These patients are negativistic and pessimistic. They display a pervasive, lifelong focus on the negative aspects of life, such as pain, death, loss, disappointment, betrayal, failure, and conflict, while minimizing the positive aspects. In a wide range of work, financial, and interpersonal situations, they have an exaggerated expectation that things will go seriously wrong. Patients feel vulnerable to making disastrous mistakes that will cause their lives to fall apart in some way—mistakes that might lead to financial collapse, serious loss, social humiliation, being trapped in a bad situation, or loss of control. They spend a great deal of time trying to make sure they do not make such mistakes and are prone to obsessive rumination. Their “default position” is anxiety. Typical feelings include chronic tension and worry, and typical behaviors include complaining and indecision. Patients with this schema can be difficult to be around because, no matter what one says, they always see the negative side of events. The glass is always half-empty
Treatment strategies depend on how the therapist conceptualizes the origins of the schema, which is primarily learned through modeling. In this case, the schema reflects a depressive tendency toward negativity and pessimism that the patient learned from a parent. The patient internalized the parent’s attitudes as a mode. Experiential work is especially helpful with patients who acquired the schema in this manner. In imagery and role-playing exercises, first the therapist, then the patient, practices fighting this Pessimistic Parent as the Healthy Adult. The Healthy Adult confronts the Negative Parent, and reassures and comforts the child.
A second origin of the schema is a childhood history of hardship and loss. In this case, patients are negativistic and pessimistic because they experienced so much adversity early in life. This is a more difficult origin to overcome. These patients, often at a young age, lost the natural optimism of youth. One patient, a 9-year-old child whose father had died years before, said, “Don’t try to tell me bad things can’t happen, because I know they can.” Many of these patients need to grieve for past losses. When personal misfortune is the origin of the schema, all of the treatment strategies are important. Cognitive techniques can help patients see that negative events in the past do not predict the occurrence of negative events in the future. Experiential techniques can help patients express anger and grief about traumatic childhood losses. Behavioral techniques can help patients spend less time worrying in their current lives, and more time seeking enjoyment. In the therapy relationship, the therapist expresses empathy for the patient’s losses, but also models and rewards optimistic attitudes and behavior.
Alternatively the schema might be an overcompensation for the Emotional Deprivation schema. The patient complains in order to get attention or sympathy. In this case, the therapist treats the underlying deprivation by reparenting the patient, providing nurturance, while being careful not to reinforce schema-driven complaining. For example, the therapist ignores the content of the patient’s pessimistic comments, focusing instead on allaying the patient’s underlying feelings of emotional deprivation. Gradually, the patient learns healthier ways to meet emotional needs, first with the therapist, and then with significant others outside of the therapy.
For some patients, the schema may have a biological component and origin, perhaps related to obsessive-compulsive disorder or dysthymic disorder. These patients might benefit from a trial of medication.
The basic goal is to help patients predict the future more objectively, that is, more positively. Some research suggests that the healthiest way to view life is with an “illusory glow” (Alloy & Abramson, 1979; Taylor & Brown, 1994), that is, as slightly more positive than is realistic. A negative view does not appear to be as healthy or adaptive. Perhaps this is because, generally speaking, if one expects things to go wrong and is accurate, one does not feel much better. It has not helped very much to imagine the worst. It is probably healthier to go through life expecting things to go well—as long as one’s expectations are not so at odds with reality that one constantly has major disappointments.
We do not realistically expect most patients with this schema to become carefree and optimistic; but at least they can move away from the extreme negative end toward a more moderate position. Some signs that patients with this schema have improved are that they worry less frequently, have a more positive outlook, and stop constantly predicting the worst outcome and obsessively ruminating about the future. They are no longer focused so obsessively on trying to avoid making mistakes. Rather, they make a reasonable effort to avoid mistakes, and focus more on fulfilling emotional needs and following their natural inclinations.
The cognitive and behavioral strategies are usually the main parts of treatment, although experiential strategies and the therapy relationship can be useful as well.
Many cognitive techniques can be helpful with this schema: identifying cognitive distortions, examining the evidence, generating alternatives, using flash cards, conducting dialogues between the schema-driven and the healthy sides. The therapist helps patients make predictions about the future and observe how infrequently their negative expectations come true. Patients self-monitor their negative, pessimistic thinking, and practice looking at their lives more objectively, based on logic and empirical evidence. They learn to stop exaggerating the negatives and focus more on the positives in their lives. Patients note corresponding changes in mood.
When patients have a past history of negative events, cognitive techniques can help them analyze these events and learn to distinguish the present and future from the past. If a past, negative event was controllable, then the therapist and patient can work together to correct the problem so that it does not happen again. If the event was not controllable, then the event has no bearing on the future. Logically, there is no basis for pessimism about a future event, even if the patient has experienced uncontrollable negative events in the past.
When the schema is serving a protective function, cognitive techniques can help patients challenge the idea that it is better to assume a negative, pessimistic perspective, so that they are not disappointed. This idea is usually incorrect: If patients expect something to go wrong, and it does go wrong, they do not feel that much better having worried about it; if they expect something to go right and instead it goes wrong, they do not feel that much worse. Whatever they gain by anticipating negative outcomes does not outweigh the cost of living day-to-day with chronic worry and tension. Patients list the advantages and disadvantages of assuming the worst. They experiment with both positions, observing the effects on their mood.
Some patients display what Borkovec calls “the magic of worrying” (Borkovec, Robinson, Pruzinsky, & DePree, 1983). They believe that worrying is a magical ritual that can prevent bad things from happening: As long as they are worrying, the bad thing will not happen. (As one patient with this schema said, “At least when I’m worrying, I’m doing something.”) This stance is a form of trying to gain control over negative outcomes. However, in actuality, many objects of their worry are either beyond their control or not controllable by worrying. Patients can also conduct dialogues between their negative, pessimistic side and their positive, optimistic side, which therapy is helping to develop. In this way, they come to see the benefits of taking a more positive stance toward life.
Experiential techniques help patients connect with their Happy Child mode. If the origin of the schema was a negativistic, pessimistic parent, patients can conduct dialogues with this parent in imagery. As the Healthy Adult, first the therapist, then the patient, enters childhood images where the Pessimistic Parent deflated the child’s enthusiasm. The Healthy Adult challenges the Negative Parent and reassures the Worried Child. The child expresses anger at the Negative Parent for being such a negative and stressful presence.
Therapists can use experiential techniques to help patients resolve underlying feelings of emotional deprivation about painful events from their past. If patients express anger and grief about these events in imagery, with the therapist empathizing, then they are often able to leave these events behind them. Rather than being stuck in unresolved grief, they can begin moving forward once again in their lives. The Healthy Adult guides the patient through the process.
Patients can conduct behavioral experiments to test their distorted, negative beliefs. For example, they can predict the worst outcome and measure how much of the time they are right; they can test the hypothesis that worrying leads to a better outcome; or they can test whether predicting negative outcomes or positive outcomes feels better.
Therapists can teach patients with a Negativity/Pessimism schema “response prevention” techniques to reduce their overvigilance about making mistakes. Patients gradually learn to become less obsessive about avoiding mistakes and to engage in fewer unnecessary behaviors designed to prevent mistakes, and then observe the increase in satisfaction and pleasure they gain from implementing these changes.
Instructing patients not to complain to others can be a helpful behavioral homework assignment. When the schema is an overcompensation for the Emotional Deprivation schema, the therapist can teach patients to ask others more directly to meet their emotional needs in relationships. Many of these negativistic, pessimistic patients—especially the ones therapists call “help-rejecting complainers” (Frank et al., 1952)—are extremely difficult to treat and often have an Emotional Deprivation schema underneath. Without any conscious awareness, they complain as a means of getting people to nurture them. The reason that the chronic complaining we see in these patients is so unresponsive to logical persuasion and evidence to the contrary is because the core issue is emotional deprivation: Patients are complaining to gain nurturance and empathy, not because they want practical solutions or advice. The self-defeating aspect of their complaining is that, after a while, other people get fed up with their complaining and become impatient or avoid them. Nevertheless, in the short run, the complaining often wins patients sympathy and attention. If they learn to ask more directly for caring rather than seeking it through complaining, then they can begin to meet their emotional needs in healthier ways.
Limiting the time spent worrying by scheduling “worry time” is a behavioral strategy that helps many of these patients. They learn to notice when they are worrying, and then postpone the worrying until the prescribed time. Many of these patients also benefit from scheduling more activities for fun. Often, people with this schema have lives oriented around survival rather than pleasure. Life is not about getting “good things”—it is about preventing “bad things.” Getting patients to schedule pleasurable activities can be an antidote to their tendency to spend so much time worrying. As with the treatment of depression, increasing pleasurable activities is an important component of treating the Negativity/Pessimism schema.
As we noted earlier, many patients with this schema were emotionally deprived as children and thus need a great deal of nurturing from the therapist. The therapist can focus on providing validation for past negative events, being careful not to support complaints or negative predictions about the future. If the therapist can nurture the patient regarding past losses, while not responding to excessive complaining about current events, the patient can begin to heal. This “limited reparenting” promotes grieving without reinforcing pessimism or complaining.
This is usually a difficult schema to change. Often, patients cannot remember a time when they did not feel pessimistic, and cannot imagine feeling otherwise. Mode work can help them free up their Happy Child mode, long buried under mountains of worry. The Healthy Adult—first role-played by the therapist, then the patient—comes into images of upsetting past and current situations, and helps the Worried Child take a more positive view of them.
Therapists must be careful not to fall into the role of arguing with patients about their negative thinking. Rather than the therapist repeatedly playing the positive side and the patient playing the negative side, it is important for the patient to play both sides. When the therapist and patient assume opposite sides, sessions tend to become too much like debates, and the relationship is prone to becoming adversarial. If the patient plays both sides, the therapist can coach the healthy side when necessary. The therapist can help the patient identify two modes, the Pessimist and the Optimist, then carry out dialogues between them.
There can be a lot of secondary gain for the schema if the patient receives attention for complaining. The therapist should try to alter these contingencies as much as possible. The therapist can meet with family members who are reinforcing the patient’s complaining and teach them a healthier response. The therapist can help them learn to ignore patients when they complain, rewarding instead expressions of confidence and hope.
When the schema is hard to change as a result of a history of extremely negative life events, it is often helpful for patients to grieve for past losses. Genuine grieving can relieve the pressure to complain. Grieving helps patients separate the present, where they (presumably) are safe and secure, from the past, where they underwent traumatic loss or damage.
As we have said, for some patients, there may be a biological component to the worrying, and medication is a potential addition to their treatment. We have sometimes found antidepressant medications, especially selective serotonin reuptake inhibitors, to be quite helpful.
These patients present as emotionally constricted and are excessively inhibited about discussing and expressing their emotions. They are affectively flat rather than emotional and expressive, and self-controlled rather than spontaneous. They usually hold back expressions of warmth and caring, and often attempt to restrain their aggressive urges. Many patients with this schema value self-control above intimacy in human interactions and fear that, if they let go of their emotions at all, they might completely lose control. Ultimately, they fear being overcome with shame or bringing about some other grave consequence, such as punishment or abandonment. Often, the overcontrol is extended to significant others in the patient’s environment (the patient tries to prevent significant others from expressing both positive and negative emotions), especially when these emotions are intense.
Patients inhibit emotions that it would be healthier to express. These are the natural emotions of the Spontaneous Child mode. All children have to learn to rein in their emotions and impulses in order to respect the rights of other people. However, patients with this schema have gone too far. They have inhibited and overcontrolled their Spontaneous Child so much that they have forgotten how to be natural and to play. The most common areas in which patients are overcontrolled include inhibition of anger; inhibition of positive feelings such as joy, love, affection, and sexual excitement; excessive adherence to routines or rituals; difficulty expressing vulnerability or communicating fully about one’s feelings; and excessive emphasis on rationality while disregarding emotional needs.
Patients with the Emotional Inhibition schema frequently meet the diagnostic criteria for obsessive-compulsive personality disorder. In addition to being emotionally constricted, they tend to be overly devoted to decorum at the expense of intimacy and play, and are rigid and inflexible rather than spontaneous. Patients who have both the Emotional Inhibition and Unrelenting Standards schemas are especially likely to meet diagnostic criteria for obsessive-compulsive personality disorder, because the two schemas together include almost all the criteria.
The most common origin for the Emotional Inhibition schema is being shamed by parents and other authority figures when, as children, patients spontaneously displayed emotion. This is often a cultural schema, in the sense that certain cultures place a high value on self-control. (One patient told the following joke to illustrate the emotional restraint of his Scandinavian heritage: “Did you hear about the Scandinavian man who loved his wife so much he almost told her?”) The schema often runs in families. The underlying belief is that it is “bad” to show feelings, to talk about them or act on them impulsively, whereas it is “good” to keep feelings inside. Patients with this schema usually appear to be self-controlled, joyless, and grim. In addition, as a result of a reservoir of unexpressed anger, they are frequently hostile or resentful.
Patients with the Emotional Inhibition schema often become romantically involved with partners who are emotional and impulsive. We believe this is because there is a healthy part of them that wants in some way to let the Spontaneous Child inside of them emerge. (One female patient, who was taught it was wrong to “show off,” married a man who loved to wear fancy clothes and go to expensive places: “When I’m with him, it feels like I’m allowed to dress up,” she explained.) When inhibited people marry emotional people, the couple sometimes becomes increasingly polarized over time. Unfortunately, sometimes the partners begin to dislike each other for the very qualities that first attracted them: The emotional partner scorns the reserve of the inhibited one, and the inhibited partner disdains the intensity of the emotional one.
The basic goal of treatment is to help patients become more emotionally expressive and spontaneous. Treatment helps patients learn how to appropriately discuss and express many of the emotions they are suppressing. Patients learn to show anger in appropriate ways, engage in more activities for fun, express affection, and talk about their feelings. They learn to value emotions as much as rationality, and to stop controlling the people around them, humiliating others for expressing normal emotions, and feeling shame about their own emotions. Instead, they allow themselves and others to be more emotionally expressive.
The behavioral and experiential treatment strategies are probably the most important. Behavioral strategies are directed at helping the patient discuss and express both positive and negative emotions with significant others, and engage in more activities for fun. Some education is useful; otherwise, cognitive strategies generally are not as helpful—they reinforce the patient’s already excessive emphasis on rationality.
Experiential work can enable patients to access their emotions. In images of childhood, the Healthy Adult helps the Inhibited Child express the emotions that patients suppressed as children. First the therapist, then the patient, plays the Healthy Adult. The Healthy Adult confronts the Inhibiting Parent and encourages the child to express feelings such as anger and love. In images of current and future situations, the Healthy Adult helps the patient to articulate emotions, and to encourage other people to articulate their emotions as well.
The therapy relationship can also be quite helpful in healing the Emotional Inhibition schema. A therapist who is generally more expressive and emotional can “reparent” the patient and provide a model. (However, a highly rational, inhibited therapist might inadvertently strengthen the schema.) Reparenting could involve occasionally doing something spontaneously in the session just for fun (e.g., telling a joke, discussing a frivolous topic, using humor) to break up the serious tone. Most importantly, the therapist reinforces the patient for expressing rather than restraining emotions. If the patient has strong feelings about the therapist, then the therapist encourages the patient to express them aloud.
Cognitive strategies help the patient accept the advantages of being more emotional, and thereby make the decision to fight the schema. The therapist presents the process of fighting the schema as seeking a balance on a spectrum of emotionality rather than as all-or-nothing. The goal is not for patients to flip to the other extreme and become impulsively emotional; rather, the goal is for patients to reach a middle position.
Finally, cognitive strategies can help patients evaluate the consequences of expressing their emotions. Patients with this schema are afraid that, if they express their emotions, something bad will happen. Often, what they fear is that they will be humiliated or made to feel ashamed. Helping patients see that they can use good judgment about expressing emotions, so that this is not likely to happen, allows them to feel more comfortable and willing to experiment.
Experiential strategies help patients access and express unacknowledged childhood emotions, such as longing, anger, love, and happiness. In imagery, patients relive important childhood situations, this time expressing their emotions. They say out loud the feelings they inhibited at the time. First the therapist, then the patient, enters the image as the Healthy Adult and helps the Inhibited Child. The Healthy Adult rewards the child for expressing feelings rather than humiliating or shaming the child, as the parent figures did. The Healthy Adult confronts the parent, and consoles and accepts the child. The patient expresses anger and sadness about his or her lost Spontaneous Child.
There are a wealth of potential behavioral role plays and homework assignments. Patients can practice discussing their feelings with other people, appropriately expressing both positive and negative feelings, playing and being spontaneous, and doing activities designed for fun. They might take a dance class or experiment sexually, or do something on the spur of the moment. They might express aggression with their bodies, for example, by playing competitive sports or pounding a punching bag. If necessary, the therapist can grade behavioral tasks in terms of difficulty, so that patients gradually let go of their overcontrol. Working with the partner can be useful. The therapist encourages both the patient and the partner to express feelings in constructive ways. Finally, patients design tests of their negative predictions, writing down what they predict will happen if they express their emotions, and what actually happens. Patients role-play interchanges with significant others in imagery and with the therapist, and then carry them out for homework assignments. They compare the actual results with the predicted ones.
The therapist both models and encourages appropriate emotional expression. Group therapy can help many patients with this schema become more comfortable expressing their emotions to others.
When people have been emotionally inhibited for virtually their entire lives, it is hard for them to begin acting differently. Expressing emotion feels so foreign to patients who have this schema—it is so contrary to what feels like their true nature—that they experience great difficulty doing it. Mode work can help patients access the healthy side of them that wants to battle the schema and express emotions more openly.
Patients with this schema present as perfectionistic and driven. They believe that they must continually strive to meet extremely high standards. These standards are internalized; therefore, unlike the Approval-Seeking/Recognition-Seeking schema, patients with the Unrelenting Standards schema do not as readily alter their expectations or behaviors based on the reactions of others. These patients strive to meet standards primarily because they “should,” not because they want to win the approval of other people. Even if no one were ever to know, most of these patients would still strive to meet the standards. Patients often have both the Unrelenting Standards and Approval-Seeking/Recognition-Seeking schemas, in which case they seek both to meet very high standards and to win external approval. Unrelenting Standards, Approval-Seeking/Recognition-Seeking, and Entitlement are the most readily observable schemas in the narcissistic personality (although Emotional Deprivation and Defectiveness schemas often underlie these compensatory schemas). We discuss this further in Chapter 10 on treating narcissistic patients.
The most typical emotion experienced by patients with the Unrelenting Standards schema is pressure. This pressure is relentless. Because perfection is impossible, the person must perpetually try harder. Beneath all the exertion, patients feel intense anxiety about failing—and failing means getting a “95” rather than a “100.” Another common feeling is hyper-criticalness, both of themselves and of others. Most of these patients also feel a great deal of time pressure: There is so much to do and so little time. A common result is exhaustion.
It is difficult to have unrelenting standards, and it is often difficult to be with someone who has unrelenting standards. (As one of our patients said about his wife, who has unrelenting standards: “This is no good, and that’s no good. Nothing’s ever any good.”) Another common feeling in patients with this schema is irritability, usually because not enough is getting done quickly enough or well enough. Yet another common feeling is competitiveness. Most patients who are classified as “type A”—that is, as demonstrating a chronic sense of time pressure, hostility, and competitiveness (Suinn, 1977)—have this schema.
Often, patients with the Unrelenting Standards schema are workaholics, working incessantly within the particular realms to which they apply their standards. The realms can be varied: school, work, appearance, home, athletic performance, health, ethics or adherence to rules, and artistic performance are some possibilities. In their perfectionism, these patients often display inordinate attention to detail and often underestimate how much better their performance is relative to the norm. They have rigid rules in many areas of life, such as unrealistically high ethical, cultural, or religious standards. There is almost always an all-or-nothing quality to their thinking: Patients believe that either they have met the standard exactly or they have failed. They rarely take pleasure from success, because they are already focused on the next task that must be accomplished perfectly.
Patients with this schema do not usually view their standards as perfectionistic. Their standards feel normal. They are just doing what is expected of them. In order to qualify as having a maladaptive schema, the patient must have some significant impairment related to the schema. This could be a lack of pleasure in life, health problems, low self-esteem, unsatisfying intimate or work relationships, or some other form of dysfunction.
The basic goal of treatment is to help patients reduce their unrelenting standards and hypercriticalness. The goal is twofold: to get patients to try to accomplish less, and to accomplish it less perfectly. Successfully treated patients have more of a balance in their lives between accomplishment and pleasure. They play, as well as work, and do not worry so much about “wasting time” and feeling guilty about it. They take the time to connect emotionally to significant others and are able to allow something to be imperfect and still consider it worthwhile. Less critical of themselves and others, they are less demanding and more accepting of human imperfection, and are less rigid about rules. They come to realize that their unrelenting standards cost more than they gain: In trying to make one situation slightly better, they are making many other situations a lot worse.
The cognitive and behavioral treatment strategies are usually most important. Although experiential strategies and the therapy relationship can be useful, they are usually not central to the treatment of this schema.
The therapist utilizes cognitive strategies to help patients challenge their perfectionism. They learn to view performance as lying on a spectrum from poor to perfect—with many gradations in between—rather than as an all-or-nothing phenomenon. They conduct cost-benefit analyses of perpetuating their unrelenting standards, asking themselves: “If I were to do things a little less well, or if I were to do fewer things, what would the costs and benefits be?” The therapist highlights the advantages of lowering their standards—all the benefits that would accrue to their health and happiness, all the ways they are suffering as a result of their unrelenting standards, and all the ways the schema is damaging their enjoyment of life and relationships with significant others. The cost of the schema is greater than the benefits: This conclusion is the leverage that can motivate patients to change. The therapist also helps patients reduce the perceived risks of imperfection. Imperfection is not a crime. Making mistakes does not have the extreme negative consequences that patients anticipate.
The Unrelenting Standards schema seems to have two different origins, with different implications for treatment. The first and more common origin is the internalization of a parent with high standards (the Demanding Parent mode). When this is the origin, experiential exercises help patients build up a part of the self that can fight the internalized Demanding Parent. This is the Healthy Adult, played first by the therapist, then by the patient. Patients express anger about the pressure and the high cost of the parent’s standards; they have paid dearly for internalizing those standards.
The second origin of the Unrelenting Standards schema is as a compensation for the Defectiveness schema: Patients feel defective and then overcompensate by trying to be perfect. When this is the origin, helping patients become aware of the underlying Defectiveness schema is an important part of treatment. Experiential strategies can help patients access the underlying shame. All of the imagery exercises that apply to the Defectiveness schema become relevant. Patients can also visualize their perfectionistic side (one patient calls hers “Miss Perfect”: “She has her hands on her hips and a stern, disappointed look on her face”). In imagery, the perfectionistic mode can step aside and let the Vulnerable Child speak.
Behavioral strategies can help patients gradually reduce their unrelenting standards. The therapist and patient design behavioral experiments to help rein in the perfectionism—to do less and to do it less well. Some examples of behavioral experiments include scheduling how much time they are going to spend working versus doing other things, such as playing and connecting to significant others; setting lower standards and practicing adhering to them; intentionally doing tasks imperfectly; giving praise for the imperfect yet worthwhile behaviors of significant others; or “wasting time” interacting with friends or family members purely for the sake of enjoyment or to enhance the quality of the relationships. Patients monitor their mood as a consequence of carrying out the assignments and observe the effects on the moods of significant others. They learn to fight the guilt they feel when they do not try hard enough. The Healthy Adult assures the Imperfect Child that it is acceptable to permit some imperfection.
Ideally, therapists model balanced standards in both their approach to therapy and in their portrayal of their own lives. Therapists who are themselves too perfectionistic can undermine the patient’s progress in treatment. The therapist uses empathic confrontation when the patient’s unrelenting standards manifest themselves in therapy, such as when the patient fills out forms too well or does the homework too perfectly. Although the therapist understands why patients feel they have to perform perfectly, because this is what was conveyed to them by their parents in childhood, in reality, they do not have to perform perfectly for the therapist. The therapist will not shame or criticize them for performing imperfectly. He or she is more interested in forming a relationship and helping the patient to heal than in evaluating the patient’s performance in therapy, and wants the patient to feel the same.
The biggest obstacle by far is the secondary gain that comes from the schema: There are so many benefits to doing things so well. Many patients with this schema are reluctant to give up their unrelenting standards because, to them, it seems that the benefits far outweigh the costs. In addition, many patients are afraid of embarrassment, shame, guilt, and their own self-criticalness, if they do not live up to the standards. The potential for negative affect seems so high that they are reluctant to risk lowering their standards even a little bit. Moving slowly can help these patients, as can closely evaluating the outcomes of lowering the standards. Mode work can help patients build up their healthy side that wants to trade perfectionism for greater fulfillment in life.
Typical Presentation of the Schema
These patients believe that people—including themselves—should be harshly punished for their mistakes. They present as moralistic and intolerant, and find it extremely difficult to forgive mistakes in other people or in themselves. They believe that, rather than forgiveness, people who make mistakes deserve punishment. No excuses are permitted. Patients with this schema display an unwillingness to consider extenuating circumstances. They do not allow for human imperfection, and they have difficulty feeling any empathy whatsoever for a person who does something they view as bad or wrong. These patients lack the quality of mercy.
The best way to detect this schema is by the punitive, blaming tone of voice these patients use when someone has made a mistake, whether they are speaking about other people or about themselves. The origin of this punitive tone of voice is almost always a blaming parent who spoke in the same tone of voice. The tone conveys the implacable necessity of exacting punishment. It is the voice of the “fire and brimstone” preacher: heartless, cold, and contemptuous. It lacks softness and compassion. It is a voice that will not be satisfied until the wrongdoer has been punished. There is also the sense that the penalty the person wants to exact is too severe—that the punishment is greater than the crime. Like the Red Queen in Lewis Carroll’s (1923) Alice in Wonderland, shouting “Off with his head!” for every minor infraction, the schema is undiscriminating and extreme.
Punitiveness is often linked to other schemas, especially Unrelenting Standards and Defectiveness. When patients have unrelenting standards and punish themselves for not meeting them, as opposed to simply feeling imperfect, they have both the Unrelenting Standards and Punitiveness schemas. When they feel defective and punish themselves for it, as opposed to simply feeling depressed or inadequate, they have both the Defectiveness and Punitiveness schemas. Most patients with borderline disorder have both Defectiveness and Punitiveness schemas: They feel bad whenever they feel defective, and they want to punish themselves for being bad. They have internalized their Punitive Parent as a mode, and they punish themselves for being defective, just as the parent used to punish them: They yell at themselves, cut themselves, starve themselves, or otherwise mete out punishment. (We discuss the “Punitive Parent” mode further in the Chapter 9 on treating patients with BPD.)
The fundamental goal is to help patients become less punitive and more forgiving, toward both themselves and others. The therapist begins by teaching patients that, most of the time, there is little value in punishing people. Punishment is not an effective way to change behavior, particularly when compared to other methods, such as rewarding good behavior or modeling. There is a great deal of operant research on the ineffectiveness of punishment as a means of changing behavior (Baron, 1988; Beyer & Thrice, 1984; Coleman, Abraham, & Jussin, 1987; Rachlin, 1976). Other research shows that an authoritarian style of parenting is less effective than a democratic style. In an authoritarian parenting style, the parent punishes “bad” behavior; in a democratic parenting style, the parent explains why the child’s behavior is wrong. Authoritarian parents tend to produce children who disobey whenever the parent is out of sight, whereas democratic parents tend to produce children who try to do what is right, whether the parent is there or not. In addition, the children of democratic parents have higher self-esteem (Aunola, Stattin, & Nurmi, 2000; Patock-Peckham, Cheong, Balhorn, & Nogoshi, 2001).
Each time the patient expresses the desire to punish someone, the therapist asks a series of questions: “Were the person’s intentions good or bad? If the person’s intentions were good, doesn’t that count for something? Doesn’t the person deserve some forgiveness? If the person’s intentions were good, then how will punishment help? Isn’t the person likely to repeat the behavior when you’re not there to see? Even if the person behaves better next time, isn’t the cost too high? The punishment will have undermined the relationship and the person’s self-esteem. Is that what you want?” These questions guide the patient to discover that punishment is not the most beneficial approach.
Patients work toward building empathy and forgiveness for human beings in all their frailty and imperfection. They learn to consider extenuating circumstances and to have a balanced response when someone makes an error or fails to meet their expectations. If they are in a position of authority (e.g., if the other person is a child or employee), they do not punish the person. Rather, they focus on helping the person understand how to behave better the next time. Punishment should be reserved for those who are grossly negligent or have immoral intentions. As the saying goes, “The scales of justice must always be tempered with mercy”)
Cognitive strategies are important in building patients’ motivation to change. The main strategy is educational: Patients explore the advantages and disadvantages of punishment versus forgiveness. They list both the consequences of punishing a person and of being more forgiving and encouraging the person to reflect on the behavior. Exploring the advantages and disadvantages helps the patient accept intellectually that punishment is not an effective way to deal with mistakes. Patients conduct dialogues between the punitive side and the forgiving side, in which the two sides debate each other. Initially, the therapist plays the healthy side and the patient plays the unhealthy side; eventually, the patient plays both sides in the dialogue. Becoming convinced on a cognitive level that the cost of the schema is greater than the benefit can help strengthen the patient’s resolve to battle the schema.
Because the schema is almost always the internalization of a parent’s Punitiveness schema, much experiential work focuses on externalizing and fighting the Punitive Parent mode. In imagery, patients picture the parent talking to them in the punitive tone of voice. They talk back to the parent, saying, “I’m not going to listen to you anymore. I’m not going to believe you anymore. You’re wrong, and you’re not good for me.” Doing imagery work with the Punitive Parent gives patients a way to distance from the schema and to make it feel less ego-syntonic. Rather than hearing the punitive voice of the schema as their own voice, they hear it as their parent’s voice. Patients can say to themselves: “This is not my voice that is punishing me; this is my parent’s voice. Punishment wasn’t healthy for me in childhood, and it isn’t healthy for me now. I’m not going to beat up on myself anymore, and I’m not going to punish other people anymore, especially the people I love.”
The aim of the behavioral strategies is to practice more forgiving responses in situations where patients have urges to blame themselves or others. Patients rehearse the behaviors in imagery exercises or role plays with the therapist, then carry out the behaviors for homework. The therapist can model more forgiving responses when necessary. Patients note whether the consequences match their dire predictions. For example, as a behavioral experiment, one patient, a mother with a young daughter, changed her response to her daughter’s misbehaviors for one week. Rather than yelling at her daughter when she misbehaved, the patient calmly explained why the behavior was wrong. The patient predicted that her daughter would misbehave more and found that, instead, her daughter misbehaved less.
The therapist can use the therapy relationship to model forgiveness. The “limited reparenting” the therapist provides emphasizes compassion over punishment. For example, if the patient makes a mistake, such as mixing up an appointment time or forgetting a homework assignment, the therapist does not reprimand the patient. Rather, the therapist helps the patient figure out how to avoid the mistake in the future.
This can be a difficult schema to change, particularly when it is combined with the Defectiveness schema. The patient’s sense of moral indignation and injustice can be very inflexible. Maintaining the patient’s motivation to change is the key to the treatment. The therapist helps the patient stay focused on the costs and the benefits of the schema in terms of improved self-esteem and more harmonious interpersonal relationships.