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Integrative Psychotherpay IX: Schema Focused Interventions


McMinn and Campbell go into detail regarding the 2nd domain of their 3 tiered model of persons/change in chapter 8 of Integrative Psychotherapy. While the first domain addresses symptoms, this domain (schema) looks beneath to deeper roots than habit and thought. “Schema-based interventions dig deeper than symptom-based interventions, looking to general core beliefs rather than specific automatic thoughts” (p. 243). Schema interventions address the heart of soul and deeply held beliefs (perceptions) about the self and the world that persist beyond specific situations.

So, they open their chapter with this assertion: “…it is often the currents beneath the surface of consciousness that have the most power and bring the most troubles in personal adjustment and interpersonal relationship.” (p. 240). They point to perceived parallels in Romans 7 (Sin causing me to do what I do not want to do) and Freudian theory regarding unmet needs to be both talking about underlying–yet controlling–currents in our lives. A wide view of sin (both active choice and result of living in a fallen world) incorporates both views without making one attack the other.

On page 242 they revisit a vignette of a unhappily married, 24 year old woman. She was afraid she didn’t love her husband and was afraid of being “doomed to misery if they stayed together.” In the vignette, “Denise” is told by her elder that she was facing a spiritual problem that required more prayer and bible reading. The authors fault the elder for having bad psychology (premature advice, no rapport) AND bad theology (that spiritual disciplines can always solve the problem of sin). They faulted the elder for not recommending a fuller orbed treatment of therapy or meds and for not considering a wider variety of underlying issues (her family of origin, communication issues, interpersonal anxiety, hidden secrets, biological predisposition, etc.)

So, is a better answer to Denise’s problem to trace her automatic thoughts back to her core belief? Not so fast say McMinn and Campbell. Linearity is nice but too simple. So, they turn to a discussion of schema.

Schema is not synonymous with core belief despite the fact that it is used that way (mea culpa in this post). Defined by the authors, “a schema is simply a structure that contains a representation of reality” (p. 247). They remind us that since we are actively interpreting our world, we shape our schemas and we shape our lives to fit our schemas. They further describe schemas with these statements (fleshed out in the book)
1. Schemas affect how we interpret and construct the world
2. Schemas are adaptive and maladaptive
3. Schemas can be activated and deactivated
4. Schemas are connect to modes (while schemas are cognitive they lead to a way of being, a personality, a motivational bent, an emotional and physiological bent)
5. Schemas can be categorized in how they interpret self, world, and future (p. 260 has a list of 18 schemas with accompanying core beliefs)
6. Schemas have a historical dimension (they point to literature describing 4 different early life experiences as key historical causes: toxic frustration, trauma, overindulged, and identifying with the pathology of a parent)
7. Schemas have an interpersonal dimension (they are not developed in a vacuum)
8. Schemas are influenced by original sin (faulty thinking doesn’t just come from bad environments. Those raised in great homes also struggle with faulty thinking because they are tainted from the Fall.)
9. Schemas have a cultural dimension (some schemas are culture-based and the authors warn against trying to change these)
10. Schemas have a faith dimension (schemas may shape perception of God; One’s theology shapes schemas)

To make this real, they refer back to “Denise.” Since Denise’s schema contains distrust of the world, she quickly interprets her husband’s cooking her favorite meal as an attempt to make up for his dis-trustfulness and so is defensive and irritable. Of course, this schema “predicts” distrust and then finds evidence of it when Don is hurt and doesn’t try to be nice after her attack of him.

So how does Integrative Psychotherapyaddress maladaptive schemas? They suggest “Recursive Schema Activation” (p. 270) over against class CT tactics that challenge core beliefs with logic. Merely engaging in logic battles minimizes, in their view, that core beliefs, “are embedded in a complex array of motivations, behaviors, emotions, and physiological responses” (p. 217). By “recursive” they mean to emphasize that we change through experience, dialog, repetitive activation and deactivation of the schema.

This means the client’s troubling schemas are activated and deactivated in the context of the therapeutic relationship, over and over again, all the time helping to foster the client’s ability to stand apart from the core beliefs and reconstruct a new, healthier identity–an outcome know as decentering. In decentering the clients begins to understand the nature, power and origins of the maladaptive core beliefs while simultaneously developing more conscious control over the schema deactivation process. (p. 272)

What is really different here from classic CT? McMinn and Campbell don’t want to talk only about a client’s schema, but to activate and experience the schema, and then decenter from it in order to understand and control it. They do not believe they can eliminate a damaged schema. Classic CT wants to correct maladaptive thoughts. IP wants attempts to recognize the impossibility of that and yet gain control and reduce the power of these maladaptive thoughts via therapeutic relationships.

My thoughts? Okay, lots to munch on here. I like how they recognize the limitations and arrogance of classic CT in correcting our struggle with deception and sin. Just as we don’t try to stop sexual temptation but fight to kill those things that lead us further along, we can’t stop initial fearful thoughts but work to stop our acting on them. What we do with our thoughts (take them captive) matters. And the authors here recognize that such efforts are not merely logical but experiential. I generally agree with their thoughts regarding how schemas color our world. We are active in shaping our interpretations of self and other and our world is active in shaping us. We are neither completely responsible for the content of our perceptions or completely victim of our perceptions. However, we are responsible for our actions and attitudes per the Scriptures. The Scriptures do not excuse us because we were mistreated. But there is grace.

I have two pet peeves. First, the example of bad pastoral care is not followed by bad example of stereotyped christian psychological care. Both are problems. I wish they did more to call out their own kind. Second, they continue to see sin primarily as only original sin. This, I think, does much to minimize active will, motivation and choices in everyday living. By listing the faith dimension of schemas last, they may unintentionally give it only a small slice of the pie when in fact it is a part of every other part of a schema. Each of the other 9 statements about schemas are clearly shaped by our spiritual beliefs and actions.  

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