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“Building on the foundation of schema therapy as laid by Jeffrey Young, the authors
bring schema therapy into the third wave of therapies; in context and the actual effects.
Acceptance and commitment therapy (ACT) is interweaved throughout the book. It is
for example in the true spirit of schema therapy to take into account different perspec-
tives on the ‘same’ context.”
—Michiel van Vreeswijk, coauthor of The Wiley-Blackwell Handbook
of Schema Therapy and Mindfulness and Schema Therapy

“Therapists today may find themselves asking how they can fit together the plethora of
psychological concepts that bombard them from many directions. Schema therapists
may ask whether schema therapy by itself is enough, or whether they need other therapy
approaches too. The authors of Contextual Schema Therapy show how important con-
cepts that are well articulated within other approaches—such as mentalization, mind-
fulness, acceptance, metacognition, and human values—can be integrated into the
basic schema therapy model. Indeed, many of them are already implicit in it. In addition
to showing the integrative power of the schema therapy model, this book offers a fresh
and readable account of its central ideas and rich clinical examples of their application,
all well-grounded in the current academic and clinical literature.”
—David Edwards, department of psychology, Rhodes University; department
of psychiatry, University of Cape Town; clinical psychologist; certified
schema therapist; president, International Society of Schema Therapy

“Contextual Schema Therapy is groundbreaking in its integration of concepts and inter-

ventions from third wave cognitive therapy models to expand schema therapy while
maintaining the integrity of Young’s model. The structure of the book, with sections on
principles, summary, and therapist tips, keep the model clear and manageable, making
it user-friendly for those new to schema therapy in addition to expert therapists. It bal-
ances theory with practical advice about how to implement schema therapy interven-
tions. The detailed case examples illustrate the application of the model, including
masterful scripts for explaining concepts to clients, and diagrams of the specifics of
interventions. In addition, Contextual Schema Therapy fills a gap by drawing interven-
tions from third wave models to develop the Healthy Adult Mode. I recommend this
book highly for all schema therapists, and congratulate the authors on this important
contribution to the practice of schema therapy.”
—Joan Farrell, PhD, adjunct professor and research director, The Center
for Borderline Personality Disorder Treatment and Research, Indiana
University–Purdue University; director of training and certification,
International Society of Schema Therapy
“This book encompasses all aspects of schema therapy, from the theoretical underpin-
nings and case conceptualization to the emotion-focused, cognitive and behavioral
techniques. In a clear, structured manner, practical suggestions are offered to cope with
the challenging situations therapists face in their clinical practice. This book can be
considered an essential element in the training to become a schema therapist. I enjoyed
the way complex phenomena in therapy are explained with the use of metaphors and
striking illustrations. In a similar transparent way, schema-triggering moments in
session are discussed, and many different strategies are offered to deal with them. This
book bridges the gap between theory and practice, and reflects the current status of
schema therapy.”
—Remco van de Wijngaart, vice president of the International Society
of Schema Therapy; senior schema therapy trainer and supervisor

“A tour de force—this penetrating yet accessible book, written by leaders in the field, is
a must-read for practicing schema therapists. The authors dig deep into the principles
of contemporary third wave therapies and return with innovative advances to Jeffrey
Young’s original model. A core contribution is the many helpful tools on how to con-
ceptualize, build, and reinforce healthy adult functioning. The reader is elegantly
guided along the complex journey that lies at the core of schema therapy—finding a
sensible balance between the potentially competing needs of connection and
autonomy.”
—Poul Perris, MD, founding president of the International Society
of Schema Therapy, and director of the Swedish Cognitive Therapy
Institute, Stockholm

“Schema therapy is the most integrative psychotherapy model of our time, and has a
rapidly accelerating literature. This latest volume explains the entire schema therapy
model, presupposing no prior knowledge, then, pushes the model forward. It adds a new
‘Case Conceptualization Form,’ an expanded theoretical framework, insights from
‘third wave’ and ‘contextual’ psychotherapies, and new and innovative applications of
schema therapy techniques (particularly emotive techniques such as guided imagery
and chair work). It is scholarly, clear, theoretically grounded, and full of clinical exam-
ples. Simply put, you will find this book extremely useful—regardless of your theoretical
orientation.”
—Lawrence P. Riso, PhD, professor of clinical psychology,
American School of Professional Psychology, Northern Virginia
“This cutting-edge guide provides a comprehensive road map for understanding and
implementing schema therapy as a truly integrative and dynamic therapeutic model. The
reader is taken on a journey that interweaves conceptual underpinnings with cutting-
edge theoretical advances, contextualizing it within the framework of second and third
wave psychotherapy approaches. This book connects the dots of the schema therapy
model. Its descriptions bring the powerful schema therapy techniques to life, while pro-
viding a clear pathway to guide the overarching process. This book is an indispensable
text that will appeal to experienced clinicians, as well as those who are simply curious to
learn more about this approach.”
—Susan Simpson, DClinPsych, NHS Lothian, Scotland;
department of psychology, University of South Australia
Contextual

Schema
Therapy
An Integrative Approach to
Personality Disorders, Emotional Dysregulation
& Interpersonal Functioning

Eckhard Roediger, MD
Bruce A. Stevens, PhD
Robert Brockman, DClinPsy

Context Press
An Imprint of New Harbinger Publications, Inc.
 Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering psycho-
logical, financial, legal, or other professional services. If expert assistance or counseling is needed, the
services of a competent professional should be sought.

Distributed in Canada by Raincoast Books

Copyright © 2018 by Eckhard Roediger, Bruce A. Stevens, and Robert Brockman

Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com

Figure 1-2, “Photograph of feet in the sand at sunset,” is reproduced with permission from the
work of Angeles Hoffmann.

Cover design by Amy Shoup

Acquired by Tesilya Hanauer

Edited by James Lainsbury

All Rights Reserved

Library of Congress Cataloging-in-Publication Data on file

     
                          
 Contents

Forewordvii

Introduction—­Why This Book?1

1 Conceptual Underpinnings5

2 The Schema Model—Mapping the Badlands25

3 Modes—­In the Present Tense39

4 From Past Tense to Present Tense—­The Case Conceptualization57

5 Harnessing the Therapy Relationship83

6 Dealing with Child, Inner Critic, and Coping Modes109

7 Building the Healthy Adult Mode125

8 How to Bring Change143

9 Imagery Techniques to Induce Mode Change149

10 Mode Dialogues on Chairs179

11 Behavior Change Techniques197

12 Treatment Planning215

13 Dealing with Difficult Clients227

14 It Takes Two to Tango—­Including the Client’s Partner in Therapy251

15 Therapist Schemas and Self-­Care259

Epilogue—­Training Opportunities and Resources273

Afterword275

References277

Index291
 Figures

Figure 1–­1. Basic emotions, coping styles, and self-­expression9

Figure 1–­2. An exercise in dual focusing13

Figure 1–­3. A second exercise in dual focusing14

Figure 1–­4. Attractors and the energetic landscape15

Figure 1–­5. The emotional tolerance window17

Figure 1–­6. Socialization and constitution of the self20

Figure 3–­1. The mode model41

Figure 3–­2.  onnecting schemas, schema-­coping styles,
C
and coping modes in terms of learning processes53

Figure 3–­3. Maladaptive coping modes and clinical symptoms55

Figure 4–­1. Genogram for Joanne61

Figure 4–­2. Mode monitoring form for Joanne69

Figure 4–­3. Descriptive mode diagram for Joanne71

Figure 4–­4. Mode map for Joanne75

Figure 4–­5. S chemas, schema coping, coping modes, and ACT
processes integrated into the behavioral analysis system81
Figure 5–­1.  onnecting the biographical, current life,
C
and therapy scenes84

Figure 5–­2. The dimensions of the therapy relationship86

Figure 5–­3. Sitting positions to support emotional activation87

Figure 5–­4. T herapist and client positions while reflecting
on the process in a working alliance90

iv Contextual Schema Therapy

Figure 6–­1. Chair positions according to the mode map111

Figure 6–­2. Chair positions for empathic confrontation116

Figure 6–­3.  ow to place the chairs when working with
H
overcompensators118

Figure 7–­1. The attention time line130

Figure 7–­2. Two ways to consistency134

Figure 7–­3. Values road map142

Figure 8–­1. Emotional processing using the two-­minds metaphor144

Figure 8–­2. Steps for lasting change148

Figure 9–­1.  orking with the two systems of information processing
W
in imagery (based on Schacter, 1992)150

Figure 9–­2. The healing process in experiential work173

Figure 10–­1. Chair positions in historical role-­play181

Figure 10–­2. Chair dialogue based on the mode map185

Figure 10–­3. The vicious cycle of an alarm reaction, and how to escape194

Figure 11–­1. Joanne’s coping mode tracking sheet202

Figure 11–­2. J oanne’s schema-­mode flash card
(modified from Young, Klosko, & Weishaar, 2003)205

Figure 11–­3. Joanne’s talking-­back diary207

Figure 11–­4. Joanne’s diary card208

Figure 11–­5. Joanne’s behavioral activation form211

Figure 13–­1. Schemas and modes of a narcissistic client229

Figure 14–­1. The maladaptive mode cycle of Joanne and Brandon253

Contentsv
 Tables

Table 1–­1. The two poles of human organization7

Table 2–­1. Schemas, domains, need states, and resulting modes27

Table 3–­1. T he relations between schemas, schema-­coping styles,
and presented coping modes51

Table 5–­1. Dropout rates in borderline personality disorder treatments97

Table 15–­1. Possible mode cycles in the therapy relationship260

vi Contextual Schema Therapy

 Foreword

I could not be more delighted that my dear friends and colleagues Eckhard Roediger,
Bruce Stevens, and Robert Brockman wrote this extraordinary book.
Contextual Schema Therapy will surely be an outstanding resource for any clini-
cian’s library. The authors are highly experienced and talented schema therapy practi-
tioners and educators, having devoted many years to sharpening their clinical skills
within each of their unique areas of expertise. They generously share a rigorous effort,
resulting in a thoughtful and comprehensive body of work that offers the reader one of
the most relevant psychotherapy guides for conceptualizing and treating a variety of
challenging populations; and demonstrating how the use of schema therapy, an
evidence-­ based model—­ with rich assessment tools and integrative treatment
strategies—­can lead to the healing of destructive lifelong patterns.
Informed by and following up on the instrumental Schema Therapy: A Practitioner’s
Guide, by Jeffrey Young, Janet Klosko, and Marjorie Weishaar (2003), Roediger, Stevens,
and Brockman delve deeper into the schema therapy approach and bring us up-­to-­date
on the latest developments for applying this evidence-­based model with some of the
most difficult cases.
The challenging work of helping those who have endured painful early life experi-
ences fraught with loss, neglect, abuse, loneliness, and/or deprivation, along with the
sustained core feelings of hopelessness, shame, inadequacy, inhibition; the need to be
perfect; and the need to control or surrender demands a psychotherapeutic approach
that thoughtfully assesses the client’s autobiographical early experiences and conse-
quential unmet needs; connects the dots between self-­defeating life patterns, coping
modes, and current activating conditions; and seeks to heal and correct biased emo-
tional experiences that inform present-­ day emotional and sensorial systems, self-­
defeating beliefs, and maladaptive coping behaviors. The elegantly designed integrative
treatment approach, founded in Jeffrey Young’s schema therapy model, is exquisitely
captured and elaborated in this beautiful body of work, as the authors illustrate the
relationship between current and lifelong stressors and early life experiences—­
uncovering critical unmet emotional needs and temperamental factors that form per-
sonality. Schema therapy evaluates the rigid truths—­that is, early maladaptive schemas
and the coping reactions that get embedded in memory and become activated under
familiar conditions throughout one’s life span. The need for a sturdy, flexible, real, and
attuned clinician is strongly proposed in the schema mode approach. The realness factor
is a critical element for correcting the longstanding, biased emotional experiences, as
you will come to appreciate in reading this book.
The authors are brilliant in making the model accessible through clear and colorful
examples in almost every chapter, along with specific case vignettes, illustrating the
comprehensive case conceptualization/assessment stage and the effective application of
treatment strategies. The reader is sure to recognize both the unique and commonly
shared challenges met in our treatment rooms in the examples shared by the authors.
The parallel process of client and clinician being triggered in the treatment room
can lead to ineffective and frustrating outcomes, especially when an overwhelmed ther-
apist ends up colluding with the client’s avoidance or ends up giving in to entitled
demands.
As I share in my book Disarming the Narcissist, about my work with narcissists, it is
not unusual to be faced with a client who shifts between an emotionally distant mode
and an angry or cynical mode; nor is it unusual to find myself having to stave off the
urge to just give in and subjugate my rights and my voice (feelings triggered within the
“little girl” mode in me), and to maintain my sturdy posture in order to meet the client’s
needs for trust, limit setting, accountability, and emotional connection.
The authors reveal how the integration of third wave therapeutic approaches, such
as mindfulness and acceptance (to meet unmet emotional needs), along with the
therapy relationship, serve to bolster the schema therapy approach to break through
detachment; to confront harmful internal messengers; and to access, care for, and
protect vulnerable modes, while strengthening the healthy adult mode in order to
thwart self-­defeating patterns in favor of healthier and adaptive responses.
I confidently recommend this exceptional book to anyone who wishes to gain more
confidence and mastery for effective treatment outcomes, especially when it comes to
facing the seemingly impermeable avoiders, narcissistic bullying and entitlement, and
the hopeless forfeiters who surrender their needs and rights—­marching to the beat of
internalized critics and demanders.
You are about to be treated to a treasure trove of invaluable information, including
conceptual and theoretical insights, along with clinical tools, tips, and strategies, in a
keenly illustrated new book that is not to be missed.

—Wendy T. Behary, LCSW

Author of Disarming the Narcissist

viii Contextual Schema Therapy

 Introduction—­Why This Book?

Schema therapy brought a profound change to how we treat clients who suffer from
chronic mental illness or a personality disorder. Building on the strengths of cognitive
therapy, this approach provides a comprehensive map of personality using eighteen
schemas, adds experiential change techniques, and uses attachment and developmental
understanding to address maladaptive schemas arising from childhood neglect and
trauma. Randomized controlled trials have demonstrated its effectiveness.
Time doesn’t stand still, and we saw a need to provide an update on schema therapy.
Contextual Schema Therapy is a comprehensive practitioner manual with clear princi-
ples and guidelines illustrated with clinical examples. We incorporated theoretical
advances into its pages, so the book is cutting edge. Its innovative and integrative pre-
sentation is very much in the spirit of schema therapy.
Since its inception, schema therapy has been highly integrative. In 1990, Jeffrey
Young outlined its parallels with and differences from major therapies, including Beck’s
“reformulated” model, psychoanalytic theory, Bowlby’s attachment theory (especially
internal working models), and emotion-­focused therapy. There have also been contri-
butions from gestalt, transactional analysis, and psychodrama (Edwards & Arntz,
2012). Schema therapy, in contrast to most cognitive therapies, has a greater emotional
focus and willingness to explore the childhood and adolescent origins of psychological
difficulties. Current problems are seen in terms of whole-­of-­life patterns that we call
schemas. All this is integrated into a cognitive information-­processing mode theory of
personality. Additionally, schema therapy’s breadth, applicability, and ease of under-
standing encourage broad application.
We believe that this integrative spirit has been a key to the success of schema
therapy. Young introduced the original schema model in 1990, and the second step was
the mode model that was developed about ten years later (Young et al., 2003). Modes
are activated schemas. Since they are present in the here and now of therapy, modes are
easier to track and to target with interventions. While in the United States, the basic
schema model is still widely in use, schema therapy has been developed further in the
Netherlands and Germany (Arntz & Jacob, 2013), where the mode model has been
center stage for both research and treatment. All of the successful randomized con-
trolled trials of schema therapy to date have used this model (Jacob & Arntz, 2013).
Schema therapy is one of the key evidence-­based treatments for people suffering
from personality disorders. Research indicates that features of personality disorder are
very common in the general population. Only 23 percent of people are relatively free of
such symptoms. According to Yang, Coid, and Tyrer (2010), more than 70 percent have
some degree of personality disturbance. For this reason, it is essential to consider mal-
adaptive personality traits in any comprehensive theory of change. There is already
some evidence base suggesting that schema therapy can effectively treat clients with
borderline personality disorder in both individual (Giesen-­Bloo et al., 2006) and group
settings (Farrell, Shaw, & Webber, 2009). A review of five schema therapy trials (three
of them randomized controlled trials; Jacob & Arntz, 2013) showed an average effect
size of 2.38 (95% CI 1.70–­3.07). Compared with other specific borderline personality
disorder treatments, dropout rates are low. Further studies have demonstrated the effec-
tiveness of schema therapy with dependent, avoidant, and obsessive-­compulsive per-
sonality disorders (Bamelis, Evers, Spinhoven, & Arntz, 2014), and antisocial individuals
can be helped to change as well (Bernstein et al., 2012). There are also indicators that
schema therapy is more cost-­effective than other treatments (Van Asselt et al., 2008).
For a more detailed overview, see Bamelis, Bloo, Bernstein, and Arntz (2012).
Recent advances in schema therapy derive from its capacity to straddle both the
second and third waves of behavior therapy. The application of the mode model is in
line with the second wave cognitive behavioral therapy (CBT) approach because
schema therapy seeks to obtain change by shifting the content (in terms of meaning)
deriving from negative early maladaptive schemas through experiential change tech-
niques. Since Tara Bennet-­Goleman (2001) introduced mindfulness to heal schemas in
2001, the ensuing years saw further evolution of the model, including the integration of
the concepts of mindfulness and acceptance (Cousineau, 2012; Parfy, 2012; Roediger,
2012; Van Vreeswijk, Broersen, & Schurink, 2014). We call this book Contextual
Schema Therapy because the model has been revised in light of contemporary contribu-
tions and understandings from third wave therapies. Schema therapy now balances the
focus on change in schema content with an approach to building a healthy version of
the self through changing the way people relate to their experiences and deal with
them.
We argue that schema therapy can do more than change coping reactions to
schema activations: it can help people become mindfully aware, disengage from unhelp-
ful patterns of relating to past experiences, and strive for healthy and well-­balanced
behavior in general. In Germany, for example, schema therapy is already seen as a third
wave therapy (Roediger & Zarbock, 2013).
The healthy adult mode is one of the key modes in schema therapy. It represents
psychological health, maturity, and good judgment. This mode maps well onto the
construct of psychological flexibility (Brockman, 2013) and can be largely described
and addressed using the concepts and strategies of acceptance and commitment therapy
(ACT; Hayes, Strosahl, & Wilson, 2012). Our comprehensive approach in this book
incorporates the basic principles of ACT on a practical level and merges the more cog-
nitive focus of ACT with the largely emotional focus of schema therapy. Thus, schema
therapy becomes a contextual therapy (Hayes et al., 2012) while balancing second and
third wave approaches, making it even more flexible and effective. However, we do not
claim to provide a comprehensive theory. Jeff Young and colleagues’ Schema Therapy: A

2 Contextual Schema Therapy

Practitioner’s Guide (Young et al., 2003) remains foundational to our approach. We
continually draw connections from their pioneering insights.
Schema therapy was developed from cognitive therapy with the intention of helping
hard-­to-­treat cases by being open to innovation and alternative perspectives in terms of
what Messer (2001) called “assimilative integration.” This describes how therapists
incorporate attitudes, perspectives, or techniques from another therapy into their
primary approach based on a consistent conceptual framework. This systematic approach
goes beyond technical eclecticism and is “truly integrative” (Young, 2008). Our frame-
work is still the schema therapy model. We see this book as one way to develop schema
therapy so it is further in line with the integrative spirit of its founder. Like Young, we
use techniques derived from other therapeutic approaches in a very specific way based
on the case conceptualization, and embed the techniques into the schema therapy rela-
tionship. In this way, schema therapy has become more than the sum of its parts.
According to Young (2008), schema therapy has three hallmark elements:
• A case conceptualization based on the schema mode model
• A specific therapy relationship called limited reparenting
• An intensive use of experiential techniques, such as imagery rescripting or
chair dialogues (in almost every session)

The schema model is easy to grasp and close to a “commonsense” psychology.

Overall, this book has a practical focus. The clinical questions are “What works?” and
“What works with the most difficult cases?” These represent the acid test for any
therapy. We will help you to make comprehensive dimensional case conceptualizations
according to the alternative dimensional model in the Diagnostic and Statistical Manual
of Mental Disorders, fifth edition (DSM-­5; American Psychiatric Association, 2013).
Our goal is to provide therapists with a kind of road map to plan interventions and then
tailor them in a specific way, using powerful techniques embedded in a caring relation-
ship. Schema therapy calls this reparenting, which feels natural because it is what good
parents do with their children!
We hope you find this book both illuminating and inspiring—­a worthy tool to help
you develop and implement schema therapy successfully.

A few words about organization. Self-­reflection is pivotal in schema therapy. Thus

over the course of the book, we invite you to take a self-­reflective stance with prompts
under the “Reflect” heading. In the spirit of self-­reflection, let’s start with the first one
now: How long have you practiced psychotherapy? What changes have you noticed?
What have been the most important therapeutic advances you can identify? Can you
see parallels with schema therapy?
We also use the “Principle” heading to identify key principles to guide your work.
In addition, we offer precise tips (“Therapist Tip”) to help you to learn clinical skills for
schema therapy. Finally, we alternate references to gender in this book in order to be as
inclusive as possible.

Introduction—­Why This Book?3

 CHAPTER 1

Conceptual Underpinnings

Why do we start this book by linking the schema therapy model with theory and by
basing its development on current research findings in various fields? While we seek to
condense the essence of rational therapies into one consistent and comparatively simple
approach, we do not dare present a unified theory. Nevertheless, having an idea of the
theories behind schema therapy deepens therapists’ understanding of the processes
involved, enabling them to develop the model beyond a purely practical “cookbook”
approach and tailor their work to individual clients. Young and colleagues (2003) indi-
cate these underpinnings but do not describe them in detail. We try to do so here.
This approach is intellectually challenging and complex. The content we present is
very condensed, and understanding it requires some basic knowledge. Especially for
those who are familiar with neurobiology findings, the rationale of schema therapy will
become clearer with an understanding of this material. In the long run, having this
knowledge will give you a fundamental understanding of change processes in general,
helping you to adapt your approach to any targeted problem. However, if you are eager
to get straight to the model, you might skip this chapter and jump directly to chapter 2.
Maybe as you read through the book your interest in the theoretical background will
grow, and later you can refer to this chapter when we connect our practical approach
with the theory to underline its foundation in current research findings.

The Emotional Core Needs, Basic Emotions,

and the Autonomic Nervous System
Needs are fundamental. Schema therapy is centered on the concept of core emotional
needs (for a review, see Lockwood & Perris, 2012). Needs are universal and nonnego-
tiable. A very large body of research indicates that the ongoing frustration of core
emotional needs detrimentally affects childhood development and leads to immediate
and long-­term impacts on physical and psychological well-­being (Vansteenkiste &
Ryan, 2013; see Ryan & Deci, 2017, for comprehensive coverage of this issue). There are
several systems of needs.

Systems of needs. Maslow (1970) outlined a pyramid of needs, reaching from basic
biological needs (such as food and water) through to the need for self-­actualization.
More recently, researchers investigating self-­determination theory have found evidence
for the key role played by three basic emotional needs in human well-­being and devel-
opment: autonomy, competence, and relatedness (Ryan & Deci, 2017). In their original
writing on the subject, Young and colleagues (2003) named five core emotional needs,
including limit setting for the child. Unlike other practitioners at that time, Young took
a developmental view of core needs, that of a child’s perspective (for details, see chapter
2). For Young, needs satisfaction leads to healthy schemas, and needs frustration leads
directly to the development of early maladaptive schemas.
We tried to keep the number of needs to a minimum in order to reduce the com-
plexity of the model presented in this book. This led us to reduce the three needs
described by Ryan and Deci (2017) to two irreducible ones, which are regarded as poles
in a dimensional construct of attachment orientation (or connection/relatedness) and
assertiveness orientation (including autonomy, competence, and control). These need-­
poles are embedded in a complex orientation of the organism as a whole (see table 1–­1).
They have an inverse relationship with one another: the more you strive for attach-
ment, the more you have to sacrifice assertiveness and autonomy, and vice versa.
However, you can aim for a good and flexible balance between them.

Principle: The needs for attachment and assertiveness are poles in the physi-
ological, psychological, and social orientation of the whole organism.

The Attachment Pole

Interpersonal connection is essential for the survival of humans. Compared to the
young of other animals, human babies are born in a very immature state and require
great care while they mature. In order to guarantee survival, human beings have an
inborn biological urge to form groups and cooperate. Thus we feel more safe in groups
than going it alone (Gilbert, 2010). When we feel we are secure in a group, our emo-
tional activation subsides and we shift into a healthy parasympathetic state. Our heart
rate oscillates when we breathe in and out, as a sign of emotional flexibility. Heart-­rate
flexibility is a predictor of good health. Being in an ongoing activated state leads to a
loss of heart-­rate flexibility and an increased morbidity risk (Porges, 2007).
The physical and mental effects of loneliness, isolation, and social rejection are
known to be severe (Hawkley & Cacioppo, 2010). Eisenberger, Lieberman, and Williams
(2003) showed that rejection “hurts” by activating almost the same insular cortical
areas that are activated when we experience physical pain. It is common to hear people
describe emotional rejection as “a kick in the guts” or “a stab to the heart.” In contrast,
people with stronger social relationships have a 50 percent higher chance of survival
than those with weaker social relationships (Holt-­Lunstad, Smith, Baker, Harris, &
Stephenson, 2015). Prosocial behavior directly activates our dopaminergic reward
system (Van der Meulen, Ijzendoorn, & Crone, 2016)—­just as drugs do!

6 Contextual Schema Therapy

 Table 1–­1. The two poles of human organization
Feature Assertiveness Attachment
Activated autonomic system Sympathetic branch Parasympathetic (vagal)
branch
Focus of attention Outward directed Inward directed
Physiological reaction type Activation of the alarm Calming down, recreation
system
Social tendency Autonomy and competence Connecting, relatedness
Type of breathing Into the chest Into the belly
Metabolic tendency Exhaustion Regeneration
Motoric tendency Expansive activation Receptive reaction
Social tendency Self-­centered, being Prosocial, seeking harmony
dominant
Tendency to react Fight or flight Cooperation up to
submission
Active child pole if Angry child pole Vulnerable child pole
threatened
Direction of inner critic Directed to others Directed to self
modes
Direction of action Externalizing Internalizing
Coping style (Piaget, 1985) Alloplastic Autoplastic
Parenting mode (Lockwood Paternal (trains Maternal (soothes directly)
& Perris, 2012) self-­soothing)

The Autonomy, Control, and Assertiveness Pole

The autonomy, control, and assertiveness pole, based on the activities of the sym-
pathetic nervous system, enables us to fight or flee and is the “second leg” that we stand
on: the need for assertiveness and autonomy. In this more self-­centered state, we tend
to be self-­reliant, and we are able to act dominantly and achieve a higher status in the
social system.

Principle: Following the attachment need and taking a cooperative stance is

essentially prosocial. Doing so makes us welcome in a group, which increases
our chances of survival. However, being able to fight or flee is important in
order to survive as an individual.

Conceptual Underpinnings7
Another random document with
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 Abb. 2

Dürer
Hirschkäfer
 Abb. 3

Dürer
Junger Feldhase
 Abb. 4

Leibl
Drei Frauen in der Kirche
Mit Genehmigung von J. J. Weber in Leipzig
 Abb. 5

Leibl
Dorfpolitiker
Mit Genehmigung der Photographischen Gesellschaft in Berlin-
Charlottenburg
 Abb. 6

Leibl
Miederstudie
Mit Genehmigung der Photographischen Gesellschaft in
Berlin-Charlottenburg
 Abb. 7

Rembrandt
Frau des Tobias mit der Ziege
 Abb. 8

Rembrandt
Jacobs Segen
 Abb. 9

Rembrandt
Jacobs Segen (Teil)
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Rembrandt
David vor Saul
 Abb. 11

Rembrandt
Tobias und seine Frau
 Abb. 12

Böcklin
Gefilde der Seligen
Mit Genehmigung der Photographischen Gesellschaft in Berlin-
Charlottenburg
 Abb. 13

Böcklin
Triton und Nereïde
Mit Genehmigung der Photographischen Union in München
 Abb. 14

Böcklin
Die Pest
Mit Genehmigung der
Photographischen Union in
München
 Abb. 15

Klinger
Tod auf den Schienen (Vom Tode I, 8)
Verlag von Amsler & Ruthardt, Berlin
 Abb. 16

Brueghel d. Ä.
Fall der Engel
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Idolino
 Abb. 18

Michelangelo
Der Morgen. Vom Grabmal Lorenzos
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Grabmal der Hegeso, Athen

 Abb. 20

Orpheusrelief
 Abb. 21

Michelangelo
Erschaffung Evas
 Abb. 22

Michelangelo
Erschaffung Adams
 Abb. 23

Dürer
Das große Rasenstück
 Abb. 24

Grünewald
Isenheimer Altar. Antonius und Paulus in der Wüste. Teilstück
 Abb. 25

Dürer
Händestudie
 Abb. 26

Michelangelo
Teilstück aus der Erschaffung Adams
 Abb. 27

Grünewald
Teilstück aus der Kreuzigung
 Abb. 28

Dürer
Baumeister Hieronymus
 Abb. 29

Michelangelo
Adams Kopf
 Abb. 30

Grünewald
Singender Engel, Studie
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Dürer
Junges Mädchen