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Troubled Adolescents: Working Therapeutically using a Schema Focused Approach

by Dorothy Ojarikri(more info)

listed in psychology, originally published in issue 217 - October 2014

As a Clinical Psychologist who specializes in working with adolescents who have experienced multiple forms of physical and emotional trauma, I am always excited by therapeutic approaches which are particularly attuned to addressing the psychological problems with which these young people struggle. The young people I work with therapeutically have suffered life-changing and sometimes life-threatening experiences including physical, emotional, sexual abuse and neglect from parents and emotionally significant others, experienced domestic violence, suffered neglect of their physical, emotional and developmental needs as a consequence of their parents or primary caregivers own difficulties with substance abuse, mental health, personality and other problems or have simply been marginalized by their family who have prioritized their personal needs or those of someone close to them above those of the adolescent.

Young people continue to grapple with adolescent issues well beyond their teenage years and adolescence is particularly extended and problematic for those young people who have experienced physical and emotional trauma. Recent neurophysiological research has supported this view demonstrating that brain and hormonal development continues well beyond the teenage years until people reach their mid-twenties.  I work with adolescents in my private practice throughout their twenties and know that it is most appropriate to focus on individual needs rather than age.

Schema Approach

One therapeutic approach I have found particularly helpful in my work with adolescents who have experienced complex psychological trauma is schema focused therapy. Schema focused therapy was developed by the Psychologist Dr Jeffrey Young in the mid-1980s.[1] Schema therapy is a powerful psychotherapeutic model which integrates the most effective aspects of cognitive, behaviour, gestalt and object relations therapy into a dynamic psychotherapeutic model. Young first systematically defined the early maladaptive schemas/beliefs which people typically develop as a consequence of adverse life experiences within their formative years. More recently the schema model has defined the modes or emotional systems which dominate people’s lives as a consequence of past and sometimes current experiences for example, the punitive parent mode in which the adolescent re-enacts in their daily lives their experiences at the hands of a critical parent figure or assumes the angry child mode venting their frustration that their emotional or developmental needs went unmet. The best way to demonstrate the power of schema therapy as a psychotherapeutic model for treating adolescent distress is by sharing a case example of a client whose emotional problems were significantly helped by schema therapy.

Dear Anna*

You contacted me in deep emotional crisis several months having reached an impasse in your life. It was evident during our first telephone consultation how difficult it is for you to seek professional help as all of your life you have had to meet your own emotional needs without support. You were born and raised in China and came to the United Kingdom (UK) two years ago aged 22 to complete a business studies degree at a North West university. You described experiencing difficulties coming to terms psychologically with being diagnosed with the chronic health condition hyperthyroidism a year before we began working together. You also described feeling anxious and depressed particularly about your ability to succeed in your degree course.

It was evident when we began working together using a schema focused approach that your issues are complex. You were obsessive in your approach to academic study working 18 hours every day and prioritized succeeding academically above all other aspects of your life neglecting your physical and emotional health.  You initially regarded your obsession with academic study as a cultural issue commenting “all Chinese students have this problem”. There is some research evidence to support this view with regards to the higher expectations Chinese parents have for their children’s academic achievement, the higher levels of academic excellence and the higher rates of psychosocial distress experienced by Chinese students compared to their Western counterparts.[2, 3]

However, we both recognize that the issues you have struggled with are more complex than cultural expectations and that your parents are more critical and have higher expectations of you than most other parents of Chinese students known to you studying in the UK. You revealed that it was actually your father who chose your degree course because it was advantageous to the family business while your Chinese student peers chose their degree subjects.

You live with your Chinese partner Mark* who assumes responsibility for providing Chinese convenience meals for you both but you were eating only a few sweets or mouthfuls of food each meal when you began therapy with me. You are very underweight as a consequence both of your poor diet and hyperthyroidism. You are 5’9” but weigh only 7 stones at least two stones underweight for a female of your height and have been warned by your GP that you risk being unable to become pregnant. You are aware that you are underweight and were not consciously trying to lose weight or stay slim because of an eating disorder but because you have such high unrelenting standards concerning academic study and achievement that you did not consider eating healthy regular meals as important. Unfortunately when we began therapy you frequently vomited your thyroid medication because you were ingesting tablets on an empty stomach further risking your health.

Your fellow students regularly approach you for academic support but you find their requests overwhelming and have no social friendships with your student peers. You achieved a first class grade in your second year exams but are of the opinion that you are not intelligent “I just work hard”.

You have clearly suffered emotional harm as a consequence of your parents’ desire for you to achieve academic excellence and one of your primary early maladaptive schemas is in respect of the high unrelenting standards that you have concerning academic success that has caused you to experience anxiety, depression and anger about studying and to neglect your health. You have found it very painful to come to terms with your hyperthyroidism because your GP warned you during your first year that you risked thyroid disorder if you continued to neglect your health. Unfortunately you experienced too much emotional conflict about academic success to reduce the amount of time you spent studying and lead a healthy lifestyle because you were fearful of disappointing your parents who did not have the opportunity to attend higher education but have since been highly successful in business.

You suffered emotional abuse and neglect within your family of origin throughout your childhood in China. As a child and now as a young woman you continue to be marginalized by your wealthy parents because you are female and have a submissive temperament. Your parents have always favoured your younger brother Sam* who is a stereotypical extrovert male and will pass the family business onto him.  Sam is not placed under extreme parental pressure to succeed and is celebrated as rebellious adolescent who disrespects his parents and refuses to study. Your partner Mark similarly secretly dropped out of his business studies degree unbeknownst to his parents this academic year and spends his time playing computer games and socializing with friends. You believe that his parents will resolve his failure by buying him a degree whereas your parents would shame you for disappointing them.

The emotional harm you have suffered extends well beyond the preference for male children within aspects of Chinese society. You were sent to live with an elderly teacher and her husband between the ages of 5-14 and rarely visited by your family. It is unusual in China for children to be sent to live with non-relatives and resulted in you developing early maladaptive schemas concerning abandonment, mistrust and abuse and social isolation which continue to affect you today. You were never allowed to play with toys as a child and your development and creativity were stifled. The elderly husband with whom you resided subjected you to repeated sexual abuse at night throughout puberty and you describe being too fearful to reveal this to your partner or family because of the taboo about sexual abuse within Chinese society. You blame your parents for your having been the victim of sexual abuse rather than the perpetrator because their abandonment left you vulnerable to abuse.

You have begun making positive life changes through therapy. You now eat regular meals, enjoy exercise and have gained half a stone in weight. Finally you have developed insight into the futility of the critical parent mode you had internalized which had dominated your life. You now recognize that your parents would criticise you for achieving a first class honours degree at Oxford University as they negatively compare your attainment with that of a Chinese student who achieved a first this from a US Ivy League university! You have chosen to work together with your Uncle, who respects your intelligence, in his international business because you know he will be a supportive mentor and build your interpersonal skills and confidence.

Best Regards

Dr Dorothy Ojarikri

Clinical Psychologist

References

1. Young, J.E and Kioski, J.S,. Reinventing Your Life: The Breakthrough Program To End Negative Behaviour and Feel Great Again. Penguin, Putnam. USA. 1998.

2. Crystal, D.S, Chen, C., Fulgini, A.J, Stevenson, H.W, Hsu, C.G, Ko, H.J and Kilharus, S.,. Psychological maladjustment and academic achievement: a cross-cultural study of Japanese, Chinese and American high school students Child Development. Jun 65 (3): 758-63. 1994.

3. Li, G., Chen, W., Duanmu, J. Determinants of International Students’ Academic Performance: A comparision between Chinese and other internal students. Jorurnal of Studies in International Education. 14 (4): 389-405. 2010.

Further Information

Written by Dr Dorothy Ojarikri Chartered Clinical Psychology and Director of UK Private Psychology Ltd.  Please visit Expert Psychology Services and  Affordable Psychology Services.

 

* Names have been changed to protect the person’s identity.

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About Dorothy Ojarikri

Doctor Dorothy Ojarikri Chartered Clinical Psychologist is Director of UK Private Psychology Limited. She specializes in working with young people and adults who have experienced psychological trauma. UK Private Psychology is registered with the BPS  and also listed on the Counselling Directory.  Further information on UK Private Psychology and Doctor Dorothy Ojarikri can be found at Expert Psychology Services and Affordable Psychology Services. UK Private Psychology are registered with the Health & Care Professions Council and Networking Community of Psychologists in Independent Practice.

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