The two fundamental schema operations are schema perpetuation and schema healing. Every thought, feeling, behavior, and life experience relevant to a schema can be said to either perpetuate the schema—elaborating and reinforcing it—or heal the schema—thus weakening it.
Schema perpetuation refers to everything the patient does (internally and behaviorally) that keeps the schema going. Perpetuation includes all the thoughts, feelings, and behaviors that end up reinforcing rather than healing the schema—all the individual’s self-fulfilling prophecies. Schemas are perpetuated through three primary mechanisms: cognitive distortions, self-defeating life patterns, and schema coping styles (which are discussed in detail in the following section). Through cognitive distortions, the individual misperceives situations in such a manner that the schema is reinforced, accentuating information that confirms the schema and minimizing or denying information that contradicts the schema. Affectively, an individual may block the emotions connected to a schema. When affect is blocked, the schema does not reach the level of conscious awareness, so the individual cannot take steps to change or heal the schema. Behaviorally, the individual engages in self-defeating patterns, unconsciously selecting and remaining in situations and relationships that trigger and perpetuate the schema, while avoiding relationships that are likely to heal the schema. Interpersonally, patients relate in ways that prompt others to respond negatively, thus reinforcing the schema.
Martine has a Defectiveness schema, stemming mostly from her childhood relationship with her mother. “There was nothing my mother loved about me,” she tells her therapist, “and there was nothing I could do about it. I wasn’t pretty, I wasn’t outgoing and popular, I didn’t have a lot of personality, I didn’t know how to dress with a lot of style. The one thing I had, which was that I was smart, didn’t mean anything to my mother.”
Now Martine is 31 years old. She has few female friends. Recently her boyfriend, Johnny, introduced her to the women who were dating his friends. Martine likes these women very much, but, although they have been welcoming toward her, she feels unable to establish friendships with them. “I don’t think they like me,” she explains to her therapist. “I get really nervous when I’m with them. I can’t settle down and relate normally.”
Cognitively, affectively, behaviorally, and interpersonally Martine acts to perpetuate her schema with these women. Cognitively, she distorts information so that it upholds the schema. She discounts the many gestures of friendliness the women have made toward her (“They’re only being nice because of Johnny. They don’t really like me.”) and falsely interprets things they do and say as evidence of their dislike. For example, when one of the women, Robin, did not ask Martine to be a bridesmaid in her upcoming wedding, Martine jumped to the conclusion that Robin “hated” her, even though she had known Robin for too short a time to be a likely candidate for bridesmaid. Affectively, Martine has strong emotional responses to events that even slightly resemble her childhood schema triggers; she feels intensely upset at any perceived rejection, no matter how slight. When Robin did not ask her to be a bridesmaid, for example, Martine felt utterly worthless and ashamed. “I hate myself,” she told her therapist.
Martine gravitates toward relationships that are likely to repeat her childhood relationship with her mother. In the group of women, Martine has most actively sought the friendship of the one who is most hard to please and critical, and, just as she did with her mother as a child, Martine behaves deferentially and apologetically toward her.
Almost all patients who have characterological disorders repeat negative patterns from their childhoods in self-defeating ways. Chronically and pervasively, they engage in thoughts, emotions, behaviors, and means of relating that perpetuate their schemas. In so doing, they unwittingly keep recreating in their adult lives the conditions that most damaged them in childhood.
Schema healing is the ultimate goal of schema therapy. Because a schema is a set of memories, emotions, bodily sensations, and cognitions, schema healing involves diminishing all of these: the intensity of the memories connected to the schema, the schema’s emotional charge, the strength of the bodily sensations, and the maladaptive cognitions. Schema healing also involves behavior change, as patients learn to replace maladaptive coping styles with adaptive patterns of behavior. Treatment thus includes cognitive, affective, and behavioral interventions. As a schema heals, it becomes increasingly more difficult to activate. When it is activated, the experience is less overwhelming, and the patient recovers more quickly.
The course of schema healing is often arduous and long. Schemas are hard to change. They are deeply entrenched beliefs about the self and the world, learned at a very young age. They are often all the patient knows. Destructive though they might be, schemas provide patients with feelings of security and predictability. Patients resist giving up schemas because the schemas are central to their sense of identity. It is disrupting to give up a schema. The whole world tilts. In this light, resistance to therapy is a form of self-preservation, an attempt to hold onto a sense of control and inner coherence. To give up a schema is to relinquish knowledge of who one is and what the world is like.
Schema healing requires willingness to face the schema and do battle with it. It demands discipline and frequent practice. Patients must systematically observe the schema and work every day to change. Unless it is corrected, the schema will perpetuate itself. Therapy is like waging war on the schema. The therapist and patient form an alliance in order to defeat the schema, with the goal of vanquishing it. This goal is usually an unrealizable ideal, however: Most schemas never completely heal, because we cannot eradicate the memories associated with them.
Schemas never disappear altogether. Rather, when they heal, they become activated less frequently, and the associated affect becomes less intense and does not last as long. Patients respond to the triggering of their schemas in a healthy manner. They select more loving partners and friends, and they view themselves in more positive ways. We give an overview of how we go about healing schemas in a later section of this chapter.