Integrative Psychotherapy X: Schema interventions for depression


In the last chapter the authors theorized about our propensity to live out of socially constructed schemas. Now in chapter 9 of Integrative Psychotherapy, McMinn and Campbell apply schema-focused interventions (domain 2–dipping beneath symptoms to core issues) to the problem of depression. But before they get to that task, they make these 2 points:

1. It’s “incorrect and potentially dangerous” (p. 278) to assume one does symptom focused interventions with anxiety problems and deeper level interventions for depression. Instead, the therapist ought to move seamlessly between them as needed. They remind the reader that their chapters are illustrations and not manuals.
2. There are useful symptom based interventions for the problem of depression that should not be overlooked: (a) medications (they explore fallacies that keep people of faith from using them and point out that meds are sometimes better than counseling alone), (b) behavioral techniques (keeping an activity schedule, assertiveness training), and (c) cognitive restructuring (keeping a dysfunctional thought and challenge record).

At this point the authors begin to illustrate their version of schema-based interventions. Unlike classic interventions (diagnosing the underlying schema and then correcting it), they describe recursive schema activation which is designed to “give clients many opportunities, session after session, to decenter [see life from another perspective] from the deep, persistent themes of their lives that can never be fully obliterated” (p. 288-9). The main difference between the IP model and the classic model is their humility in seeing schemas as understood and managed rather than corrected. Also, they desire to activate and experience schemas as much as talk about them.

The goal of this part of IP is to stand apart from one’s schema so as to see it and choose to deactivate it where it is not helpful. In the case of depression, it means standing back from “depressogenic thoughts” using mindfulness and spiritual disciplines. The client doesn’t challenge thoughts so much as he or she activates the schema in counseling over and over in a manner that allows distance and the possible formation of a new schema or identity.

Just how does this work in therapy? McMinn and Campbell suggest these strategies:

1. Taking a life history to identify re-occurring themes that might signify the presence of maladaptive schematics (e.g., long history of feeling rejected by others). In taking the history, the client not only tells but re-experiences the schema with the counselor
2. Schema inventories. They mention one in particular: www.schematherapy.com. These are used to get the client thinking about schemas that contribute to their problems.
3. Discussion of faith. The therapist explores how the client’s view of God fits in their view of self. The assumption is that a maladaptive schema likely contains distortions of the character of God. The goal is to understand at this point, not correct.
4. Moving from specific to general. Clients often describe recent painful events (and thoughts and feelings). The therapist encourages the client to explore how these thoughts and feelings fit their general conclusions in life (e.g., people always leave me).
5. Looking for themes. The counselor looks to articulate and activate themes and creates space for the client to do the same.
6. Evoking emotions. The counselor needs to move from an intellectual discussion to the emotions attache to the schema. Often-times, this means using the here-and-now to explore emotions. Otherwise clients only report on feelings in a disconnected manner. If so, they remain disconnected from the insights they gather.
7. Guided discovery (vs. just telling the client the interpretations). The authors present a good illustration  of the difference between telling and collaboration on p. 298.
8. Imagery and meditation. The goal here is to use these techniques to activate and deactivate schemas. Why? They suggest these techniques support safety (to limit overwhelming oneself). They do note that while prayer may help in schema alteration its primary purpose is to connect with God and shouldn’t be thought of as some technique apart from its main purpose.

Finally, in the last 13 pages the authors take up how recursive schema activation is a bridge-building exercise. It bridges cognitive processes (logic, analysis) and emotional and relational processes; unconscious and conscious processes; past and present; events and meanings that we give them; schema activation and deactivation. They conclude that not every person has the psychological resources to deactivate schemas once activated and point the reader to the next two chapters where relationship interventions will need to be used.

MY THOUGHTS: This is a good chapter that describes what I think is core to therapy: self-observation in a safe environment that happens as much through experience as it does through logical analysis. The reality is that our schemas shape our sense of self and the world as much as our 5 senses do. We think we merely ascertain what is happening to us but in fact we are prepping our critical thinking with assumptions. Here’s my question. Is the schema something that can be changed. I hear the authors saying that they aren’t all that optimistic about it but just maybe we can control it, decide not to listen to it. In part I agree. And yet I don’t want to underestimate just how much a person can change their outlook on life and self. Where I think the biggest challenge lies is helping clients feel safe enough to accept that they make these assumptions. In couples counseling I find many/most couples unwilling to consider the possibility that their assumptions about their no-good spouse were formed before the ever met their spouse. They come wanting to fix the marriage and part of my job is to help them see that before they can fix the marriage they need to understand how their responses tell a lot about themselves and maybe less about their spouse than they think. This is hard for counselees to accept because it sounds to them that they are responsible for their spouse’s bad behavior. Helping a client not live in all/nothing thinking is my challenge. Further, I must make sure not to fall into “telling” mode when helping someone come to this realization. Sometimes I want to speed up the process and thereby lose the client.

5 Comments

Filed under book reviews, christian counseling, christian psychology, Cognitive biases, counseling skills, Depression

5 responses to “Integrative Psychotherapy X: Schema interventions for depression

  1. True integrative therapy is one that supports growth in all areas of life – physical, mental, emotional, spiritual, relationships, and careers. There is a great book that talks about spiritual growth and the role that depression can play in it called The Depression Advantage. They have a website at http://www.depressionadvantage.com that has a team of top experts in each field. Specific to Christian Counseling, Scott Sullender PhD is an ordained minister, a licensed Psychologist (#8931) and a Diplomate with the American Association of Pastoral Counselors. His component is deeply integrated with experts in the fields of cognitive therapy, relationships, life coaching, peer support, mind skills development, nutrition and fitness. Taking care of the whole person in an integrated program is where we need to be heading.

  2. Forgive me off-topic question. What books/resources do you suggest for adult men who were sexually abused as children?

    My case is not repressed. I’ve always thought I had not been too effected by being molested at eight years of age, but nearly forty years later, I am beginning to realize this is something that has had a profound negative impact on me.

    My sincere thanks.

  3. I will need to get back to you on this. Are you looking for books from a Christian perspective or not? I’m going to ask my boss who would be better versed on what is good.

    Phil

  4. Scott Knapp, MS

    JFred, it sounds like we’re in the same general age group, and we certainly share a common developmental anomaly…I was abused as a young child myself. I’m not aware of all the literature available out there, but I’ve enjoyed reading works by Dan Allender, PhD. “The Wounded Heart” was one of his earlier works for adult survivors of childhood sexual trauma, and he followed it up a decade or so later with a companion “next installment” entitled “The Healing Path.” I have noted that although I’m a fairly well-read guy, the most profound “healing” experiences I’ve had have always been while in fellowship with others, as opposed to while doing my reading. I wish you the best. Scott

  5. JFred

    Phil — I would be interested in any Christian or non-Christian resources. Thank you very much.

    Scott — Thanks for the recommendation and for sharing your experience about the need for fellowship. I’ve discovered that one of the worst parts of this is that I tend to think of myself as damaged goods, and no matter how well life looks on the outside, I feel like I’m a far worse sinner than others. The result of course being that I isolate alot and begin to think that others are judging me.

    Indeed, reading can become unhealthy at times!

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