Even when patients successfully change their behaviors, a problematic situation may remain painful and destructive. In such cases, patients may decide that major life changes are necessary, such as changing schools or jobs, finding new careers, moving to new places, disengaging from family members or friends, or ending romantic relationships. The therapist provides support as patients choose the path that is right for them.
When patients contemplate leaving a problematic situation, it is important for the therapist to determine whether their reasons for leaving are healthy or schema-driven. Schema-driven reasons are usually forms of avoidance or overcompensation. For example, a young male patient named Jim decides to leave his job in the financial district and move to the beach. Although this move is financially possible for him, on reflection he realizes that it is driven by his Subjugation schema. The move represents both schema avoidance and overcompensation: By moving, Jim could avoid facing conflicts with his clients and coworkers, and he could over-compensate for his schema by doing what he wants to do. Jim concedes that, if he did not have the conflicts with clients and coworkers, he would want to remain at his job.
Whenever patients introduce life changes that appear drastic or sudden, the therapist should assess the situation carefully. The “flight to health” noted in the psychotherapy literature is probably schema overcompensation. Even if their behaviors look healthy, patients may be behaving in an uncharacteristic manner without sufficient preparation. In such cases, the therapist empathically confronts the schema avoidance and overcompensation.
If the change the patient proposes does not seem to be a manifestation of avoidance or overcompensation, the next step is to explore alternative courses of action. The therapist and patient list the advantages and disadvantages of each alternative and then evaluate which is best. The therapist asks, “If you didn’t have your schemas, what would you do?” This question helps patients identify the right course. In addition, the therapist and patient weigh the advantages and disadvantages of changing versus not changing. Sometimes the decision rests on pragmatic considerations. Can the patient afford the change financially? Is the patient likely to find another, better job? Will the patient find a more satisfying relationship? Can the person obtain the necessary resources to carry out the change?
The therapist helps patients prepare for the challenges of major life changes. These include such potential hardships as tolerating frustration and disappointment, dealing with the disapproval of significant others, and grappling with unanticipated problems.