What can be done if a patient suffers from several disorders? What interventions are required for ‘difficult patients’? And what happens if the problem has become chronic? Jeffrey Young, an American psychologist, has spent 20 years developing schema therapy to provide a solution for these problems. In this article, we’re going to focus on a cornerstone of his method: his maladaptive coping styles.

Schema therapy is an integrative process. It combines elements from the cognitive-behavioral school, attachment theory, gestalt, constructivist, and psychodynamic models. It’s been mainly employed in treating personality disorders. That said, research is also being developed on its effectiveness in other disorders such as anxiety, depression, and eating disorders.

“Sometimes, patients have a hard time accessing their feelings, thoughts, and images.”

-Young-

The basics of schema therapy

Before examining the maladaptive coping styles proposed by Young, we’re going to look at the basic concepts that underpin schema therapy. This will help shed light on Young’s approaches and elements of his therapy.

1. Early maladaptive schemas

Young’s model examines early maladaptive schemas (EMS). These schemas work as guides. In fact, they tell us how to behave, think, feel, and perceive. They develop and are elaborated throughout our lives. According to Young, these are their characteristics.

• They’re true, a priori.
• They’re self-perpetuating.
• They resist change.
• They’re dysfunctional. That’s to say, they produce discomfort.
• They’re generated and activated by environmental experiences.
• They produce intense and elevated affective states.
• They arise from the interaction between temperament and dysfunctional developmental experiences.

Early maladaptive schemas are a reflection of how the beliefs we have about ourselves are organized in relation to what surrounds us. They’re the products of stressful events, sometimes traumatic, with people who were significant and important to us when we were little, basically, our families.

“Knowing the early dysfunctional scheme implies knowing the origins, the childhood of the patients and the influence of all this on their problems.”

-Rodríguez-Vílchez-

2. Origin of the schemas

Early maladaptive schemas arise as a consequence of dissatisfaction with our emotional needs in childhood. The kinds that are basic and nuclear:

• The need to establish affection and secure bonds with other people.
• To know ourselves as autonomous, competent, and having a sense of identity.
• Being free to express our own needs and emotions and know that they’re valid.
• To be spontaneous and play.
• To set realistic boundaries and develop self-control.

3. Early life experiences and schemata

The schemas that tend to have the greatest impact on the lives of patients are those that originate at a young age and within the family. Young identified four types of early life experiences that predispose to the development of EMS:

• Toxic frustration of needs. This occurs when the child receives ‘too little of a good thing’. The experience promotes the development of schemas such as emotional lack or abandonment/instability. They arise because something important is missing in the child’s environment such as love, understanding, or stability.
• Traumatization or victimization. It occurs when the child is harmed, criticized, or humiliated. As a result, the child is likely to develop mistrust/abuse, imperfection, or vulnerability to danger schemata.
• Too much of a good thing. This is the counterpart of the toxic frustration of needs. In this case, the parents have given the child something that, when given in moderation is healthy, but ceases to be when given in excess. It generates dependency/incompetence-type schemas.
• Selective internalization or identification with significant others. This happens when the child endorses and internalizes the schemas of their parents, making the fears and phobias of their parents their own. They often generate schemas of vulnerability.

“We believe that temperament largely determines whether a child identifies with and internalizes a specific characteristic of a parent.”

-Rodríguez-Vílchez-

Maladaptive coping styles according to Young

Young’s therapy is extremely extensive. For this reason, we’ve just given a basic outline of his most relevant concepts in order to understand his maladaptive coping styles better.

Imagine that you’re walking down a path and a snake appears. You can deal with the situation in three ways. You could give up, freeze, do nothing to save yourself, and accept the fact that it’s going to bite you.  Or, you could avoid it and also decide you’ll never go on trails again because there are snakes. Finally, you could ‘overcompensate’. This consists of doing the opposite of what your schema dictates. As an example, if your schema were ‘social isolation’, overcompensating would mean socializing.

Maladaptive coping styles have arisen because, in the past, they allowed us to reduce the emotional intensity that we experienced in one or more situations. Although in the past they had a function, in the present they produce discomfort. In fact, they perpetuate and maintain the problem.

1. Surrender to the schema

Surrendering to a schema means putting off the fight against it. We don’t avoid it but we accept it as an unchangeable truth We experience emotional pain directly, which reaffirms the schema.

“Without realizing what he is doing, the patient repeats patterns that lead to the schema, so that in his adult life he continues to relive the childhood experiences that created it.”

-Rodríguez-Vílchez-

In the early days of schema therapy, the ‘schema surrender’ coping style was called ‘schema maintenance’. For example, a woman with a mistrust-abuse schema may pursue a loving relationship with a man who’s prone to being unfaithful. This would confirm her beliefs that, sooner or later, she’ll be betrayed.

2. Avoid the schema

Avoiding the schema means consciously ignoring thoughts, emotions, and behaviors in order to avoid the emotional intensity of experiencing the situation.

“Through this process, the individual is trying to avoid the discomfort that appears with the activation of the schema.”

-Rodríguez-Vílchez-

It refers to any activity we do that prevents a schema from being activated. They can range from thinking and blocking out thoughts and images, distracting ourselves, avoiding experiencing certain feelings, and also eating or drinking excessively.

3. Overcompensation of the schema

Overcompensation occurs when you decide to fight the schema by behaving in the opposite way to how you really feel. In effect, you behave as if the schema was wrong.

Overcompensation is an attempt to fight the schema, even if it means that the schema continues to perpetuate itself.

“In fact, some of the most admired individuals in our society, for example, political leaders, media stars or big businessmen are very often overcompensating.”

-Rodríguez-Vílchez-

For Young, curing a schema means reducing the intensity and volume of the elements that make it up. For instance, memories, emotions, bodily sensations, and thoughts. In fact, curing a schema implies changing our behavior and learning to replace a maladaptive style of coping with a healthier one.

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