We call the primary stance that the schema therapist takes throughout treatment “empathic confrontation” or “empathic reality-testing.” In the cognitive stage of treatment, empathic confrontation means that the therapist empathizes with the reasons for patients having the beliefs that they do—namely, that their beliefs are based on their early childhood experiences—while simultaneously confronting the fact that their beliefs are inaccurate and lead to unhealthy life patterns that patients must change in order to improve. The therapist acknowledges to patients that their schemas seem right to them because they have lived entire lives that seem to verify their schemas and that they adopted certain coping styles because it was the only way to survive adverse childhood circumstances. Consistent with constructivist models, the therapist validates patients’ schemas and coping styles as understandable conclusions based on their life histories. At the same time, the therapist reminds patients about the negative consequences of their schemas and maladaptive coping styles. Their schemas and coping styles were adaptive in early childhood but now are maladaptive. A therapeutic stance of empathic confrontation acknowledges the past while distinguishing the realities of the past from the realities of the present. It supports the patient’s ability to see and to accept what is.
Empathic confrontation requires constant shifting between empathy and reality-testing. Therapists often err in one direction or the other. Either they are so empathic that they do not push patients to face reality, or they are too confrontational and cause patients to feel defensive and misunderstood. Either way, patients are unlikely to change. With empathic confrontation, the therapist strives for the optimal balance between empathy and reality-testing that will enable patients to progress. When the therapist is successful in this endeavor, patients feel truly understood and affirmed, perhaps for the first time in their lives. Feeling understood, they are more likely to accept the necessity of change, and they are more receptive to healthy alternative perspectives offered by the therapist. Further, patients experience the therapist as allying with them against the schema. Rather than viewing the schema as a core part of who they are, they begin to view it as foreign.
The therapist explains to patients that, given their life histories, it makes sense that they see things as they do and behave as they do. However, in the end, the ways in which they see and behave have only served to perpetuate their schemas. The therapist builds a case in favor of fighting their schemas with new ways of behaving rather than persisting in the same self-defeating patterns. The material gathered in the Assessment Phase enables the therapist to substantiate the destructiveness of the schemas and coping styles in their lives. The therapist encourages patients to respond to schema triggers in healthier ways. In so doing, they can eventually heal their schemas and meet their basic emotional needs. The following excerpt provides a brief example of empathic confrontation and is taken from the interview Dr. Young conducted with Marika, a patient whom we introduced in Chapter 2. Marika entered therapy to improve her marriage. Marika and her husband, James, are stuck in a repetitive, vicious cycle in which she becomes more and more aggressively demanding of attention and affection, and he becomes more and more withdrawn, indifferent, and cold. After exploring her childhood relationship with her father, Dr. Young speaks to Marika about her approach to James.
“Marika, I know it feels natural to you to try to get James upset in order to get his attention. But, even though it’s the only way you think he’ll give you any caring, you still need to approach him in a more vulnerable way. Let him know why you need his love and see if he responds before moving so quickly to that other style of upsetting him. I understand it was the only way that got you any attention from your father, but it might not be the only way that works with James.”
Thus the therapist empathizes with Marika’s reason for approaching James in such an aggressive way—because that was the only way she got anything from her father—while still presenting the negative consequences of this approach and the wisdom of approaching James in a more vulnerable way.