Impaired Autonomy and Performance: Suffering from Chronic Feelings of Worthlessness and Inadequacy

by Jennifer Martin Rieck, LCPC

Feeling defeated, inadequate, or uncertain, is not uncommon for individuals who experience symptoms of depression. Many individuals who come into therapy seeking treatment for depression often recognize the symptoms of feeling down and hopeless without understanding the beliefs they hold that underpin those symptoms. Treating mental health should not just be about medicating symptoms or slapping bandaids on people’s pain, but about unearthing the damaging messages that individuals have received throughout their lives and challenging negative automatic thoughts and core beliefs that have resulted from those painful messages.

Schema Therapy and Assessment

Schema focused Cognitive Behavioral Therapy focuses on assessment and treatment of hurtful messages and beliefs by looking at the eighteen most common Early Maladaptive Schemas that tend to show up in counseling offices. Schemas are uncovered in individuals by using an assessment called the Young Schema Questionnaire, or YSQ. Clients taking the YSQ assessment are asked to reflect on a variety of statements and rate how much or little they identify with each statement. The assessment is scored and clients receive results of low, medium, high, or very high on all of the eighteen different identified Early Maladaptive Schemas. The YSQ statements are reflective of a variety of schema domains having to do with one’s concept of themselves, others, relationships, and the world. Clients who have taken the assessment often report that they could easily see that they were relating strongly to certain sections of questions and not at all to others, which is often the case.

Impaired Autonomy and Performance Domain: Failure Schema

The Impaired Autonomy and Performance domain schemas have to do with beliefs one holds regarding their own self and their performance in the world. Schemas in this category include Failure, Dependency/Incompetence, Vulnerability to Harm, and Enmeshment/Underdeveloped Self. Each of these schemas come from receiving messages directly or indirectly by parents, relatives, or peers, or by forming beliefs following hurtful or damaging childhood experiences. Although there are four different schemas in this domain, this post will focus primarily on Failure schema. Although high scoring Early Maladaptive Schemas typically make sense in the context of each client’s childhood story, as they did have experiences or internalized messages leading to the schema formation, they can later become less obvious to the adult who continues to re-experience painful feelings and emotions related to them. For example, a highly successful individual who has achieved educational milestones and created the career that they set out to create might continue to feel inadequate and experience deep sadness, believing that they are a failure. Likewise, a person who got what their heart desired by marrying their greatest love and having a family, might continue to feel like they can’t succeed at managing their family despite being an excellent mother and wife by any reasonable standard. Perhaps, in the first scenario, this person was raised by a critical father who frequently gave their child the message that what they were doing was never good enough. Perhaps in the second scenario as a young adolescent this individual dropped the child that she was babysitting and was told that she would never be a good mother – a painful message that has never left.

Treating Early Maladaptive Schemas

Although most of us have low scores on some of the schemas assessed by the YSQ, low scores don’t typically impact us the way that high-scoring schemas do. After practicing Schema Therapy for many years I have witnessed the correlation between high scoring schemas and the emotional distress that they cause in individuals. Individuals who have many high scoring schemas across domains tend to have severe depression and anxiety, while individuals who only have a few low scoring schemas, typically have little to none. It becomes evident, then, that by healing schemas, individuals are likely to experience a reduction in both anxious and depressive symptoms. In the case of Failure schema, although an individual might cognitively understand that they are succeeding in life they just can’t shake the feeling of being a Failure which ultimately drives feelings of sadness and depression. Many people mistakenly believe that taking a medication for depression will alleviate their sadness and yet many times if depressive symptoms are being driven by an underlying schema, such as Failure schema, though a medication might put a floor on how low that depression goes, it isn’t likely to completely fix the depression and sadness as long as the individual’s Failure schema is still strong.

Using Schema Therapy to treat mental health symptoms involves several layers of work. First, individuals must honestly reflect on their feelings and attempt to honestly answer the YSQ form. This is sometimes problematic if individuals are over-thinking and dumbing-down their responses, or if they generally lack self-awareness or the ability to self-reflect. Once they have completed the YSQ the therapist will score it and go over the results, assisting the client in exploring the possible origin of their schemas, and providing treatment that will be most beneficial to that particular client based on their results. Treatment for Early Maladaptive Schemas is often two fold: helping individuals identify when their schemas are triggered and helping them to not act out of their schemas. When an individual’s schemas are triggered they experience strong emotions and often act on those emotions, unfortunately reinforcing the schema. It is important for individuals to learn to recognize emotions caused by schemas being triggered and to reality test those schemas rather than acting on the emotions.

When an individual’s schemas are triggered they experience strong emotions and often act on those emotions, unfortunately reinforcing the schema. It is important for individuals to learn to recognize emotions caused by schemas being triggered and to reality test those schemas rather than acting on the emotions.

For someone with a high Failure schema it is important for them to take the time to notice their depressive symptoms, connect their depression or sad feelings to an event that triggered their Failure schema, such as making a mistake at work or being criticized by someone, and then reality test the automatic thoughts and core beliefs that have come up because of the incident. Next, the client must reframe the harmful thoughts or beliefs based on facts. The individual with the successful career might say something like, “Yes, I made a mistake because I am a human, but that does not make me a Failure. Clearly I am not a failure as I have completed college, gotten my dream job, and am succeeding at it.” The mother and wife might say to herself, “I didn’t parent my child as well as I would have liked due to the fact that I am human and lost my temper, however that doesn’t make me a Failure. I can repair the situation and try again tomorrow.”

Although we can’t go back to our childhoods and relive them and we can’t change the mistakes that our parents or loved ones made, we can still heal to the point where we overcome mental health symptoms and challenge negative core beliefs and automatic thoughts. If we are diligent in taking the time to explore our emotions and symptoms, connecting them to the thoughts and beliefs that drive them, and intentionally challenging and changing our minds about ourselves we can allow the wounded child part or us to mature and grow and we can reparent our way to wholeness. We might always wish that things had been different for us or that we had received healthier and happier messages, but at the end of the day what we believe about ourselves is what makes the most difference when it comes to healing our mental health and loving ourselves well. Not only can we grow and heal ourselves but we can be mindful of the messages that we give to the children in our lives, recognizing that the words we say live on in the hearts of children long after we have moved on and forgotten about them.

For more on the Impaired Autonomy and Performance schema of Enmeshment read Enmeshment and Boundaries or Option and Obligation: Boundaries Mean Letting Others Choose.

For more on Vulnerability to Harm Schema, see Combat Dread and Anxiety by Combatting Vulnerability to Harm Schema.

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