Jeffrey E. Young: From Cognitive Therapy to Schema Therapy and Beyond

Jeff it's so nice to have you with us I know as a graduate student you are always interested in Psychotherapy and you even had a chance of having a class with the L great Arnold Lazarus can you take us back to those days and remember your excitement well I would say that I was interested in Psychology from a very early age like probably in childhood but um like in childhood I was always like the person who would listen to everyone else's not just problems or just talk to everybody particularly people I was close to so

I was like sort of like a I don't know born to listen to problems or absorb what people are thinking about and I think that's just a natural part of me and I think for many therapists it's a good um it's a good aspect of temperament to have already so for so for example when I we're looking to choose therapists for training I I'm look I look for people who have this like a natural uh I don't want to use the word talent but just say a natural interest or uh comfort in in in inter

in understanding people asking people about themselves and have a genuine interest and ability to do that so I would say it start so it's going to we're going to start with me way before then in high school I decided to start collecting psychological test so I started uh it was on some kind of Charity thing where we collected newspapers and then you gave him to charity but the thing is in one of the people's baskets was a c a test catalog a psychological test catalog so I wrote to them and made up a name of

who I was and which wasn't too great but in fact they started sending me tests I gave my friends the test and would keep records of what they scored on different personality Dimensions wow so already yeah this was at 16 years old probably great then uh then in college I continued being interested in test in psychological testing and particularly personality and happen to have a roommate it I don't I went to Yale as an undergraduate I don't think it was a coincidence but but my roommate was probably the only other person that I knew at

that age who was also interested in psychological tests and he's become actually a well-known psychologist Bob Sternberg so but we both continued our interest in that and I worked for educational testing service for one summer over the course of my co of college so there was that leading up to to leading up to it but now while I'm in college so of course I'm interested in Psychology and want to take psychology courses and one of the one of the years I'm there I think it was my sophomore year they have a guest lecturer a guest

faculty member who who T just there tempor like temporarily for the year and it happened to be Arnold Lazarus who at that point I had no idea who he was but I knew that I wanted to learn every approach there was even then to psych Psy both personality but more particularly to psychotherapy so in a way I guess I'd say he was my first formal exposure to psychotherapy in an academic setting and he was a very very inspiring lecture I mean charismatic yeah very charismatic extremely exactly and he would play you know like audio tapes

of him with with clients and you know and it was very it was exciting and it also had of course a theory behind what he was doing which I liked I don't like techniques without theories this was before his multimodal days right more the behavior therapy right well I'd say yes but it was I think it was in as in part of the developing transition right only because it was not at all I knew wal's model so I knew it wasn't pure walpi he was doing some other things in addition to it that I wasn't

sure where they came from but I didn't I knew they were not so you already noticed he was a traitor to the cost right yes exactly that didn't lose that didn't cause me to lose interest in wal's work but it did lead me to be extremely interested in Psychotherapy so I would say it was a major major turning point in that it took something that was a real interest just from early my early in life and made it into a more definite career choice I guess i' I really decided from that point on and also

decided that I wanted to take a rote of therapy more similar to his than to psychoanalysis which unfortunately at that time I hated really hated it I would read it and I think it was ridiculously it was convoluted it didn't it didn't have lot it did was not logical so I got very frustrated with it all later I came back to parts of it but early on I was I really couldn't stand psychoanalysis and would avoid anything with psych so and that continued until many many years later so um so I guess at that point

I sort of decided that I was probably going to do something in Psychology and grad and and go to graduate school and then I had my idea then was I would be a psycho a psychotherapist basically a psychologist um I didn't think of Psychiatry because I was not good at memorizing and I I don't I didn't like to wake up in the middle of the night so I knew that I was probably not going to do well in medical school and I could never get through a residency where I had to sleep late and be

on call so that wasn't even an option that's self- understanding it's good ex well then I took a year off in between college and graduate school try to decide where I wanted to go and what I decided was I wanted to find where the top people were doing interesting types of psychotherapy in any field any area of psychotherapy and see where they actually were and go and learn it from them it was always my idea that the best way to learn a therapy and I maybe it was because of the course with blazar was to

go to the person who was SCE yeah go to the source exactly so the the trouble is the source is can be in many different cities it so happened that walpi was in Philadelphia at the time minuchin for family therapy was in Psychotherapy Beck who I was knew about but not much at that time was also in Philadelphia so I made a decision to go to University of Pennsylvania primarily because they there were a number of psychotherapists who had like summer workshops or training programs could take in addition to what I was doing graduate because

I knew that graduate programs don't really teach psychotherapy but I wanted to learn Psychotherapy anyway so I had to do it I knew I'd have to do it outside of the actual graduate and you were able to go to w Center correct right so I spent I spent a summer I went to their summer training program this was very early well I say very early but I mean nowadays it would be considered very early sure because there were very there you know but all the main people in behavior therapy were either faculty or would be

coming all the time as guest lectures Ed got Ed right Edna and Edna by the way was in Philadelphia also at that time great so exactly so it was like I really got exposure to all of these people and me many of them I don't know many of them probably people wouldn't recognize anymore because it's been so long ago but it was a chance to get to know walpi which was interesting and his family I was also always interested in the personality of the person who developed therapies not just in the therapy yeah and Inter

to know to what extent was their model coming out of them and to what extent was it something they were deriving acade through some academic or theoretical or empirical way as opposed to their something coming from their own nature or their own uh personality this might bring us way to I don't want to get us off track it might bringing us later to something because I I know even from the 1990 book that you have I actually have it right here that that you you already quoted Theodore Millan and there's that great book by Theodore

that uh it's masters of mind I think in which he's also like doing comments on the personality of the people EXA exactly and I was always very interested in that and so personality even though the models I looked at I was studying were not about personality I was always interested in personality not to say disorders but just personality in general um more than I was in like axis what you axis one disorders even though the models were all doing axis one I didn't mind that much but anyway so so so I go I think I'm

gonna make the bridge like you were just about to do with is so you're in the W Center and you're in Philadelphia how do you remember the experience of reading cognitive therapy and emotional disorders by be for the first time right well that actually was going to be next because well in between by the way I did get a training from manin in Family Therapy which is very fascinating but I didn't want to really work with fam so anyway so then what happened was I was in the I was so at this point I'm in

graduate school and I've I've already taken wp's course although I still go going to weekly seminars but still and I happened to be in the bookstore at the University of Pennsylvania and looking at the I don't know whether it was the psychology section or looking at other psychology courses and Psychiatry courses that were that might have interesting books to read and there I happened to see Beck's book which was cognitive therapy and emotional disorders so I purchased it I had known about Beck but had never read anything and I would say that was another transformative

experience because there I found a model that came closest to what at that particular time fit me personally and I could relate to it in a way that I couldn't to wp's work although I liked wal's work but I couldn't connect to it but I felt like here's a here's a per he writes incredibly well it's extremely well-laid out model it looks inside the mind not just at behaviors so I I really was very affected by that look like you're pretty excited yeah exactly and I decided I wanted to do my dissertation based on that

so I call I I called Beck's Center which at that time had like six people in it and uh no no I'm s I'm sorry I'm wrong so what happened was then I was teaching a master's level course while I was in graduate school to Master's students and and you introduced his book into your class right right I introduced his book into the class and then one of my someone who's now a good friend but she was at she was working with Beck happened to go to the bookstore and look at she was looking at

the books and the psychology and she saw an actual his book ordered for a course which was extremely rare at that time because nobody really knew much about who he was and here was a course at pen you using his work so she told back about it I guess and then he called me and and asked would I come and have a meeting with him that's the first time meet this is the first time right so I came in we had a meeting I talked about the dissertation I was thinking about he asked how I

happen to see the book and how how I liked it and at the end of our talking he offers me a position he says when you're done with graduate school and if you first of all he agreed to be in my dissertation committee and second he agreed he wanted me to come and work with him after how happy were you yeah I was extremely happy because uh here I didn't even have to apply or go through a process and you know it was like a perfect position but I never realized at the time the impact

it would have on me and my whole career forever I mean it's it's still the major turning point in my career and as a as a parenthesis I knew that your dissertation I think was on cognitive therapy for loneliness right exactly what Drew you to that well loneliness had always been an issue for me all I'd say all my life um feeling maybe different from other people people in ways that I I couldn't actually Define what it was but yet I always would feel somewhat on the outside and I thought well here was an opportunity

to take uh this therapy that I was interested in and my interest in loneliness and put them together and that that's how I did it it wasn't because I thought loneliness was a specifically good fit for for for cogn therapy it was just because I I took two of my interests and put them together again the personal of the person pops up exactly exactly I always found it interesting that you did this topic of loneliness considering that you lately later developed what I think is an extremely Humane model so it's very interesting yeah well it

continues to be an interest a lot of the attachment Theory I got interested in C what came out of the interest in loneliness so so so so then you do the postdoctorate that backs and you train with him most people are familiar with the cognitive model but I'd be interesting for you to talk a little bit about what you learned from back as a person and as a therapist the Practical side yeah yes well actually I often tell people who who ask me that I think it's a shame that the textbook on cognitive therapy didn't

reflect better what Beck actually did as a therapist because he's a very very intelligent sensitive and skilled therapist but without all the structure that you you associate with the model in a good in a in a good way so he would he would be like a great even though he wasn't that old then but he looked old because he had gray hair even when he was younger so he'd be he always came across sort of like a grandfather he was extremely easygoing I often say he was like Columbo like he would act like he didn't

know very much why well why do you think you're depressed you you your life doesn't seem that bad why do you think it isn't the person with say he they'd say well you know I I just broke up with my husband oh that's terrible terrible what happened why did that how did that you know so it was like you didn't he didn't you could see the patient didn't feel that they were being like interrogated or a formal interview it was like he was talking to them but in his talking he was leading them to to

see a different perspective but he blended it so smoothly that you and there was no structure uhhuh so it was not at all obvious what he's doing and yet by the end of the session cuz he has a strategy in mind and you can see once you know the model you can see the strategy but the patient would never see it because it's done through this very very gentle gradual questioning that leads the patient to see have you ever thought about this or couldn't you think of it this way or something like that and so

it was amazing and I began to at I always have done actually I didn't mention by the way I also was very interested in Ellis before and i' gotten training from Ellis so here was something that Contra tremendous contrast in style to Ellis who I thought was very interesting but not a very good style I actually tried using with patients it was terrible but anyway so here was a style that I could actually you like mimic it almost with my own personality but using almost trying to trying to imitate the style and translated into me

cuz it I could see how how good it was and I think what I take away from Beck in in in watching him sitting in with him on sessions or sometimes through a mirror was not the model as as we see it in in the book um box the go what's the handbook of whatever it's called the main the main book on cogntive therapy it was the second the next book Handbook of the main Cy book but if you go back to cognitive therapy and emotional disorders that is his model that's how he operates and

through that and watching him I really learned you know how cogni therapy could be done by someone who was really masterful and I can't underestimate understate how intelligent he is how brilliant he is so and not only is he a wonderful therapist but he's a brilliant person which to be true in every area that I work with him on so I think a lot of people I guess they I guess it's not not shocking but on the other hand you might might people might have an idea of what he's like as a therapist it's very

different from what he's actually like as a therapist it's interesting that that interpersonal skill side wasn't so much explored in y books it's a shame exact right and and in fact because other people did most of the writing they recognized that to make it short to make it structured and easy to relatively easy to learn they could put a structure around it that even someone less skilled could still be able to learn and do it yeah but not with a finesse that Beck did it which but I ALS no I can imagine it made you

question how much of the model was effective because of the techniques and how much because of this interpersonal skills right and actually what it made me do was to that's true but also realized I knew I could by watching the session and then later rating tapes of therapists in different parts of the country for for outcome studies that it was clear that someone where their style was off or their inals were bad the model wouldn't work either yeah so that's that at that point I was developing that cognitive therapy rating scale to rate therapists and

I added in sections about the qualities of the therapist to be sure that that wasn't ited because I realized by then that you could be doing every technique correctly following the protocol and still get terrible results so one of my it's interesting that you mentioned Alice because he was for me very important and it's I've always wondered uh because we know about all these studies over the time about the importance of empathy and interpersonal skills Etc and I'm always surprised how was ell is effective even though I totally believe that he could be effective Ive

it doesn't fit with this general idea we have of interpersonal skills in some way exactly well I think what it is my own theory is he was only effective with people who live in New York it's an EXA it's an exaggeration it's a cluster point if you live in New York there are a lot of very intellectual sort of very rationally oriented and smart people in New York in Manhattan who were perfect fits for this model because they they weren't very they' cut off their emotions as I now look at it and they were in

a very logical rational world and his internal world and that's how model worked so when he'd interact with patients like that he did extremely well and and I would just say it's an example of having to find the perfect fit for someone who didn't care about the interpersonal components but you know would would would could learn through rational process without the emotional part I'm sorry for putting us a little bit off track no I'm always interested actually in that part of it anything about the emotional versus the rational is of Interest well I'm sure we'll

talk a little bit about that well when you were in back Center you were treating or seeing basically pure AIS one patients like depression I don't believe there are very many pure AIS one patients they were supposed to be pure AIS one patients um but in reality the number of a what we learned was the number of axis one patients who don't have personality issues is very small particularly yeah it's my opinion so certainly there is a subset like that where maybe you can think some some specific trigger problem happened in their lives they were

very healthy before then all of a sudden some tragedy happens and then they get depressed of course that there were some patients like that but most of patients had had issues in their lives before and this was just another episode of depression so it's great you're getting into that I've always been questioning about this and I even the you know Richard wesler I think was his name yeah sure he he had such a great sentence which was a therapists had we lived in a world with therapists with an Nexus One mind in an Nexis 2

world yes that's exact exactly what I think and in fact you know now in DSM M5 they don't separate them there aren't two axes anymore so which was a good decision but um when I taught schema when I was when I was introducing schema theapy although I we we always want to know what the axis one disorder was I'd make it always make it clear there it's a rare patient where you can work on axis one without working on schemas and personality Dimensions because they intersected so so but then having said that how satisfied were

you with the model then if most of the people coming in with supposedly XS one disorders but even now you're saying that even those people had characterological issues right well the thing is that some people even if they have character logical issues many people can still use the strategies and get better from this episode the problem is it doesn't necessarily keep them from having another episode but more importantly it doesn't necessarily make their life happy getting and this is something I learned from back actually through separate way is that being the absence of depression is

not the same as being happy in your life and what I always say to people and I I once said to ask backck I was saying I was asking him this was when I was in at his Institute and I was saying why is it that when you develop the Beck inventory there aren't items for every item why aren't there the positive ones like I feel good I feel great he says well we actually did that but they came out as two different dimensions the negative dimension of the negative did not was not on a

Continuum with the positive side which makes it clear that being happy is not the opposite of being depressed being non-depressed is the opposite of being depressed so it's important to realize that I was not satisfied having a patient go out end therapy have their depression gone I mean that was an accomplishment I thought that was worthwhile I still do but they still often were very unhappy their lives you know they had major life problems but they were no longer clinically depressed so to me so you still felt that even in the clinic absolutely yeah and

then when I went to Private Practice where the patients weren't screened at all in a private practice the way they were because they were screened for having major depression they couldn't screen at every personality disorder but when we did for depression in a private practice you have many more people who are subclinically depressed they have depression but it's more characterological like dymic disorder and many many more of the patients were like that and they would only have a minimal response to cognitive therapy and that's what I think was more of the transition when I moved

from a from a population that was primarily which was they were strongly depressed to ones where they were more like a typical Private Practice situation just like a like the normal patient population where you know a percentage are clinically depressed but a much larger number have depression but not enough to be clinical yeah so I guess this is at the time of the private practice or when you go to Private Practice is when you start hearing that often quoted phrase like yeah I can get the rationale intellectually but I still feel the same exactly I

that's what I put in that book you had 1990 was that's what I kept hearing from patients and of course it only would come up with what white an alcohol schemas because they wouldn't say that around like just everyday situations trying to show them where they were not looking at it properly but when I it might be something about self-esteem and I'd say well you know as you can s like all the evidence doesn't doesn't uh justify your feeling that you're a totally worthless person they say well like that makes sense objectively but I I

still feel like I'm totally worthless and no matter what I did that was any where cognitive or behavioral it wouldn't change that it was a pretty frustrating time as a therapist no right it was frustrating because but for me frustrating is challenging because okay it's Bor see it's it's boring if you do the same thing over and over again there's nothing challenging in the patient it can get boring doing therapy so in a way they were also the most interesting to me because I had to figure out what's missing in the model what do I

need to come up with what can I draw on to help patients where the cognitive therapy or behavior therapy were not enough and that's what led to developing the schema therapy really over a period of time well I think people know who know a little bit more about schema theapy know that of course you're influenced by bulby and attachment Theory there is a particular group of authors that I personally love that is not I think is not so well so much talked about these days and I wonder if you could say a little bit about

their influence which was guano guano yeah and I think I mentioned it in that book too they were a major influence although I'd never seen them do therapy so the problem was I'd like it to also be I guess it's another example of an abstract theory that I liked because it went deeper but on the other hand it was so so abstract you didn't know how itn't practice how would you how would you use it so as a theory it was extremely helpful as a transition from from cogni therapy into what I would eventually you

know call schema theapy I would say G on the Audi's work and attachment Theory were both extremely important influences and of course I have to touch on this your own gestal therapy right and that came that came a little later which is when I started gestal therapy and if you talk about something again that changed my whole work it was that and it was only tell you the truth although I had many sessions two main sessions cuz the first two sessions were just imagery work in which you'd have me like picture myself as a child

and all of a sudden I just pictured memories of very deep issues and that I had never ever remember because they things from five years old and seven years old and yet they were when I when I would when I was doing the imagery work the gal therapy which by the way doesn't do very much in it which was which we do much more in schema theapy but they don't do much they just elicit the image and do don't do that much once you're in the image it's like the cutting the wound exactly but that

was ex that by itself was extremely valuable because I could make a lot of the links to loneliness and to other things that I could never have done without the imagery because it cut through my logical style and went to my feelings and my emotions in a way through memories that I could never have gotten to and that's where that was a major component of schema theapy was having the emotion Focus or or uh you know emo emotionally oriented part of the therapy and so it it's very very the blending of the cognitive and the

attachment and the emotion focus and the therapy relationship is really was really probably by that time it's 1982 1984 something around there I already you know could had seen how they a way to integrate them when you saw for yourself in your own therapy the importance or the impact of this more experiential work did it shake your beliefs about the power of Reason over emotion in the way well that had already been shaken but I didn't have an alternative so the thing is I knew already that that logic and reason wasn't enough cuz I could

see that no matter what approach cogni cognition I use even in just inserting schemas if I did them in a logical way it helped but it's still left something miss something was missing so I was still not satisfied and my own belief in rationality had already begun to like lessen but the G the gestal therapy gave me a concrete alternative or a concrete way to crystallize what's missing so I would say that made something I was already aware wasn't enough yeah and then gave me what the other dimension was that I was missing so so

and did you have likeminded colle because you talk you were touching on topics that were basically unheard of in the CBT literature exactly was it kind of a solitary process developing the model well I'd say developing it was solitary but what I did was after I put together the the main pieces and by the way there is the reparenting thing if you want to get that because some point it's a very important part of the model and differentiates it from most any other integrative model but any case um I would say that what what happened

then is I I I was supervising people from Beck Center when I was in private practice so they'd come over some of them come over and get sessions from me as part of my arrangement with the with Beck Center but then I decided I set up a little group and we'd meet and I'd talk over we talk over cases but one that might fit this alternative model so we were actually working together to see like what so I could I didn't just have my own cases I would have their cases too and they would try

some of the things I'd suggest and say well this didn't work very well or when I tried to do the imagery this happened or so some of the techniques we developed as part of this learning group and a lot of them went on to actually become right you know cogn ists themselves and and and write their and write their own books and their own Liv yeah yeah yeah you introduced with this when you were doing this kind of work you introduced what I think was one of your one of your biggest contributions in a way

also to the CBT literature which is just the simple idea of emotional needs right and like this idea of emotional needs for many therapists from the CBT Camp was kind of disdained sometimes it's part of the demands of the the clients right well there were two things that the the two parts of schema theapy that were most controversial some of the some of the there was a tremendous backlash against the cognitive therapy Community when I presented schema therapy uh as a book and has started lecturing about it tremendous backlash some of them wouldn't talk to

me anymore they'd write me letters saying it wasn't that much different from cognitive therapy why did I have to give it a new name in fact it was Dan Goldman who who's a good friend who wrote emotional intelligence and we were talking he say why do you keep calling it cognitive Focus whatever I called at that time and he said this is a this is different it's not just cognitive therapy with a little bit of different it's a different therapy just give it another name and I said but I know people are going to react

badly to it and he said no you have it's it's the it's correct you need to do it cuz it's otherwise maybe politically it's could be good but it's not accurate and it's it's it's not presenting your model where it should be which is a different model so when as soon as I did that and dropped cognitive from it from the name and then started lecturing about it I got terrible back because I was like must have been Outcast for like five years which was very courageous because you were quite a personality in cognitive Camp

exactly well that's was happening is it like it it was pickly obvious that what's now now AB c a it was an aabt The Association for Behavior therapists and um it was OB because originally I'd been one of the main lectures all the time on cognitive therapy each year at their conference but then all of a sudden I didn't want to lecture anymore on cogn theapy because I was not doing schema theapy and what went on during that period was amazing because when I for a while they wouldn't ask me at to lecture at all

then they asked me to lecture and you have a split in the feedback half the people would hate it because they said this isn't cogn therapy half of them would love it and say this isn't this this is new this is something interesting so they didn't know what to do with it so it was a created a problem for me in both in the CBD Community but also in specifically within that organization and did you talk to back about it do you know his feedback on that um well I got his feedback through through other

people who were friends of mine who told them told them what to tell me so I got feedback indirectly okay but I knew that his basic feeling was that I mean like like many psychotherapists I think they're competitive and they the idea of something that's a different model they see as you know I don't know like competition for their model and I think that rather than just saying this is great to have something new which is how I am when I hear a new model I'm excited about it even if it's not mine I just

like a new model so uh but I've Le learned that most people who develop models they actually don't like new models a little bit threatened or right yeah exactly and I think that's what was happening the whole all the CBT people were feeling threatened by a new model yeah and but I think over 10 years time that change and they started incorporating major aspects of schema theapy into yeah uh into uh cogntive therapy but one other thing is that the which answering your question more directly the two biggest things they were uncomfortable with much of

it they would just say it's it's just the same as cogn theapy which it wasn't because schemas are not the same as cogn theapy but the bigger thing was that they didn't like reparenting limit limited reparenting and they didn't like needs yeah because why do you have to why do you have to insert a something you can't observe it's not empirically observable why do you have to insert it into your model what does it get you and of course if you don't deal with personality and you're only dealing with relieving axis one symptoms you often

don't need to get into needs or reparenting but as soon as you get like severe patients like borderlines or people with severe personality disorders if you don't have the idea of needs you don't understand why they're so damaged and what they need to get better they don't just need a correction in their thinking or in their emotions they need experiences in life that meet those needs and one of the ways to do it is through the limited reparenting but since if you don't accept the needs you can't accept the reparenting because they don't they're linked

together so I I actually think as a contributions to therapy it was the introduction of needs and the use of reparenting in addition to just the putting it together in in this particular way just the way themes I think those are the major contributions of schem theapy people who don't know could you just briefly mention what it is this reparenting yeah we call it limited reparenting because it's important because there were models that were called reparenting before that where the therapist literally tried to become like parent and the par the patient would call them daddy

or things like that and well and then there was a big a big case with a Harvard Professor who was doing that and her patient committed suicide oh God okay Terri terrible thing but any rate so limited reparenting is basically the idea that the therapist through G through getting history and doing imagery exercises figures out what of which of the core needs of a of the of the patient when they were a child were not met like the need to be listened to the need to be uh nurtured the need to be have limits set

there are many that we have we have like 18 needs like this and the thing is that the idea is that the the therapists often can can meet those needs to a limited degree within the therapy uh session and begin to change the schemas directly by meeting the needs in the session so if you know what needs weren't met you meet them during the session and we have ways that you can do reparenting for different for different needs it need you require a different kind of interaction with the patient to meet that need okay imagine

you training in yourself when the model wasn't developed in your kind solitary process trying to figure out the different needs and kind of reparenting needed for that exactly that's where borderline personal patients with BPD were so helpful because they they have almost every need almost every need they had as a child was unmet so if you want I if I wanted a group that there was a group of patients where just focusing on these patients I could see almost every need you learned the entire menu right you got the whole menu and you can try

out like you can find out what things are you not doing because when you try to do this and then they get angry at you you oh well so I frustrated something they wanted what was it then I'll find out why were you upset with me and then I can say oh that that's another need I didn't realize so I have to now figure out a way to meet that need too so I'd say the BPD patients were extremely helpful in in continuing to develop the reparenting idea and the needs yeah linking what you're just

saying with something a little bit earlier on going back to the X's one X's 2 thing yeah so when you read be Classics like uh cognitive therapy for depression or anxiety disorders and phobias do you still basically agree with the major Notions there or do you now just feel that something is missing like this more characterological work yeah that's what I feel there there's something missing it's a it's an in if you want to look at it it's a good complete model of cogni of the cognitive functioning yeah but there cognitive is only one component

of of understanding people and it's only the one component of changing of healing all psychiatric disorders so to the extent that you only want to look at the cognitive Dimension it's a good very good therapy but if you want to look at characterological dimensions other dimensions emotional Dimensions attachment Dimensions the model is missing all of those things so it's just it's an incomplete model if you try to look at the whole whole range of problems that come up for for patients with you know come in with psychiatric problems so but for the patients who only

need cognitive work and that's where most of their problem is it's a and you want and particularly if you're interested in shorter term change meaning just symptom symptomatic change as I say I think it's a still a good model but as a theoretical model it's it's it it's leaving out and I think many dimensions and of course the more and more work there is in Neuroscience the more evidence there is that there are major parts of how of the brain and information processing emotional processing that are just not in that model and I think a

lot of that although a lot of it's already in schema theapy but there's no model of the brain that explains it and I feel a lot of the Neuroscience is very helpful in sort of validating some of the constructs because a lot of them are do come up when they do like there's a field now called effective Neuroscience which is very interesting and in that field you have a real specific focus on the emotional components of of the brain and those are the ones that I feel are not adequately dealt with in in uh cognitive

therapy but I still think it's good for it's still good for Co it's good for Cog if you can focus just at the cognitive level I think all the books on cogn therapy are still good I remember what I felt more frustrated with I liked the I enjoyed always reading the books I always felt the lack of the developmental issue of how did we get here yeah right and that's of course where the needs came in because you see in order to have because I was I was very interested in Origins but I didn't like

the way way psychoanalysis looks at Origins and there was no model I looked at many models for childhood development and and Origins and none of them seemed to really be complete enough or give you they weren't really the kinds of Origins that were the pro things my patients had experienced that gave them their issues so I had to develop Origins to go with each schema but as I started to figure out what are the origins of the schema I would start getting back inevitably to a need that wasn't met so I let's say i' get

back to the origin of somebody who was let's say someone who could never get intimate with anybody I find that many of them would have extremely cold distant unaffectionate parents and then I'd say well why did what effect did that have on the child well then I said well there must be a need the child has to be nurtured to be someone to connect with them attached to them and that if that need wasn't met then the patient develops a schema then the schema leads to various symptoms in many cases or life problems yeah so

the needs and the developmental thing for me ended up being the same exploring developmental Origins and led me into needs and that's so to me if I feel if you don't understand the developmental origins of a patient's issues you don't understand the patient you haven't conceptualize and you will not be able bble to help them enough so to me it's like it's like essential part of doing Psychotherapy is to really and in a very specific way know what the developmentmental origins were not just you know they had a distant parent or you know there was

abuse it can't be General it has to be specific to the patient what did the parent do or not do and what need did that frustrate another thing I really enjoy about the model is sometimes giving importance to the schema of the therapists themselves right i' like to kind of like uh I wouldn't say challenge you but still a little bit of disclosure question in the sense that uh what are some of the schemas you might have had that you had to work on in order to do better therapy sure well I'd say that one

one obvious one was well some one of them I'd say was an B an advantage in doing cogni therapy because I could relate to it in patience but like say one of my main schemas is emotional deprivation which is the idea that of not being getting enough enough affection um warmth listening and empathy um and having had that as a schema and that as a childhood origin it wasn't an obstacle to doing therapy but in the opposite it actually allowed me to understand it better okay yeah and you see so sometimes having some schemas actually

help you many schemas help because when you have someone with that issue yeah if you've worked on it now so the problem becomes not do you have the schema it's have you ever resolved it and are you aware of it and if you have a therapist who has the schema doesn't know they have it and hasn't worked on it then they will not be able to meet the need of the patient the coord need of the patient because they don't realize they didn't get it so let's say before I was aware of that if I'd

had a patient I had a deprivation but I had a patient who also wasn't nurtured I wouldn't understand what it was they needed because I never got it myself so how could I then give it to the patient so that would be an example of of an issue yeah and I'd say in my but since by developing the model I had to work on the schema so in a way when you develop a model it's not that often you encounter a schema you that you have that you're not aware of but and if I did

then I'd add a new schema cuz I knew there was something I didn't I wasn't getting so I say the biggest thing is really the therapist understanding of their own needs and childhoods and schemas and having done enough work to correct it that they can then meet the needs of their patients and at this point I guess if I had to pick one that maybe a need that maybe wasn't met enough that's still creating problems with patients I would say I would say it's it's probably not a schema it's a temperament thing like I I

have a a slightly impatient temperament like I like to go fast and I have to learn to be patient I've learned over a long time to do but I think that's we do have some we do we do have a temperament is part of our model and some things are really not your schemas they're they're your nature your nature your your temperament still working on it yeah so I and that I'm still working on but I would say the schemas I've mostly worked on but most of the people we've coming in of course when they're

starting don't know their own schemas certainly have not gotten therapy or training to work on that schema and therefore there's almost always something and and I always say borderline patients trigger almost every schema so whichever one you're not aware of they will trigger and then we find out what's schema the therapist is not aware of and how to deal with it so exactly so it's an essential part of the model that the therapists know their own schemas and see how they're playing themselves out in the therapy session with particular patients and then do enough work

on themselves to be able to at least be able to meet that need for the patient even if they can't completely heal themselves at least they need to be able to to recognize it when they see patient and not let their own issues get in the way of providing good therapy so so je we're drawing here to close but also bringing up lots of things that you've been talking about uh if you were in therapy yourself now how would you describe your ideal psychotherapist um well of course it's a little different now because now that

I I have a model to understand myself that I use but you need to chemotherapist now yeah what if we if maybe it better to go back to if I hadn't developed a therapy said what before developing schema theapy if I were looking what would I look for in a therapist would what given what I now know yeah I guess I would say I'd look for a therapist who could meet my own unmet needs so to I need a warm I need someone warm not just not just impa not just I call it the role

of the therapist some people play the role of a therapist they know how to pretend to be warm or pretend to listen it needs to be someone who's very genuine very direct someone who will truly care someone who's loving if possible so I'd say for me that element of the personality is probably the most important single thing second I think is someone who's able to see patterns and I always say in what I've learned in schema theapy is it's your ability to spot patterns because when a patient comes in they don't tell you well here's

my schema what they do they give you lots of examples of things in their life and you can get examples from their childhood and you have to put them together into a pattern and if the therapist can't see your pattern they can't get you to change it so I think the ability to spot long-term emotionally based patterns would be an absolute necessity in a therapist work with me and then I would guess I'd say I'd want somebody who could understand Origins enough to help me at that make that connection make a connection why do I

have this pattern why am I having trouble with this so I could make a link that makes sense to me and then they have to have enough life experience and judgment to know what would help me solve it because it's separate you can understand it you can be warm but you've also got to figure out a way to get the patient and help the patient find Solutions and often those are relationship behav how you are in in relationships how you overreact or underreact to situations and so you need a therapist who's able to get down

to really specific things in how I interact with people or work or whatever and help me to make those changes seems like an active therapist also right they have to be they have to be active exactly but not skills not primarily skills oriented I need to feel understood and cared for and once I feel that I need guidance to help me say well like here's like a therapist who would say well look when I was in a relationship ex relationship when I was younger I did so and so and it had this effect then I

learned that if I did this instead or if I could show more say this instead of just keeping it myself they'd feel more loved so I think you need to find a way to express what you feel but don't say and express it to the person so they know what you feel toward them so let's practice that why let's pretend I'm your you know partner or whatever and now let's play how how could you express your feeling to them so they'd make it concrete they'd be telling me what to do and they'd be able to

to help me to do it so and and having said that how optimistic are you now days about deep schema change have you actually seen this happen a good number of times along the way yes oh yeah we've had if I hadn't seen deep schema change I would you wouldn't be doing it would be doing it yeah exactly so I would say that I see deep schema change all the time I don't mean every patient but I mean I see it all the time meaning there's always a significant percentage of patients that I see who

make deep schema change however I've learned that deep schema change is not usually getting rid of the schema and it's not usually being 100% healthy it's making significant schema change and in particular enough schem of change that allows you to deal with the world differently so sometimes you can deal with the world differently get your needs core needs met and develop good relationships without completely healing every schema you have but but at least when the SCH is it's adaptive but also if it is if it's still there and it gets triggered by something let's say

a a boss says or someone says I and I get and I overreact I can figure out that I overreacted and why I overreacted and then tone it down yeah so I couldn't stop I can't always stop the initial emotional trigger but I can change what I then do with that once I know the schema so in some cases my actual reactivity go if you really change the schema your reactivity to the situation goes way down yeah or isn't there anymore but in right I say all right I seen a lot of the time but

more frequently you get someone where the the reaction to the same situations that us is very much much lower very manageable and they understand it and then their life can be happy and that is the goal the goal is not to get rid of every schema it's to be able to weaken each schema that's Rel that's important enough that the patient can have a happy life fulfilling life healthy relationships that's really the goal but if there is not significant scheme of change in most patients with long-term problems you won't the patient's not going to get

better that's one last question that I still like to ask you uh I've asked all of our colleagues is what what advice would you wish to have received when you were starting out as a psychotherapist um I would have liked to have someone who already had a model so that I wouldn't known what I was looking for so I don't know that there was advice I already knew I wanted I already knew how important the therapy relationship was because when I'd go to look for a therapist I knew what I look I knew I was

looking for someone of a certain personality type I wasn't looking for any skills so that I already knew I guess if someone had said to me directly you don't understand emotion enough and you and because of the way you were brought up you haven't Incorporated emotion either into your own development or into your therapy yeah and therapy is not just about logic it's also about feelings relationships and closeness and you need to devel find a therapy or develop a therapy that allows you to balance your logical side which you already have with a more emotional

and I'd say attachment oriented side that would be something I think someone could plausibly have said to me back then that that that was known that would have helped yeah and they would have had to say it very forcefully because I would have argued about them logically and said why would you need it but I could have been convinced through many examples if they had pushed hard enough you could be logically convinced right exactly could be logically convinced enough to go and get help from someone who did that kind of therapy at an earlier point

in my life than waiting until I was in my 30s to do it Jeff this is a great opportunity to talk thank you so much great well it was great I'm glad to have an opportunity to share all of the different experiences I've had because I think and if it helps other therapists that's wonderful I'm sure it and also I'd say to therapist one more thing is always think of yourself as someone who potentially could develop a therapy or significantly add to approaches to therapy don't look at yourself as someone who just learns therapies always

look at yourself as someone in saying what can I contribute to therapy how can I Advance therapy either the theory or the technique in a way that would both help me and patients but also that I could teach to other people like many therapists either their modesty or they're they're getting locked into a model keep keeps them from thinking maybe I could actually either develop a model or make existing models better than they are that's spoken like a true integrationist yeah well exactly it is and it's also a true belief that people shouldn't stay shouldn't

stay stuck in any model or combinations of models that they have they should you it's not just finding other models it's you trying to figure out things that are missing and you trying to find Solutions either by your partly by yourself you don't always have to look to other people to find them sometimes you can find the answers inside you if you'll experiment and try things and be experimental thanks so much Jeff good talking I'm glad we had to talk Alexander