The Sex Addict’s Schema and the Drive to Act Out Presented By: Mary L. Deitch, JD, PsyD and Tanisha M. Ranger, PsyD, CSAT(4)

Origins of Schema Theory Developed to address CBT “treatment failures” CBTs fundamental assumptions Compliance with treatment The ability to collaborate with the therapist A logical basis for change Accurate self-assessment Problem specificity Schema theory is a unifying theory combining cognitive, behavioral, attachment, psychodynamic and gestalt theories and techniques

Schema Theory What is a schema? Where do schemas come from? How do schemas work? What are the known schemas? How do schemas change? What is the goal of schema therapy?

What is a Schema? A dysfunctional assumption about the self, the world and one’s relationship to others Broad and pervasive pattern comprised of thoughts, feelings, bodily sensations and memories Developed during childhood/adolescence and elaborated upon throughout the life span – schemas become the lens through which life is seen

Where do Schemas come from? Toxic frustration of core childhood needs Attention Affection Protection Play Victimization, traumatization and/or abuse during childhood and adolescence

How do schemas work? Two primary operations: schema perpetuation and schema healing All thought processes, behaviors and feelings can be seen as contributing to one of the two operations Schema Perpetuation The routine processes by which schemas function to perpetuate themselves Includes: cognitive distortions, self-defeating behavior patterns and maladaptive coping styles Schemas tend to highlight and exaggerate environmental evidence that supports them, while minimizing or ignoring evidence that refutes

How do schemas work? Schema Perpetuation (Cont’d) Schemas are made up of thoughts, feelings and bodily sensations It is through the maladaptive coping styles that they exert influence over behavior and ensure their survival Three maladaptive coping styles: Surrender, Avoidance, and Overcompensation

How do schemas work? Schema Perpetuation (Cont’d) Surrender Avoidance Refers to the ways in which people passively give in to the schema They accept the schema as fact and then act in ways that confirm Avoidance Refers to the ways in which people attempt to avoid the schema – they may avoid activating the schema or avoid experiencing the painful emotions once the schema has been activated Three types of avoidance are: cognitive, emotional and behavioral Overcompensation Refers to behavior that directly contradicts what the schema suggests in an attempt to avoid triggering the schema They may appear healthy on the surface, but often take behaviors to the extreme

How do schemas work? Schema Healing Occurs when therapeutic techniques are used to weaken maladaptive schemas and coping styles Involves an alliance between the therapist and the client’s healthy side against the schemas Therapeutic techniques: Challenging, questioning and contradicting schemas Role playing and real world experiments Guided imagery Limited re-parenting Empathic confrontation

ECU Sample Data Total Clients: 50 Attachment Style (ECR Scale) Level One: 14 (28%) Level Two: 19 (38%) Level Three: 17 (34%) Attachment Style (ECR Scale) Fearful/Avoidant: 11 (22%) Preoccupied: 11 (22%) Dismissing: 7 (14%) Secure: 21 (42%) Clients with more than 1 schema ranked Very High - 36 (72%) Client with no schemas High or Very High - 3 (6%) These clients also described themselves as Securely Attached

What are the known Schemas? Disconnection & Rejection Domain Focused on the expectation that one’s needs for security, safety, empathy, belonging and respect will not be met in a predictable manner ABANDONMENT – MISTRUST – EMOTIONAL DEPRIVATION DEFECTIVENESS – SOCIAL ISOLATION

Emotional Deprivation This schema is characterized by the expectation that one’s normal needs for emotional support will not be met. Typically a result of deprivation of nurturance, empathy or protection as a child. Very High: 16 (32%) Level One: 3 (19%) Level Two: 9 (56%) Level Three: 4 (25%) Fearful: 5 (31%) Preoccupied 5 (31%) Dismissing: 2 (13%) Secure: 4 (25%) High: 6 (12%) Level One: 3 (50%) Level Two: 2 (33%) Level Three: 1 (17%) Fearful: 3 (50%) Preoccupied: 1 (17%) Dismissing: 0 Secure: 2 (33%) Total: 22 (44%) Total: 6 (28%) Total: 11 (50%) Total: 5 (23%) Total: 8 (37%) Total: 2 (9%) Total: 6 (27%)

Abandonment This Schema is about the perceived instability or unreliability of those who are meant to provide support and connection. Withdrawal of support may be due to death, imminent illness, emotional instability, or finding someone new/better. Very High: 13 (26%) Level One: 3 (23%) Level Two: 7 (54%) Level Three: 3 (23%) Fearful: 6 (46%) Preoccupied: 4 (31%) Dismissing: 0 Secure: 3 (23%) High: 5 (10%) Level One: 0 Level Two: 3 (60%) Level Three: 2 (40%) Fearful: 0 Preoccupied: 1 (20%) Dismissing: 2 (40%) Secure: 2 (40%) Total: 18 (36%) Total: 3 (17%) Total: 10 (56%) Total: 5 (28%) Total: 6 (33%) Total: 5 (28%) Total: 2 (40%)

Mistrust/Abuse Individuals with this schema operate under the assumption that others will use, hurt, abuse, cheat, lie to, or otherwise take advantage of them, and that this harm is typically maliciously intended. Very High: 13 Level One:2 Level Two: 9 Level Three: 2 Fearful 4 Preoccupied: 3 Dismissing: 1 Secure: 5 High: 10 Level Two: 4 Level Three: 4 Fearful 3 Secure: 3 Total: 23 Total: 4 Total: 13 Total: 6 Total: 7 Total: 2 Total: 8

Social Isolation This Schema is characterized by the belief that one is isolated from the rest of the world, different from other people, and/or not part of any group or community. . Very High: 13 Level One:2 Level Two: 8 Level Three: 3 Fearful: 3 Preoccupied: 5 Dismissing: 2 Secure: 3 High: 4 Level One:1 Level Two: 2 Level Three: 1 Fearful: 2 Preoccupied: 0 Dismissing: 0 Secure: 2 Total: 17 Total: 3 Total: 10 Total:4 Total: 5 Total: 2

Defectiveness This Schema is characterized by the belief that one is flawed, defective, or inferior. These individuals believe that if they let anyone get close enough to see these flaws, they would be unlovable. Very High: 16 Level One:3 Level Two: 7 Level Three: 6 Fearful: 4 Preoccupied: 4 Dismissing: 3 Secure: 5 High: 9 Level One:2 Level Two: 4 Level Three: 3 Fearful: 2 Preoccupied: 3 Dismissing: 1 Secure: 3 Total: 25 Total: 5 Total: 11 Total:9 Total: 6 Total: 7 Total: 4 Total: 8

What are the known Schemas Impaired Autonomy & Performance Domain Focused on expectations about the self and one’s surroundings that interfere with one’s perceived ability to survive, thrive, separate and function independently DEPENDENCE – VULNERABILITY TO HARM ENMESHMENT – FAILURE

Failure This Schema involves the belief that one will fail or has failed in major areas of achievement such as work, school or sports. Individuals generally feel. inadequate when compared to others. Very High: 9 Level One:2 Level Two: 5 Level Three: 2 Fearful: 2 Preoccupied: 2 Dismissing: 2 Secure: 3 High: 3 Level Two: 0 Level Three: 1 Fearful:0 Preoccupied: 1 Dismissing: 1 Secure: 1 Total: 12 Total: 4 Total: 5 Total:3 Total: 2 Total: 3

Dependence This Schema is characterized by the belief that one is incapable of handling everyday responsibilities and decisions without considerable help from others Very High: 10 Level One: 2 Level Two: 4 Level Three: 4 Fearful: 3 Preoccupied: 4 Dismissing: 1 Secure: 2 High: 4 Level One: 1 Level Two: 2 Level Three: 1 Fearful:2 Preoccupied: 1 Secure: 0 Total: 14 Total: 3 Total: 6 Total:5 Total: 5 Total: 2

Vulnerability This Schema is characterized by fear of catastrophe and that one will be unable to prevent harm. These fears can involve medical issues, emotional crises, or external crises. Very High: 6 Level One:1 Level Two: 2 Level Three: 3 Fearful: 0 Preoccupied: 2 Dismissing: 1 Secure: 3 High: 5 Level One:0 Fearful:2 Dismissing: 0 Secure: 1 Total: 11 Total: 1 Total: 4 Total:6 Total: 2

Enmeshment Individuals with this schema often have a history of excessive emotional involvement with significant others (often parents) that hinders their ability separate/individuate and experience normal social development. May include feelings of emptiness, being smothered by others, or being codependent on others. Very High: 4 Level One: 1 Level Two: 1 Level Three: 2 Fearful: 1 Preoccupied: 2 Dismissing: 0 Secure: 1 High: 6 Level One:2 Level Two: 3 Level Three: 1 Fearful:2 Preoccupied: 1 Dismissing: 1 Secure: 2 Total: 10 Total: 3 Total: 4 Total:3 Total: 1

What are the known Schemas? Impaired Limits Domain Focused on a deficiency of internal limits, responsibility to others, or long-term goal-orientation which leads to difficulty respecting the rights of others, cooperating, committing, and setting/meeting realistic personal goals ENTITLEMENT – INSUFFICIENT SELF-CONTROL

Entitlement This Schema is characterized by the belief that one is superior to others, not guided by normal social rules or entitled to special treatment. These individuals display competiveness towards others, asserting power and controlling others. Sometimes they display a lack of empathy towards others. Very High: 11 Level One: 3 Level Two: 7 Level Three: 1 Fearful: 2 Preoccupied:4 Dismissing: 0 Secure: 5 High: 7 Level One:2 Level Two: 3 Level Three: 2 Fearful:2 Preoccupied: 2 Dismissing: 1 Secure: 2 Total: 18 Total: 5 Total: 10 Total:3 Total: 4 Total: 6 Total: 1 Total: 7

Insufficient Self Control This Schema is characterized by pervasive difficulty in exercising self control in order to achieve goals; impaired limits on emotional expression; or exaggerated emphasis on avoiding painful or uncomfortable experiences. Very High: 16 Level One:4 Level Two: 8 Level Three: 4 Fearful: 5 Preoccupied: 4 Dismissing: 1 Secure: 6 High: 13 Level One:3 Level Two: 5 Level Three: 5 Fearful:2 Dismissing: 2 Secure: 5 Total: 29 Total: 7 Total: 13 Total:9 Total: 8 Total: 3 Total: 11

What are the known Schemas? Other-Directedness Domain Involves an excessive focus on the desires, feelings and responses of others, at the expenses of one’s own needs in order to avoid rejection & retaliation or to gain love & acceptance SUBJUGATION – SELF-SACRIFICE – APPROVAL-SEEKING

Subjugation The schema of subjugation involves an excessive surrendering of control to others out of a fear of anger, retaliation or abandonment. It takes two major forms: subjugation of needs (the suppression of one’s preferences, decisions and desires) and subjugation of emotions (the suppression of emotional expression, particularly anger) Very High: 15 Level One:4 Level Two: 8 Level Three: 3 Fearful: 5 Preoccupied: 5 Dismissing: 2 Secure: 3 High: 2 Level One:2 Level Two: 0 Level Three: 0 Fearful:0 Preoccupied: 1 Dismissing: 1 Secure: 0 Total: 17 Total: 6 Total: 8 Total:3 Total: 5 Total: 3

Self-Sacrifice This schema involves an excessive focus on voluntarily meeting the needs of others, at the expense of one’s own gratification. The most common reasons are: to prevent causing pain to others, to avoid the guilt from feeling selfish, or to maintain a connection with others who are perceived as needy. Very High: 16 Level One:7 Level Two: 4 Level Three: 5 Fearful: 5 Preoccupied: 4 Dismissing: 2 Secure: 5 High: 13 Level One:2 Level Two: 6 Fearful:3 Secure: 4 Total: 29 Total: 9 Total: 10 Total:10 Total: 8 Total: 4

Approval Seeking This Schema is characterized by excessive emphasis on gaining approval, attention or recognition from others as the expense of forming one’s personal identity. One depends on others to provide a sense of self and self esteem and uses their reactions to gage their decisions and thoughts. Very High: 20 Level One: 5 Level Two: 10 Level Three: 5 Fearful: 6 Preoccupied: 7 Dismissing: 1 Secure: 6 High: 6 Level One:2 Level Two: 2 Level Three: 2 Fearful:1 Preoccupied: 1 Dismissing: 2 Secure: 2 Total: 26 Total: 7 Total: 12 Total: 8 Total: 3

What are the Known Schemas? Overvigilance & Inhibition Domain Involves an excessive emphasis on suppression of spontaneous feelings, impulses or choices OR on meeting rigid internalized rules and expectations for behavior, often at the expense of one’s own happiness, self-expression, relaxation, close relationships or health NEGATIVITY – EMOTIONAL INHIBITION UNRELENTING STANDARDS – PUNITIVENESS

Negativity This Schema is characterized by focusing on negative aspects of life while ignoring the positive aspects. These clients believe that things will go wrong or fear making mistakes. Very High: 11 Level One: 2 Level Two: 5 Level Three: 4 Fearful: 4 Preoccupied: 3 Dismissing: 0 Secure: 4 High: 10 Level One:0 Level Two: 6 Fearful:2 Preoccupied: 2 Dismissing: 2 Total: 21 Total: 2 Total: 11 Total:8 Total: 6 Total: 5 Total: 4

Emotional Inhibition This Schema is characterized by the suppression of spontaneous expressions in order to avoid disapproval, or out of a fear losing control. Typically involves inhibition of anger, inhibition of positive impulses, difficulty communicating ones needs or excessive focus on rationality and disregard for emotions. Very High: 15 Level One:4 Level Two: 7 Level Three: 4 Fearful: 7 Preoccupied: 2 Dismissing: 3 Secure: 3 High: 8 Level One:3 Level Two: 3 Level Three: 2 Fearful:0 Preoccupied: 4 Dismissing: 1 Total: 23 Total: 7 Total: 10 Total:6 Total: 6 Total: 4

Unrelenting Standards Individuals with this schema hold very high standards for themselves and others towards which they are always striving. They often feel a great deal of pressure to perform and/or behave in accordance with these standards, which interfere with their ability to relax, feel pleasure, or enjoy a sense of accomplishment. Very High: 20 Level One: 6 Level Two: 8 Level Three: 6 Fearful: 4 Preoccupied: 5 Dismissing: 2 Secure: 9 High: 9 Level Two: 3 Level Two: 1 Level Three: 5 Fearful: 0 Preoccupied: 3 Dismissing: 1 Secure: 5 Total: 29 Total: 9 Total: 11 Total: 4 Total: 8 Total: 3 Total: 14

Punitiveness This Schema is characterized by the belief that people, including oneself, should be harshly punished for mistakes. These clients will be overly punitive towards themselves and others and have difficulty forgiving. Very High: 8 Level One: 1 Level Two: 4 Level Three: 3 Fearful: 1 Preoccupied: 2 Dismissing: 0 Secure: 5 High: 13 Level One: 3 Level Two: 8 Level Three: 2 Fearful:6 Preoccupied: 3 Dismissing: 1 Secure: 3 Total: 21 Total: 4 Total: 12 Total:5 Total: 7 Total: 5 Total: 1 Total: 8

How do schemas change? Two phases of treatment Assessment and education Therapist conducts in-depth clinical interview and assigns Young Schema Questionnaire. May also use imagery techniques to assess for schemas Goal is to identify the schemas and coping styles that are most important in the client’s psychological make up and link schemas to presenting problem Therapist educates the client about how schemas form and helps foster connection to the feelings that surround each schema

How do schemas change? Two phases of treatment Change Therapist uses cognitive, behavioral and experiential techniques (as well as the therapeutic relationship) to help the client begin to heal schemas and alter maladaptive coping behaviors Cognitive techniques Efforts to restructure thinking related to schemas and develop a healthy voice to challenge maladaptive thoughts Behavioral techniques Practice new behaviors and rehearse for interpersonal interactions Experiential techniques Engage in emotive exercises to vent anger, grieve early pain and empower the client Therapeutic relationship Therapy relationship provides limited re-parenting, as well as opportunities to examine and address schemas triggered in sessions

Suggested Readings and References Books Schema Therapy: A Practitioner’s Guide by Young, J., Klosko, J., and Weishaar (2003) Reinventing Your Life by Young, J. & Klosko, J. (1993) Articles Avoidance and Shame: A Schema-focused Approach to the Treatment of Sex Addiction by Ranger, T. (2009) Websites www.schematherapy.com