Emotional Schema Therapy

Distinctive Features

Robert L. Leahy

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138561106
• eBook ISBN: 9781351359429
• Topic: Psychology
• Subtopic: Cognitive Behavioral Therapy (CBT)
• Index: Psychology

Emotional Schema Therapy: Distinctive Features offers a concise overview to what is distinctive about this new approach to helping clients cope with "difficult" emotions. Written by a researcher with many years of clinical experience, it provides an accessible, bitesize overview. Using the popular Distinctive Features format, this book describes 15 theoretical features and 15 practical techniques of Emotional Schema Therapy.

Emotional Schema Therapy will be a valuable source that is written for psychotherapists, clinical, health and counselling psychologists, counsellors, psychiatrists, and all who wish to know more about the role of emotions and emotion regulation.

Part I

THE EMOTIONAL
SCHEMA MODEL

1

From cognition to emotion

When I reflected on how I got to the point of developing a model of emotional schemas I began to think about the long journey I seem to be on in my thinking and feeling about psychotherapy. Like many people of my generation I started as an enamoured acolyte of psychoanalytic thinking, reading almost every book that Freud published, even fancying the idea that my interpretations of Rorschach inkblots and other projective techniques would shed light on the inner recesses of the souls of the people I tested. For three years in college I was an English Literature major, which meant that I was exposed to the great traditions of Western literature and, for me, the special nature of the tragic vision. It was not only Shakespeare who fascinated me, but also the tragic genre of Greek literature and its message of unforeseen doom, even for the noble and powerful. I found myself fascinated by the tragic vision that Unamuno described and by the complexity of character and fate in Dostoyevsky’s novels. Psychoanalytic thinking seemed comfortable with the cultural forces that enthralled me and seemed to have an answer for everything.

But then in graduate school reality set in for me and I began to read more of the somewhat limited research of that time on the effectiveness of psychodynamic therapy and the lack of reliability of psychodiagnostic testing. It was bleak indeed, and I became less enamoured, eventually disillusioned; I turned my interest to the growing research and theory on social cognition.

The research on social cognition demonstrated that we are often biased in our perceptions by the schemas we employ, our explanations of performance that follow an attribution paradigm, and our inferences of traits that are often determined by whether we are observing or acting. For example, we explain the behaviour of people we observe by inferring traits, whereas we are more likely to explain our own behaviour by the specific situation—this is known as the “actor-observer” bias. This social psychological tradition owes a great deal to the early work of Fritz Heider (1958) and others who followed in the 1970s and 1980s. The attribution model, advanced by Weiner and later applied to depression by Seligman, Alloy and Abramson, was a direct outgrowth of the field of social cognition that described the processes we use in inferring intention and other psychological processes in others. This was the foundation of the field of social cognition, which today goes by other names—“theory of mind” or “Metacognition”—but owes its inspiration to the earlier work in social psychology. At the same period of time I was involved in research on developmental social cognition, influenced by the adult work and by the constructivist model advanced by Jean Piaget. My model was that people “construct” aspects of their social experience, sometimes in a developmental sequence. I was doing research on how children and adults “construct” social inequality—how they explain, justify or challenge economic inequality and infer traits in others.

When I first read Beck and Ellis in the late 1970s I was impressed with how sensible and powerful their approach was in understanding and treating depression and anxiety. This “rational” approach appealed to the logical part of my mind—it allowed me to draw on my background in analytic philosophy and the logic of arguments, and it seemed to empower both the patient and the therapist. It drew me back into clinical work and—like many people who “find the answer”—I became a devotee. The cognitive model also seemed consistent with what I had been working on in social cognition—especially the emphasis on schematic processing, which was a well-established process in the field of cognition and social cognition. I felt that I had found the answer. Later I would realize that these answers led me to ask more questions.

I wasn’t sure if I should continue as an academic researcher or pursue clinical work. Then, one sad afternoon, as I was sitting in my office in Vancouver at the University of British Columbia, I got a call from Sara Sparrow from the Yale Child Study Center—an old friend from my Yale days—that our mutual friend and colleague, Dave, had committed suicide. Dave was a research associate at Yale and had been a close friend and collaborator of mine on research. I felt crushed, overwhelmed, confused, and even angry, and I knew as the days followed that I wanted to work with people who struggled with the dark demons of depression. I wanted to make sure that someone like my loved and dear friend would have a way out. It is telling that tragedy helped me turn in a direction that gave greater meaning to my work. I have never regretted that decision. I decided to get intensive training from Beck at the Center for Cognitive Therapy at the University of Pennsylvania.

Earlier approach to cognitive therapy

Over the first years of my work in cognitive therapy I must have seemed like a technique-driven cognitive therapist, issuing forth one technique after another. Many of my patients improved but I also began to realize I was hitting walls with some people. Rather than drive forward with more techniques I decided to stop and listen to them, to hear what accounted for their less than positive response. I also listened to the critics of cognitive therapy. These included people saying that we did not deal with resistance, transference, counter-transference, early childhood experience, the unconscious, or emotion. Like any acolyte and dedicated follower of a “cause” or “movement” I was defensive at first, rejecting these criticisms. But in the back of my mind I thought, “Maybe they have a point”.

Rather than off-handedly reject the criticisms of CBT I viewed these issues as excellent opportunities to expand the scope of cognitive therapy. I wrote and edited books on these topics, including Overcoming Resistance in Cognitive Therapy, The Therapeutic Relationship in the Cognitive Behavioural Psychotherapies, Roadblocks in Cognitive-Behavioural Therapy and Treatment Resistant Anxiety Disorders. Because I viewed emotion as a central issue in therapy I wrote two books on this topic—Emotion Regulation in Psychotherapy and Emotional Schema Therapy. When critics of CBT try to portray our approach as simplistic and formulaic, I believe that we have good answers. Along with the sophisticated work on personality disorders and case conceptualization by Aaron Beck, Judy Beck, Art Freeman, Denise Davis, Jeffrey Young, Arnoud Arntz, Jackie Persons, Christine Padesky and William Kuyken, I think that the CBT approach offers powerful and complex models for addressing the many issues that were once viewed as the reserved domain of psychodynamic therapy. The cognitive model has potential to integrate research and theory from evolutionary psychology, socialization, attachment theory, neuropsychology, social cognition, personality theory, affect forecasting, emotion regulation theory and other models. In a sense I think that we are just beginning to expand our work into a more sophisticated model of human functioning.

The role of emotion is a major part of this. My interest in emotion has always been there but a few observations and experiences were turning points. Many years ago, when my mother died suddenly from a brain haemorrhage, I was talking on the phone with a CBT colleague. As I spoke to him I began to cry and he commented, “It’s interesting that as an adult I have never cried.” I knew that he was also validating me and cared about me, but his comment reflected a missing piece in the CBT model at the time. And that is the experience of inevitable loss, tragedy, and the validity of pain and suffering. It reminded me of something I read by Miguel de Unamuno in Tragic Sense of Life. Unamuno tells the story where he compares the pragmatic and tragic visions of life. An old man is sitting by the side of the road weeping and a young man comes along and comments, “Why do you weep?” The old man sadly replies, “I weep over the death of my son.” The young man says, “Why do you weep? Weeping avails nothing.” The old man reflects back, “I weep precisely because weeping avails nothing.” And Unamuno continues and observes that we must learn to “weep for the plague—not just cure it”. Tragedy is shared suffering; it is the validity of loss that hurts; and it is part of the necessary pain of a fully experienced life.

Rather than thinking that our goal is to “feel good”, we must learn that finding meaning involves the ability to feel everything. It is impossible to go through a deep, meaningful life with attachments and losses without experiencing the full range of emotions. All of us will experience anger, anxiety, sadness, jealousy, envy, helplessness and hopelessness. But it is our response to these emotions that will determine whether we use these experiences effectively or whether we attempt to escape from the emotions that come with the territory.

Recent advances in CBT

In recent years advances have been made in CBT that address how individuals can cope with difficult emotions. Leading cognitive behavioural models now address the complexity of all levels of emotion and emotion processing, offering a transdiagnostic approach based on processes rather than the DSM categories (Hayes & Hofmann, 2018; Hofmann, 2015). Acceptance and commitment therapy, along with the emphasis on mindfulness, stresses the relationship that one has with thoughts and emotions, rather than the content of the thoughts that give rise to emotions (Hayes, Strosahl et al., 2011). The ACT model also emphasizes the role of values in clarifying the purposes that may allow us to tolerate frustration and discomfort as we pursue meaning in our lives. The EST model draws on some of the ideas in ACT, but the model that I am advancing is more of description of the individual’s theory of emotion and theory of emotion regulation (Leahy, 2015; 2018). It is a cognitive model of how people think and respond to their emotions, but it utilizes strategies that are consistent with ACT. Another model of relevance is the DBT model, which focuses on skills for emotion and behaviour regulation and assists clients in recognizing their “myths” about emotions (Linehan, 1993). Again, EST recognizes and incorporates many of these ideas and techniques, but the DBT model is not in itself a model of how people think about, evaluate, explain or value emotions. The Metacognitive model advanced by Wells has the most direct link to the EST model, with the emphasis on cognitive attentional syndrome (CAS) whereby individuals fixate on their thoughts, attempting to control or suppress unwanted thoughts, thereby perpetuating a cycle of worry or rumination (Wells, 2000). One can view the EST model as having some structural similarities to the Meta-Cognitive model, but the emphasis in the proposed model is on emotions, not thoughts, as these are linked to values, behaviour, and interpersonal functioning. As such, the content of EST is on an elaborated “naïve theory” held by clients about the appraisal of emotions, shame and guilt, the role of expression and validation, and the normalization of emotional experiences (Leahy, 2015). And, of course, Paul Gilbert’s valuable work on compassion-focused therapy (CFT) has moved CBT in the direction of the soothing and healing effects of activating the attachment emotions that often are part of compassion—caring, nurturing, accepting, and creating safety (Gilbert, 2009). Certainly, the CFT model has considerable value in addressing negative beliefs and strategies about emotions. And, finally, Greenberg’s emotion-focused therapy enriches our understanding that emotions may “contain” information about our needs, intentions and thoughts, and that elaborating primary and secondary emotions can deepen the meaning of therapy (Greenberg, 2002).

As much as I value the important work on positive psychology, we should not confuse this with the absence of painful feelings. It is this recognition that led me in the direction of developing a model of “emotional schemas”—that is, a model of how we think about our emotions, evaluate them and cope with them. From this perspective emotions are a “given” to which we respond. For example, “given” that I am sad, what do I think about this sadness? Do I think it makes sense, do I believe it will go on forever, do I think I have no control over my moods, do I feel ashamed of my sadness and do I think that no one could understand me? What emotion regulation strategies do I invoke? Do I try to avoid situations that remin...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of figures and table
• Part I The Emotional Schema Model
• Part II Modifying Emotional Schemas
• References
• Index