentment can then be explored to the
-~ `4~;~ a)Hlgy0client’s benefit. This may lead to a useful exploration of other instances in which the
+Z o8m1R9xo6F\0client complies with others and later resents it, and how they might better cope at those
!qs.c4Ob T0times.心理学空间6Ib8GY[5z.E?)C
Another type of interpersonal technique involves including a client’s spouse in therapy. A心理学空间d/K^4Z!S5}1I
man with a Self-Sacrifice schema might choose a wife who tends to ignore his wishes.心理学空间 ac0_"ff
The therapist may wish to involve the wife in the treatment in order to help the two of
zz;f;Ty M.{+E0them to explore the patterns in their relationship and change the ways in which they心理学空间 d%]pQ r"z%T`$^
interact.
W|TH;o POH0Cognitive techniques are those in which the schema-driven cognitive distortions are心理学空间(P&Lp0bb6\pCg
challenged. As in short-term cognitive therapy, the dysfunctional thoughts are identified心理学空间 M4{y Y9R4o-j!O/Ls\
and the evidence for and against them is considered. Then new thoughts and beliefs are
/@,D,NE}5vYDA{0substituted. These techniques help the client see alternative ways to view situations.心理学空间9[Xx!wl%nuFq
The first step in dealing with schemas cognitively is to examine the evidence for and
.Ya'SQs!Mv0against the specific schema which is being examined. This involves looking at the client’s
3N7Te| ee@!XX[0life and experiences and considering all the evidence which appears to support or refute
rs!G1Xj0the schema. The evidence is then examined critically to see if it does, in fact, provide心理学空间F b&bDuW
support for the schema. Usually the evidence produced will be shown to be in error, and心理学空间8Y6e7}+}3]"Z
not really supportive of the schema.
DgJE4P C"q mc|0For instance, let’s consider a young man with an Emotional Deprivation schema.心理学空间 [2Tm Ar;p#C
When asked for evidence that his emotional needs will never be met, he brings up
/Ln)b#]b0instances in which past girlfriends have not met his needs. However, when these past
iRp.z6~[n0relationships are looked at carefully, he finds that, as part of the schema surrender心理学空间j!fX;t*P ] wn
process, he has chosen women who are not capable of giving emotionally. This心理学空间Z)qA2_#fJjmo,|(M(E
understanding gives him a sense of optimism; if he starts selecting his partners
d(X)d7kK5^2j0differently, his needs can probably be met
/Q'y%WY+R0Another cognitive technique is to have a structured dialogue between the client and心理学空间0u~#c P^/l
therapist. First, the client takes the side of the schema, and the therapist presents a
K3Y|/_M*^y%C0more constructive view. Then the two switch sides, giving the client a chance to心理学空间"W#]P0_+~9A2g"e&y
verbalize the alternative point of view.心理学空间]pP ^E0H
After having several of these dialogues the client and therapist can then construct a
NzrT+w @y!Z?0flashcard for the client, which contains a concise statement of the evidence against the心理学空间m }|5iT3X#^
schema.心理学空间m\$JYB }bF/?
A typical flashcard for a client with a Defectiveness/Shame schema reads: “I know
8M@)s,dR0that I feel that there is something wrong with me but the healthy side of me knows that
PB0e.|1s%~l0I’m OK. There have been several people who have known me very well and stayed with心理学空间yF5Jv/wi E
me for a long time. I know that I can pursue friendships with many people in whom I心理学空间$n%Z)qdW&L7|V6S
have an interest.”心理学空间"ep&ZJ8m
The client is instructed to keep the flashcard available at all times and to read it
;\?8Ai#ot6vy0whenever the relevant problem starts to occur. By persistent practice at this, and other心理学空间H Ev$I0g+aI
cognitive techniques, the client’s belief in the schema will gradually weaken.心理学空间g.PuQ#lYm
Behavioral techniques are those in which the therapist assists the client in changing心理学空间 s;Uk mJJ
long-term behavior patterns, so that schema surrender behaviors are reduced and
T'D(L&O U9YoS0healthy coping responses are strengthened.心理学空间@p.Ru f@;q8Y
One behavioral strategy is to help clients choose partners who are appropriate for them
/P Ek!Y'b ^0and capable of engaging in healthy relationships. Clients with the Emotional心理学空间6tyb)r%jzu W)M.h
Deprivation schema tend to choose partners who are not emotionally giving. A
gN:r},a*t!H6MuF z0therapist working with such clients would help them through the process of evaluating心理学空间`:yn7J2bB
and selecting new partners.心理学空间g(_(W8zu$@&^]
Another behavioral technique consists of teaching clients better communication skills.心理学空间#s5r sH!_P:FJ2}
For instance, a woman with a Subjugation schema believes that she deserves a raise
-sPK"w*X;` U.F.q0at work but does not know how to ask for it. One technique her therapist uses to teach心理学空间 IS IW,\Q*h,{`
her how to speak to her supervisor is role -playing. First, the therapist takes the role of心理学空间 u g c wh.`
the client and the client takes the role of the supervisor. This allows the therapist to
6u7u'ca(a.[Bo0demonstrate how to make the request appropriately. Then the client gets an opportunity心理学空间SV6P?l:u |/EKM
to practice the new behaviors, and to get feedback from the therapist before changing心理学空间7[5VE}O@6M
the behavior in real life situations.
sRymM Q'W}3I3k0IN SUMMARY, schema therapy can help people understand and change long-term life心理学空间"m'[9O`d;e-z?[2j
patterns. The therapy consists of identifying early maladaptive schemas, coping styles心理学空间(E!c"Hx0O0O+XN
and modes, and systematically confronting and challenging them.心理学空间|!vm,T`[s$v
References:
CW2w9D4N-o%D0e5V T(@0Young, J.E., and Klosko, J.S. (1993). Reinventing your life. New York:
C m*@T8YM0Dutton, 1993.
z'QN;fG0Young, J.E., Klosko, J.S., and Weishaar, M.E. Schema therapy: A
&\f#Dzl1^0practitioner’s guide. New York: Guilford, 2003.心理学空间}g$e ]|n2B ~nR
Copyright 2004, Cognitive Therapy Center of New York心理学空间#r|w8io2Y
For more information contact:
g LUI.OI0David Bricker, Ph.D.
US8o"R L5{M.AN3`8E0160 Broadway心理学空间WH1qP@
New York, NY 10038心理学空间kn9pp f|
(212) 406-3520心理学空间O'AzFu#v!L~

www.psychspace.com心理学空间网
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