Recognition-Based Self-Schema Therapy

Self-Schema Therapy

When in clinical practice in the early 2000’s, I had developed a new way of approaching therapy that had been based on my training, knowledge, and readings on both Mary Goulding's Redecision Therapy (an integration of Transactional Analysis and Gestalt Therapy) and Francine Shapiro's EMDR.  Though I had named it Systematic Reexperiencing  & Reprocessing Therapy (SSRT), since it involved a specific method involving appraisal/schema recognition, the temporary reexperiencing of an emotional reaction to another as in the empty chair’s Gestalt Therapy, the reprocessing of memory that had been outside awareness up until that point in time of therapy, and treatment.  

Dr. Jerome Young (1990) documented and conceptualized schema therapy as a Cognitive Behavioral Therapy for adolescents and adults.  In the early 2000’s he developed a questionnaire YSQ L2 Short/Long Form (2003).  This questionnaire inquired into the current adult patient’s generalizations of one’s impressions of others, the adult’s conclusions drawn from those impressions, adult impressions of others and of one’s reactions to others, the nature of the adult’s stated need for fulfillment or lack of fulfillment, cognitive assessments drawn from other’s emotional responses, and cognitive assessments of one’s coping mechanisms.    

The major differences between Mary Goulding’s (1979) self-schemas in Redecision Therapy and Dr.  Young’s (2003) schemas have to do with the time of their development in any individual.  Mary Gouldings self-schemas start their development during early childhood and progress over time.  Redecision therapy focuses on helping the patient to access those early-developing self-schemas (through empty chair age regression) to help the adult to redecide and move on from their childhood and lifetime influences.  Francine Shapiro’s EMDR also encourages the recognition of self-schemas as an important and integral component for processing traumatic experience.  Both Redecision Therapy and EMDR would be considered to be reprocessing psychotherapies, since they support the  reliving and reprocessing, to some degree, of source schema.  

Dr. Young’s schemas, on the other hand, as a Cognitive-Behavioral Therapy (Martin & Young, 2010), reflect on the adult’s current responses to those schemas.  Therapy focuses on conceptualizing and identifying those schemas (with recognition tools) and modulating and enhancing an adult’s coping behaviors to reduce their influences and impacts on the present day adult.  Schema therapy, as widely practiced today, follows the cognitive-behavioral model protocol in the adult.

Schemas versus Self-Schemas

A schema is developed to guide and filter the processing of ongoing and later self-relevant information. It functions to  arrange and organize incoming information through cognitive operations (Markus, 1977).  Specifically, it broadly:

• categorizes and sorts likeness of experience, 

• detects and analyzes stimulus patterns, 

• makes inferences on vague concepts, implicit information and transactions, 

• transforms and restructures prior beliefs in response to changing information, 

• attributes personal meaningfulness to transactions and to the self,

• allows for the regeneration and recreation of prior perceptual, emotional, cognitive, and behavioral experiences (Nelson, 1986). 

A  self-schema is a generalized cognitive assessment, belief, or idea about the self, which has been derived from many prior experiences, episodes, and actions (that had been experienced during social interactions with others). (Markus, 1977).

If I clarify on the concept of a self-schema within Katherine Nelson’s classification system (above), a self-schema broadly:

• categorizes and sorts human personal experience by likeness of experience of social relationships of self and other,

• detects and conceptualizes social (and/or family) relationship patterns between and among self and other,

• makes inferences of relationship factors of self and other,

• transforms and updates old relationship beliefs of self and other based on new information,

• attributes personal meaningfulness to current social relationships based on the prior relationship patterns of self and other.

Important: When talking about one’s sense of oneself, one needs to include the other, because one’s sense of self is derived from cumulative experiences of interactions within social relationships with others.  The earliest sense of self during infancy is derived from mother (other).  But with ontogenetic development, a sense of self emerges that is different from that of the other.  However, the sense that one has of oneself, later on, reflects both, self and other.

Applying Schema Concepts to Early Childhood Self-Schemas

If I apply Dr. Nelson’s classification system above to the above individual, the received,  implied  parental communication from other (the injunction) and the developed and conceptualized self-schema so derived, we can conclude that these self schemas: 

Don’t Be Close — I am unlovable 

• categorize and sort prior affection-seeking attempts.  This will guide the adult to avoid affection-seeking behaviors and intimacy, and result in uncompleted attempts at intimacy-seeking.

• detect and later establish a pattern for affection avoidance in adult intimate relationships.

• make inferences that the other will eventually reject the person to meet the “don’t be close” standard.

• embody and maintain beliefs of others and of the self in interaction.

Working with Traumatized Individuals

Patients with traumatic histories have difficulty spontaneously accessing painful memory for which there is amnesia especially chronically traumatized and/or emotionally rejected vulnerable individuals in foster placement.  In the course of providing therapy, self-schemas were found to be quite effective at helping an individual to spontaneously and, sometimes, effortlessly, access trauma emotion and experience.  Self-schema recognition seemed to add clarity to the individual’s experience, and helped to facilitate the elicitation and expression of associated emotion.  

I developed a list of self-schemas, which incorporated examples provided by Ms. Goulding, Dr. Shapiro, and Dr. Markus.  I also detected the existence of patterns in those self-statements, which could be traced to different social motivations, like the social motivation need for love and affiliation, valuation, control over outcomes, achievement, well-being, etc.  Self-schemas seemed to describe and conceptualize the outcomes of transactions that sought to address social motivational need in interaction.

I had developed a list of parental injunctions and examples of parental injunctions or statements that are used at the start of therapy to help the patient to ease into the therapeutic process with less resistance (Please reference Mary Goulding’s “Changing Lives with Redecision Therapy”’). These parental injunctions, which are characteristic of the attachment relationship in interaction (Bowlby, 1980), asked a patient to underline all those that apply to a specific relationship. The following is a sample that has been taken from a four page document:

1. I ask the patient to select 4 statements that are particularly disturbing and develop a written homework assignment that lists each of the four statements. 

2. I ask the patient to elaborate on the situation or context where each statement was made. 

3. I ask the patient to note who else had been present and what did this person say about the other's statements and behaviors. 

4. I ask the patient to write down on a piece of paper what his or her responses were to this situation and to approach this written assignment, as if the patient were talking to each person in the present tense (Note: concepts of Gestalt Empty Chair Therapy). 

5. The patient is required to note how he/she is feeling in response to one or both individuals throughout the written dialogue. 

6. The patient works on this written assignment and prepares it for our next meeting. 

7. When we meet again we review that which had been written. 

8. I read the assignment aloud, tried to elicit more details about the statements, and events, and then asked the patient to select the most disturbing aspect of each of the four statements. 

9. I then take out a blank list of assessments of self in interaction (self-schemas) and ask the patient to highlight those assessments of self in interaction that had applied to his/her sense of the world at that time when the statement had been made. (Note: These assessments describe our sense of safety, how each of us lives up to the expectations of others, the level and degree of responsivity of others, etc. Some examples taken from this list are the following: I can't get it right. I can't be good enough. I am unlovable. I don't belong; I can't get close. I am powerless. I am unsafe). 

10. I then ask the patient to highlight those assessments of self in interaction that the patient brings into his/her experience in the present and to give examples when the patient in the present thought of him/herself in the same way (Note: again, concepts from Gestalt Therapy).

It would look like the following:

Parental injunction: Don't be close.*
Example: Get outta my sight.
Context noted during therapy: Patient wrote the following. After I cleaned the barn the way you wanted me to, you told me to "get outta my sight", because your friends are over. You pushed me and hurt me. Grandma says "leave your dad alone. You should know better." Patient thinks “Dad you have no right to push me away like that. Grandma why do you blame me for what he does? I am angry grandma because it's not my fault.” During the next therapy session the patient tells me, "I was proud because I cleaned the barn. My dad was partying with friends and didn't want me interrupting him. He grabbed my arm and threw me across the room and hurt me. I was mad. I was confused because I cleaned the barn just the way he wanted me to. My grandmother told me to leave my dad alone that I should keep away from him he gets like this when his friends are over. She said that I should know better. I was mad at grandma for taking my dad's side. She always took his side when he was mean to me.”
Highlighted assessments of self in interaction: “I can't get it right.” “I can't be good enough.” “I am unlovable.” “ I don't belong”; “I can't get close.” “I am powerless.” “I am unsafe.”
Emotion: “Anger because I did what he wanted me to do, but didn't care.” “Sad because I cleaned the barn just the way I thought he wanted me to because I wanted him to respect me. Sad because he told me he wanted me to be a certain way, but I didn?t know what to do to be the way that he wanted me to be.”
SUDS: Disturbance of 6 then, 4 now.
Current example: “I got mad when my boss flicked me off when I wanted to show him my corrections.”

We repeat this sequence over the next 2-4 sessions with different examples and parental injunctions. Then we conclude by reviewing all our work. After the patient has completed this part of the therapy, the patient has gained a clearer sense of the nature of the attached state with significant caregivers in his or her life and their impacts on current relationships. After completing this aspect of therapy it is also easier to identify early childhood traumas for which there has been amnesia. We then go onto the next part of therapy, which is processing trauma.

Recognition-Based Self-Schema Therapy

After the patient has identified and processed the nature of significant attachment relationships from early childhood in following the above course, the patient then identifies a trauma or disturbing event and describes its occurrence in a written homework assignment. 

The homework assignment asks the patient to reflect on a troubling occurrence. 

• State what happened. 

• State who was there and what was said. 

• What was your response to what was done and said. Describe your reaction (e.g. thoughts, emotions, visceral responses, behaviors, etc.) 

• How did the other participants respond? 

• How did it conclude? 

During non-therapy time, the therapist transfers the contents of the assignment onto a worksheet, which had been devised to coordinate with the self-schema worksheet that the patient had typically used during the course of therapy. During the next session, the therapist reviews the assignment and asks questions to elicit further details. The therapist then reads the trauma one sentence, one frame at a time. The adult patient is encouraged to identify from a list of self-schemas those that pertain to each event frame. With conclusion of the narrative event frame review - self-schema identification, the therapist reviews each individual event frame - self schema identification again and then inquires into the vulnerable emotion and visceral sensation that had/has been associated with the specific self-schema. Below is a written example of how this review would be reflected.

“I was five years old and playing at the beach. I was busy trying to build a sandcastle. I imagined that I could make it real big. My mom said "Come into the water; it'll cool you off!" My dad came along and scooped me up. He wanted us to join my mom deeper in the water. I resisted him and said "Let me go. I don't wanna go!" As I struggled to free myself I knocked my dad's favorite sunglasses off his face. His sunglasses fell into the ocean and were never seen again. I saw my father's disappointment immediately. He refused to talk to me the rest of the day. I felt really bad for losing his glasses.”

As suggested by John Bowlby (1980-page 233) we review the role and behavior of source in the troubling interaction or trauma and the nature of selected self-schemas. Attention is paid to examining the thought progression for the later development of self-blame that had produced constructions that internalized the event. This internalization seemed to underlie this patient’s adult rigidity and persistence of the low self-esteem. In addition any expectations for different behaviors that the patient may have had for source are also examined.

After processing in this manner, we examine the development of new positive thoughts in interaction, a redecision (of Mary Goulding) or positive cognition (of EMDR) that can modify the existing cognitive bias (Bowlby, 1980). Each trauma or disturbing event is processed in this way until all events that have had a capacity to impair adaptation and produce behavioral symptoms have been processed.

References

Bowlby J (1980): Attachment and Loss-Volume 3-Sadness and Depression. Basic Books, New York.

Goulding MM & Goulding RL (1979): Changing Lives Through Redecision Therapy. Grove Press, New York.

Markus, H. (1977). Self-schemata and processing information about the self.  Journal of Personality and Social Psychology, 35(2), 63-78.

Martin, R. & Young, J. (2010).  Schema Therapy. Ed.: K.S. Dobson. In: Handbook of Cognitive Behavioral Therapies-Third Edition, pp. 317-346. New York: Guilford Press

Nelson, K. (1986). Event knowledge and cognitive development.  Ed.: K. Nelson. In:  Event knowledge: structure and function in development, pp. 1-19.  Hillsdale, New Jersey: Lawrence Erlbaum Assoc., Publishers.

Young, J. E. (1990). Cognitive Therapy for Personality Disorders. Sarasota, FL: Professional Resources Press.

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