Transcription
Hi, my name is Jess O'Garr. I'm a clinical psychologist. I'm coming to you today from Oscar Online.org (now thePSYCHcollective.com), and today I'm going to talk to you about schema therapy.
So the model that I'm going to present today is based on Schema Mode Therapy, and the modes that we're going to be referencing today, I'm taking leave from the work done originally by Joan Farrell and Ida Shaw from the US, who I was lucky enough to do my training with many years ago. So today, I'm going to talk about the different modes of schema therapy and give a bit of an overview as to a conceptualization as to how they all fit together, okay?
So, first of all, let's talk about schemas. So when we talk about schemas, what we're really referring to is like a blueprint. You've heard of schematic drawing, which is referring to kind of a blueprint drawing you'd have of a house, for example. When we talk about schemas in this sense, we're looking at a schema in terms of how you organize information. So it's the way that you would collect information, organize it, and kind of sort it into almost like a mind map within your brain. Everyone has schemas; that's how we develop our understanding of the world around us.
Now, schema therapy posits that with early experiences in childhood, if there have been some unmet needs, there would be the development of some maladaptive schemas. I'm going to be not so much focusing on the schemas themselves today. Examples of those, just to give a bit of context, would be something like an abandonment schema, and it kind of ties into core beliefs. Like schemas are almost like the category, then the core belief itself would be the thought within that. So if you have a schema of abandonment, then the core belief would be something like, "Everyone always leaves me," okay? So that's schemas, and there's 18 different maladaptive schemas that were identified by a guy called Jeffrey Young, in the 1980s, I think. But we're going to focus more on the schema modes today, okay?
So, when we talk about schema modes therapy, it's almost like there's different characters within the brain. You've seen the movie *Inside Out*? That's kind of similar to that. The characters within the brain (we're not talking about auditory hallucinations or different voices or different personalities or anything like that) it's just recognizing that everyone's got different parts of themselves and trying to conceptualize that.
So, for the start of schema therapy, everything revolves around a mode that we call the Vulnerable Child. When we talk about a mode, it's kind of like a mood plus it's got a behavioral component attached to it. So the center of everything for schema is this thing we had called the Vulnerable Child. Now, they reference it as a Vulnerable Child because it talks about this idea that everyone was a child in the beginning, obviously, but this sense of vulnerability, that part of us where we feel fear and scared and ashamed and worried, that part of us never actually leaves us. It's always there, no matter how old we get. It's kind of that inner child kind of metaphor, but it's the one that feels all the vulnerability, and that's where schema therapy really centers around, okay?
So, we started off with this schema mode called the Vulnerable Child. It's at the center of everything, and it's kind of almost like the source of where the distress would come from when this mode gets triggered. Attached to that, you have a mode called... Angry Child. Now, don't worry, this isn't too clear because I'm going to attach a word document that's got all of these models laid out for you as something that's a little bit easier for you to print off and download, okay?
Now, the Angry Child links in with the Vulnerable Child. The way I like to think about it is: imagine you've got a four-year-old girl sitting in a chair (or a boy, up to you), and the girl is in a room full of adults who are responsible for looking after her and caring for her, and she's sitting in that chair and she's crying. No one's paying any attention to her. You've got to remember this is around unmet needs, so if the child's getting their needs met, they're unlikely to be developing the maladaptive schema modes. So we've got a child who's upset, no one's paying attention to her, she's not getting her needs met, okay? There's your Vulnerable Child.
Now, imagine she's got a brother who's about six, old enough to recognize that my sister's upset, my sister's sad, something needs to happen here, but also young enough that they are not able to do anything about it themselves. So a six-year-old, you know, worried about his younger sister in a room full of adults who's supposed to be looking after them but not actually paying any attention to them, is going to do what a normal six-year-old would do and throw a tantrum. There might be yelling, there might be screaming, they might be stomping their feet, and the idea behind it is it's a way of trying to draw in attention to say, "Hey, something's not right here. This situation is not okay. I'm not okay. The vulnerable child's not okay. Someone come and give us some attention in a way of getting our needs met."
The problem with that is that if you've got adults or people who are in a responsible role of caring for your needs, who see you having a tantrum, if they're already ignoring you when you're upset, chances are they're going to either ignore you or punish you if you're showing the anger, okay? So there is this real strong kind of desire to get the needs met and bring attention and draw people in. The problem is, it doesn't work so well. So these are kind of the two base child modes.
Attached around that is an element of coping strategies. Now, as humans, we are born with three primary responses: Fight, Flight, Freeze. I'm going to draw those now. So these three main responses, as I said, they're hardwired into everyone. Everyone is born with these in some sort of capacity, and they develop over time in terms of their level of sophistication in the way in which we choose to implement them. Most of us will have a default setting or kind of our 'go to' with these sort of things, but everyone has the capacity to move between all three of these, okay?
Now, these coping strategies come in the way of trying to keep us safe from threat. Now, originally, they're developed as part of helping us from an evolutionary point of view avoid actual physical threat, sabre-toothed tigers and whatnot. From a schema point of view, we're looking at prevention or safety around physical threat, but also a kind of verbal, emotional, or psychological threat or abuse. So these coping layers come in almost as a way of providing a shield around the Vulnerable Child. You know that everything centers around this, so this is what we're trying to actually protect. We're trying to protect our vulnerability, we're trying to keep ourselves safe, and these are the three options that we have available to us as children. But again, we don't lose that; we don't grow out of our Fight/Flight strategies. It's something that we still have accessible to us as adults, and really, we need them accessible to us as adults because we need to still keep ourselves safe, no matter how old we are.
But we can break these Fight, Flight, Freeze categories down further into modes that would actually look at how we respond when we're feeling vulnerable. The first one I am going to talk about is a fight strategy. It's a Perfectionistic Overcompensator. Now, usually, when we hear "fight," the assumption is that there's going to be some sort of aggression to it, or like actually getting in a fistfight with someone. That's not necessarily the case when we're looking at schema therapy. This can be more around a psychological fight strategy, and it comes with an overcompensatory mode. So, let me give you an example. If we've got someone who's feeling vulnerable. So say I'm feeling vulnerable about my performance on a task at work. My Perfectionistic Overcompensator would kind of kick in to say, "I'm going to protect you from feeling vulnerable by making sure you do everything perfectly, alright? Because if you were perfect, and if you can show other people that you have absolutely no flaws whatsoever, then they've got nothing to threaten you about. There's no danger there because everything's perfect, everything's neat and tidy, and there's no issues."
So the Perfectionistic Overcompensator is going to mean that I show up at 7 o'clock in the morning, I'm here until 10 o'clock at night, I triple-check every single piece of work that I do, I'm constantly checking to make sure that I'm getting the approval from other people, that they're happy with the work that I'm doing, and generally, on the surface, can probably look like I'm functioning pretty well. The fallout from the Perfectionistic Overcompensator is you can't keep it up forever. This is where we get to burnout. So there's pros because it looks functional, and you know what, it's going to get rewarded because other people, particularly in like an employment circumstance or something like that, they're going to love it. They're getting the best work out of you! So the Perfectionistic Overcompensator on the surface, it looks good, but the problem is it's not sustainable.
So, moving on for a different Fight strategy... You have something like Bully-Attack. This is probably more your classic sort of Fight strategy. This is where we'd see someone who, when they're feeling vulnerable, so maybe if they're feeling a bit cornered, if someone's coming at them with a bit of criticism or some negative feedback, this is the person who's going to come out swinging. It may not necessarily be physical; it may be more verbal, but it would look like someone who, like, if a staff member walks up to me and said, "Look, I'm not happy with how you did X report," then the Bully-Attack response would be, "Well, when you did the last report, you made all these spelling mistakes and it was a mess and rah-rah-rah." And the idea of shifting the attention off what I've done wrong, pushing it on to the other person, so then the focus is all on them and what they've done wrong, which then deflects the attention off of my vulnerability, off of my failings, or of where I've done this wrong. Often, what we'll see with this is someone who uses a lot of Bully-Attack mode has a lot of difficulty taking responsibility for things that they've actually done wrong or acknowledging when they've stuffed up, and usually has quite an aggressive sort of mannerism about them.
Similar to that one... We have the Self-Aggrandising mode. This is going to be probably similar to what we consider a narcissistic defense. The idea of the person is, "I'm going to prevent anyone from seeing my vulnerability by showing how completely awesome I am and talking myself up whenever I can." So it's the person who thinks that they are wonderful, they see themselves walking on water, they can never make any particular mistake. It's different to this because these ones know that they can make mistakes and they're trying so hard to overcompensate for it. The Self-Aggrandising is more of a kind of big ego and "look how good I am," and it's a lot more showy, but usually, what we find under that is a very, very, very scared person, a very, very strong vulnerable child that they're trying incredibly hard to try and hide.
The last one I'm going to talk about... Is the Suspicious Overcontroller. So this one we'd see where there is a fear that something bad is going to happen, and there is a desire to go into a response of controlling everything. They've got not only a plan B but they've got a plan C, D, E, and F. They're watching everything. You might get a bit of micromanagement happening here in the sense of, "I don't trust anyone to do it right, so I'll do it myself." They're suspicious of other people's intentions. There can be kind of some elements of paranoia coming into here and fear that something bad is going to go wrong unless I control every single outcome.
There are a few more fight strategies if you actually look at some of the literature on schema therapy. Some of them going to like Predator Mode and Conning Mode, but we see those really more with a forensic setting. Not something that we usually work with kind of in a normal community sample within mental health, so I'm going to leave those and move on to Flight strategies.
So, Flight, in its simplest form, is avoidance. And we see exactly the same thing when we look at the modes, slight variations on the categories here. Detached Protector is the first one. This is a form of psychological flight. On the surface, it can look like the person can actually be in the room, in the building, be participat- well, be attentive in what is going on, but there's a form of psychological shutdown happening with the Detached Protector. It's the element that kind of, it's almost like the lights are on but nobody's home. There can be an element of dissociation to this at times, and it would be going into a situation that you know you have to go into but being able to switch off emotionally to what's happening. So it's when people can kind of activate that sense of feeling numb. The rationale behind this is that "if I don't feel anything, then I don't have to connect with my Vulnerable Child" because in the flight strategies, it's "I would do anything to avoid contact with this because this is scary and overwhelming and it gets too intense and I don't want to deal with it, so I'm just going to avoid it." And Detached Protector is a way of having that avoidance when you're still forced to be in the room.
The flip side of that... Is the Avoidant Protector. This is more of a physiological flight or more of a physical flight. It's "just don't go out the room." If you're expecting something bad to happen or if you're catastrophizing something bad is gonna happen, don't go. Don't go to the party, don't go to the staff meeting, don't even go down to the grocery store because it could be terrible, it could be an attack, catastrophic. It's easier to just simply avoid.
Mixed in with this, we also have... the Anger Protector and the Angry Child, because on the surface, they look the same; they're both angry. But the function of the behavior is what actually differentiates it here. With an Angry Protector, it's part of the flight strategies, so it's around pushing people away. You think about, if you're walking down the street and you see someone who's acting really aggressive and they're yelling or they're screaming or whatever, you're more likely to cross the road and get away from that person as opposed to go up and engage with them. And that's what an Angry Protector is trying to do. These are the ones who will push everyone away because "If no one can get close to me, then no one's gonna hurt me. I can be scary and I can be intimidating." It's the ones that have got "go away" tattooed on their foreheads, so to speak, and keeping everyone away at arm's length. That usually comes back to a massive fear that "if anyone gets close, then they might get to know me, they might abandon me, and that might hurt me."
And the final Flight strategy we're going to talk about... Is the Detached Self-Soother. This is a similar form of flight because it's around "I don't want to feel my vulnerability. I don't want to feel the feelings that are intense or scary or overwhelming, so I'm going to do something to take those feelings away." So Detached Self-Soother is where we see behavior where people who are engaging in self-soothing behaviors that are going to be maladaptive. So it could be alcohol, substances, food, shopping, sex, risky driving, self-harm, as a way of transforming this feeling that I have of vulnerability into something more manageable, a physical manifestation of distress that I can see and I can show others and I can tend to, or something that brings a different emotion such as happiness or joy or exhilaration (that's usually short-lived) but feels something that's more of kind of the positive spectrum in terms of emotions.
So all of these are around flight, and for Freeze, we pretty much just have one... Complaint Surrender. This is where the strategy is pretty much just give into it. Just go with whatever is happening. You don't like it, you don't want it to happen, but you've just got no Fight left, you've got no Flight left, you're kind of at the bottom level in terms of your strategies, and it's that sense of "I give up." If we're talking about it from a schema point of view, so if someone's got a schema of say, failure, where the core belief is "I fail at everything," this one's going to be, "No, no, no, I can't fail. I won't fail perfectly. I'll do everything perfectly so I don't fail." This one's going to be, "I'm not even going to try because then I can't fail." This is more of a, "Yep, I just fail at stuff, that's just me, that always happens." So the Compliant Surrender really is kind of just that final line of defense of just giving up and giving in.
Now, we talk about these three layers as being a layer of protection for the Vulnerable Child. It's almost like they form a concrete bunker. But the rationale for having a bunker is if you perceive that there's threat in your environment. So that's where we get to the dysfunctional parent modes...
So the Punitive Parent Mode is the primary one that we see in terms of the source of threat. Now, from a schema therapy point of view, they call it a Punitive Parent Mode because the rationale behind these is children aren't born hating themselves. If you've ever been around a two-year-old, they think they're awesome. They see themselves as the center of the universe. So then how do you go from a two-year-old who thinks they're awesome to a twelve-year-old who hates themselves to a twenty-two-year-old that's got depression? It's usually a result of their external environment. Obviously, biology has got a part to play with this, but in terms of what they think about themselves, how they talk to themselves, that's usually going to come from what's happening in their environment. So it starts off as being from external sources, and over time, that voice gets internalized, and it starts to become what we will more colloquially call our 'inner critic'.
Now, parent mode- again, this is not saying that's mum and dad's fault. It's more just recognizing that as children, we are very strongly influenced by the adults in our lives. The Punitive Parent is an amalgamation of all of the negative things that we heard growing up. It could be mum and dad, it could be grandparents, it could be aunties and uncles, it could be coaches, it could be teachers, it could be Scout leaders, it could be religious educators, anyone who was in a position of authority or power or responsibility for a child who either said negative, harmful, or hurtful things, or there was an absence of positive things.
Now, this could be that the parent with the best of intentions trying to calm a child down, but if it's done in a way that is perceived as invalidating or dismissive, if it's the kind of, "Stop crying, you're fine, there's nothing wrong," in an attempt to calm the child down, can actually come across as, "My feelings are wrong. I'm not supposed to be feeling this," which then turns you into an internal message of, "I can't show anyone when I'm upset." So the Punitive Parent is that negative, critical voice of, "I'm not good enough. No one loves me. No one wants me." It's just the sense that everything is kind of failure, and it feeds back into those negative core beliefs and the schemas we were talking about earlier.
There's a second Parent Mode... This one is called the Demanding Parent. Slightly different because this is more of the one that gives you the push. So the Punitive Parent is the one who just criticizes and puts down; the Demanding Parent is more like the one who's cracking the whip. So this is kind of a bossy critic, and it's the one that says, "You need to try harder. You need to do more. You need to push more. You need to get up at four o'clock in the morning to be able to get to work, to do it all perfectly, to make sure that no one's ever going to question you or threaten you."
Now, these Parent Modes are targeting the Vulnerable Child. So you've kind of got these snipes coming through and these attacks coming through here. Sometimes, your coping mechanisms work and they deflect the criticism from coming through and actually hitting the Vulnerable Child, but nothing about our coping strategies are ever perfect. So sometimes the hits do come through, and that's when we get that kind of gut-wrenching, soul-crushing feeling of vulnerability that comes from our own internal processes. So this is a representation of the maladaptive schemas at work, in terms of the dysfunctional parent modes and maladaptive coping modes.
I want you to keep in mind, this stuff was developed for children because we have limited resources available to us as kids. We've got to rely on the absolute basics of Flight, Flight, Freeze. Problems occur when we continue to apply the strategies that work for us in childhood into our environment as adults. The environment has changed; we've gotten older. Ideally, we want to learn some more sophisticated strategies of managing it, and that's why you start to see people presenting for treatment because their coping modes that used to work, don't work anymore.
Now, not all hope is lost; we do actually have some positive modes here to talk about. The first one being Healthy Adult... This is the part of us that actually allows us to do our adulting. This is the part of us that is ideally working as almost like a stage director, to be able to control all of these characters on stage and to be making some healthy grown-up decisions. What this means is that when we're faced with any sort of situation, instead of having our three options of response, you've actually got four. You've got Fight, Flight, Freeze, and Healthy Adult. The problem is, Healthy Adult needs to be learned. We're not actually born with this response the way we are with these ones; this one needs to evolve over time based on having a good education and a good role model from people around us to teach us how to do this. In situations where people haven't had those positive experiences in early childhood, the Healthy Adult Mode is probably going to be underdeveloped.
The second healthy mode that is in with that... Is our Happy Child Mode. Again, this is a positive mode. It is one of the child modes, but it's actually one of the healthy modes, so we keep it up here. And the Happy Child Mode is where we get that sense of fun, where we get the sense of play. People who've grown up in environments where their needs weren't being met usually aren't afforded many opportunities for fun and play and novelty and autonomy and independence. So if it's lacking in childhood, it's really hard for us to continue that in adulthood. The second part of that is for people who have actually had it in adulthood, society kind of tells us to stop fooling around and grow up and act your age and be more serious, so we can lose that sense of fun at times. What we recognize though, is that having that Happy Child is a really good kind of balance to the Vulnerable Child. You don't want to get rid of this; you need this. This is where our humanity sits, but this is more where our happiness sits, so that's really important.
Now, in terms of schema therapy, how we actually make some changes here. Schema, as I said, schema works on the principle that there were negative experiences in childhood that led to the development of maladaptive schema modes. Therefore, we need to reintroduce some positive experiences to lead to the increase of functioning of the healthy modes. So we talk about... The idea of a Good Parent, and schema therapy actually uses this concept of re-parenting. So teaching you new ways or different ways to actually respond to perceived or actual threat.
Now, in terms of schema therapy, the good parent is actually represented by the therapist. It's the good parent as the therapist instructing the patient how to increase their Healthy Adult to manage the rest of these modes. So we've got some pretty kind of clear sort of strategies in terms of what needs to happen here from a management point of view.
So from a therapeutic point of view, Vulnerable Child is the center of everything. That doesn't change. We need to actually learn how to look after that Vulnerable Child, to get used to allowing ourselves to experience that Vulnerable Child in order to learn how to master it. So the strategy for the Vulnerable Child is not shut it down, it's not get rid of it, it's actually to SOOTHE it.
For the Angry Child, if you've ever worked with anyone or been around anyone who's angry, their primary kind of point is they're feeling unheard. So the management strategy for Angry Child is actually let them talk. Find out what's going on for them. Let their point of view be heard, because nine times out of ten, once you've dealt with the anger, you uncover the vulnerability. So here... We need to VALIDATE.
Now, with the coping modes, I don't want you to turn them off because Flight, Flight, Freeze are automated for a reason. It's something that we were born with for a reason. If there's a bus coming barreling down the street as you're crossing the road, I want you to get out of the way, and it's these systems that are going to make that happen. So I don't need to get rid of them, but I want you to be able to CHOOSE when and if you engage them. So there's times when Perfectionistic Overcompensator can actually be quite functional, but it needs to be time-limited. There are times where if you're faced with someone who represents an actual threat to you, Avoidant Protector is going to help you get out of danger. But there's going to be other people that aren't threatening to you that you're having difficulty engaging if you're so used to being in your protective mode. So then the strategies for this... Is to be selective.
Your strategy for your parent modes, there's two different strategies. Because your Punitive Parent is critical and rude and negative and horrible at all times, it has absolutely no value whatsoever... we BANISH. Get rid of it, to the best of your ability. Maybe not a hundred percent, but at least be able to recognize when it is that the inner critic is talking and go, "I don't want to hear it. Go away. Shut up." Whatever you need to do. Imagine kicking it off a cliff.
But Demanding Parent, on the other hand, there is actually some element of functionality and purpose in that one. You need that voice in the back of your head that says, "Get out of bed. You've hit snooze three times. If you don't get out of bed now, you're going to be late." What you don't need is a voice that says, "Get up at four o'clock in the morning; you need to clean the house, mop the floors, go to the gym for two hours, then you're allowed to go to work. Once you get to work, you need to do this, this, this." It just gets too out of control. So for here... we NEGOTIATE.
The Healthy Adult modes, what we really need to do here is DEVELOP and FLOURISH... And for the Happy Child Mode, the biggest thing that we want here... let it out. PLAY. Have some fun. It's a really good balance to this stuff down here, and something that we never actually grow out of.
Okay! I hope all that's made sense. As I said, I'm going to include the word document that's got kind of the overview of these, so you've got something you can actually download and print out if you need it. We will do some more videos coming up talking about some of the modes within these, but for today, that is my schema conceptualization.
Download diagram at www.thepsychcollective.com.