Domain I: Disconnection and Rejection Domain
Typical Presentation of the Schema
The common emotions are chronic anxiety about losing people, sadness, and depression when there is an actual or perceived loss, and anger at the people who have left them. (In more intense forms, these emotions become terror, grief, and rage.) Some patients even become upset when people leave them for short periods of time. Typical behaviors include clinging to significant others, being possessive and controlling, accusing others of abandoning them, jealousy, and competitiveness with rivals – all to prevent the other person from leaving. Some patients with an Abandonment schema avoid intimate relationship altogether, in order to avoid experiencing what they anticipate to be the inevitable pain of loss. (One patient with this schema, when asked why he could not make a commitment to the woman he loved, answer: “What if she dies?” Consistent with the schema perpetuation process, these patients typically choose unstable significant others, such as uncommitted or unavailable partners, who are highly likely to abandon them. They usually have intense chemistry with these partners, and often fall obsessively in love.
Goals of Treatment
Their linked schemas are usually diminished as well. Because they feel less subjugated, or dependent, or defective, abandonment is not as frightening to them as it used to be. They feel more secure in their relationships, so they do not have to cling, control, or manipulate. They are less angry. They select significant others who are consistently there for them, and no longer avoid intimate relationships. Another sign of improvement in patients with this schema is that they are able to be alone for extended periods of time without becoming anxious or depressed, and without having t o reach out immediately and connect to somebody.
Strategies Emphasized in Treatment
The more severe the Abandonment schema, the more important the therapy relationship is to the treatment. Patients with BPD typically have Abandonment as one of their core schemas, and, therefore, the therapy relationship is the primary source of healing. According to our approach, the therapist becomes a transitional parent figure – a stable base from which the patient can venture into the world and form other stable bonds. First, the patient learns to overcome the schema within the therapy relationship, and then transfers this learning to significant others outside of therapy. Through “limited reparenting,” the therapist provides the patient with stability, and the patient gradually learns to accept the therapist as a stable abject. Mode work is especially helpful (I’ll talk about this some other time). Through empathic confrontation, the therapist corrects the patient’s distorted sense that the therapist is constantly about to abandon the patient. The therapist helps the patient accept the therapist’s departures, vacations, and unavailability without catastrophizing and overreacting. Finally, the therapist helps the patient find someone to replace the therapist as the primary relationship – someone stable, who is not going to leave – so the patient is not dependent forever on the therapist to be the stable object.
Cognitive strategies focus on altering the patient’s exaggerated view that other people will eventually leave, die, or behave unpredictably. Patients learn to stop catastrophizing about temporary separations from significant others. Additionally, cognitive strategies focus on altering the patient’s unrealistic expectation that significant others should be endlessly available and totally consistent. Patients learn to accept that other people have the right to set limits and establish separate space. Cognitive strategies also focus on reducing the patient’s obsessive focus on making sure the partner is still there. Finally, cognitive strategies address the cognitions that link to other schemas – for example, changing the view that patients must do what other people want them to do or else they are going to be left; that they are incompetent, and need other people to take care of them; or that they are defective, and other people will inevitably find out and leave them.
In terms of experiential strategies, patients relive childhood experiences of abandonment or instability in imagery. Patients re-experience through imagery memories of the parent who left them, or of the unstable parent who was sometimes there and sometimes not. The therapist enters the image and becomes a stable figure for the child. The therapist expresses anger at the parent who acted irresponsibly, and comforts the Abandoned Child; then, patients enter the image as Healthy Adults and do the same. They express anger at the parent who abandoned them and comfort the Abandoned Child. Thus, patients gradually become able to serve as their own Healthy Adults in the imagery.
Behaviorally, patients focus on choosing partners who are capable of making a commitment. They also learn to stop pushing partners away with behaviors that are too jealous, clinging, angry, or controlling. They gradually learn to tolerate being alone. Countering their schema-driven attraction to instability, they learn to walk away from unstable relationships quickly and to become more comfortable in stable relationships. They also heal their linked schemas: They stop letting other people control them; they learn to become more competent in handling everyday affairs, or they work on feeling less defective.
Special Problems with This Schema