Professional Documents
Culture Documents
Textbook Contextual Schema Therapy An Integrative Approach To Personality Disorders Emotional Dysregulation and Interpersonal Functioning 1St Edition Eckhard Roediger Ebook All Chapter PDF
Textbook Contextual Schema Therapy An Integrative Approach To Personality Disorders Emotional Dysregulation and Interpersonal Functioning 1St Edition Eckhard Roediger Ebook All Chapter PDF
https://textbookfull.com/product/psychodynamic-therapy-for-
personality-pathology-treating-self-and-interpersonal-
functioning-1st-edition-eve-caligor/
https://textbookfull.com/product/psychodynamic-therapy-for-
personality-pathology-treating-self-and-interpersonal-
functioning-1st-edition-otto-f-kernberg/
https://textbookfull.com/product/emotion-focused-therapy-for-
complex-trauma-an-integrative-approach-2nd-edition-sandra-c-
paivio/
The Emotional Foundations of Personality A
Neurobiological and Evolutionary Approach Kenneth L.
Davis
https://textbookfull.com/product/the-emotional-foundations-of-
personality-a-neurobiological-and-evolutionary-approach-kenneth-
l-davis/
https://textbookfull.com/product/statistics-using-stata-an-
integrative-approach-sharon-lawner-weinberg/
https://textbookfull.com/product/abnormal-psychology-an-
integrative-approach-eighth-edition-david-h-barlow/
https://textbookfull.com/product/anatomy-physiology-an-
integrative-approach-3rd-edition-theresa-stouter-bidle/
https://textbookfull.com/product/an-integrated-approach-to-short-
term-dynamic-interpersonal-psychotherapy-a-clinician-s-guide-1st-
edition-joan-haliburn/
“Building on the foundation of schema therapy as laid by Jeffrey Young, the authors
bring schema therapy into the third wave of therapies; in context and the actual effects.
Acceptance and commitment therapy (ACT) is interweaved throughout the book. It is
for example in the true spirit of schema therapy to take into account different perspec-
tives on the ‘same’ context.”
—Michiel van Vreeswijk, coauthor of The Wiley-Blackwell Handbook
of Schema Therapy and Mindfulness and Schema Therapy
“Therapists today may find themselves asking how they can fit together the plethora of
psychological concepts that bombard them from many directions. Schema therapists
may ask whether schema therapy by itself is enough, or whether they need other therapy
approaches too. The authors of Contextual Schema Therapy show how important con-
cepts that are well articulated within other approaches—such as mentalization, mind-
fulness, acceptance, metacognition, and human values—can be integrated into the
basic schema therapy model. Indeed, many of them are already implicit in it. In addition
to showing the integrative power of the schema therapy model, this book offers a fresh
and readable account of its central ideas and rich clinical examples of their application,
all well-grounded in the current academic and clinical literature.”
—David Edwards, department of psychology, Rhodes University; department
of psychiatry, University of Cape Town; clinical psychologist; certified
schema therapist; president, International Society of Schema Therapy
“A tour de force—this penetrating yet accessible book, written by leaders in the field, is
a must-read for practicing schema therapists. The authors dig deep into the principles
of contemporary third wave therapies and return with innovative advances to Jeffrey
Young’s original model. A core contribution is the many helpful tools on how to con-
ceptualize, build, and reinforce healthy adult functioning. The reader is elegantly
guided along the complex journey that lies at the core of schema therapy—finding a
sensible balance between the potentially competing needs of connection and
autonomy.”
—Poul Perris, MD, founding president of the International Society
of Schema Therapy, and director of the Swedish Cognitive Therapy
Institute, Stockholm
“Schema therapy is the most integrative psychotherapy model of our time, and has a
rapidly accelerating literature. This latest volume explains the entire schema therapy
model, presupposing no prior knowledge, then, pushes the model forward. It adds a new
‘Case Conceptualization Form,’ an expanded theoretical framework, insights from
‘third wave’ and ‘contextual’ psychotherapies, and new and innovative applications of
schema therapy techniques (particularly emotive techniques such as guided imagery
and chair work). It is scholarly, clear, theoretically grounded, and full of clinical exam-
ples. Simply put, you will find this book extremely useful—regardless of your theoretical
orientation.”
—Lawrence P. Riso, PhD, professor of clinical psychology,
American School of Professional Psychology, Northern Virginia
“This cutting-edge guide provides a comprehensive road map for understanding and
implementing schema therapy as a truly integrative and dynamic therapeutic model. The
reader is taken on a journey that interweaves conceptual underpinnings with cutting-
edge theoretical advances, contextualizing it within the framework of second and third
wave psychotherapy approaches. This book connects the dots of the schema therapy
model. Its descriptions bring the powerful schema therapy techniques to life, while pro-
viding a clear pathway to guide the overarching process. This book is an indispensable
text that will appeal to experienced clinicians, as well as those who are simply curious to
learn more about this approach.”
—Susan Simpson, DClinPsych, NHS Lothian, Scotland;
department of psychology, University of South Australia
Contextual
Schema
Therapy
An Integrative Approach to
Personality Disorders, Emotional Dysregulation
& Interpersonal Functioning
Eckhard Roediger, MD
Bruce A. Stevens, PhD
Robert Brockman, DClinPsy
Context Press
An Imprint of New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering psycho-
logical, financial, legal, or other professional services. If expert assistance or counseling is needed, the
services of a competent professional should be sought.
Figure 1-2, “Photograph of feet in the sand at sunset,” is reproduced with permission from the
work of Angeles Hoffmann.
Contents
Forewordvii
1 Conceptual Underpinnings5
12 Treatment Planning215
Afterword275
References277
Index291
Figures
Figure 10–3. The vicious cycle of an alarm reaction, and how to escape194
Contentsv
Tables
I could not be more delighted that my dear friends and colleagues Eckhard Roediger,
Bruce Stevens, and Robert Brockman wrote this extraordinary book.
Contextual Schema Therapy will surely be an outstanding resource for any clini-
cian’s library. The authors are highly experienced and talented schema therapy practi-
tioners and educators, having devoted many years to sharpening their clinical skills
within each of their unique areas of expertise. They generously share a rigorous effort,
resulting in a thoughtful and comprehensive body of work that offers the reader one of
the most relevant psychotherapy guides for conceptualizing and treating a variety of
challenging populations; and demonstrating how the use of schema therapy, an
evidence- based model— with rich assessment tools and integrative treatment
strategies—can lead to the healing of destructive lifelong patterns.
Informed by and following up on the instrumental Schema Therapy: A Practitioner’s
Guide, by Jeffrey Young, Janet Klosko, and Marjorie Weishaar (2003), Roediger, Stevens,
and Brockman delve deeper into the schema therapy approach and bring us up-to-date
on the latest developments for applying this evidence-based model with some of the
most difficult cases.
The challenging work of helping those who have endured painful early life experi-
ences fraught with loss, neglect, abuse, loneliness, and/or deprivation, along with the
sustained core feelings of hopelessness, shame, inadequacy, inhibition; the need to be
perfect; and the need to control or surrender demands a psychotherapeutic approach
that thoughtfully assesses the client’s autobiographical early experiences and conse-
quential unmet needs; connects the dots between self-defeating life patterns, coping
modes, and current activating conditions; and seeks to heal and correct biased emo-
tional experiences that inform present- day emotional and sensorial systems, self-
defeating beliefs, and maladaptive coping behaviors. The elegantly designed integrative
treatment approach, founded in Jeffrey Young’s schema therapy model, is exquisitely
captured and elaborated in this beautiful body of work, as the authors illustrate the
relationship between current and lifelong stressors and early life experiences—
uncovering critical unmet emotional needs and temperamental factors that form per-
sonality. Schema therapy evaluates the rigid truths—that is, early maladaptive schemas
and the coping reactions that get embedded in memory and become activated under
familiar conditions throughout one’s life span. The need for a sturdy, flexible, real, and
attuned clinician is strongly proposed in the schema mode approach. The realness factor
is a critical element for correcting the longstanding, biased emotional experiences, as
you will come to appreciate in reading this book.
The authors are brilliant in making the model accessible through clear and colorful
examples in almost every chapter, along with specific case vignettes, illustrating the
comprehensive case conceptualization/assessment stage and the effective application of
treatment strategies. The reader is sure to recognize both the unique and commonly
shared challenges met in our treatment rooms in the examples shared by the authors.
The parallel process of client and clinician being triggered in the treatment room
can lead to ineffective and frustrating outcomes, especially when an overwhelmed ther-
apist ends up colluding with the client’s avoidance or ends up giving in to entitled
demands.
As I share in my book Disarming the Narcissist, about my work with narcissists, it is
not unusual to be faced with a client who shifts between an emotionally distant mode
and an angry or cynical mode; nor is it unusual to find myself having to stave off the
urge to just give in and subjugate my rights and my voice (feelings triggered within the
“little girl” mode in me), and to maintain my sturdy posture in order to meet the client’s
needs for trust, limit setting, accountability, and emotional connection.
The authors reveal how the integration of third wave therapeutic approaches, such
as mindfulness and acceptance (to meet unmet emotional needs), along with the
therapy relationship, serve to bolster the schema therapy approach to break through
detachment; to confront harmful internal messengers; and to access, care for, and
protect vulnerable modes, while strengthening the healthy adult mode in order to
thwart self-defeating patterns in favor of healthier and adaptive responses.
I confidently recommend this exceptional book to anyone who wishes to gain more
confidence and mastery for effective treatment outcomes, especially when it comes to
facing the seemingly impermeable avoiders, narcissistic bullying and entitlement, and
the hopeless forfeiters who surrender their needs and rights—marching to the beat of
internalized critics and demanders.
You are about to be treated to a treasure trove of invaluable information, including
conceptual and theoretical insights, along with clinical tools, tips, and strategies, in a
keenly illustrated new book that is not to be missed.
Schema therapy brought a profound change to how we treat clients who suffer from
chronic mental illness or a personality disorder. Building on the strengths of cognitive
therapy, this approach provides a comprehensive map of personality using eighteen
schemas, adds experiential change techniques, and uses attachment and developmental
understanding to address maladaptive schemas arising from childhood neglect and
trauma. Randomized controlled trials have demonstrated its effectiveness.
Time doesn’t stand still, and we saw a need to provide an update on schema therapy.
Contextual Schema Therapy is a comprehensive practitioner manual with clear princi-
ples and guidelines illustrated with clinical examples. We incorporated theoretical
advances into its pages, so the book is cutting edge. Its innovative and integrative pre-
sentation is very much in the spirit of schema therapy.
Since its inception, schema therapy has been highly integrative. In 1990, Jeffrey
Young outlined its parallels with and differences from major therapies, including Beck’s
“reformulated” model, psychoanalytic theory, Bowlby’s attachment theory (especially
internal working models), and emotion-focused therapy. There have also been contri-
butions from gestalt, transactional analysis, and psychodrama (Edwards & Arntz,
2012). Schema therapy, in contrast to most cognitive therapies, has a greater emotional
focus and willingness to explore the childhood and adolescent origins of psychological
difficulties. Current problems are seen in terms of whole-of-life patterns that we call
schemas. All this is integrated into a cognitive information-processing mode theory of
personality. Additionally, schema therapy’s breadth, applicability, and ease of under-
standing encourage broad application.
We believe that this integrative spirit has been a key to the success of schema
therapy. Young introduced the original schema model in 1990, and the second step was
the mode model that was developed about ten years later (Young et al., 2003). Modes
are activated schemas. Since they are present in the here and now of therapy, modes are
easier to track and to target with interventions. While in the United States, the basic
schema model is still widely in use, schema therapy has been developed further in the
Netherlands and Germany (Arntz & Jacob, 2013), where the mode model has been
center stage for both research and treatment. All of the successful randomized con-
trolled trials of schema therapy to date have used this model (Jacob & Arntz, 2013).
Schema therapy is one of the key evidence-based treatments for people suffering
from personality disorders. Research indicates that features of personality disorder are
very common in the general population. Only 23 percent of people are relatively free of
such symptoms. According to Yang, Coid, and Tyrer (2010), more than 70 percent have
some degree of personality disturbance. For this reason, it is essential to consider mal-
adaptive personality traits in any comprehensive theory of change. There is already
some evidence base suggesting that schema therapy can effectively treat clients with
borderline personality disorder in both individual (Giesen-Bloo et al., 2006) and group
settings (Farrell, Shaw, & Webber, 2009). A review of five schema therapy trials (three
of them randomized controlled trials; Jacob & Arntz, 2013) showed an average effect
size of 2.38 (95% CI 1.70–3.07). Compared with other specific borderline personality
disorder treatments, dropout rates are low. Further studies have demonstrated the effec-
tiveness of schema therapy with dependent, avoidant, and obsessive-compulsive per-
sonality disorders (Bamelis, Evers, Spinhoven, & Arntz, 2014), and antisocial individuals
can be helped to change as well (Bernstein et al., 2012). There are also indicators that
schema therapy is more cost-effective than other treatments (Van Asselt et al., 2008).
For a more detailed overview, see Bamelis, Bloo, Bernstein, and Arntz (2012).
Recent advances in schema therapy derive from its capacity to straddle both the
second and third waves of behavior therapy. The application of the mode model is in
line with the second wave cognitive behavioral therapy (CBT) approach because
schema therapy seeks to obtain change by shifting the content (in terms of meaning)
deriving from negative early maladaptive schemas through experiential change tech-
niques. Since Tara Bennet-Goleman (2001) introduced mindfulness to heal schemas in
2001, the ensuing years saw further evolution of the model, including the integration of
the concepts of mindfulness and acceptance (Cousineau, 2012; Parfy, 2012; Roediger,
2012; Van Vreeswijk, Broersen, & Schurink, 2014). We call this book Contextual
Schema Therapy because the model has been revised in light of contemporary contribu-
tions and understandings from third wave therapies. Schema therapy now balances the
focus on change in schema content with an approach to building a healthy version of
the self through changing the way people relate to their experiences and deal with
them.
We argue that schema therapy can do more than change coping reactions to
schema activations: it can help people become mindfully aware, disengage from unhelp-
ful patterns of relating to past experiences, and strive for healthy and well-balanced
behavior in general. In Germany, for example, schema therapy is already seen as a third
wave therapy (Roediger & Zarbock, 2013).
The healthy adult mode is one of the key modes in schema therapy. It represents
psychological health, maturity, and good judgment. This mode maps well onto the
construct of psychological flexibility (Brockman, 2013) and can be largely described
and addressed using the concepts and strategies of acceptance and commitment therapy
(ACT; Hayes, Strosahl, & Wilson, 2012). Our comprehensive approach in this book
incorporates the basic principles of ACT on a practical level and merges the more cog-
nitive focus of ACT with the largely emotional focus of schema therapy. Thus, schema
therapy becomes a contextual therapy (Hayes et al., 2012) while balancing second and
third wave approaches, making it even more flexible and effective. However, we do not
claim to provide a comprehensive theory. Jeff Young and colleagues’ Schema Therapy: A
Conceptual Underpinnings
Why do we start this book by linking the schema therapy model with theory and by
basing its development on current research findings in various fields? While we seek to
condense the essence of rational therapies into one consistent and comparatively simple
approach, we do not dare present a unified theory. Nevertheless, having an idea of the
theories behind schema therapy deepens therapists’ understanding of the processes
involved, enabling them to develop the model beyond a purely practical “cookbook”
approach and tailor their work to individual clients. Young and colleagues (2003) indi-
cate these underpinnings but do not describe them in detail. We try to do so here.
This approach is intellectually challenging and complex. The content we present is
very condensed, and understanding it requires some basic knowledge. Especially for
those who are familiar with neurobiology findings, the rationale of schema therapy will
become clearer with an understanding of this material. In the long run, having this
knowledge will give you a fundamental understanding of change processes in general,
helping you to adapt your approach to any targeted problem. However, if you are eager
to get straight to the model, you might skip this chapter and jump directly to chapter 2.
Maybe as you read through the book your interest in the theoretical background will
grow, and later you can refer to this chapter when we connect our practical approach
with the theory to underline its foundation in current research findings.
Systems of needs. Maslow (1970) outlined a pyramid of needs, reaching from basic
biological needs (such as food and water) through to the need for self-actualization.
More recently, researchers investigating self-determination theory have found evidence
for the key role played by three basic emotional needs in human well-being and devel-
opment: autonomy, competence, and relatedness (Ryan & Deci, 2017). In their original
writing on the subject, Young and colleagues (2003) named five core emotional needs,
including limit setting for the child. Unlike other practitioners at that time, Young took
a developmental view of core needs, that of a child’s perspective (for details, see chapter
2). For Young, needs satisfaction leads to healthy schemas, and needs frustration leads
directly to the development of early maladaptive schemas.
We tried to keep the number of needs to a minimum in order to reduce the com-
plexity of the model presented in this book. This led us to reduce the three needs
described by Ryan and Deci (2017) to two irreducible ones, which are regarded as poles
in a dimensional construct of attachment orientation (or connection/relatedness) and
assertiveness orientation (including autonomy, competence, and control). These need-
poles are embedded in a complex orientation of the organism as a whole (see table 1–1).
They have an inverse relationship with one another: the more you strive for attach-
ment, the more you have to sacrifice assertiveness and autonomy, and vice versa.
However, you can aim for a good and flexible balance between them.
Principle: The needs for attachment and assertiveness are poles in the physi-
ological, psychological, and social orientation of the whole organism.
Conceptual Underpinnings7
Alarm System
When we feel individually threatened, or when our attachment needs are con-
stantly frustrated, our alarm system gets activated, providing us with the energy to fight
or flee. If we are energetic and strong enough, being excluded or dominated can create
a secondary anger, driving us to stand up for our rights. Thus we can try standing on
our assertiveness leg in order to get the situation under control again. Successful social
interaction is based on a good and flexible balance between these two poles of human
behavior (see table 1–1).
1. Fight, if we see a chance to win and become “top dog.” We call this the asser-
tiveness way to gain autonomy, control, dominance, and respect.
2. Flight, as an active escape. In the human model, this means overt avoidance
and self-soothing activities.
Needs frustration and coping styles. Anger drives us to fight. Disgust makes us turn
away and care for ourselves (flight). When feeling sad, we tend to withdraw (freeze).
Fear pulls us more to the submission side (surrender). The downside of these solutions
is that they can become unbalanced when we overuse them and neglect the other pole
of the needs spectrum, leading to needs frustration and the maintenance of schemas.
Only when we are able to find a flexible solution with mutually changing roles do we
(Internalization/autoplastic)
Submissive self
Attachment
Follow
(guilt)
Fear
Sadness
Constrained self
Healthy adult/
Absorbed self
Centered self
happy child
Freeze
(pain)
Flight
(lust)
(joy)
Disgust
Anger
(Externalization/alloplastic)
Dominant self
Assertiveness
(pride)
Fight
Activation Inhibition
Conceptual Underpinnings9
On Attachment
The need for attachment is biologically entrenched. Panksepp (2011) and, earlier,
Bowlby (1969) described an attachment system acting in resonance with a caretaking
system within the nurturing person as the neurobiological underpinning of our need to
connect with other people and care for them. So what we perceive as “love” to a great
extent is based on biology.
Principle: The attachment and caretaking systems are the glue in our social
system.
To survive, it is essential for the child to be able to induce goodwill in her caregiv-
ers. In everyday language, the child must make us like her. When watching Edward
Tronick’s video of his “still face” experiment, people usually react with a painful feeling
to the deterioration of the child’s mood following the rupture of this interpersonal reso-
nance (Tronick, 2009). Being reconnected allows the child to calm down and get back
into a parasympathetic (or vagal) state again. But not only does the child calm down,
so too does the adult. Even we observers do! These feelings are connected with the
release of oxytocin—the attachment hormone.
Oxytocin is the prosocial hormone par excellence. It supports trust in people,
induces intimacy, and keeps young couples together (Kosfeld, Heinrichs, Zak,
Fischbacher, & Fehr, 2005). After a nasal application of the hormone, people on the
autistic spectrum are able to look into another person’s eyes for twenty minutes
(Buchheim et al., 2009), for as long as the drug acts. This is not a very romantic message,
but a great deal of oxytocin underlies the activities we do for “love.” These feelings of
empathy are probably based on a system of so-called mirror neurons (for an overview,
see Bargh, 2014).
Mirror neurons bridge the gap between our perceptions of ourselves and others (for
an overview, see Gallagher & Frith, 2003). Unfortunately, these neurons are not prein-
stalled, but have to be trained by stimulation. Stern (1985) argued that a key role of
caregivers in the development of an infant’s self-regulation is their capacity to commu-
nicate affect attunement to the child. Caregivers, mostly at an unconscious level,
undertake a range of gestures and behaviors that reflect some essential aspects of the
baby’s behavior and presumed emotional state. These mirroring acts of the caregiver
constitute consistent states within the child.
Affect attunement helps to create for the baby a kind of preverbal feeling of being
understood, setting the scene for the infant to develop self-regulation and identity
(Winnicott, 1958). Beyond that, it lays the tracks to understand what’s on other peo-
ple’s minds (Siegel, 1999; see “Mentalization and the Theory of Mind” in this chapter).
The attractor model. The attractor model is another approach, derived from physics,
to describe these processes (Haken, 1983). A system of neural connections organizes
Conceptual Underpinnings11
itself out of chaos around so-called attractors. They work like a footpath on a lawn:
once a few people have walked a certain route and the grass is worn down, a kind of
pathway starts to emerge, making it more and more likely that other people will take
the same pathway. Eric Kandel (1989) was honored with a Nobel Prize for demonstrat-
ing that the repetitive stimulation of neurons leads to more intense synaptic connec-
tions between cells, building up these pathways. “Schemas” is another word for these
rigid connections that tend to stabilize in a given state. In this way, it is much easier for
us to be led by automatic patterns of activation. The attractor model underlies con-
structivist theories of self-organization (Maturana & Varela, 1998). In its essence, the
model infers that, on the one hand, neural systems always tend toward low levels of
energy or activation, just as water runs downhill. On the other hand, being in an unsta-
ble state of fluctuation induces feelings of discomfort. Once our mental process finds an
interpretation for the current situation, the level of activation goes down again.
Mentally, we perceive this as a positive feeling of relaxation or relief.
Consistency theory. If we have a perception but there is no attractor in our brain (or
mind) representing it, or if the perception does not match an existing attractor, this
creates an inconsistency. This leads to increased activation (perceived as stress or emo-
tional tension) until the information is assimilated into the existing structure or the
system has to adapt by changing. Piaget (1985) called the latter process to gain consis-
tency “accommodation.” One way or another, the system tries to overcome the incon-
sistency. Ongoing high levels of inconsistency (and associated emotional activation)
lead to a persisting stress reaction (Selye, 1936), exhaustion, and, finally, disorders.
Ongoing stress leads to changes in the hypothalamic-pituitary-adrenal axis and finally
to a reduced expression of corticoid receptor genes as an epigenetic change (Meaney,
2001). These changes are currently regarded as an important mediator of many disor-
ders (Weaver et al., 2004).
How did your level of activation change when you started looking at the picture?
You probably perceived an initial rise in activation that quickly dropped after you iden-
tified the content. This drop indicates that you built up an attractor about the content
of the picture. Getting out of the activation state is a powerful driver of our mental
processes because the brain tries to save energy. Your mental process forces you into
this interpretation. You became a slave of your autopilot. Hard to believe? You will see!
Let us now examine the content of what you first saw.
You probably saw feet in the sand. We assume that most of you saw elevated feet
coming out of the sand, as if they had been carved out of it, correct? Okay, let us get
rational now. How probable is it that somebody made the effort to carve these feet out
of the sand? And the footprints of the seagulls, too? Watch your level of activation. Is
it rising again? Well, we seeded some inconsistency between your automatic perception
process and your rational mind. This inconsistency leads to increased activation. Do
Conceptual Underpinnings13
you find yourself trying to find some justification for why the feet are carved out of and
not printed into the sand? A fairly normal reaction! The attractor (or the schema)
fights for its “life” and tries to avoid getting back into the fluctuation state.
From the person who took the picture, we know that these are footprints on a
beach in Brittany, close to sunset. So with this in mind, you should be able to see the
feet as being printed in the sand. Some of you probably can. How about your level of
activation? Try to change your perspective now. Not possible? Then you are probably
not trying hard enough! Please, try a bit harder!
And how about your level of activation? Are you starting to feel a bit bothered or
annoyed by us being pushy? This is the normal reaction coming from your assertiveness
need. Clients feel the same when we get too demanding. Now, reparenting comes into
play. Look at the heel of the foot on the right. Can you see the sunlight streaming in
from the right side across the sand, forming the edge where the heel is pressed into the
sand? The footprint creates the shade at the right edge. Further to the left, the sunlight
lightens the footprint in the sand. Did this instruction work? Great! Is your level of
activation dropping again? Are you a little happy and proud that you passed the test?
This feeling indicates that you built up a second attractor. Now you have two interpre-
tations of the picture. Your mind has broadened; you have gained flexibility.
How about those of you who still failed to shift your perspective? Your tension prob-
ably still remains high. To give you some relief and bring the experiment to a successful
end (as in every schema therapy session), take a look at figure 1–3.
Course of time
Traveling the road from good intentions to actual behavioral change often takes
time, patience, and ongoing effort (for details, see chapter 8). The therapy relationship
is a powerful tool for connecting with clients and supporting them as they climb the
energetic hills between two attractors. Inducing change takes three major steps that
may occur throughout therapy:
1. Building up motivation and showing the client that there is another road he or
she might take. Often, this will occur by identifying with the client what a
healthy schema or a healthy adult response looks and feels like.
Conceptual Underpinnings15
In schema therapy, the organizer or conductor of this change process is called the
healthy adult mode. We describe in detail in chapter 7 how therapists can explicitly
train this mode to clients in therapy.
Emotional Learning
Joseph LeDoux (1996) described two major pathways for processing incoming
information:
• The so-called lower (but faster) pathway in the limbic system, driven primarily
by precognitive (basic) emotions
• The slower pathway, including more cognitive procedures, in the cortical areas
of the brain
Brain processes and modes. The autonomic responses of the lower pathway reflect the
older stage in the development of the brain. This pathway is needs based, driven by
contingencies, and still present as the lowest level of functioning once we become
intensively emotionally activated. We experience these precognitive emotions as if in a
“child” mode, sometimes in a preverbal state (Stern, 1985). During the development of
speech, symbolic representations of the world outside get stored in cortical areas in
terms of cognitive relational frames (see “The Contextual or Third Wave Perspective”
in this chapter). They help us to develop a set of display rules (Fuster, 2002) that we
later experience as beliefs or what are called inner critic modes in the schema therapy
context. The anterior cingular cortex provides a convergence zone to merge emotional
and cognitive input (Botvinick, Braver, Barch, Carter, & Cohen, 2001), preparing the
executed behavior (coping modes). With maturation, the skills of self-control emerge in
conscious procedures of the working memory in the lateral prefrontal cortex (LeDoux,
1996); we call this the healthy adult mode. We will go into the details of the modes in
chapter 3. This brief summary is only meant to roughly outline the relationship of the
modes to underlying brain processes.
Changing schemas. Since schemas are like footpaths in the neural structure of the
brain, they cannot be deleted or healed in the sense of undoing them (Hayes et al.,
2012). However, by developing additional pathways, we can build up a superposing
network, for example, by building up inhibitory synaptic connections. This kind of
overlearning weakens the attractors and makes changing into more functional attrac-
tor states easier. In the footpath metaphor, that means consciously taking a new road
and not following automatic pilot. According to the control theory of Power (1973),
doing this requires influencing the existing system from a higher level of functioning.
In the beginning of therapy, this influence is the therapist. Later, the healthy adult
mode of the client is strong enough to take over. Thus, the “good parent” model of the
therapist is internalized by the client. Unlike a rewarding contingency, this structure
The period which follows after about the year 1862 is notable as
witnessing not only the gradual universal adoption of the screw in
steamships, but the more general appreciation of iron as the material
from which to construct a vessel’s hull. After the prejudices which
already we have seen arising at different stages of the steamship’s
history, it was scarcely to be wondered at that iron should come in
for its full share of virulent criticism and opposition. The obvious
remark made on all sides was that to expect iron to float was to
suppose that man could act exactly contrary to the laws of Nature,
and this notwithstanding that already, besides barges, a few ships
thus built had somehow not only managed to keep afloat, but to
traverse channels and oceans in perfect safety, carrying such heavy
weights as their own machinery, to say nothing of their cargoes and
human freights. But slowly the public prejudice began to wane.
Already the Cunard Company had given way to iron in 1856, and in
1860 the Admiralty were at last convinced that the new method was
just and sound. Within the limited scope at our command we have
not space here to enter into the elaborate discussion of matters
which have to be taken for granted before the building of the
steamship begins. But the plain answer to the natural inquiry, as to
how and why a vessel made out of iron does not immediately sink to
the bottom as soon as ever she is launched, is this: whereas iron in
itself is far heavier than water, yet the iron ship has not the same
specific gravity as the iron from which it is made. Therefore, the ship
of this material will be supported by the water in which it is placed.
In actual displacement, an iron ship is proportionately lighter
than a ship built of wood, and by “displacement” is meant the amount
of water which a vessel displaces through being allowed to float. Of
course, the quantity of water which a ship displaces (or pushes to
one side) depends entirely on the weight of the vessel, and is exactly
equal to the weight of the ship. Thus, suppose we were to fill a dock
with water up to the level of the quay and then lower down into it by
means of gigantic cranes a Mauretania or Lusitania, the water would,
of course, flow over on to the quays. Now the amount of water thus
driven out would be the exact equivalent of the liner’s displacement.
When we say, for instance, that the displacement of the Mauretania
is 40,000 tons, when loaded, we mean that her total weight when
loaded is this number of tons, and her hull when afloat puts on one
side (or “displaces”) just that amount of water.
Now, as compared with wooden ships, the use of iron meant a
saving in displacement of about one-third, taking the wooden and the
iron ships to be of the same dimensions. From this followed the fact
that the iron ship could carry a greater amount of cargo with
consequent greater profit to her owners. And, as I have already
indicated in another chapter, before it was possible to build ships of
great length iron had to be introduced to enable them to endure such
longitudinal strains. Again, a wooden ship must have her skin and
ribs made of a thickness far greater than an iron ship, for the clear
reason that one inch of iron is much stronger than one inch of wood;
in other words, to obtain a given strength the iron will take up less
room in the ship. Thus in an iron steamer there will be more space
available for cargo than in a wooden ship of the same design. We
could go on enumerating the advantages of iron, and quote
instances of iron ships, whose cargo had got on fire, arriving safely
in port and coming into dock where the assistance of the local fire-
brigade had enabled the vessel’s own pumps to get the conflagration
under. It is only as recently as December of 1909 that the Celtic, the
well-known White Star liner, during a voyage between New York and
Liverpool, had the misfortune to get on fire while at sea. By means of
tarpaulins and injections of steam it was possible to control the
burning until the Mersey was reached, when it was intended to flood
her holds. Had she been a wooden ship instead of steel, or even
iron, the Celtic would undoubtedly have ended her days in the
Atlantic.
The first Atlantic company to build all its steamers of iron was the
Inman Line, which had been founded in 1850, and until 1892 was
one of the foremost competitors for the coveted “blue ribbon” of the
Atlantic. Their first ships had been the City of Glasgow and the City
of Manchester, and these, inasmuch as they were built of iron, and
were propelled by a screw at a time when prejudice had not yet died
down, were entirely different from the prevailing type of steamer; and
this, it should be remembered, at a period six years before the
Cunard had built their iron Persia. This City of Glasgow was built by
a Glasgow firm of shipbuilders, and Mr. Inman had sufficient
confidence in her to purchase her and form a company. Barque-
rigged, with a single funnel, she was of only 1,610 tons and 350
horse-power. Under the command of Captain B. E. Matthews, who
had been on the famous Great Western, she had already crossed
from Glasgow to New York and back in 1850, and on December 11th
of that year began her regular sailings between England and
America. The City of Glasgow—all the ships of this line were named
after cities—was fitted up in a manner which at that time called forth
the greatest admiration. “One room,” wrote a correspondent in the
Glasgow Courier, about that date, “is being fitted up as an
apothecary’s shop, from which the surgeon will dispense his
medicines.” She was provided with five water-tight bulkheads, and
had a propeller whose diameter was 13 feet, with an 18 feet pitch. It
was in connection with the Inman ships that the custom was
inaugurated of carrying steerage passengers on the best Atlantic
liners, although hitherto they had been taken across solely on board
sailing ships.
THE “CITY OF PARIS” (1866).
From the Model in the Victoria and Albert Museum.