Individual treatment Flashcards
1
Q
What is schema therapy?
A
- An integrative therapy approach
- Used to treat clients with PDs, characterological issues, some chronic Axis I diagnoses, and various others
- integrates aspects of cognitive therapy, behavioral therapy, object relations, Gestalt therapy, constructivism, attachment models, and psychoanalysis
- Targets the chronic and characterological aspects of a disorder rather than the acute psychiatric symptoms
2
Q
Who created schema therapy?
A
Jeffrey Young
3
Q
When is schema therapy indicated?
A
- When the presenting problem is chronic and long term
- When a person with an Axis I disorder relapses chronically or is non-reponsive to therapy
- When the presenting problem is vague yet pervasive
- When the client is highly avoidant, shows rigid patterns of thought and behavior, or is unusually needy, demanding, or feels entitled
4
Q
Differentiation of schema therapy from CBT?
A
Schema therapy puts greater emphasis on the developmental origins of psychological problems on lifelong patterns of psychosocial functioning, and on entrenched core themes of maladaptive cognition and behavior
5
Q
What are the three main constructs in schema therapy?
A
Schemas - core psychological themes
Coping styles - characteristic behavioral responses to schemas
Modes - the schemas and coping styles operating at a given moment
6
Q
According to schema therapy what causes emotional difficulties?
A
Unmet core needs in childhood and adolescent development –> maladaptive schemas and coping styles
7
Q
Definition of schemas:
A
- Internal phenomena that influence external behavior through the development of coping styles.
- Incorporate how one conceptualizes
oneself and one’s relationships with others. - They comprise memories, emotions, cognitions, and bodily sensations
- They develop during childhood and adolescence and are elaborated throughout one’s lifetime
- Generally accepted as a priori truths and are
outside of awareness,
8
Q
Definition of early maladaptive schemas (EMSs)
A
Broad, self-defeating, pervasive patterns that begin in childhood and repeat throughout a person’s life
They comprise memories, emotions, cognitions, and bodily sensations
9
Q
Types of schemas:
A
- positive
- negative
- earlier
- later
10
Q
How do early schemas develop?
A
- Usually in the nuclear family
- From an interaction of the child’s innate temperament and specific unmet, childhood needs
11
Q
Five core emotional needs in childhood
A
- secure attachments to others (safety, stability, nurturance, and acceptance)
- autonomy, competence, and sense of identity
- freedom to express valid needs and emotions
- spontaneity and play
- realistic limits and self-control
12
Q
4 types of early life experiences that may foster the development of EMSs
A
- toxic frustration of needs
- traumatization
- the child is provided with too much of a good thing
- selective internalization or identification
13
Q
Toxic frustrations of needs and schemas
A
- Occurs when the child experiences deficits in the early environment (in stability, understanding, or love)
- Acquired schemas: Emotional deprivation, Abandonment
14
Q
Traumatization and schemas:
A
- Occurs when the child is harmed, criticized, controlled, or victimized
- Developed schemas: Mistrust/Abuse, Defectiveness or Subjugation
15
Q
“Too much of a good thing” and schemas
A
- The child is given too much of something that in moderation would be healthy
- Schemas: Dependence and Entitlement
16
Q
“Selective internalization or identification” with significant others and schemas:
A
- Occurs when the child selectively identifies with, and internalizes, the parent’s thoughts, feelings, experiences, and schemas
- Schema: vulnerability
17
Q
“Schema chemistry”
A
People are drawn to people who trigger their schemas; the schema is known and feels right, even tho it causes suffering
18
Q
“Schema perpetuation”
A
All that an individual does internally or behaviorally to maintain a schema, including thoughts, feelings, actions, and interactions
19
Q
Schema healing
A
- The goal of schema therapy
- The intensity and influence of a schema are diminished and clients learn to replace maladaptive coping styles with more adaptive patterns of behavior
20
Q
Coping styles
A
Various strategies that are utilized to cope with a schema (behaviors)
21
Q
Disconnection and rejection domain: main characteristics and which schemas?
A
- Expectation that one’s needs for security, safety, stability, nurturance, empathy,
sharing of feelings, acceptance, and respect will not be met in a predictable manner.
Typical family origin is detached, cold, rejecting, withholding, lonely, explosive,
unpredictable, or abusive
Schemas: - Abandonment/Instability
- Mistrust/Abuse
- Emotional Deprivation
- Defectiveness/Shame
- Social isolation/Alienation
22
Q
Impaired autonomy and performance domain: main characteristics and which schemas?
A
- Expectations about oneself and the environment that interfere with one’s perceived
ability to separate, survive, function independently, or perform successfully. Typical
family origin is enmeshed, undermining of the child’s confidence, overprotective, or
fails to reinforce the child for performing competently outside the family
Schemas: - Dependence/Incompetence
- Vulnerability to harm or illness
- Enmeshment/Undeveloped self
- Failure
23
Q
Impaired limits domain: main characteristics and which schemas:
A
- Deficiency in internal limits, responsibility to others, or long-term goal orientation.
Leads to difficulty respecting the rights of others, cooperating with others, making
commitments, or setting and meeting realistic personal goals. Typical family origin
is characterized by permissiveness, overindulgence, lack of direction, or a sense
of superiority—rather than appropriate confrontation, discipline, and limits in
relation to taking responsibility, cooperating in a reciprocal manner, and setting
goals. In some cases, the child may not have been pushed to tolerate normal levels
of discomfort, or may not have been given adequate supervision, direction, or
guidance.
Schemas: - Entitlement/Grandiosity
- Insufficient self-control/Self-discipline
24
Q
Other-directedness: main characteristics and which scehmas?
A
- An excessive focus on the desires, feelings, and responses of others at the expense
of one’s own needs—in order to gain love and approval, maintain one’s sense of
connection, or avoid retaliation. Usually involves suppression and lack of awareness
regarding one’s own anger and natural inclinations. Typical family origin is based
on conditional acceptance: Children must suppress important aspects of themselves
in order to gain love, attention, and approval. In many such families, the parents’
emotional needs and desires—for social acceptance and status—are valued more than
the unique needs and feelings of each child
Schemas: - Subjugation
- Self-sacrifice
- Approval seeking/Recognition seeking
25
Abandonment/Instability schema
Perceived instability or unreliability of those available for support and
connection. Involves the sense that significant others will not be able to
continue providing emotional support, connection, strength, or practical
protection because they are emotionally unstable and unpredictable (e.g.,
angry outbursts), unreliable, or erratically present; because they will die
imminently; or because they will abandon the patient in favor of someone
“better"
26
Mistrust/Abuse schema
Expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate,
or take advantage. Usually involves perceptions that the harm is intentional
or the result of unjustified and extreme negligence. May include the sense of
always being cheated or disadvantaged relative to others
27
Emotional deprivation
Expectation that others will not adequately meet one’s desire for a
normal degree of emotional support. Major forms of deprivation are
[A] Deprivation of nurturance: Absence of attention, affection, warmth, or companionship;
[B] Deprivation of empathy: Absence of understanding,
listening, self-disclosure, or mutual sharing of feelings from others;
[C] Deprivation of protection: Absence of strength, direction, or guidance
from others.
28
Defectiveness/Shame
Feeling that one is defective, bad, unwanted, inferior, or invalid in important
respects; or that one would be unlovable to significant others if exposed.
May involve hypersensitivity to criticism, rejection, and blame; self-consciousness, comparisons, and insecurity around others; or a sense of
shame regarding one’s perceived flaws. These flaws may be private (e.g.,
selfishness, angry impulses, unacceptable sexual desires) or public (e.g.,
undesirable physical appearance, social awkwardness).
29
Social isolation/Alienation schema
Feeling that one is isolated from the rest of the world, different from other people, and/or not part of any group or community
30
Dependence/Incompetence schema
Belief that one is unable to handle one’s everyday responsibilities in a
competent manner, without considerable help from others (e.g., take care of
oneself, solve daily problems, exercise good judgment, tackle new tasks, make
good decisions). Often presents as helplessness.
31
Vulnerability to harm or illness schema
Exaggerated fear that imminent catastrophe will strike at any time and that
one will be unable to prevent it. Fears focus on one or more of the following:
[A] Medical catastrophes (e.g., heart attacks, AIDS);
[B] Emotional
catastrophes (e.g., going crazy);
[C] External catastrophes (e.g., elevators
collapsing, victimized by criminals, airplane crashes, earthquakes).
32
Enmeshment/Undeveloped Self
Excessive emotional involvement and closeness with one or more significant
others (often parents) at the expense of full individuation or normal social
development. Often involves the belief that at least one of the enmeshed
individuals cannot survive or be happy without the constant support of the
other. May also include feelings of being smothered by, or fused with, others
or having insufficient individual identity. Often experienced as a feeling
of emptiness and floundering, having no direction or, in extreme cases,
questioning one’s existence.
33
Failure schema
The belief that one has failed, will inevitably fail, or is fundamentally
inadequate relative to one’s peers, in areas of achievement (school, career,
sports, etc.). Often involves beliefs that one is stupid, inept, untalented,
ignorant, lower in status, less successful than others, and so forth.
34
Entitlement/Grandiosity schema
The belief that one is superior to other people; entitled to special rights and
privileges; or not bound by the rules of reciprocity that guide normal social
interaction. Often involves insistence that one should be able to do or have
whatever one wants, regardless of what is realistic, what others consider
reasonable, or the cost to others; or an exaggerated focus on superiority
(e.g., being among the most successful, famous, wealthy) in order to achieve
power or control (not primarily for attention or approval). Sometimes
includes excessive competitiveness toward, or domination of, others:
asserting one’s power, forcing one’s point of view, or controlling the behavior
of others in line with one’s own desires—without empathy or concern for
others’ needs or feelings.
35
Insufficient self-control/Self-discipline
Pervasive difficulty or refusal to exercise sufficient self-control and
frustration tolerance to achieve one’s personal goals, or to restrain the
excessive expression of one’s emotions and impulses. In its milder form, the
patient presents with an exaggerated emphasis on discomfort avoidance:
avoiding pain, conflict, confrontation, responsibility, or overexertion—at the
expense of personal fulfillment, commitment, or integrity.
36
Subjugation schema
Excessive surrendering of control to others because one feels coerced—
usually to avoid anger, retaliation, or abandonment. The two major forms of
subjugation are
[A] subjugation of needs: suppression of one’s preferences,
decisions, and desires;
[B] subjugation of emotions: suppression of
emotional expression, especially anger.
Usually involves the perception that
one’s own desires, opinions, and feelings are not valid or important to others.
Frequently presents as excessive compliance, combined with hypersensitivity
to feeling trapped. Generally leads to a buildup of anger, manifested in
maladaptive symptoms (e.g., passive–aggressive behavior, uncontrolled
outbursts of temper, psychosomatic symptoms, withdrawal of affection,
“acting out,” substance abuse)
37
Self-sacrifice schema
Excessive focus on voluntarily meeting the needs of others in daily
situations, at the expense of one’s own gratification. The most common
reasons are to prevent causing pain to others; to avoid guilt from feeling
selfish; or to maintain the connection with others perceived as needy. Often
results from an acute sensitivity to the pain of others. Sometimes leads to a
sense that one’s own needs are not being adequately met and to resentment of
those who are taken care of. (Overlaps with concept of codependency.)
38
Approval seeking/Recognition seeking
Excessive emphasis on gaining approval, recognition, or attention from
other people, or fitting in, at the expense of developing a secure and true
sense of self. One’s sense of esteem is dependent primarily on the reactions
of others rather than on one’s own natural inclinations. Sometimes includes
an overemphasis on status, appearance, social acceptance, money, or
achievement—as means of gaining approval, admiration, or attention
(not primarily for power or control). Frequently results in major life decisions
that are inauthentic or unsatisfying; or in hypersensitivity to rejection
39
Overvigilance and inhibition domain: main characteristics and which schemas?
Excessive emphasis on suppressing one’s spontaneous feelings, impulses, and
choices, or on meeting rigid, internalized rules and expectations about performance
and ethical behavior—often at the expense of happiness, self-expression, relaxation,
close relationships, or health. Typical family origin is grim, demanding, and
sometimes punitive: Performance, duty, perfectionism, following rules, hiding
emotions, and avoiding mistakes predominate over pleasure, joy, and relaxation.
There is usually an undercurrent of pessimism and worry—that things could fall
apart if one fails to be vigilant and careful at all times
Schemas:
- Negativity/Pessimism
- Emotional inhibition
- Unrelenting standards/hypercriticalness
- Punitiveness
40
Negativity/Pessimism schema
A pervasive, lifelong focus on the negative aspects of life (pain, death, loss,
disappointment, conflict, guilt, resentment, unsolved problems, potential
mistakes, betrayal, things that could go wrong, etc.), while minimizing
or neglecting the positive or optimistic aspects. Usually includes an
exaggerated expectation—in a wide range of work, financial, or interpersonal
situations—that things will eventually go seriously wrong, or that aspects
of one’s life that seem to be going well will ultimately fall apart. Usually
involves an inordinate fear of making mistakes that might lead to financial
collapse, loss, humiliation, or being trapped in a bad situation. Because
potential negative outcomes are exaggerated, these patients are frequently
characterized by chronic worry, vigilance, complaining, or indecision.
41
Emotional inhibition schema
The excessive inhibition of spontaneous action, feeling, or communication—
usually to avoid disapproval by others, feelings of shame, or losing control
of one’s impulses. Common areas of inhibition involve:
[A] inhibition of anger and aggression;
[B] inhibition of positive impulses (e.g., joy,
affection, sexual excitement, play);
[C] difficulty expressing vulnerability
or communicating freely about one’s feelings, needs, and so forth;
[D] excessive emphasis on rationality, while disregarding emotions
42
Unrelenting standards/hypercriticalness schema
The underlying belief that one must strive to meet very high internalized
standards of behavior and performance, usually to avoid criticism.
Typically results in feelings of pressure or difficulty slowing down,
and in hypercriticalness toward oneself and others. Must involve
significant impairment in pleasure, relaxation, health, self-esteem, sense
of accomplishment, or satisfying relationships. Unrelenting standards
typically present as [A] perfectionism, inordinate attention to detail, or an
underestimation of how good one’s own performance is relative to the norm;
[B] rigid rules and “shoulds” in many areas of life, including unrealistically
high moral, ethical, cultural, or religious precepts; or [C] preoccupation with
time and efficiency, so that more can be accomplished.
43
Punitiveness schema
The belief that people should be harshly punished for making mistakes.
Involves the tendency to be angry, intolerant, punitive, and impatient with
those people (including oneself) who do not meet one’s expectations or
standards. Usually includes difficulty forgiving mistakes in oneself or others,
because of a reluctance to consider extenuating circumstances, allow for
human imperfection, or empathize with feelings.
44
Which are the three basic maladaptive coping styles?
Surrender, avoidance, overcompensation
45
Surrender coping style
- The schema is accepted as true; The individual does not try to avoid or to fight the schema, and he or she directly feels the emotional consequences of the schema
- Surrender coping styles: dependence and compliance
46
Avoidance coping style
- Thoughts, feelings, and behaviors connected to the schema are avoided, and
avoidance behaviors may be extreme or excessive. Situations that trigger the
schema are avoided, such as intimate relationships, work challenges, or even
entire areas of life in which an individual feels vulnerable
- Avoidance coping styles: social and psychological withdrawal, excessive autonomy, compulsive stimulation seeking, addictive self-soothing and substance use or abuse
47
Overcompensation coping style
- Resisting the schema by going to the opposite extreme
- When the schema is triggered, they counterattack vigorously.
48
Which are the main types of modes?
- Child modes
- Maladaptive Coping modes
- Dysfunctional Parent modes
- Healthy Adult mode
