Lecture 11: Schema Therapy Flashcards
what are the 5 core emotional needs (and the proposed extra 2)
- Stability, nurturance, safety,
acceptance - Autonomy, competence, sense of identity
- Freedom to express needs and emotions
- Spontaneity and play
- Realistic limits and self control
PROPOSED:
6. Fairness
7. Self-coherence / comprehensible world
explain the ST theory
unmet core needs/trauma –> maladaptive schema’s –> coping with schema activation (= emotion activation; influenced by temperament) –> schema modes
what are the 7 schema domains related to the unmet needs
-
Disconnection and rejection
* Abandonment/instability
* Mistrust/abuse
* Emotional deprivation
* Defectiveness/shame
* Social isolation/alienation -
Impaired autonomy and achievement
* Dependency/incompetence
* Vulnerability to harm and illness
* Enmeshment/undeveloped self
* Failure -
Overvigilance and inhibition
* Negativity/pessimism
* Emotional inhibition
* Unrelenting standards
* Punitiveness -
Other-directedness
* Subjugation
* Self sacrifice
* Approval seeking -
Impaired limits
* Entitlement/grandiosity
* Insufficient self-control -
Unfairness/Injustice
* Unfairness -
Lack of coherence
* Lack of self-coherence
* Incomprehensible world
mode
= emotional-cognitive-behavioral state
–> combination of activated schema and coping with this
–> modes vary from functional to dysfunctional
what are the 3 types of dysfunctional coping with activated schema
-
Surrender: give in to schema activation (believe it is true)
→ child and internalized parental modes (e.g., Vulnerable Child, Punitive Parent)
(NB new term: resignation, resign to the schema) -
Avoidance: avoid (full) schema activation
→ avoidant coping modes
(e.g., Detached Protector, Self-Soother) -
Overcompensation: believe the opposite is true
→ overcompensation coping modes (e.g., Self-Aggrandizer)
(NB new term: inversion; inverting the schema)
what are 4 categories of modes
- dysfunctional child modes = when basic emotional needs were frustrated in childhood
- dysfunctional parent modes = internalised negative beliefs about the self based on behaviour from (significant) others (eg. parents, caregivers, etc)
- dysfunctional coping modes = coping strategy of avoidance or overcompensation
- healthy modes = being able to deal with emotions/needs and enjoy fun, play and spontaneity
what 3 foci and 3 channels of change
focus:
1. therapeutic relationship
2. past (childhood)
3. present (in/outside therapy)
channels;
1. feeling (experiential)
2. thinking (cognitive)
3. doing (behavioural)
explain the 7 child modes, 2 parent modes and 10 coping modes
CHILD MODES
1. Lonely child: Feels alone, socially unaccepted, unloved, and unlovable.
2. Abandoned, abused child: Feels abandoned, sad, anxious, helpless, hopeless, and threatened; fear to be left alone, to be mistreated, or to be neglected.
3. Dependent child: Feels incapable and overwhelmed by adult responsibilities
4. Angry/enraged child: Feels angry, enraged, frustrated, and impatient because the core needs of the vulnerable child are not fulfilled. Loss of control over anger leading to inappropriate verbal or behavioral expressions of anger or aggression
5. Impulsive child: Lacks the ability to delay gratification and engage in long-term goals, acts impulsively to get need fulfillment
6. Undisciplined child: Feels frustrated quickly, has difficulties with rules, discipline, and finishing routine tasks, gives up easily
7. Happy child: Feels happy and content as core needs have been met. Feels loved, valued, understood, hopeful, optimistic, and spontaneous. Has a sense of belonging and connection to others
DYSFUNCTIONAL PARENT MODES
1. Punitive parent: Internalized punitive messages of significant others leading to self-devaluation, self-contempt, self-hatred, shame, and guilt. Feels like the expression of needs, emotions, or mistakes need to be punished.
2. Demanding parent: Internalized extremely high standards of perfection and efficiency, modesty, or achievement. Criticizes or induces guilt when feelings, needs, or spontaneity are expressed
MALADAPTIVE COPING MODES
1. Compliant surrender: Is reassurance-seeking and acts passively and submissively in order to avoid conflicts or rejection.
2. Detached protector: Tries to achieve distance from emotions by withdrawing from relationships and dysfunctional emotion control strategies (e.g., substance use, dissociation, distraction).
3. Avoidant protector: Avoids social interaction, challenging situations, and conflicts, as well as intensive sensations or activities.
4. Angry protector: Tries to keep others at distance by angry and aggressive behavior.
5. Detached self-soother: Tries to avoid emotions by engaging in activities that soothe, stimulate, or distract (e.g., addictive or compulsive behaviors like gambling, sports, eating, TV, fantasies, sex).
6. Self-aggrandizer: Behaves in a grandiose, arrogant, and self-confident manner. Acts competitive, highlights own strengths and achievements and others’ mistakes and weaknesses. Lacks empathy for other peoples’ needs and feelings. Expects and demands special treatment.
7. Attention and approval-seeking mode: Acts extravagant, inappropriate, and exaggerated in order to get other peoples’ attention and approval
8. Perfectionistic over-controller: Tries to prevent misfortune, criticism, mistakes, or guilt by perfectionistic behavior, rumination, worrying, excessive planning, and control
9. Suspicious over-controller: Tries to prevent threat by suspiciousness, vigilance, and looking for signs of malevolence in others
10. Bully and attack: Tries to prevent loss of control and being harmed by being aggressive and intimidating toward others
explain the typical child, parent and coping modes for BPD, HPD, NPD, DPD, AVPD, OCPD and PDP
Borderline PD: Typical schema mode is the abandoned, abused child mode accompanied by feelings of threat, another is the angry child mode and the impulsive child mode and punitive parent mode
Histrionic PD: typical schema modes are abandoned abused and impassive undisciplined child mode, as well as attention approval seeking mode
Narcissistic PD: Lonely child mode and demanding parent mode, self-aggrandizer and detached self-soother mode (coping)
Dependent PD: abandoned abused or dependent child mode and a demanding and punitive parent mode
Avoidant PD: lonely or abandoned abused child mode and punitive parent mode, avoidant, detached protector mode (coping)
Obsessive-compulsive PD: Lonely child mode and demanding parent mode, perfectionistic overcontroller, detached self soother and self-aggrandizer mode (coping)
Paranoid PD: abandoned abused or angry child mode and punitive parent mode; suspicious over-controller mode (coping)
what are 2 important treatment techniques
- Chair dialogues: used to explore different modes of patients, fight parent modes, confront coping modes, soothing child modes and strengthen healthy adult mode (chair represents different modes)
-
Imagery exercises:
- diagnostic imagery exercises = use current recent emotionally disturbing situation and ask patient to imagine it vividly intensely by asking them to describe in detail their experiences/sensations/feelings/thoughts/etc., they then ask the person to let go of the situation but hold enter the feelings and “float back” to their childhood to see if an image associated with these feelings emerges (= affect bridge) and express feelings needs
- imagery rescripting = reprocess aversive childhood memories in order to change maladaptive schemas –> 2 phases: 1) recalling imaging of an unpleasant situation –> can be down through affect bridge, 2) rescripting the situation to a better ending
explain the effectiveness of ST for BPD and other PDs and it’s treatment retention compared to other kinds of therapies
ST is most effective for both BPD and other PDs, and has better treatment retention than other treatments (TAU)
limited parenting
= therapeutic attitude of behaving as a good parental figure towards patient throughout treatment while respecting the professional limits
–> model appropriate parental responses/behaviors, validate emotions
empathetic confrontation
= the way in which the therapist reacts to problematic behaviour/views of the patient; validating feelings/needs that led to the behaviour and link them to early life and schema mode model while at the same time confronting them with the consequences of their behaviour in a friendly but explicit way and revealing their own reactions/feelings towards them
