Patients develop maladaptive coping styles and responses early in life in order to adapt to schemas, so that they do not have to experience the intense, overwhelming emotions that schemas usually engender. It is important to remember, however, that, although coping styles sometimes help the patient to avoid a schema, they do not heal it. Thus all maladaptive coping styles still serve as elements in the schema perpetuation process.
Schema therapy differentiates between the schema itself and the strategies an individual utilizes to cope with the schema. Thus, in our model, the schema itself contains memories, emotions, bodily sensations, and cognitions, but not the individual’s behavioral responses. Behavior is not part of the schema; it is part of the coping response. The schema drives the behavior. Although the majority of coping responses are behavioral, patients also cope through cognitive and emotive strategies. Whether the coping style is manifested through cognition, affect, or behavior, it is not part of the schema itself.
The reason that we differentiate schemas from coping styles is that each patient utilizes different coping styles in different situations at different stages of their lives to cope with the same schema. Thus the coping styles for a given schema do not necessarily remain stable for an individual over time, whereas the schema itself does. Furthermore, different patients use widely varying, even opposite, behaviors to cope with the same schema.
For example, consider three patients who typically cope with their Defectiveness schemas through different mechanisms. Although all three feel flawed, one seeks out critical partners and friends, one avoids getting close to anyone, and one adopts a critical and superior attitude toward others. Thus the coping behavior is not intrinsic to the schema.
All organisms have three basic responses to threat: fight, flight, and freeze. These correspond to the three schema coping styles of overcompensation, avoidance, and surrender. In very broad terms, fight is overcompensation, flight is avoidance, and freeze is surrender.
In the context of childhood, an Early Maladaptive Schema represents the presence of a threat. The threat is the frustration of one of the child’s core emotional needs (for secure attachment, autonomy, free self-expression, spontaneity and play, or realistic limits). The threat may also include the fear of the intense emotions the schema unleashes. Faced with the threat, the child can respond through some combination of these three coping responses: the child can surrender, avoid, or overcompensate. All three coping styles generally operate out of awareness—that is, unconsciously. In any given situation, the child will probably utilize only one of them, but the child can exhibit different coping styles in different situations or with different schemas. (We provide examples of these three styles below.)
Thus the triggering of a schema is a threat—the frustration of a core emotional need and the concomitant emotions—to which the individual responds with a coping style. These coping styles are usually adaptive in childhood and can be viewed as healthy survival mechanisms. But they become maladaptive as the child grows older because the coping styles continue to perpetuate the schema, even when conditions change and the individual has more promising options. Maladaptive coping styles ultimately keep patients imprisoned in their schemas.
When patients surrender to a schema, they yield to it. They do not try to avoid it or fight it. They accept that the schema is true. They feel the emotional pain of the schema directly. They act in ways that confirm the schema. Without realizing what they are doing, they repeat schema-driven patterns so that, as adults, they continue to relive the childhood experiences that created the schema. When they encounter schema triggers, their emotional responses are disproportionate, and they experience their emotions fully and consciously. Behaviorally, they choose partners who are most likely to treat them as the “offending parent” did—as Natalie, the depressed patient we described earlier, chose her emotionally depriving husband Paul. They then frequently relate to these partners in passive, compliant ways that perpetuate the schema. In the therapy relationship, these patients also may play out the schema with themselves in the “child” role and the therapist in the role of the “offending parent.”
When patients utilize avoidance as a coping style, they try to arrange their lives so that the schema is never activated. They attempt to live without awareness, as though the schema does not exist. They avoid thinking about the schema. They block thoughts and images that are likely to trigger it: When such thoughts or images loom, they distract themselves or put them out of their minds. They avoid feeling the schema. When feelings surface, they reflexively push them back down. They may drink excessively, take drugs, have promiscuous sex, overeat, compulsively clean, seek stimulation, or become workaholics. When they interact with others, they may appear perfectly normal. They usually avoid situations that might trigger the schema, such as intimate relationships or work challenges. Many patients shun whole areas of life in which they feel vulnerable. Often they avoid engaging in therapy; for example, these patients might “forget” to complete homework assignments, refrain from expressing affect, raise only superficial issues, come late to sessions, or terminate prematurely.
When patients overcompensate, they fight the schema by thinking, feeling, behaving, and relating as though the opposite of the schema were true. They endeavor to be as different as possible from the children they were when the schema was acquired. If they felt worthless as children, then as adults they try to be perfect. If they were subjugated as children, then as adults they defy everyone. If they were controlled as children, as adults they control others or reject all forms of influence. If abused, they abuse others. Faced with the schema, they counterattack. On the surface, they are self-confident and assured, but underneath they feel the press of the schema threatening to erupt.
Overcompensation can be viewed as a partially healthy attempt to fight back against the schema that unfortunately overshoots the mark, so that the schema is perpetuated rather than healed. Many “overcompensators” appear healthy. In fact, some of the most admired people in society—media stars, political leaders, business tycoons—are often over-compensators. It is healthy to fight back against a schema so long as the behavior is proportionate to the situation, takes into account the feelings of others, and can reasonably be expected to lead to a desirable outcome. But overcompensators typically get locked into counterattacking. Their behavior is usually excessive, insensitive, or unproductive.
For example, it is healthy for subjugated patients to exert more control in their lives; but, when they overcompensate, they become too controlling and domineering and end up driving others away. An overcompensated patient with subjugation cannot allow others to take the lead, even when it would be healthy to do so. Similarly, it is healthy for an emotionally deprived patient to ask others for emotional support, but an over-compensated patient with emotional deprivation goes too far and becomes demanding and feels entitled.
Overcompensation develops because it offers an alternative to the pain of the schema. It is a means of escape from the sense of helplessness and vulnerability that the patient felt growing up. For example, narcissistic overcompensations typically serve to help patients cope with core feelings of emotional deprivation and defectiveness. Rather than feeling ignored and inferior, these patients can feel special and superior. However, though they may be successful in the outside world, narcissistic patients are usually not at peace within themselves. Their overcompensation isolates them and ultimately brings them unhappiness. They continue to overcompensate, no matter how much it drives away other people. In so doing, they lose the ability to connect deeply with others. They are so invested in appearing to be perfect that they forfeit true intimacy. Further, no matter how perfect they try to be, they are bound to fail at something eventually, and they rarely know how to handle defeat constructively. They are unable to take responsibility for their failures or acknowledge their limitations and therefore have trouble learning from their mistakes. When they experience sufficiently powerful setbacks, their ability to overcompensate collapses, and they often decompensate by becoming clinically depressed. When overcompensation fails, the underlying schemas reassert themselves with enormous emotional strength.
We hypothesize that temperament is one of the main factors in determining why individuals develop certain coping styles rather than others. In fact, temperament probably plays a greater role in determining patients’ coping styles than it does in determining their schemas. For example, individuals who have passive temperaments are probably more likely to surrender or avoid, whereas individuals who have aggressive temperaments are more likely to overcompensate. Another factor in explaining why patients adopt a given coping style is selective internalization, or modeling. Children often model the coping behavior of a parent with whom they identify.
We elaborate further on these coping styles in Chapter 5.
Coping responses are the specific behaviors or strategies through which the three broad coping styles are expressed. They include all the responses to threat in the individual’s behavioral repertoire—all the unique, idiosyncratic ways in which patients manifest overcompensation, avoidance, and surrender. When the individual habitually adopts certain coping responses, then coping responses adhere into “coping styles.” Thus a coping style is a trait, whereas a coping response is a state. A coping style is a collection of coping responses that an individual characteristically utilizes to avoid, surrender, or overcompensate. A coping response is the specific behavior (or strategy) that the individual is exhibiting at a given point in time. For example, consider a male patient who uses some form of avoidance in almost any situation in which his schema of abandonment is triggered. When his girlfriend threatened to break up with him, he went back to his apartment and drank beer until he passed out. In this example, avoidance is the patient’s coping style for abandonment; drinking beer was his coping response in this one situation with his girlfriend. (We discuss this distinction further in the following section on schema modes.)
Table 1.1 lists some examples of maladaptive coping responses for each schema. Most patients use a combination of coping responses and styles. Sometimes they surrender, sometimes they avoid, and sometimes they overcompensate.
We believe that the Axis II diagnostic system in DSM-IV is seriously flawed. Elsewhere (Young & Gluhoski, 1996) we have reviewed its many limitations, including low reliability and validity for many categories and the unacceptable level of overlap among the categories. In this chapter, however, we emphasize what we see as more fundamental conceptual flaws in the Axis II system. We believe that in an attempt to establish criteria based on observable behaviors, the developers have lost the essence of both what distinguishes Axis I from Axis II disorders and what makes chronic disorders hard to treat.
According to our model, internal schemas lie at the core of personality disorders and the behavioral patterns in DSM-IV are primarily responses to the core schemas. As we have stressed, healing schemas should be the central goal in working with patients at a characterological level. Eliminating maladaptive coping responses permanently is almost impossible without changing the schemas that drive them. Also, because the coping behaviors are not as stable as schemas—they change depending on the schema, the life situation, and the patient’s stage of life—the patient’s symptoms (and diagnosis) will appear to be shifting as one tries to change them.
For most DSM-IV categories, the coping behaviors are the personality disorders. Many diagnostic criteria are lists of coping responses. In contrast, the schema model accounts for chronic, pervasive characterological patterns in terms of both schemas and coping responses; it relates the schemas and coping responses to their origins in early childhood; and it provides direct and clear implications for treatment. Furthermore, each patient is viewed as having a unique profile, including several schemas and coping responses, each present at different levels of strength (dimensional) rather than as one single Axis II category.