Schema Therapy for Addiction Treatment
It’s a word that’s used in casual conversation every day by the clinical staff at Cornerstone of Recovery, but to the uninitiated, the word “schema” sounds like a football play or a get-rich-quick scam.
It’s actually one of the biggest therapeutic tools in the Cornerstone arsenal. Schemas – pronounced “skee-muhs” – are associated with a number of other descriptions: life traps, character defects, maladaptive coping mechanisms and more, but they boil down to one essential definition: unhealthy patterns developed primarily in childhood, which persist into adulthood and shape our decision-making processes. They were developed by Dr. Jeffrey Young and Dr. Janet Klosko out of the cognitive behavioral school of psychology, built on a foundation established by Dr. Aaron Beck; officially, their use in treatment is known as Schema-Focused Cognitive Therapy, and they combine elements of behavioral, experiential, interpersonal and psychoanalytic therapies into a single, unified model.
If that sounds complicated, just know this: In addiction, schemas become both a means of self-protection and a barrier to getting better. In treatment, our clinically trained staff members work within the guidelines laid out by Young, Beck and Klosko to help patients examine these self-defeating patterns of thinking and behavior, which if not addressed will become obstacles in the way of long-term recovery.
Schema therapy consists of three stages, but it all begins with the first step:
Assessment: To tailor a specific treatment path for each patient, counselors and therapists work to discover what their particular schemas might be. Questionnaires may be used to get a clearer picture of various life patterns, and all schemas are categorized as one of 18, broken down by five separate domains.
- Domain One: Disconnection and rejection, meaning that the patient expects his or her needs for security, safety, stability, nurture, empathy, acceptance and respect will not be met in a predictable manner. Schemas include (a) abandonment/instability, (b) mistrust/abuse, (c) emotional deprivation, (d) defectiveness/shame and (e) social isolation/alienation.
- Domain Two: Impaired autonomy and performance, meaning that a patient perceives his or her personal value is diminished, that he/she will be unable to function independently or perform successfully due to certain environmental factors. Schemas include (a) dependence/incompetence, (b) vulnerability to harm or illness, (c) enmeshment/undeveloped self and (d) failure
- Domain Three: Impaired limits, meaning that patients have difficulty respecting the rights of and cooperating with others, making commitments or setting and achieving realistic personal goals. Schemas include (a) entitlement/grandiosity and (b) insufficient self-control/self-discipline
- Domain Four: Other-Directedness: The patient focuses excessively on the needs, desires, feelings and responses of others at the expense of his or her own needs, often in order to gain love and approval, maintain friendships or avoid retaliation. Schemas include (a) subjugation, (b) self-sacrifice and (c) approval-seeking/recognition seeking
- Domain Five: Over-Vigilance and Inhibition: The patient either excessively suppresses his or her own emotions and desires or sets rigid internalized rules about their own performance or behavior, often at the expense of happiness, health, close relationships or self-expression. Schemas include (a) negativity/pessimism, (b) emotional inhibition, (c) unrelenting standards/hyper-criticalness and (d) punitiveness.
Where do these schemas originate?
Most of these issues stem from the family of origin, meaning that they’re almost always developed from the age of 0 to 12 years old, and for the rest of an individual’s life, they’re continually reinforced. That does not mean that the family is at fault; this is an especially difficult concept for family members to accept, especially ones who are already feeling guilty and wondering if something they did or didn’t do might have “caused” a loved one’s addiction. Schema therapy addresses the root cause of these coping mechanisms, but it does not assign blame to individuals in the patient’s life.
Schemas develop from two sources: temperament, the core of an individual that’s hard-wired with certain personality traits from birth; and experience, the unique events that occur in a person’s life. Example: An individual’s abandonment/instability schema might stem from anything from being left alone in a grocery store aisle for a few minutes as a 4-year-old to the divorce of parents during childhood. Regardless of how significant or insignificant such an event may seem to the patients themselves or to outside observers, they’ve made an indelible impact on those patients’ psyches, and they impact them in certain ways as they go through life.
Everyone has schema or two (or many), but not everyone develops an addiction. The schemas aren’t necessarily the cause of the addiction, but they can be a stumbling block to the recovery process, as brain changes brought on by heavy drug and alcohol use can exacerbate them or prevent the afflicted from coming to terms with them. And unless they’re examined and addressed during the recovery process, they can certainly stand in the way of the emotional and spiritual recovery process.
Keep in mind that schema therapy is much more complex than this brief description might indicate. Should you want more information about it, our staff members will be more than happy to provide it to you, and in case you’re seeking the Cliff’s Notes version of this page, it’s this: There is emotional trauma in every addict’s life that must be dealt with once the drugs are removed. Schema therapy is a way to do that, and we’ve found it to be an extremely useful and successful part of the therapeutic process at Cornerstone of Recovery.
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