SCHEMAS IN THE COGNITIVE AND CLINICAL SCIENCES:
AN INTEGRATIVE CONSTRUCT
Dan J. Stein
Dept of Psychiatry,
College of Physicians and Surgeons and the
New York State Psychiatric Institute,
722 W 168 St,
NY, NY 10032
Correspondence concerning this article should be sent to Dan J.
Stein, M.B., Psychiatric Institute, 722 W 168 St, NY, NY,
10032.
Key Words: Schemas, Cognitive science, Psychotherapy
integration
Running Head: Schemas and Integration
Acknowledgements: Several anonymous reviewers deserve thanks
for their extremely helpful comments on earlier drafts of this
manuscript.
ABSTRACT
This paper is concerned in general with the
intersection of cognitive and clinical science and
in particular with schema theory. The use of
schema theory in the various subdisciplines of
cognitive science, as well as by cognitive-
behavioral clinicians and psychoanalytically
oriented clinicians is reviewed. It is argued
that schema theory, in both cognitive and clinical
sciences, allows a focus on mental structures,
their biological basis, their development and
change, and on the way in which they direct
psychological events. Schema theory not only
enables important advances in different clinical
schools, but it allows central clinical themes to
be tackled in convergent ways. It is concluded
that the schema construct allows integration
within cognitive science, within the clinic, and
between the two.
INTRODUCTION
Psychology has over the last few decades
witnessed a cognitive revolution, and the
multidisciplinary arena known as cognitive science
has increasingly come to the fore as a possible
unifying paradigm for the various psychological
sciences and schools. Workers within philosophy,
neuroscience, developmental psychology, cognitive
psychology, and social psychology have begun to
use similar constructs (Gardner, 1985).
Within the clinic, however, there remains
reluctance to accept a unified model of the mind.
Diverse theories and practices abound.
Nevertheless, some have argued that rigorous
research techniques and sophisticated theoretical
ideas have combined to foster a climate for a
unified, eclectic theory and practice of
psychotherapy (Beitman, Goldfried and Norcross,
1989).
There are some constructs, moreover, that are
being employed not only in the subdisciplines of
cognitive science but also in the clinic, and
indeed cognitive science appears to constitute a
paradigm to which diverse clinicians are attracted
(Bowers and Meichenbaum, 1984; Colby and Stoller,
1988; Ingram, 1986; Horowitz, 1988; Ruesch and
Bateson, 1968; Williams, Fraser, MacLeod, and
Matthews, 1988). Perhaps the most widely known of
the constructs used within both cognitive and
clinical science is that of schemas. It has been
argued that schemas are a heuristic and useful
concept in cognitive theory (Fiske and Linville,
1980). In this paper the suggestion is made that
schemas may be a heuristic and integrative notion
in clinical science. The argument procedes by
noting how cognitive scientists have used schema
theory to focus on the structures of the mind,
their biological basis, their development and
change, and the way in which they direct
psychological events. The paper then demonstrates
that schemas have been used by clinical scientists
to focus on analogous issues. It is concluded
that schemas constitute an important construct
that fosters integration within cognitive science,
within the clinic, and between the two.
COGNITIVE SCIENCE AND SCHEMA THEORY
The paper begins with a review of the use of
the schema concept in the various subdisciplines
of cognitive science. An historical perspective
is employed; the review begins with authors who
were important in laying the foundations for
cognitive science, and moves to a consideration of
contemporary workers.
a) Philosophy
Cognitive science may be viewed as an
enterprise that is concerned with the ways in
which the structures of the mind allow
representations of the world, and the ways in
which they process such representations. The
question of the mind's representation of the world
has long been posed by philosophy, and philosophy
may therefore be considered the founding
subdiscipline of cognitive science (Gardner,
1985).
One of the greatest philosophers, Kant,
employed the concept of the schema precisely in
order to discuss the possibility of knowledge.
Kant attempted to go beyond the impasse between
the empiricists, who argued that knowledge has its
origins in the external world, and the
rationalists, who argued that knowledge is a
product of the mind. He argued that schemas
interdigitate between properties of the mind (the
a priori categories) and raw sensory data (of a
posteriori experience). "This representation of a
universal procedure of the imagination in
providing an image for a concept, I entitle the
schema of the concept" (quoted in Gardner, 1985).
In more contemporary terms, mental schemas are
activated by the external world, and
simultaneously provide an interpretation of it.
b) Neuroscience
Cognitive science acknowledges that structures
of the mind have a biological basis, and
neuroscience is therefore an important
subdiscipline of cognitive science. Furthermore,
the neurologists Head and Holmes (1911) were among
the first to use the concept of the schema.
These workers were interested in the spatial
perceptions of patients of their bodies, and
referred to the basis of these as the postural
schema. The postural schema integrated sensations
which were triggered by postural change. In
lesions of the parietal lobe the schema may be
destroyed, with the possible outcome that patients
ignore part of their body, treating it as if it
were not their own. Conversely, an amputee may
have an intact brain schema, and therefore
experience movements in the missing phantom limb.
Today the more widely used term is the body schema
(Frederiks, 1969), and contemporary neuroscience
has advanced to the point where it can begin to
consider the biological underpinnings of more
complex schemas such as cognitive and affective
schemas (LeDoux, 1989).
c) Developmental Psychology
Although developmental psychology is not
usually considered one of the subdisciplines of
cognitive science, Piaget is one of the most
important figures in the prehistory of cognitive
science. The notion of the schema was central in
Piaget's work.
According to Piaget, the initial schemas of
the child comprise biologically based sensorimotor
reflexes which coordinate the child's interactions
with the environment. Gradually these biological
schemas allow adaptation to the environment by two
complementary processes. Via assimilation the
schema grasps some novel aspect of the
environnment, so modifying itself to cope with
the environment better. Via accomodation the
schema is differentiated and elaborated so as to
be consistent with the environment. With time,
the schemas are transformed to the point where the
organism reaches a new stage of development.
Piaget succeeds in providing a detailed
description of these transformations from the
point of sensorimotor schemas to the operations of
formal thought (Piaget, 1952).
d) Cognitive Psychology
The concept of the schema in contemporary
cognitive science is perhaps most directly
traceable to the work of the British cognitive
psychologist Bartlett (1932). Bartlett, a onetime
student of Head, was interested in memory, and in
particular in the notion that the context of an
experience had crucial effects on what was
retained and how well this was recalled.
Ebbinghaus had pioneered the experimental study of
memory using nonsense syllables, but this approach
did not seem adequate to Bartlett's concerns. A
conversation with Norbert Weiner, one of the
founding figures in cognitive science, gave
Bartlett an experimental methodology for
developing his ideas. Weiner's idea was to use
the Russian Scandal parlor game in which a story
is passed around the room, and then the original
and final versions compared. Bartlett found that
subjects showed consistent patterns of error in
the recall of narratives. Thus, for example, an
American Indian narrative would regularly be
revised by subjects until it came to resemble a
Western tale. Bartlett developed the construct of
the schema to explain this, describing a schema as
a component of memory which is formed from
encounters with the environment, and which
organizes information in specific ways. Such
schemas aid the recall of a typical (Western)
narrative, but systematically distort the recall
of an unusual (American Indian) narrative.
Bartlett (1932) wrote,
"Remembering is not the re-excitation of
innumerable fixed, lifeless, and
fragmentary traces. It is an
imaginative reconstruction, or
construction, built out of the relation
of our attitude towards a whole active
mass of past experience....It is thus
hardly ever really exact, even in the
most rudimentary cases of rote
recapitulation, and it is not at all
important that it should be so. The
attitude is literally an effect of the
organism's capacity to turn round up
upon its own "schemata" and is directly
a function of consciousness."
He defined a schema as
"an active organization of past
reactions or of past experiences which
must always be supposed to be operating
in any well-adapted organic repsonse.
Whenever there is any order or
regularity of behavior, a particular
response is possible only because it is
related to other similar responses which
have been serially organized, yet which
operate not singly as individual members
coming one after another, but as a
unitary mass."
A variety of definitions of schemas have been
offered subsequently. Thorndyke and Hayes-Roth
(1979) describe three universal assumptions made
by different authors: that a schema is an
organization of conceptually related elements
representing a prototypical abstraction of a
complex concept; that a schema gradually develops
from past experience; and that a schema guides the
organization of new information. A schema
comprises an architectural element (its structure)
and a propositional element (its content).
Cognitive schemas are involved in cognitive
operations (e.g. encoding, retrieval), in which
cognitive events (e.g. thoughts, images) are
produced and processed. Schemas are highly
interdependent and hierarchically organised, they
may involve verbal or nonverbal-elements, and they
may be more or less open to awareness (Craik and
Lockhart, 1972; Ingram and Kendall, 1986).
Schema theory has proven valuable in
accounting for a variety of psychological
phenomena. Schema theory has been used in
contemporary studies of memory (Schacter, 1989),
concept representation (Smith, 1989), problem
solving (VanLehn, 1989), movement (Jordan and
Rosenbaum, 1989) and language (Arbib et al, 1987).
Schemas have been found to facilitate recognition
and recall, to influence speed of information
processing and problem solving and allow for the
chunking of information into more meaningful units
to enable inference about missing data, and to
provide a basis for prediction and decision
making. It is thought that schemas engender bias
by relying on confirmatory evidence at the expense
of disconfirming evidence, but that this process
maintains schemas (Rumelhart, 1984;
Meichenbaum
and Gilmore, 1984; Winfrey and Goldfried, 1986).
A variety of other constructs have been used
by cognitive scientists and their forerunners to
describe mental structures. Many bear a good deal
of family resemblance to the idea of schemas.
Notable examples include Abelson and Shank's
(1981) "scripts", Bandura's (1978) "self-systems",
Kelly's (1955) "personal constructs", Miller,
Galanter and Pribram's (1960) "plans", and
Minsky's (1975) "frames". The notion of the
connectionist network, currently extremely popular
in the field of artifical intelligence, has been
argued to represent a microlevel description of
the schema concept (Ben Zeev, 1988).
BETWEEN COGNITIVE AND CLINICAL SCIENCE
This review of the schema construct in
cognitive science demonstrates that schema theory
has been widely employed by cognitive scientists.
However, it may be objected that the very
diversity of the use of schema theory points to
the problematic nature of the schema concept.
Different cognitive scientists operationalize and
measure schemas in different ways. Similarly the
versatility of the concept may reflect only a lack
of theoretical rigor.
On the other hand the concept of schemas has
general heuristic value insofar as it allows
different cognitive scientists to theorize about
mental structures from the perspective of their
particular subdiscipline. The schema construct
allows different cognitive scientists to begin to
build an integrative framework that addresses such
questions as how the structures of the mind enable
representation, how they are based in biology, how
they develop and change, and how they account for
a variety of psychological phenomena.
Certainly there is room in schema research for
improvement in both empirical measurement and
theoretical rigor (Fiske and Linville, 1980;
Williams et al, 1988). Nevertheless, the
development of the schema concept as a broad
heuristic is important insofar as it represents a
move in cognitive science away from a molecular
and bottom-up approach (concentrating on the
elementary units of processing and on the
influence of the details of a task on
performance), and toward a molar and top-down
approach (highlighting the large-scale properties
of processing and the influence of strategies and
contexts on performance). Similarly schema theory
represents a move away from the laboratory and
artificial Ebbinghausian methodologies to a
concern with the investigation of day-to-day human
activity.
These shifts in cognitive science are
reflected in increasing interest in using schema
theory to investigate such phenomena as self and
other representation, and the representation of
emotion.
Schema theory has been applied to concepts of
the self by a number of workers (Markus, 1977;
Rogers, 1981). This research follows the line of
earlier work on schemas. Thus, self schemas are
viewed as generalizations about the self that
develop out of past experience and that organize
the processing of self-related information in the
social environment. This in turn results in
various forms of bias, but allows the maintenance
of a consistent self-concept (Greenwald, 1980).
Similarly a number of authors (Cantor and
Mischel, 1977; Fiske, 1981; Taylor and Crocker,
1982) have described evaluative schemas for
assessing others. In this kind of research,
schemas have been used as to explain such
phenomena as stereotypes and the reactions they
elicit.
Finally, schema theory has begun to grapple
with the problem of emotion. Early authors
suggested that affect and cognition are seperate
but interactive systems. Affect was argued to be
either postcognitive (Neisser, 1976; Mandler,
1975) or precognitive (Zajonc, 1980). On the
other hand, Leventhal (1982) and Greenberg and
Safran (1984) have offered schema models which
attempt to synthesize affect and cognition.
Leventhal (1982), for example, writes that
emotions "....can be regarded as a form of
meaning. They have significance for the person
experiencing and expressing them. Their meaning
has two aspects: they 'say' something about our
organismic state...and they 'say' something about
the environment". In this line of thinking,
schemas have both an ideational and an affective
component.
All these areas require further empirical and
theoretical development (Higgins and Bargh, 1987;
Klein and Kihlstrom, 1986). As cognitive
scientists begin to research these subjects, their
interests begin to approximate those of
clinicians. Let us move, then, to clinical theory
and practice.
CLINICAL SCIENCE AND SCHEMA THEORY
It has been demonstrated that cognitive
scientists use schema theory to address a number
of salient issues about mental structures. First,
structures of the mind enable representation.
Second, these structures are based in biology.
Third, structures develop and change. Fourth,
such structures may account for a variety of
psychological phenomena, including behavior,
cognition, and emotion.
With this range of issues in mind, it is not
difficult to see how schema theory may be useful
in the clinic. Psychopathology may involve, for
example, conflict (where underlying schemas are
somehow distorted) or deficit (where underlying
schemas are absent or underdeveloped).
Psychopathologists are interested, then, in
disturbed representations, in particular in
disturbances in representations of self, other,
and the interaction of self and other. Insofar as
these disturbances have a biological underpinning,
this too is of interest. The developmental
transformations which lead to such disturbances
are of course of great importance. Models of
psychopathology attempt to describe the psychic
structures that lead to abnormal behavior,
cognition, and emotion.
Similarly, psychotherapy may involve, for
example, transference (where the therapist is seen
through pre-existing schemas), resistance (where
pre-existing schemas undermine change) and
interpretation (where a meta-cognitive process of
disengagement from and reflection on the patient's
schemas occurs). Psychotherapists are interested,
then, in changes in representations of self and
other, and in the way in which psychotherapy leads
to such changes. Insofar as psychopharmacological
interventions help promote such changes in
representations, therapists will be interested in
how this occurs. Models of psychotherapy attempt
to describe the psychic structures that account
for various phenomena in psychotherapy that
involve behavior, cognition, and emotion.
While these concerns are common to different
psychopathologists and psychotherapists, many
concepts other than that of schemas are, of
course, employed to explain psychopathology and
psychotherapy. I want to show that although such
concepts may be useful, they may also be open to
transformation into, or subsumption under, schema
theory. It may be objected that this merely
constitutes the translation of different terms
into schema language. However, I want to argue
that schema theory allows different clinical
schools to include rigorous components of their
orientation and to discard less rigorous aspects,
and so enables advances in these schools.
Furthermore, schema theory fosters integration by
allowing central themes to be tackled in
convergent ways.
These arguments are made in the following
sections in terms of two divergent approaches in
modern clinical work, the cognitive-behavioral and
the psychoanalytic. Schema theory may be seen as
increasingly important in each school. It will be
suggested that schema theory enables important
advances within each school, and that it allows
important clinical themes to be considered in an
integrative way.
COGNITIVE-BEHAVIORAL THERAPY AND SCHEMAS
The initial behavioral model of
psychopathology and psychotherapy was that of
Watson. The exemplar discussed by Watson and his
students (Watson and Rayner, 1920) was the
induction and elimination of a fear of white rats
in an eleven month old boy, Albert B., with
techniques of conditioning and deconditioning. A
critique of this discussion is beyond the scope of
this paper, but it may be noted that such work
does not readily allow a focus on some of the
concerns that psychopathologists and
psychotherapists have been listed as having.
Mental structures are pointedly ignored,
constitutional factors are downplayed,
developmental processes are limited to those of
conditioning, and while behavioral events such as
phobias and learning are tackled, other complex
phenomena in psychopathology and psychotherapy
such as personality disorder, or resistance and
transferance, are ignored. It is not surprising,
then, that there has been a shift in clinical
behaviorism to more cognitive models.
While the early cognitive-behaviorists, such
as Ellis (1962), incorporated cognitions into
their theory, there was still a reluctance to
focus on the structures of the mind. Abnormal
cognitions resulted from cognitive distortions,
and the structures that produced cognitive
distortions were glossed over. There was a
corresponding neglect of the development of
cognitive distortions. It may be again be argued
that this view has difficulty in accounting for
complex kinds of psychopathology and for complex
phenomena in psychotherapy.
However, later cognitive-behaviorists have
become increasingly interested in structures of
the mind. Beck, for example, introduced the
schema concept in the context of depression (Beck,
1964, 1967), and more recently he and his
colleagues (1990) have elaborated the notion of
schemas in order to extend cognitive therapy to
the personality disorders. Other authors in the
cognitive-behavioral tradition have also employed
the notion of schemas (Arnkoff, 1980; Turk and
Speer, 1983; Goldfried and Robins, 1983; Greenberg
and Safran, 1984; Young, 1990), but Beck's is the
most extensive contribution.
Beck and his co-workers suggest that different
types of schemas have different functions. In
their view cognitive schemas are concerned with
abstraction, interpretation and recall, affective
schemas are responsible for the generation of
feelings, motivational schemas deal with wishes
and desires, instrumental schemas prepare for
action, and control schemas are involved with
self-monitoring and self-regulation. There are
also subsystems of schemas. Thus cognitive
schemas include schemas concerned with
self-evaluation and evaluation of others, schemas
concerned with memory and recall, and schemas
concerned with expectancies and predictions. They
argue that such schemas can be viewed as operating
in logical linear progression. A dangerous
stimulus activates a "danger schema", which in
turn activates affective , motivational, action,
and control schemas.
This framework is used to discuss development
and change. Schemas develop as a result of both
constitutional and environmental factors. A
particular schema may develop in response to
developmental experiences, or as a result of
identification with family members. Certain
patterns may be derived from or compensate for
such schemas. Therapists use cognitive, affective
and behavioral strategies to change cognitive,
affective, and behavioral schemas. Change
comprises a continuum from restructuring of
schemas to more subtle modifications.
This framework is also used to discuss
different kinds of psychopathology. Dysfunctional
thoughts, feelings, and behaviors are due to
schemas that produce consistently biased
judgements. The schemas of personality disorders
resemble those of the symptom disorders, but they
are involved in the everyday processing of
information, and are operative on a more
continuous basis.
Finally this model is used to discuss complex
aspects of psychotherapy. Schemas regarding
change, self, and others may impede therapy.
Schemas regarding the therapist may be labelled
transferance cognitions.
PSYCHOANALYTIC THERAPY AND SCHEMAS
Classical psychoanalytic theory posits that
psychopathology can be understood in terms of an
energetics model. Freud argued that the forces of
the unconscious are expressed, repressed, and
transformed, resulting in everyday behaviors and
in psychopathology. During development these
forces manifest in different configurations, and
developmental events may therefore affect later
dynamics in specific ways. Psychoanalysis leads
to insight into such dynamics, and allows for
their working through.
Modern analysts have increasingly rejected
this model, which is drawn from nineteenth century
science. Many have attempted to de-emphasize the
drive component of psychoanalytic theory, and to
focus on its relational aspects; on the self, the
object, and their interaction (Mitchell, 1988).
On this model, the past is important insofar as
previous relationships determine the nature of
future ones. Symptoms are explicable, for
example, in terms of relational deficits. Therapy
occurs within the context of an empathic
relationship, and so allows for growth.
Furthermore, in considering new models to
replace the energetic one, a number of
psychoanalysts have drawn on schema theory (Eagle,
1986; Slap and Saykin 1983; Wachtel, 1982).
Perhaps the most extensive contribution, however,
is that of Horowitz (1988, in press).
Horowitz (1988) suggests that every individual
has a repertoire of multiple schemas of self and
other. Self schemas include ways to gain pleasure
or avoid displeasure (motivational schemas),
positioning in relation to the world (role
schemas), and ways of helping a person decide
which of two motives to choose (value schemas).
Superordinate schemas that articulate self to
other schemas in ways that organize a script of
wishes, fears, and likely reactions are called
role relationship models. Schemas are applied
simultaneously along multiple parallel channels.
Shifts in schema activity are accompanied by
shifts in state of mind, and control processes
prevent the emergence of certain states of mind in
defensive fashion.
This model is again used to account for
development and change. Self-schemas develop from
a basis of genetic and environmental interaction.
Role relationship models develop in the context of
interpersonal behavioral patterns. Common issues
are those of love and care, power and control, and
sexuality and status.
The framework is also used to discuss
different kinds of psychopathology. Changes in
the environment may lead to a poor fit between
external reality and preexisting role-relationship
models. Emotional response to stress is due in
part to the discord between the new situation and
enduring schemas. In some people schemas and
patterns of control of schemas are inappropriate
and insistent. These constitute personality
problems.
Finally this model is used to account for the
phenomena of psychotherapy. In therapy the
schemas of the patient become manifest in the
role-relationship models between clinician and
patient. The therapeutic alliance allows the
patient to develop insight into such schemas, and
during a process of working through to gradually
replace or modify them.
AN INTEGRATIVE APPROACH
While schema theory may be increasingly
important in both cognitive-behavioral and
psychodynamic work, Beck and Horowitz approach
clinical theory and practice from widely divergent
positions. This is reflected in their assumptions
about schemas. Beck's view of schemas as
triggered in a linear fashion is consistent with
the focus of cognitive therapy on the automatic
cognitions that precede emotion. Horowitz's
division of schemas into motivational, role and
value schemas, on the other hand, reflects the
Freudian concern with the id, ego, and superego
structures. Furthermore, differences in
theoretical assumptions lead to divergent methods
for measuring schemas.
Nevertheless, as in the case of schema theory
in cognitive science, the schema concept may have
a broad heuristic value in the clinic insofar as
it allows different clinicians to approach common
concerns about mental structures, their
development, and their importance in understanding
psychopathology and psychotherapy. The work of
Beck and Horowitz on schemas converges on these
subjects.
This section attempts to illustrate the
heuristic value of schema theory in the clinic.
It is argued first that the cognitive-behaviorist
and psychoanalytic models each have distinct
advantages and disadvantages, and that schema
theory has potential for incorporating the
advantages and eschewing the disadvantages of
these schools. It is then suggested that schema
theory allows a number of important clinical
themes to be considered in an integrative way.
One advantage of behaviorism lies in is its
emphasis on a systematic and empirical approach.
The model presented here is consistent with the
idea that it is possible to study psychopathology
and psychotherapy in a systematic way, and to
provide empirical descriptions of psychological
phenomena. Clinicians have begun to devote
attention to the rigorous assessment of schemas
(Landau and Goldfried, 1981; Rudy and Merluzzi,
1984; Segal, 1988), and such methodologies are
important in research on the nature of
psychopathology and on the efficacy of
psychotherapy. Furthermore, while it may be
argued that the advance of clinical theory will
always be intimately tied to clinical practice,
schema theory allows for the incorporation of more
general experimental techniques and findings.
On the other hand, the cognitive-behavioral
tradition has increasingly chosen to theorize
about the mental structures that early
behaviorists wanted to ignore. Early cognitive-
behaviorists noted abnormal cognitions, but
continued to de-emphasize the structures
responsible for these cognitions, their
development, and their manifestation in the clinic
in the form of resistance and transferance.
Finally, modern cognitive- behavioral therapists
such as Guidano and Liotti (1983) have devoted a
good deal of attention to psychological
structures, to their development, and to their
importance in psychopathology and psychotherapy.
It is at this point that cognitive-behavioral
theory begins to employ a schema model.
In contrast to behaviorism, psychoanalysis
tackles mental structures without hesitation. In
many ways, Freud may be considered a cognitivist
who focused on mental structures, their growth and
change, and their consequences for behavior and
for the clinical situation.
On the other hand, Freud never really escaped
his natural science background. The theory of
drive permeates all his works. While the drive
model constitutes a good model for such phenomena
as movement and momentum, it fails to provide an
adequate account of the subtle meanderings and
manipulations of the mind. Drive and force are
too cumbersome for meaning and cognition.
Further, Freud's notion of drives is one which
conceives of the child's unconscious as identical
to that of the adult, and his notion of memory
traces is in terms of a passive perceptual
apparatus; his usual penetrating focus on
development and transformation blurrs at this
crucial point. Finally, the inherently conflicted
notion of an energy that is psychic exemplifies
Freud's failure to resolve the relation between
psyche and soma. Modern analysts have retained
aspects of drive theory, but have shifted their
emphasis to the construction of the self, of the
other, and of the space between them (Mitchell,
1988). This view rejects drives (as energetic or
psychological concepts), without going to the
opposite extreme of denying that psychoanalysis is
a science concerned with models. It is at this
point that psychodynamic theory begins to adopt a
schema model.
Given the kinds of approximations outlined
here, it is not surprising to find an overlap of
various techniques in clinical practice. Modern
cognitive therapists work with dreams and
spontaneous images (Young, 1990), while
psychoanalysts have become increasingly open to
the adoption of cognitive-behavioral techniques
(Wachtel, 1977).
Further, the possibility of increasing
theoretical integration emerges. By way of
example let us use schema theory to consider some
central focuses of psychotherapy - the
unconscious, drives and defenses, symptoms and
therapeutic change.
Insofar as schemas are not known to the
person, they are unconscious. The importance of
unconscious processes has become increasingly
apparent in cognitive science (Kihlstrom, 1988).
It is clear that the processes that take place out
of awareness are not only extremely important, but
can be scientifically described. While empirical
clinical research on the relation between schemas
and the unconscious is limited (Shevrin, 1988),
schema theory may be theoretically useful in the
clinic. Consider, for example, a female victim of
incest, who describes difficulties in
relationships with men, but who is largely unaware
of how these relationships reflect earlier
familial patterns. It is possible to
conceptualize this patient as having particular
schemas about herself, about men, and about her
interactions with men; schemas of which she may be
or less aware. Thus this patient may have schemas
in which atttention is given her by men only when
she is seductive, and in which all men are
untrustworthy. The patient may consciously deny
the presence of such schemas but nevertheless her
thoughts, feelings and actions may entail their
existence. Thus a clinical formulation is
constructed which posits particular unconscious
schemas, and which is employed to account for
consciously reported psychological phenomena.
This schema view of the unconscious discards the
classical analytic metaphor of the unfettered
beast lurking in the mind, as well as the modern
analytic metaphor of the damaged baby at the core
of the patient. It also departs from the
behaviorist avoidance of the unconscious. The
schema view, however, maintains the classic
analytic ideas of psychic determinism and of the
existence of unconscious processes, and also
conforms to the attempts of modern analysts and
behavioral-cognitive therapists to describe how
the past repeats itself unwittingly in the
present.
Insofar as schemas direct behaviors,
cognitions, and emotions in a particular way, they
result in repetitive patterns of behavior,
thought, and feeling. However, schemas develop in
adaptation to life, and can therefore be seen not
only as constrictive (defensive) but also as
creative (strategic). Thus in the patient
discussed earlier the schema in which all men are
viewed as untrustworthy, may have proved helpful
at home, but may have lead to inappropriate affect
in later relationships. Analysts may object to
this kind of thinking for it appears to downplay
the libidinal and aggressive phenomena which are
highlighted in analytic defense theory. Certainly
schema theory has only begun to theorize affect,
sexuality and aggression (Horowitz, 1988).
Nevertheless, the idea that schemas have defensive
and strategic aspects discards the classical
notion of energetic forces being defended against
by the ego, and downplays the modern analytic
emphasis on psychic deficit as accounting for the
repetitive patterns of the present. However, this
view can perhaps incorporate the classic analytic
concern with affect, as well as the modern
analytic and cognitive-behavioral emphasis on the
adaptive or strategic aspects of fixed patterns of
behavior, thought, and feeling.
Insofar as the behaviors, cognitions, and
emotions directed by schemas are abnormal, they
constitute symptoms. Psychotic symptoms may, for
example, point to the absence or lack of
development of certain symptoms (Perris, 1990).
Character symptoms may indicate the presence of
maladaptive schemas (Young, 1990). Dissociative
symptoms may point to a lack of integration
between schemas (Hilgard, 1977). Schemas in the
patient mentioned earlier may, for example, result
in personality features such as being overly
seductive, or being quick to anger. Further work
needs to be done on the way in which schema theory
acccounts for the range of clinical symptoms. It
is clear, however, that a schema theory of
symptoms contrasts with the classical analytic
notion of symptoms as dynamic compromise
formations, the modern analytic emphasis on
symptoms as the result of relational deficits, the
behaviorist concept of symptoms as
stimulus-response mediated, and the early
cognitivist description of symptoms as emerging
from cognitive distortions. Schema theory does,
however, follow psychoanalytic and
cognitive-behavioral theory insofar as they
emphasize the mental structures responsible for
symptoms.
What about therapeutic change? According to
schema theory, therapy involves an affective and
cognitive process in which a variety of techniques
are used to engage and explore schemas.
Subsequent events depend on the nature of the
pre-existing schemas. Some schemas may be
non-linguistic in nature, and these may then be
given a voice. Other schemas may be out of
awareness, and these may then be acknowledged.
The patient may be encouraged not to use a
particular schema or to develop compensatory
schemas (Ingram and Hollon, 1986). Alternatively
schema change can be fostered, either of more
superficial schemas or of deeper ones, using
emotive, cognitive and behavioral methods (Young,
1990). In the patient we have discussed, the
operation of schemas of seduction and mistrust
within the therapeutic relationship, and the way
in which they lead to particular thoughts and
feelings may be brought into awareness, and the
patient may be encouraged to practice new ways of
relating to others. This kind of theorizing
contrasts with the classic analytic model of cure
as the result of dynamic catharsis, the modern
analytic model of cure as the result of empathic
reparenting, and the cognitive-behavioral models
of reinforcement or relearning. Schema theory
nevertheless maintains the Freudian emphasis on
insight, the modern analytic emphasis on empathy,
and the cognitive notion of the remodelling of
mental structures. In similar vein, transferance
involves not so much a distorted neurotic
repetition, nor a genuine holding environment, but
rather an entry into and reshaping of the patterns
of the patient.
The cumulative effect of these sketches of the
clinical application of schemas hopefully
indicates the integrative potential of this
construct. Nevertheless much work remains to be
done. Each of these clinical sketches requires
theoretical expansion. Theoretical work at the
overlap of cognitive and clinical science, such as
the use of schemas to understand self and affect,
also requires further development (Williams et al,
1988). Furthermore, such theory must be
complemented by empirical research. If schemas
are to be accepted as real mental structures which
explain mental and clinical phenomena, then their
accurate definition, and documentation become
paramount. The operationalization and measurement
of deep constructs is, however, difficult (Segal,
1988). Schemas are measured only indirectly, for
example, by pencil-and-paper methodologies (Coyne
and Gotlib, 1986). Furthermore, different
cognitive scientists and clinicians have defined
schemas in somewhat different ways, with each
worker attaching his or her theoretical framework
to the construct. While schemas have a degree of
constancy, they may also be dynamic and
multifaceted, so exacerbating the difficulties of
the empiricist. In sum, both theoretical
innovation and detailed clinical observation will
be necessary in order to advance an adequate
account of schemas in the clinic.
SUMMARY
I have shown that schema theory is used by a
variety of cognitive theorists and clinicians. I
have suggested that schema theory allows a focus
on mental structures, their biological basis,
their development and change, and the way in which
they direct psychological events. These focuses
are important not only in cognitive science, but
also in the clinic.
Schema theory therefore allows cognitive
scientists and clinicians to conduct a convergent
discourse. Furthermore, schema theory may be
useful in allowing different clinicians to employ
a unified framework.
I have also indicated that a great deal of
work in both the cognitive and clinical sciences
remains to be done. Problems in the
operationalization and measurement of schemas
remain to be solved, and a variety of theoretical
areas need to be developed further.
Nevertheless, the use of schema theory in the
clinic opens up cognitive science to a whole
series of phenomena. The clinic confronts schema
theory with a variety of psychological structures
(cognitive and affective), processes (top-down or
molecular and bottom-up or molar), and forms of
representation (fantasies, dreams, hypnotic
recollections, hallucinations, delusions). Such a
confrontation benefits cognitive science insofar
as it shifts its focus away from the laboratory
and toward man in all his complexity.
Conversely, by looking at cognitive science,
clinicians may begin to incorporate empirical and
experimental methodologies. Cognitive theory may
provide a unified model of the mind to underpin an
unified clinical approach.
Hopefully this paper will encourage the
dialogue between the cognitive and clinical
sciences, and will encourage empirical and
theoretical research on schemas.
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