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Re:Critiques of Schema Therapy
Jim Pretzer · 01/02/02 at 10:08 PM ET
Ian James criticism isn't focused specifically on Young's Schema Therapy, he's challenging what he sees as an unthinking enthusiasm for schema-focused interventions. I think he raises some important points. The idea that dysfunctional schemas underly many problems and that we need to identify and change those schemas "makes sense" to many therapists and clients. However, not every idea that "makes sense" turns out to be true. Perhaps it would be a good idea for us to test whether schema-focused interventions increase the effectiveness of CT. You write "I do maintain that the offenders need to understand they hold a core belief of defectiveness or powerlessness and without this understanding, they will continue their counterattacking behaviors that include truely hurting other people." This is a potentially testable proposition, but I am not aware of empirical evidence that these schemas need to change in order for antisocial behavior to change. You mention the offender who almost killed his wife when he found out she was cheating on him and describe a pattern of his bending over backwards to get her to stay and then eventually retaliating physically. I can see how his schemas may be relevant but I'm left wondering whether he really needs to understand that he has "'surrendered' to his schemas of abandonment, defectiveness and powerlessness" or whether it is more important for him to learn that it is a really bad idea to be excessively accomodating and then lash out violently when accomodation doesn't work. We have some empirical evidence that interventions which focus on changing automatic thoughts and behavior can be effective with this type of problem and we have precious little evidence that schema-focused interventions are more effective than interventions which focus on changing automatic thoughts and behavior. When you assert "First they have to feel the emotional pain of their maladaptive schemas or else they will continue to counterattack and be violent. Then we work on changing their schemas. I know exactly what to do to help the men I work with. And I have found that only Young's schema focus approach has shown the way to reach down into these hostile, and angry men to find their sad, more vulnerable side." I'm left wondering if there is any evidence that offenders have to feel the emotional pain of their maladaptive schemas in order for their behavior to change. Does helping them find their sad, more vulnerable side result in greater improvement of more lasting change? At this point I'm aware of studies showing that "traditional" CT and CBT is effective with this population and I'm not aware of any studies showing that schema-focused approaches are equally effective, let alone more effective. Several authors have expressed a concern that when therapists rely on theoretical arguments or personal conviction rather than empirical evidence there is a risk of shifting from effective but "boring" interventions to interventions which are "sexier" but which may be less effective. This is a risk when we get too far ahead of the data.
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