COGNITIVE THERAPY FORUM ARCHIVE
Return to the active forum
Re:Critiques of Schema Therapy
Linda Nauth · 12/29/01 at 9:41 PM ET
I would like to weigh in on the usefulness of Young's schema therapy with mixed personality clients. I've had similar discussions with Dr. Pretzer earlier and I have since come to be convinced that using underlying schema and the schema processes of maintenance, compensation, avoidance can help give insight and change ideas for these difficult clients. There is an interesting book by Len Sperry called "Cognitive Behavior Therapy of DSM-IV Personality Disorders in which Dr. Sperry states that mixed personality disorders are like a chocolate-vanilla swirled cone- thus each individual disorder is treated separately. He states that each disorder is relatively discrete and intact at any one time. I disagree and find mixed personality disorders are more like a mixture of the colors red and yellow that yield the color orange [to use Sperry's words]. Mary Layden et al.'s book "Cognitive Therapy of Borderline Personality Disorder" try to grasp this mixture by identifying spectrums of Borderline PD with other personality disorders. Thus, these authors describe an borderline-antisocial/paranoid PD client versus a borderline avoidant/dependent PD client. I like this approach but find the number of possible mixtures overwhelming. And as they note "two borderline patients may posess the same abandonment schema but develop different beliefs and different behavioral styles to cope with these beliefs. The possibilities of different combinations are unlimited! I find human beings very creative in finding new ways to demonstrate pathology. I use Young's schema approach with mixed personality offender clients in a group setting. I teach the offenders the schemas [I only use 5 core schemas-abandonment, defectiveness, emotional deprivation, mistrust/abuse and subjugation which I have renamed powerlessness] and the 3 basic schema processes like "surrender, counterattack and avoidance"[Young's names in his self-help book, "Re-inventing your life."] Then each can identify his own mixture. The schema processes are very important especially for antisocial clients who often use compensation and avoidance. Instead of feeling bad about themselves, they bully someone and then feel good about themselves. Or they drink or do crime to avoid feeling the emotional pain of their early maladaptive schemas. Once they understand how they use these processes, they can better accept the fact they they may indeed feel defective or feel powerless. They also can see themselves as similar to other, non-criminal individuals. They have the same schema as other people, they use counterattacking coping styles. They can also take responsibility for their behaviors while understanding that the emotional pain of their schemas are real and not their fault. The technique I use most to get at schemas is David Burn's Vertical Arrow technique. It's also used in "Mind over mood" and just works great. Also, it seems to me that by teaching the schema and the processes and the way for the client to identify their own schema is more in the collaborative mode and is stressed more in Jeff Young's work than in the other CBT work on personality disorders.
Replies:
| Behavior OnLine Home Page | Disclaimer |
Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.
