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SCHEMA THERAPY: A DEPTH APPROACH FOR AVOIDANT PERSONALITY DISORDER

What is Avoidant Personality Disorder?

Avoidant Personality Disorder (avoidant PD) can be thought of as a more extreme and pervasive type of social anxiety that cuts across many parts of your life. For example, if you have social anxiety, you may have specific social fears such as public speaking, dating, making phone calls, fear of authority figures, meeting new people, etc. With avoidant personality, your fears are more generalized across many types of people and situations so that it is hard to form deep, intimate connections with other people or go new places that involve extensive social interaction. In avoidant PD, anxiety is related to worries that other people may find you to be socially inept and inferior, and you may also worry that you can’t cope with challenging situations in general. Your self-view may characterized by low self-esteem and inability to cope, resulting in avoidance as a dominant coping strategy.

Arguments have been made that avoidant PD is characterized by avoidance not only in the social arena, but many people with avoidant PD also tend to avoid making decisions, experiencing negative and positive emotions, sharing intimate feelings, experiencing bodily sensations, experiencing sexual arousal, eating a variety of foods, and engaging in perceived “risky” activities. Avoidant PD is associated with high levels of emotional abuse in childhood and there is evidence that lack of parental affection and nurturing may be related to the development of avoidant PD.

What is Schema Therapy?

Schema TherapySchema Therapy is an integrative approach, founded on the principles of cognitive-behavioral therapy and expanded to include concepts from other psychotherapies. Schema therapy can help you to change entrenched, self-defeating life patterns using cognitive, behavioral, and emotion-focused techniques. Schema therapy focuses on the therapeutic relationship, improving functioning in daily life outside of therapy, and gaining insight for change based on the early life experiences that led to the development of maladaptive schemas.

The four main concepts in the Schema Therapy model are: Maladaptive Schemas, Schema Domains, Coping Styles, and Schema Modes.

  • The 18 Early Maladaptive Schemas are self-defeating, core themes or patterns that we keep repeating throughout our lives.
  • The 18 schemas are grouped into five broad Schema Domains: 1) Disconnection & Rejection, 2) Impaired Autonomy & Performance, 3) Impaired Limits, 4) Excessive Responsibility & Standards and 5) Overvigilance & Inhibition.
  • Coping Styles refer to the ways a person adapts to damaging childhood experiences. For example, some surrender to their schemas and act as if they are true; some find ways to block out or escape from pain; while others fight back or overcompensate. Since this is how you learned to deal with pain as a child, it is natural that you continue to use these unhelpful coping styles as an adult.
  • Schema Modes are the moment-to-moment emotional states and coping responses that we all experience. Our maladaptive schema modes are triggered by life situations that we are oversensitive to (our “emotional hot buttons” or schemas). Many schema modes lead us to over-react or under-react to situations and, thus, to act in ways that end up hurting us or others.

You can learn more about schema therapy by reading A Client’s Guide to Schema Therapy by David Bricker. PhD, and Jeffrey Young, PhD of the Schema Therapy Institute of New York.

What Schema Modes are Most Common with Avoidant Personality?

Recent developments in schema therapy tend to focus more on schema modes than on schemas.
The most common coping modes in Avoidant PD are the Avoidant Protector and the Detached Protector modes. The avoidant protector is characterized by interpersonal and situational avoidance. In the detached protector mode, you may detach from your inner needs, feelings and thoughts, which may prevent you from emotionally connecting to other people. If you tend to be non-assertive and comply with other people’s wishes, you might also have a compliant surrender mode. Often, a punitive parent mode is active, representing the internalization of emotionally abusive parenting experienced as a child. At the core of Avoidant PD are the lonely and inferior child and abandoned and abused child modes. The lonely and inferior child mode represents the emotional states you try to avoid to experiencing, in which you feel the loneliness and inferiority you experienced as a child. The abandoned/abused child mode represents the emotional state you experienced if you were abused or abandoned as a child.

How Can Schema Therapy Treat Avoidant Personality?

The goal of schema therapy is to help you get your core emotional needs met. For Avoidant Personality Disorders, some specific goals include:

  • 1) Help you develop and find safety through emotional processing of traumatic childhood memories, acknowledge the needs and emotions of the your vulnerable child mode, and have corrective emotional experiences through the therapeutic relationship.
  • 2) Eliminate the punitive and critical parent modes as much as possible, and replace them with healthy attitudes toward your needs and emotions as well as healthy standards and moral principles.
  • 3) Develop your healthy adult side so the dysfunctional coping modes are less necessary.

Schema therapy for Avoidant Personality Disorder is generally a minimum of 50 sessions and can be divided into several phases:

  • Assessment Stage: The start of treatment is generally the first 6-8 sessions. This phase includes establishing a strong therapeutic relationship, assessing your goals, conducting a diagnostic interview, education and explanation of schema therapy, and a case conceptualization connecting your life history with your current problems. Often, schema inventories and schema mode inventories are used to identify and prioritize the schemas and modes that are most impacting your life.
  • Recognizing Schemas and Modes: As schema therapy progresses, you will learn to recognize schemas and modes in your daily life and you may keep a schema diary to record your triggers, thoughts, schema activation and coping responses as well as start to recognize more healthy ways to think and respond.
  • Bypassing the Detached Protector Modes: When a mode like the detached protector is preventing you from experiencing emotions and exploring early memories, we might use techniques like imagery, pros and cons, two chair work and empathic confrontation to help you get connected with your thoughts and emotions. In addition, overcoming the avoidant protector mode may involve situational exposures and behavioral experiments.
  • Fighting the Punitive/Critical Parent Modes: A main goal is to minimize and eliminate the punitive or critical parent mode, which is the negative voice you have internalized and keeps you from successfully overcoming avoidance. Some powerful strategies to do this include role playing, chair work, imagery rescripting and letter writing.
  • Limiting Reparenting: The primary strategy of schema therapy that differentiates it from standard cognitive behavioral therapy is limited reparenting. A schema therapist allows you to express the needs and feelings of your vulnerable child mode and provides safety and validation to help you have a corrective emotional experience over time. Through this, you learn to internalize a healthy parent voice and eventually to reparent your vulnerable child yourself. Limited reparenting happens throughout schema therapy but tends to be most effective once the therapist has been able to bypass the detached protector and weaken the voice of the punitive, critical parent.

Laura Johnson, LMFT, LPCC
Director, NSAC Silicon Valley / Sacramento Valley

How to Get Help for Social Anxiety

The National Social Anxiety Center is a national association of regional clinics with certified cognitive therapists specializing in social anxiety and anxiety-related problems. We have compassionate therapists who can help you to reduce social anxiety. Currently, we have regional clinics in San Francisco, District of Columbia, Los Angeles, Pittsburgh, New York City, Chicago, Newport Beach / Orange County, Houston / Sugar Land, St. Louis, Phoenix, South Florida, Silicon Valley, Dallas, Des Moines, San Diego, Baltimore, Louisville and Philadelphia. Contact our national headquarters at (202) 656-8566 or visit our Regional Clinics contact page to find help in your local area.
 
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