It's A Hard Knock Life

There has been a great deal of attention in the media regarding Post Concussion Syndrome, although for decades, it is not something which has gone unnoticed within the medical field.  It has eluded doctors and researchers for years, and continues to do so currently. Post Concussion Syndrome (PCS) is an important subject matter to me, for more reasons than the impact on mental health. I've decided to share my story, to raise awareness and possibly help others who may have or know someone with PCS.

In 2007, I suffered a closed head injury.  I was on a long board, which for those who do not know, is a very fast skateboard designed for just that, going fast.  Without helmet, my head hit pavement at approximately 35-40 m.p.h.  I lost consciousness and came to about 100 feet from the spot I wrecked.  There was no CT done, no MRI, and I absently attempted to carry on with my daily routines.  Or so I thought.

The first month I don't recall much at all. I have about three blurry snapshots. In the initial two weeks, standing for more than a few minutes resulted in nausea. I operated without awareness or understanding of why or what I was doing.  In the wreck, I also separated my shoulder, tearing through all three ligaments attached to the clavicle. Because of this injury, I also was taking pain medication, though sporadically.

Post-surgery for my shoulder, the next nine months was a test of courage, perseverance, and the most painful months in my life. I'm no stranger to injury. I was the child for whom you paid your insurance deductible on January 1st, because you WILL use it. My days as an athlete brought torn ligaments, displaced joints, and numerous other mishaps.

However, well off pain pills, the migraines emerged.  Everyday. My mood was unstable, and from what I've been told, my speech was, interesting.  I would begin talking, abruptly stop, and then either be dumbfounded for my thought or unaware that I had stopped speaking at all.  I was briefly in a relationship, and would ask my partner for a head massage daily. I am not a high maintenance person, so this was not an attempt to be pampered religiously. It was, at the time, the only comfort for the migraines.  Yet it barely took the edge off.  My heartbeat would pound in my head every night, and eleven to twelve hours of daily sleep was never enough. Impulsiveness, anger, crying, dizzy spells, headaches, apathy. Knowing what I know now, this is well within the norm for PCS.  Back then, I was a mess.

I began working with a doctor who was as uncertain of a treatment as I was.  For the next year, I was essentially her guinea pig.  We tested medications, researched through medical journals, and finally came to a conclusion of PCS.  This was a relief of sorts, yet terrifying.  Dementia, Alzheimer's, Parkinson's were splattered everywhere in medical literature. The sobering news of all was my realization that the symptoms of PCS, if lasting more than a year, were most likely permanent. At this point, I was heading into my eighteenth month.

My first attempts to get back into routine were clumsy and embarrassing. Social anxiety plagued me. My moods were still erratic. I began to understand my tolerance, or lack thereof, for noise and light. The light from a desk lamp was manageable.  My actions continued to be impulsive.  The headaches were a constant, yet dampened by medication.  For a brief time, I was happy in every aspect of my life, yet I had suicidal tendencies. This was bigger than "normal" depression or anxiety, I didn't want to end my life, but my moods were uncontrollable. The trigger, I learned, was stress.

When you have PCS, stress is your worst enemy. Alcohol ranks right up there as well.  Driving and talking on a phone, unbearable. Two people talking in the same room, overwhelming. Being interrupted in normal conversation, nerve-racking.  Needless to say, the smallest tasks I had taken for granted were sources of stress. You can only imagine what a "normal" stress could cause.

 Fortunately, my doctor found medications that keep my headaches to a minimum. I began to learn my limitations, which was a battle in itself. I do not LIKE limitations! My doctor provided the perfect analogy. My brain used to run like a Mac, now its more like an Apple IIe.

Five years later, I still have a daily low-grade headache. I would like to put my PCS in the past, but it's impossible. It is taxing, and is WORK.  Everyday I work on managing symptoms. Avoiding multi-tasking, pushing through lack of motivation, and thinking through every conversation. Words don't come easy anymore, I have to search for the next one to come out of my mouth. Happiness was once intrinsic, but now I work to get through the haze that is a part of my life. It is not a depression. It is a continuous process of reminding myself to display my genuine joy and happiness when my headaches and cognitive struggles stifle my reactions. An ex partner thought it was she that made me unhappy. No, the work involved to show my happiness gets exhausting.

However, I keep fighting.  There is always another potential solution, my latest grasp for straws involves treatment through a Chinese herbalist. Sure, I'll drink tea that tastes like, what I only imagine, is urine mixed with mulch. If it works, it's worth it. Although my recollection is fuzzy, I haven't forgotten what I was before the injury. Support is necessary. My biggest obstacle to overcome is acceptance. To face the difficulties and accept what comes with PCS. Understanding my injury is not visible to those around me, or those who care about me. Accepting the burden that I will be the one to make adjustments.  Most importantly, I have become vocal and a self-advocate for my injury.

With this being said, there are thousands of people whose symptoms are similar or far more debilitating. There are children and adults who will end up with PCS, who will need support. As a therapist, my job challenges me. But having PCS provides me with greater insight and awareness for myself and clients.
Here are some steps to take if someone you know has a head injury, even a minor one.

• Have a baseline assessment. The Rivermead Post Concussion Questionnaire  and the Standardized Assessment of Concussion are free on the internet. Establishing what is "normal" is key to determining changes. I have attached links to the questionnaires, and can be used before injury, immediately following injury, 24 hours post injury, and then 30 and 60/90 days post injury. 

• Ask for an MRI. This can rule out bleeding and second impact syndrome. A clean MRI does not guarantee a problem-free future though. This is the enigma of PCS.  

• Rest. Keep brain activity to a minimum. Even if a person can do daily activity, the brain needs to heal, immediately. 

• Seek support. Friends, family, a therapist, and/or online groups. It is critical to ask for assistance. I've provided links for associations and groups here too. 

• Be selective with doctors and professionals. There are those who believe PCS is imagined or an attempt to seek compensation (pending lawsuits). Find a physician who is supportive and understanding of your various symptoms and needs. 

• Seek information. Medical journals are chock full of studies relating to PCS or head injury. Heed my warning: There is disheartening and scary information to be found. Again, ask a friend to help and be aware of the stress involved in this task. 

• Never give up. There is hope for those with PCS. The spotlight on brain injury and concussions in the media has ignited the medical field, and will result in awareness, funding, and research on PCS.  

Fortunately, only a slim minority of those with post concussive symptoms will develop chronic or prolonged PCS such as myself. We are discovering the effects of concussions everyday, and I believe there will be a protocol or standard of care to emerge to reduce the likelihood of lasting damage.  The human body is resilient. If neuro-pathways are damaged, the brain will create new ones.  It may be a slow process, as i compare it to hacking through a jungle with a machete to create a walkway instead of following the trail.   I have shared my experience with others, but this was not always the case. I felt ashamed, weak, and terrified of ensuing judgment.  I made the decision to share my story, because it may help others and is a part of me.  I realized it is my strength that has brought me to this point, not a weakness.  With this comes greater control, acceptance, and hope. With this, I can be myself and discuss my injury freely.  Usually, this includes a sense of humor, as I am not afraid to poke fun at myself.  And laughter really can be the best medicine.


Links:

Rivermead Post Concussion Questionnaire 

Standardized Assessment for Concussion

Brain Injury Association of America

NeuroTalk Support Group

PCS/PPCS Facebook Support Group

Sowing Seeds of Play

I took a bit of a sabbatical from my blog :)

Looking back through my posts, I thought this one would be important enough to re-post.  We all have moments in our lives when we need to find our roots.  Whether that is spiritually, physically, mentally, or emotionally.  Of course, sometimes our roots have sprouted from seeds planted in soil which is not suitable for growth, leaving us with a false sense of stability.  Our flowers sure do look pretty, but underneath we are fragile and easily susceptible.  

At what point do we pull ourselves up from the ground and replant?  When do we realize that it is more important to plant the seed in good soil so our roots can support us, than it is to have the pretty flowers for all to see?

My reasons for this post, originally, was about using some basic concepts of play therapy in daily play with children to "plant a seed".  This still applies.  It is one of the principle reasons for which I am a therapist.  If I can be the one person in a child's life who accepts them unconditionally, after they have come to me having endured severe abuse, then I can possibly plant a seed of hope or doubt.  Hope that someone accepts them for who they are as a person.  Doubt that "everyone" dislikes them.  There is that seed that one person has accepted them unconditionally.  

However, I realized that this post and parable has always been important to me.  When we were scattered, where did we land? What do our roots look like?  Is it more important for our flowers to look pretty, even if the roots are brittle?  And maybe we our roots are strong, but it just is taking a long time for the flower to come out and bloom.  

I'm not going to change anything else in the post, so here goes:  
 
Although in this blog, I would like to keep religious views separate, I personally have always loved this parable:

³ Then he told them many things in parables, saying: “A farmer went out to sow his seed. ⁴As he was scattering the seed, some fell along the path, and the birds came and ate it up. ⁵ Some fell on rocky places, where it did not have much soil. It sprang up quickly, because the soil was shallow. ⁶ But when the sun came up, the plants were scorched, and they withered because they had no root. ⁷ Other seed fell among thorns, which grew up and choked the plants. ⁸ Still other seed fell on good soil, where it produced a crop—a hundred, sixty or thirty times what was sown. ⁹ ~Matthew 13: 3-9

This week, I was given the opportunity to attend a banquet to honor foster parents and children who had excelled, in spite of the challenges placed before them. As the county judge read their accomplishments, their eyes lit up, they sat up straight, and my boss stated the overall sentiment perfectly, "Seeing that makes it all worth it."

I hold firmly in my belief that children are incredibly resilient. This is based on my time spent, the hours being there with my clients as we work through the trauma, sexual abuse, fear, anger, and uncertainty under the cloak of play. 

But it takes so much more.  A therapist doesn't have a magic wand.

Sometimes I come across foster parents, bio parents, guardians, teachers, etc, who are hesitant to follow a guideline I provide. I am aware of the strain they are already under, and my requests are minimal, proven, and uncomplicated. Moreover, I assure them I am there to see it through. Yet still there are those who see the scattered seeds and point the finger when they will not grow.

An old friend and coach told me, at one of many low points in my life, "Everyone has a story." My head went down. "No, you'll make it. The great ones always have the best stories of how it came to be. Go tell em your story."

Everyone has a story. Carl Rogers believed every person has an inner desire to be better, and in turn, even the most poorly behaved child wants to be heard. Every child wants to be the seed that is planted and cared for, yet it is so difficult for children to tell us (with words) the reasons behind their actions. That is why play, and play therapy, is so important to me and my focus of work with kids. It is the best way, as of yet, to allow kids to tell their story and be heard.

I would like to share, for those who aren’t familiar with the basics of child-centered play, some of the fundamentals of the theory.  These are simple skills that can be applied anytime, with any client actually.  

For those not working from a therapeutic angle, try them out with a niece or nephew, a grandchild, your child.  Anyone.  Make it a special time set aside.  You can honestly start with 20 minutes a week and witness the child begin to tell his or her story. 

If you are setting time aside, let the child know that he or she can, “Say anything they want and do ALMOST anything.  If there is something they cannot do, you’ll let them know.”

This way, you aren’t setting the limitations ahead of time.  Normally, no hitting, nothing pointed at the face.

 

Then, follow these basic guidelines:

• Refrain from giving advice
• Let the child lead the action and conversation
• Avoid using praise words, instead, reflect the child's emotion upon achievement
• Accept the child’s expressions, feelings and choices exactly as they are
• Allow the child to make the decisions and direct, and avoid providing instruction
• Again, set limitations that are necessary to maintain safety

Think of yourself as a play-by-play commentator watching a game in action.  Pay genuine attention to the child’s actions, expressions, and thoughts.  Then, simply try to mirror these, verbally and expressively, back to the child.

Here's a link to the National Institute of Relationship Enhancement for more info: 

http://www.nire.org/

The Forest Through The Trees

In a therapy session, when I find my mind drifting, I remind myself to focus on one thing. One thing the client is saying or doing. If I can center all my attention on one thing, even for a moment, it will pull me back in. And I am, again, attending to the client. I'm in their world.

The past month has been a challenge, personally, and I find my thoughts wandering in and out of session.  This happens to all of us. We are influenced and distracted by thoughts, emotions, fears, etc. on a daily basis. As employees, spouses, parents and friends. One of the philosophies of being a therapist is "know thyself". And as I am aware of a shift in my focus, I am once again reminded of this important mantra.

Without observing yourself, our perceptions of the life we are living and our sense of self is skewed. Our emotions take over, and our ability to remain self aware is greatly decreased. I was on a teeter-totter today, yes...a teeter-totter. And in between my moments terror at the thought of sending my little client shooting out of her seat like a rocket, I realized how "knowing thyself" is much like a teeter-totter. Emotions balanced with self awareness. Tough. A balance between well being and personal integrity. Even tougher!  I read in another blog..."Even if we’ve gone off the beaten track, once we’ve found ourselves, we may still be in the woods, but we’re no longer lost."  Being a sucker for analogies, I had to include it!

There are several ways to increase your self awareness and find your path, but mindfulness is (relatively) easy and can be done anywhere.  It's a process of open attention to the present. You let your thoughts, feelings, and sensations pass before you, observing them fully. The key is to be aware of them, not to judge them. When emotions (any emotion)  seem to be teetering too much in one direction, for a minute, a day or several days, mindfulness creates center and totters you back out.  Obviously, more practice makes perfect, but even a quick check-in can help you focus and possibly be the catalyst needed to change your situation.   

 

Here are examples of mindfulness:

 

Notice Five Things 

1. Pause for a moment
2. Look around, and notice five things you can see.
3. Listen carefully, and notice five things you can hear.
4. Notice five things you can feel in contact with your body. (E.g. your watch against your wrist, your trousers against your legs, the air upon your face, your feet upon the floor, your back against the chair etc)  

ADHD - Ain't What It's Cracked Up To Be

There seems to be an onslaught of attention regarding ADHD lately, due to the recent reports of psychopharmaceutical overuse within the foster care system, mixed with the shortage of generic Adderall.  I thought it was a good time to blog about ADHD, and recalled an article I read on the Huffington Post by Dr. Lawrence Diller regarding children, ADHD diagnoses, and prescription medications.  Dr. Diller had been berated for his middle of the road stance, neither advocating meds nor discouraging them.

In general, everyone seems to have an opinion about what causes ADHD.  And for every opinion on the cause, there are ten more on the "solution".  The truth of the matter is there is seldom a blanket answer or quick fix in mental health.  There are mitigating factors to consider such as family history, home and school environment, and past trauma or abuse.  If you combine these complex factors with the daily social demands placed upon us all (adults and kids), an ADHD diagnosis can be confusing and riddled with questions.

There are several strong points made by Dr. Diller, who has eloquently coined the term, “Adderall Wars” to describe our nation’s unique dependency on this drug.  These are a selection of Dr. Diller’s arguments regarding the roots of ADHD.  I chose to list these in particular because I believe they are, outside of the neurobiological reasons, the most impacting and contributing factors of ADHD. 

His arguments include the following: (I’m paraphrasing and will provide a direct link at the end of this blog)

• Poverty, racism, adult violence and substance abuse are the main reasons for all children's mental health problems, including ADHD.

• Class sizes are larger, yet the pressures and expectations are higher.  In 1991, a kindergartner was expected to “sing” the ABCs.  In 2011, that same child would be expected to read and do simple math prior to first grade. 

• The American standard is a two-income family.  Preschool and latch-key are the norm, creating long days for both children and parents.  Managing within the structured bureaucracies of preschool and after-school programs sets up behavioral demands that many children cannot meet.

• ADHD became “official” in 1980 in the DSM-III, making it an easy target for the root of misbehavior or poor performance.

• Pharmaceutical companies, because they are very wealthy, fund research and continuing education within the medical profession.  These companies, in turn, become highly influential. 

• Pharmaceutical companies advertise to physicians first, then parents.  These companies are also offering free samples (vouchers for drugs like Adderall) to physicians. 

• Therapy, when offered to ADHD children, is often individual play therapy, which is not effective for this problem. What works is family/parent oriented counseling for behavioral management strategies and support.

As Dr. Diller noted, many children who struggle with mental health disorders or other mental health challenges come from or live in environments that are less than ideal.  As a society, we are quick to throw on the ADHD label, prescribe meds and call it a day.  However, a child living in a home with an abusive parent is probably going to have problems at school.  To be honest, the source of a child’s behavioral problems can stem from a multitude of sources.    

Think of a time, as an adult, in which you had an argument with your partner and had to go to work.  Perhaps you’ve been through a difficult financial time with the holidays around the corner.  Or maybe you have been the adult victim of abuse, and have attempted to carry on a normal daily life.  As a rational adult, it is difficult to stay focused during these times.  A child who lives in a frenzied, callous, and/or abusive environment falls easy to distraction and disappointment.  This environment may be home, school, the community, or all three. 

The only point I will disagree with Dr. Diller on is the final bullet regarding play therapy.  As a proponent of child-centered play, I do not dispute that behavior management intervention is a likely choice to manage ADHD symptoms.  However, as Dr. Diller indicates, ADHD is typically a result of a deficient environment.  Deficient in these terms can include affection, emotional attachment, love, nurturing, or other essential human needs. In turn, ADHD usually presents as a co-morbid disorder.  For those reading who are not familiar with the term, co-morbid means that the client has ADHD and something else that is clinically significant, such as depression.   

Here’s what I have seen.  When kids have ADHD to the extent that requires medication, it’s usually a no-brainer.  There are noticeable symptoms.  Does that mean the parent/guardian should medicate?  That’s up to the individual and their belief system, finances, ability to monitor, willingness to monitor, child’s health, etc. 

Furthermore, not all ADHD diagnoses are the same.  If the hyperactivity component is missing, you may feel the child is just lazy.  An ADHD diagnosis that falls under the inattentive-type may not garner the same attention as the other two.  Hyperactivity and impulsivity, which are a part of the combined-type and hyperactive-impulsive ADHD, are much more obvious and well, annoying to say the least.

My point is this: the symptoms of ADHD parallel other difficulties or disorders.  Is ADHD real?  In my clinical opinion, yes.  Is it as prevalent as reported?  Probably not. 

I believe it is important to step back and take an objective, and individual, look into the child’s world.  Here are some steps to take as a parent or guardian to help establish a baseline of your child’s behavior, as well as a chance to get to know your child a little better.  

• Take a moment to think about your child’s schedule.  Write it down.  Is it consistent or haphazard?  Is your child getting enough sleep?  How much television is he or she watching?  How much time are you spending in one-on-one interactive play/engagement?

• Talk to your child and your child’s teacher(s) about school.  Do you know what is expected of your child?  The sooner your child knows you are there to help, the better.  Ask to sit in on the class if you are allowed. Go to parent-teacher conferences.

• Talk to your child about bullying, drugs, alcohol, and sex.  All in an age-appropriate manner and provide them with tools to protect themselves.  You also can let you child know that you are there for them to talk to about any of the above, no matter how difficult, and will help them.  If you can’t make this promise, don’t say it.

ADHD can be confusing and scary.  Children with ADHD may exhibit severe aggression, irritability, withdrawal, or many other symptoms.  The decision to put a child on medication for ADHD should be well thought out and monitored closely at home and by the child’s prescribing doctor. 

It’s also important to keep in mind that what you think may be ADHD may be a clue to a different problem.  Sometimes a child may have slight tendencies of ADHD, but a bullying problem serves as a magnifying glass.  As always, the most important act you can do as a parent or guardian is engage, 100%.  No phone, no TV, one-on-one.  Ten minutes a day will create a miracle, I encourage even ten minutes a week to start. 

Link to Dr. Diller post:  http://tinyurl.com/692p48h

Children and Adults with Attention-Deficit/Hyperactivity Disorder: http://www.chadd.org/

Simmering Stew II

I took a mental vacation, but I’m back!

As mentioned in my last post, I want to talk about schema development in my second installment. As a reminder, we ALL have schemas! Some of these are healthy, some are not. The unhealthy ones are referred to as maladaptive. It is important to keep in mind that schemas are core beliefs, they are not behaviors. Behaviors are the coping skills we use as a result of our schemas.

Maladaptive schemas develop early on in life, before our pre-teen years. Typically, the deeper the schema, the earlier it developed, and the more difficult to work through. Since we have all been children at one point in our lives, we can all identify with the ups and downs of youth.

If you’ve read my other posts, you may have noticed my love of metaphors. So as not to disappoint, a maladaptive schema is like a pimple. Sometimes a pimple lingers under the surface, rearing its head under duress, refusing to be ignored. A pimple can fester deep within layers of skin, or it may cause a bothersome blemish. Your skin may glow, your pimple undetectable to the eye. It may stick out like a third eye in the center of your forehead for the world to see. The pimple may be caused and then further developed by a multitude of factors. Genetics, poor habits, stress, etc. However, regardless of our pimple(s), there is an Oxypad for us all.

What, exactly, happens for a maladaptive schema to form? This is simple. A need is not met. A basic, human, necessary, and warranted need is not being met in a child’s early years. A need can be something tangible like shelter or food. But it can be intangible as well. Affection, empathy, safety, and autonomy are all examples of needs.

Dr. Young (as mentioned in the previous post), lists four aspects of need development:

1) Caregivers provide TOO LITTLE of a good thing

· Creates a need for love, understanding, stability

2) Traumatization (Presence of danger or threat)

· Creates a need for safety

3) Caregivers provide TOO MUCH of a good thing

· Realistic limits not set

· Creates a need for autonomy

4) Selective Internalization/Identification with significant others

· Child identifies with/internalizes parent’s thoughts, feelings, behaviors

· Creates a need for identity

However, it is also important to note that temperament is a key factor in schema development. As I stated before, some of us are born with oily skin and pores that feel (at times) visible from outer space. In these situations, it makes it tougher to build a resilience to pimples (maladaptive schemas).

At a young age, and in an emotionally threatening situation, a child will do what he or she needs to do to survive. Since children typically cannot physically escape, they develop coping skills to survive. The type or types of coping skills they use will more than likely depend upon their emotional temperament. Sometimes, a child is more resilient (for numerous reasons, not always by birth) and seems to develop a thicker emotional skin.

I will have to say, resilience should not be mistaken for avoidance or over-compensation. Adults who are resistant to self-exploration, content with surface-level functioning, and/or operate on a one-sided range of emotions are most likely plagued by maladaptive schemas and hurting.

What we are left with as adults are scripts, comfortable patterns that we have followed time and time again, even if at times tormenting us. The way to relieve yourself of your schemas is to proactively fight against it. In my first post about schemas, I shared a link to Dr. Young’s Schema Therapy Page. There you can find the Schema Questionnaire and identify your maladaptive schemas. Dr. Young also lists links to resources regarding maladaptive schemas.

A big step in the process of healing is identifying your schemas. However, recognizing and being cognizant of your everyday triggers is also crucial. If you realize some of your schemas may be severe, talking with a professional therapist may help you make the connection between your childhood and your current life patterns.

Next post will be a less heavy on the head ;) Take care, see you soon!

The Simmering Stew of Schemas

I chose to blog about schemas in this post.  My intentions were to create a two-part segment (perhaps three) with this being the second.  However, schemas kept popping up in both my personal and professional lives, and I’m taking it as a sign.

Schemas are beliefs about how we see ourselves, others, and the world.  They are neither fleeting nor easily altered.  Schemas are entrenched and at times, so inconspicuously interwoven, we cannot comprehend the depths they reach.  Think Jacques Cousteau.  James Earl’s voice.  That deep.

Here are some basics about schemas: 

1)  Everybody has them 

2)  The source of most start very early in life  

3)  There are healthy schemas  

4)  There are unhealthy schemas, a.k.a. maladaptive schemas

Personally, I think of maladaptive schemas as a big pot of gumbo.  Mumbo-jumbo gumbo.  There are emotions, memories, sensations, thoughts, and various other ingredients tossed in throughout our lives.  Our pot of gumbo sits on the stove top, simmering, until someone or something comes along and cranks the dial and turns up the heat.  Whoa! What happened?  Our gumbo is boiling and things are bubbling up to the surface that had floated way down to the bottom of the pot. 

During these times, we notice our schemas, or at least we notice our REACTIONS to our schemas.  However, our pot is always simmering, so what is happening between these bouts of intensity?  How do maladaptive schemas even develop?

Although this may appear bass-akwards, I’m going to briefly address maladaptive schema development.  I’ll cover it more in part two. 

During our childhood and adolescence, we have basic needs.  Food, water, shelter, affection, nurturing, protection, empathy, understanding, safety, and guidance.  Huh? Ahh yes, the emotional needs.  Many adults swear up and down, “I had a great childhood!” because their parents did not abuse them or blatantly abandon them.  At times we realize that a parent was physically there, but emotionally absent.  A child may have been overly protected, controlled, or placed on a pedestal.  Of course, some of us experience severe incidents of trauma or prolonged abuse and neglect that lead to the development of pervasive and/or multiple maladaptive schemas.

Dr. Jeffery Young developed schema therapy, co-authored Reinventing Your Life, and has a website with several tools for practitioners or the general public for self-assessment.  I’ll post a link at the end.  Schema therapy is an offshoot of cognitive-behavioral therapy, and attempts to address the source of our vulnerabilities.  Dr. Young came up with eighteen maladaptive schemas: Abandonment/Instability, Emotional Deprivation, Entitlement/Grandiosity, Defectiveness/ Shame, Subjugation, Unrelenting Standards/Hypercriticalness, Mistrust/Abuse, Self-Sacrifice/Recognition-Seeking, Social Isolation/Alienation, Dependence/Incompetence, Vulnerability to Harm or Illness, Enmeshment/Undeveloped Self, Failure, Insufficient Self-Control/Self-Discipline, Approval Seeking, Negativity/Pessimism, Emotional Inhibition, and Punitiveness.

Although schema therapy is typically used with adults, a recent publication, Counseling Children: Core Issues Approach, applies schema therapy among the child and teen population. 

Okay, let’s check on our simmering pot of mumbo-jumbo gumbo.  Why do we even keep this glob of voodoo on the stove?

Because we are human, and the human species are creatures of comfort.  We hold tight to what we know, even when it is unhealthy.  We seek out, sometimes unknowingly, people who will fit our schemas (healthy and maladaptive), because they allow us to perpetuate our schemas and how we see our self, the world, and others.  Makes you wish you were a dog, doesn’t it?

This is what we do to keep that gumbo simmering.  We distort our thinking.  We choose self-defeating patterns.  We develop unbalanced coping styles.  In regards to coping styles, there are three, following the primitive and well-recognized fight, flight, and freeze response.  In relation to schemas, we overcompensate (fight), avoid (flight), or surrender (freeze).  Some of us prefer one particular style, others like to mix it up, which is especially fun for our partner!  Each coping style presents very differently, but stems from the same maladaptive schema.

Let’s use the emotional deprivation schema as a model.   An emotionally deprived person believes his or her emotional needs will never be met.  With this schema, a self-defeating pattern would include choosing partners who are not emotionally available, giving, or willing.  If using overcompensation to cope, this person resembles someone with the “little man syndrome,” provoking fights with their partner.  They may be emotionally demanding of friends, family, and their partner.  Essentially, this person behaves in the complete opposite of the schema in order to hide or prevent a trigger.

Avoidance appears to be self-explanatory.  Yet many may not realize they are employing this coping style.  Traumas are buried involuntarily.  Using emotional deprivation again, a person may avoid intimate relationships or perhaps use illegal substances to numb thoughts, fears, or feelings.  Avoidance, therefore, can be based cognitively, behaviorally, and/or emotionally.

Lastly, we have the surrender coping style, which parallels the primitive freezing instinct.  This stems from the body’s physiological response of immobilizing under duress, perhaps, for example, standing in front of a saber tooth tiger.  In most instances, you would essentially surrender to the trauma and be eaten.  The same concept applies in modern day reality. 

A person with emotional deprivation who surrenders to his or her schema chooses partners who are incapable of providing for their emotional needs, which only reaffirms his or her belief that emotional needs will never be met.  The person with this coping style never asks anyone to meet his or her basic emotional necessities .

Depending on how strong the particular schema and/or severe the trigger, we may use an onslaught of coping styles.  The older we get, we tend to develop into major league pitchers, honing our skills, coming up with sinkers, curve balls, sliders, and the deadly heater (all coping styles) to throw off batters (healthy/unhealthy partners and/or triggers).

If you managed to get through this lengthy blog without being utterly confused or falling asleep and doing a face plant on your keyboard, congrats!  Here is what is wonderful about schemas:  They are a tremendous tool for self-awareness, provide another means to conduct psychoanalysis on others (if you are into that), and most importantly, will actually help you strengthen your relationships with others.

It is the natural tendency to strive towards healing.  By identifying and developing an awareness of your schema, the battle between self-defeat and healing can begin.  Once you recognize your schema, you can begin the process of discovering where it developed and how it has stewed, bubbled, and boiled over the years.  You begin to notice your reactions to your schemas and in time, begin to separate the reaction from the reality. 

Take the time to learn more about these schemas by visiting Dr. Young’s page.  There is too much information to write about and post on a blog which is not entirely devoted to schema theory.  Yet many have written about maladaptive schemas and his work.  You can find his page HERE

I have also attached the Young Schema Inventory in a separate PDF file on this blog page in the right hand column, along with a scoring guide.

If you would like the link for the inventory for the Young Schema Inventory can be located HERE

Have fun, more to come soon!