the sex addict’s schema and the drive to act out

The Sex Addict’s The Sex Addict’s SchemaSchema

and the Drive to and the Drive to Act OutAct OutPresented By:Presented By:

Mary L. Deitch, JD, PsyDMary L. Deitch, JD, PsyDandand

Tanisha M. Ranger, PsyD, CSAT(4)Tanisha M. Ranger, PsyD, CSAT(4)

Origins of Schema Origins of Schema TheoryTheory

• Developed to address CBT “treatment Developed to address CBT “treatment failures”failures”

• CBTs fundamental assumptionsCBTs fundamental assumptions– Compliance with treatmentCompliance with treatment– The ability to collaborate with the therapistThe ability to collaborate with the therapist– A logical basis for changeA logical basis for change– Accurate self-assessmentAccurate self-assessment– Problem specificityProblem specificity

• Schema theory is a unifying theory Schema theory is a unifying theory combining cognitive, behavioral, combining cognitive, behavioral, attachment, psychodynamic and gestalt attachment, psychodynamic and gestalt theories and techniquestheories and techniques

Schema TheorySchema Theory

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

What is a Schema?What is a Schema?

• A dysfunctional assumption about the A dysfunctional assumption about the self, the world and one’s relationship to self, the world and one’s relationship to othersothers

• Broad and pervasive pattern comprised Broad and pervasive pattern comprised of thoughts, feelings, bodily sensations of thoughts, feelings, bodily sensations and memoriesand memories

• Developed during childhood/adolescence Developed during childhood/adolescence and elaborated upon throughout the life and elaborated upon throughout the life span – schemas become the lens through span – schemas become the lens through which life is seenwhich life is seen

Where do Schemas come Where do Schemas come from?from?

• Toxic frustration of core childhood Toxic frustration of core childhood needsneeds– AttentionAttention– AffectionAffection– ProtectionProtection– PlayPlay

• Victimization, traumatization and/or Victimization, traumatization and/or abuse during childhood and abuse during childhood and adolescenceadolescence

How do schemas work?How do schemas work?• Two primary operations: schema Two primary operations: schema

perpetuation and schema healingperpetuation and schema healing– All thought processes, behaviors and feelings can All thought processes, behaviors and feelings can

be seen as contributing to one of the two be seen as contributing to one of the two operationsoperations

• Schema PerpetuationSchema Perpetuation– The routine processes by which schemas function The routine processes by which schemas function

to perpetuate themselvesto perpetuate themselves– Includes: cognitive distortions, self-defeating Includes: cognitive distortions, self-defeating

behavior patterns and maladaptive coping stylesbehavior patterns and maladaptive coping styles– Schemas tend to highlight and exaggerate Schemas tend to highlight and exaggerate

environmental evidence that supports them, environmental evidence that supports them, while minimizing or ignoring evidence that while minimizing or ignoring evidence that refutesrefutes

How do schemas work?How do schemas work?

• Schema Perpetuation (Cont’d)Schema Perpetuation (Cont’d)– Schemas are made up of thoughts, Schemas are made up of thoughts,

feelings and bodily sensationsfeelings and bodily sensations– It is through the maladaptive coping It is through the maladaptive coping

styles that they exert influence over styles that they exert influence over behavior and ensure their survivalbehavior and ensure their survival

– Three maladaptive coping styles:Three maladaptive coping styles: Surrender, Avoidance, and Surrender, Avoidance, and OvercompensationOvercompensation

How do schemas work?How do schemas work?• Schema Perpetuation (Cont’d)Schema Perpetuation (Cont’d)

– SurrenderSurrender• Refers to the ways in which people passively give in to the Refers to the ways in which people passively give in to the

schemaschema• They accept the schema as fact and then act in ways that They accept the schema as fact and then act in ways that

confirmconfirm– AvoidanceAvoidance

• Refers to the ways in which people attempt to avoid the Refers to the ways in which people attempt to avoid the schema – they may avoid activating the schema or avoid schema – they may avoid activating the schema or avoid experiencing the painful emotions once the schema has been experiencing the painful emotions once the schema has been activatedactivated

• Three types of avoidance are: cognitive, emotional and Three types of avoidance are: cognitive, emotional and behavioralbehavioral

– OvercompensationOvercompensation• Refers to behavior that directly contradicts what the schema Refers to behavior that directly contradicts what the schema

suggests in an attempt to avoid triggering the schemasuggests in an attempt to avoid triggering the schema• They may appear healthy on the surface, but often take They may appear healthy on the surface, but often take

behaviors to the extreme behaviors to the extreme

How do schemas work?How do schemas work?

• Schema HealingSchema Healing– Occurs when therapeutic techniques are used to Occurs when therapeutic techniques are used to

weaken maladaptive schemas and coping stylesweaken maladaptive schemas and coping styles– Involves an alliance between the therapist and Involves an alliance between the therapist and

the client’s healthy side against the schemasthe client’s healthy side against the schemas– Therapeutic techniques:Therapeutic techniques:

• Challenging, questioning and contradicting schemasChallenging, questioning and contradicting schemas• Role playing and real world experimentsRole playing and real world experiments• Guided imageryGuided imagery• Limited re-parentingLimited re-parenting• Empathic confrontationEmpathic confrontation

ECU Sample DataECU Sample Data• Total Clients: 50Total Clients: 50

– Level One: 14 (28%)Level One: 14 (28%)– Level Two: 19 (38%)Level Two: 19 (38%)– Level Three: 17 (34%)Level Three: 17 (34%)

• Attachment Style (ECR Scale)Attachment Style (ECR Scale)– Fearful/Avoidant: 11 (22%)Fearful/Avoidant: 11 (22%)– Preoccupied: 11 (22%)Preoccupied: 11 (22%)– Dismissing: 7 (14%)Dismissing: 7 (14%)– Secure: 21 (42%)Secure: 21 (42%)

• Clients with more than 1 schema ranked Very High - 36 Clients with more than 1 schema ranked Very High - 36 (72%)(72%)

• Client with no schemas High or Very High - 3 (6%) These Client with no schemas High or Very High - 3 (6%) These clients also described themselves as Securely Attachedclients also described themselves as Securely Attached

What are the known What are the known Schemas?Schemas?

• Disconnection & Rejection DomainDisconnection & Rejection Domain– Focused on the expectation that one’s needs Focused on the expectation that one’s needs

for security, safety, empathy, belonging and for security, safety, empathy, belonging and respect will not be met in a predictable respect will not be met in a predictable mannermanner

– ABANDONMENT – MISTRUST – ABANDONMENT – MISTRUST – EMOTIONAL DEPRIVATIONEMOTIONAL DEPRIVATION

– DEFECTIVENESS – SOCIAL ISOLATIONDEFECTIVENESS – SOCIAL ISOLATION

Emotional Deprivation Emotional Deprivation

• This schema is characterized by the This schema is characterized by the expectation that one’s normal needs expectation that one’s normal needs for emotional support will not be met. for emotional support will not be met. Typically a result of deprivation of Typically a result of deprivation of nurturance, empathy or protection as a nurturance, empathy or protection as a child.child.

Very High: 16 (32%)

Level One: 3 (19%)

Level Two: 9 (56%)

Level Three: 4 (25%)

Fearful: 5 (31%)

Preoccupied 5 (31%)

Dismissing: 2 (13%)

Secure: 4 (25%)

High: 6 (12%)

Level One: 3 (50%)

Level Two: 2 (33%)


Fearful: 3 (50%)

Preoccupied: 1 (17%)

Dismissing: 0

Secure: 2 (33%)

Total: 22 (44%)

Total: 6 (28%)

Total: 11 (50%)

Total: 5 (23%)

Total: 8 (37%)

Total: 6 (28%) Total: 2 (9%)

Total: 6 (27%)

AbandonmentAbandonment• This Schema is about the perceived This Schema is about the perceived

instability or unreliability of those who instability or unreliability of those who are meant to provide support and are meant to provide support and connection. Withdrawal of support may connection. Withdrawal of support may be due to death, imminent illness, be due to death, imminent illness, emotional instability, or finding someone emotional instability, or finding someone new/better.new/better.

Very High: 13 (26%)

Level One: 3 (23%)

Level Two: 7 (54%)


Fearful: 6 (46%)


Dismissing: 0

Secure: 3 (23%)

High: 5 (10%)

Level One: 0

Level Two: 3 (60%)


Fearful: 0


Dismissing: 2 (40%)

Secure: 2 (40%)

Total: 18 (36%)

Total: 3 (17%)

Total: 10 (56%)

Total: 5 (28%)

Total: 6 (33%)

Total: 5 (28%) Total: 2 (40%)

Total: 5 (28%)

Mistrust/AbuseMistrust/Abuse• Individuals with this schema operate Individuals with this schema operate

under the assumption that others will under the assumption that others will use, hurt, abuse, cheat, lie to, or use, hurt, abuse, cheat, lie to, or otherwise take advantage of them, and otherwise take advantage of them, and that this harm is typically maliciously that this harm is typically maliciously intended.intended. Very

High: 13Level One:2

Level Two: 9

Level Three: 2

Fearful 4 Preoccupied: 3 Dismissing: 1

Secure: 5

High: 10 Level One:2

Level Two: 4

Level Three: 4

Fearful 3 Preoccupied: 3 Dismissing: 1

Secure: 3

Total: 23

Total: 4 Total: 13

Total: 6 Total: 7 Total: 6 Total: 2 Total: 8

Social IsolationSocial Isolation• This Schema is characterized by the belief This Schema is characterized by the belief

that one is isolated from the rest of the that one is isolated from the rest of the world, different from other people, and/or world, different from other people, and/or not part of any group or community.not part of any group or community. . .

Very High: 13

Level One:2

Level Two: 8

Level Three: 3

Fearful: 3

Preoccupied: 5

Dismissing: 2

Secure: 3

High: 4 Level One:1

Level Two: 2

Level Three: 1

Fearful: 2

Preoccupied: 0

Dismissing: 0

Secure: 2

Total: 17

Total: 3 Total: 10

Total:4 Total: 5 Total: 5 Total: 2 Total: 5

DefectivenessDefectiveness• This Schema is characterized by the This Schema is characterized by the

belief that one is flawed, defective, belief that one is flawed, defective, or inferior. These individuals or inferior. These individuals believe that if they let anyone get believe that if they let anyone get close enough to see these flaws, they close enough to see these flaws, they would be unlovable.would be unlovable.Very

High: 16Level One:3

Level Two: 7

Level Three: 6

Fearful: 4 Preoccupied: 4

Dismissing: 3

Secure: 5

High: 9 Level One:2

Level Two: 4

Level Three: 3

Fearful: 2 Preoccupied: 3 Dismissing: 1

Secure: 3

Total: 25

Total: 5 Total: 11


What are the known What are the known SchemasSchemas

• Impaired Autonomy & Performance Impaired Autonomy & Performance DomainDomain– Focused on expectations about the self and Focused on expectations about the self and

one’s surroundings that interfere with one’s one’s surroundings that interfere with one’s perceived ability to survive, thrive, separate perceived ability to survive, thrive, separate and function independentlyand function independently

– DEPENDENCE – VULNERABILITY TO DEPENDENCE – VULNERABILITY TO HARM HARM

– ENMESHMENT – FAILURE ENMESHMENT – FAILURE

FailureFailure• This Schema involves the belief that This Schema involves the belief that

one will fail or has failed in major areas one will fail or has failed in major areas of achievement such as work, school or of achievement such as work, school or sports. Individuals generally feel. sports. Individuals generally feel. inadequate when compared to others.inadequate when compared to others.

Very High: 9

Level One:2

Level Two: 5

Level Three: 2


Secure: 3

High: 3 Level One:2

Level Two: 0

Level Three: 1

Fearful:0 Preoccupied: 1 Dismissing: 1

Secure: 1

Total: 12

Total: 4 Total: 5 Total:3 Total: 2 Total: 3 Total: 3 Total: 4

DependenceDependence• This Schema is characterized by the This Schema is characterized by the

belief that one is incapable of belief that one is incapable of handling everyday responsibilities handling everyday responsibilities and decisions without considerable and decisions without considerable help from othershelp from othersVery

High: 10Level One: 2

Level Two: 4

Level Three: 4

Fearful: 3

Preoccupied: 4 Dismissing: 1

Secure: 2

High: 4 Level One: 1

Level Two: 2

Level Three: 1


Secure: 0

Total: 14 Total: 3

Total: 6 Total:5 Total: 5 Total: 5 Total: 2 Total: 2

VulnerabilityVulnerability

• This Schema is characterized by fear This Schema is characterized by fear of catastrophe and that one will be of catastrophe and that one will be unable to prevent harm. These fears unable to prevent harm. These fears can involve medical issues, can involve medical issues, emotional crises, or external crises. emotional crises, or external crises. Very

High: 6Level One:1

Level Two: 2

Level Three: 3

Fearful: 0 Preoccupied: 2

Dismissing: 1

Secure: 3

High: 5 Level One:0

Level Two: 2

Level Three: 3


Secure: 1

Total: 11


EnmeshmentEnmeshment• Individuals with this schema often have a history Individuals with this schema often have a history

of excessive emotional involvement with of excessive emotional involvement with significant others (often parents) that hinders significant others (often parents) that hinders their ability separate/individuate and experience their ability separate/individuate and experience normal social development.normal social development. May include feelings May include feelings of emptiness, being smothered by others, or of emptiness, being smothered by others, or being codependent on others. being codependent on others. Very

High: 4Level One: 1

Level Two: 1

Level Three: 2

Fearful: 1


Secure: 1

High: 6 Level One:2

Level Two: 3

Level Three: 1


Secure: 2

Total: 10



• Impaired Limits DomainImpaired Limits Domain– Focused on a deficiency of internal limits, Focused on a deficiency of internal limits,

responsibility to others, or long-term goal-responsibility to others, or long-term goal-orientation which leads to difficulty respecting orientation which leads to difficulty respecting the rights of others, cooperating, committing, the rights of others, cooperating, committing, and setting/meeting realistic personal goalsand setting/meeting realistic personal goals

– ENTITLEMENT – INSUFFICIENT SELF-ENTITLEMENT – INSUFFICIENT SELF-CONTROLCONTROL

EntitlementEntitlement

• This Schema is characterized by the belief that This Schema is characterized by the belief that one is superior to others, not guided by normal one is superior to others, not guided by normal social rules or entitled to special treatment. social rules or entitled to special treatment. These individuals display competiveness towards These individuals display competiveness towards others, asserting power and controlling others. others, asserting power and controlling others. Sometimes they display a lack of empathy Sometimes they display a lack of empathy towards others. towards others.

Very High: 11

Level One: 3

Level Two: 7

Level Three: 1

Fearful: 2

Preoccupied:4 Dismissing: 0

Secure: 5

High: 7 Level One:2

Level Two: 3

Level Three: 2

Fearful:2


Secure: 2

Total: 18

Total: 5 Total: 10


Insufficient Self ControlInsufficient Self Control

• This Schema is characterized by pervasive This Schema is characterized by pervasive difficulty in exercising self control in difficulty in exercising self control in order to achieve goals; impaired limits on order to achieve goals; impaired limits on emotional expression; or exaggerated emotional expression; or exaggerated emphasis on avoiding painful or emphasis on avoiding painful or uncomfortable experiences. uncomfortable experiences. Very

High: 16Level One:4

Level Two: 8

Level Three: 4


Secure: 6


Level Two: 5

Level Three: 5


Secure: 5

Total: 29

Total: 7 Total: 13



• Other-Directedness DomainOther-Directedness Domain– Involves an excessive focus on the desires, Involves an excessive focus on the desires,

feelings and responses of others, at the feelings and responses of others, at the expenses of one’s own needs in order to avoid expenses of one’s own needs in order to avoid rejection & retaliation or to gain love & rejection & retaliation or to gain love & acceptanceacceptance

– SUBJUGATION – SELF-SACRIFICE – SUBJUGATION – SELF-SACRIFICE – APPROVAL-SEEKINGAPPROVAL-SEEKING

Subjugation Subjugation • The schema of subjugation involves an excessive The schema of subjugation involves an excessive

surrendering of control to others out of a fear of surrendering of control to others out of a fear of anger, retaliation or abandonment. It takes two anger, retaliation or abandonment. It takes two major forms: subjugation of needs (the major forms: subjugation of needs (the suppression of one’s preferences, decisions and suppression of one’s preferences, decisions and desires) and subjugation of emotions (the desires) and subjugation of emotions (the suppression of emotional expression, particularly suppression of emotional expression, particularly

anger)anger) Very High: 15

Level One:4

Level Two: 8

Level Three: 3


Secure: 3

High: 2 Level One:2

Level Two: 0

Level Three: 0


Secure: 0

Total: 17 Total: 6 Total: 8 Total:3 Total: 5 Total: 6 Total: 3 Total: 3

Self-SacrificeSelf-Sacrifice• This schema involves an excessive focus on This schema involves an excessive focus on

voluntarily meeting the needs of others, at the voluntarily meeting the needs of others, at the expense of one’s own gratification. The most expense of one’s own gratification. The most common reasons are: to prevent causing pain to common reasons are: to prevent causing pain to others, to avoid the guilt from feeling selfish, or others, to avoid the guilt from feeling selfish, or to maintain a connection with others who are to maintain a connection with others who are

perceived as needy.perceived as needy. Very High: 16

Level One:7

Level Two: 4

Level Three: 5

Fearful: 5


Secure: 5


Level Two: 6

Level Three: 5


Secure: 4

Total: 29

Total: 9 Total: 10


Approval SeekingApproval Seeking• This Schema is characterized by excessive This Schema is characterized by excessive

emphasis on gaining approval, attention emphasis on gaining approval, attention or recognition from others as the expense or recognition from others as the expense of forming one’s personal identity. One of forming one’s personal identity. One depends on others to provide a sense of depends on others to provide a sense of self and self esteem and uses their self and self esteem and uses their reactions to gage their decisions and reactions to gage their decisions and thoughts. thoughts. Very

High: 20Level One: 5

Level Two: 10

Level Three: 5

Fearful: 6

Preoccupied: 7

Dismissing: 1

Secure: 6

High: 6 Level One:2

Level Two: 2

Level Three: 2


Secure: 2

Total: 26

Total: 7 Total: 12 Total: 7 Total: 7 Total: 8 Total: 3 Total: 8

What are the Known What are the Known Schemas?Schemas?

• Overvigilance & Inhibition DomainOvervigilance & Inhibition Domain– Involves an excessive emphasis on Involves an excessive emphasis on

suppression of spontaneous feelings, impulses suppression of spontaneous feelings, impulses or choices OR on meeting rigid internalized or choices OR on meeting rigid internalized rules and expectations for behavior, often at rules and expectations for behavior, often at the expense of one’s own happiness, self-the expense of one’s own happiness, self-expression, relaxation, close relationships or expression, relaxation, close relationships or healthhealth

– NEGATIVITY – EMOTIONAL INHIBITIONNEGATIVITY – EMOTIONAL INHIBITION– UNRELENTING STANDARDS – PUNITIVENESS UNRELENTING STANDARDS – PUNITIVENESS

NegativityNegativity

• This Schema is characterized by focusing This Schema is characterized by focusing on negative aspects of life while ignoring on negative aspects of life while ignoring the positive aspects. These clients believe the positive aspects. These clients believe that things will go wrong or fear making that things will go wrong or fear making mistakes. mistakes.

Very High: 11

Level One: 2

Level Two: 5

Level Three: 4


Secure: 4


Level Two: 6

Level Three: 4


Secure: 4

Total: 21


Emotional InhibitionEmotional Inhibition

• This Schema is characterized by the suppression This Schema is characterized by the suppression of spontaneous expressions in order to avoid of spontaneous expressions in order to avoid disapproval, or out of a fear losing control. disapproval, or out of a fear losing control. Typically involves inhibition of anger, inhibition Typically involves inhibition of anger, inhibition of positive impulses, difficulty communicating of positive impulses, difficulty communicating ones needs or excessive focus on rationality and ones needs or excessive focus on rationality and disregard for emotions.disregard for emotions.Very

High: 15Level One:4

Level Two: 7

Level Three: 4

Fearful: 7


Secure: 3

High: 8 Level One:3

Level Two: 3

Level Three: 2


Secure: 3

Total: 23

Total: 7 Total: 10


Unrelenting StandardsUnrelenting Standards• Individuals with this schema hold very high Individuals with this schema hold very high

standards for themselves and others towards standards for themselves and others towards which they are always striving. They often feel a which they are always striving. They often feel a great deal of pressure to perform and/or behave great deal of pressure to perform and/or behave in accordance with these standards, which in accordance with these standards, which interfere with their ability to relax, feel pleasure, interfere with their ability to relax, feel pleasure, or enjoy a sense of accomplishment.or enjoy a sense of accomplishment.

Very High: 20

Level One: 6

Level Two: 8

Level Three: 6

Fearful: 4

Preoccupied: 5

Dismissing: 2

Secure: 9

High: 9

Level Two: 3

Level Two: 1

Level Three: 5

Fearful: 0

Preoccupied: 3

Dismissing: 1

Secure: 5

Total: 29

Total: 9

Total: 9

Total: 11

Total: 4

Total: 8 Total: 3 Total: 14

PunitivenessPunitiveness

• This Schema is characterized by the belief that This Schema is characterized by the belief that people, including oneself, should be harshly people, including oneself, should be harshly punished for mistakes. These clients will be punished for mistakes. These clients will be overly punitive towards themselves and others overly punitive towards themselves and others

and have difficulty forgivingand have difficulty forgiving. . Very High: 8

Level One: 1

Level Two: 4

Level Three: 3

Fearful: 1

Preoccupied: 2

Dismissing: 0

Secure: 5

High: 13 Level One: 3

Level Two: 8

Level Three: 2

Fearful:6


Secure: 3

Total: 21


How do schemas change?How do schemas change?

• Two phases of treatmentTwo phases of treatment1.1. Assessment and educationAssessment and education

• Therapist conducts in-depth clinical Therapist conducts in-depth clinical interview and assigns Young Schema interview and assigns Young Schema Questionnaire. May also use imagery Questionnaire. May also use imagery techniques to assess for schemastechniques to assess for schemas

• Goal is to identify the schemas and coping Goal is to identify the schemas and coping styles that are most important in the styles that are most important in the client’s psychological make up and link client’s psychological make up and link schemas to presenting problemschemas to presenting problem

• Therapist educates the client about how Therapist educates the client about how schemas form and helps foster connection schemas form and helps foster connection to the feelings that surround each schemato the feelings that surround each schema

How do schemas change?How do schemas change?• Two phases of treatmentTwo phases of treatment

2.2. ChangeChange• Therapist uses cognitive, behavioral and experiential Therapist uses cognitive, behavioral and experiential

techniques (as well as the therapeutic relationship) to help techniques (as well as the therapeutic relationship) to help the client begin to heal schemas and alter maladaptive the client begin to heal schemas and alter maladaptive coping behaviorscoping behaviors

• Cognitive techniquesCognitive techniques• Efforts to restructure thinking related to schemas and develop Efforts to restructure thinking related to schemas and develop

a healthy voice to challenge maladaptive thoughtsa healthy voice to challenge maladaptive thoughts

• Behavioral techniquesBehavioral techniques• Practice new behaviors and rehearse for interpersonal Practice new behaviors and rehearse for interpersonal

interactionsinteractions

• Experiential techniquesExperiential techniques• Engage in emotive exercises to vent anger, grieve early pain Engage in emotive exercises to vent anger, grieve early pain

and empower the clientand empower the client

• Therapeutic relationshipTherapeutic relationship• Therapy relationship provides limited re-parenting, as well as Therapy relationship provides limited re-parenting, as well as

opportunities to examine and address schemas triggered in opportunities to examine and address schemas triggered in sessionssessions

Suggested Readings and Suggested Readings and ReferencesReferences

• BooksBooks– Schema Therapy: A Practitioner’s GuideSchema Therapy: A Practitioner’s Guide by by

Young, J., Klosko, J., and Weishaar (2003)Young, J., Klosko, J., and Weishaar (2003)– Reinventing Your LifeReinventing Your Life by Young, J. & Klosko, by Young, J. & Klosko,

J. (1993)J. (1993)

• ArticlesArticles– Avoidance and Shame: A Schema-focused Avoidance and Shame: A Schema-focused

Approach to the Treatment of Sex AddictionApproach to the Treatment of Sex Addiction by Ranger, T. (2009)by Ranger, T. (2009)

• WebsitesWebsites– www.schematherapy.comwww.schematherapy.com

the sex addict’s schema and the drive to act out

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