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Therapeutic cross-breeding: EFT's approach to self-interruption splits applied to outdated coping modes in schema therapy

"The walls we build to protect ourselves become the prisons in which we live"   Alice Miller (adapted) 

Here's a blog post for "the anoraks"!  I mean that this post is mostly going to interest a rather limited group of psychotherapists but, hey, here goes.  This evening I'm due to go to a support group for therapists working with "Emotion-focused therapy (EFT)".  This has been an interest of mine for many years and I've written about EFT quite a bit on this blog - see, for example, "Emotion-focused therapy workshop series (first post): excitement and why am I doing this?" or simply search on "emotion-focused" in the "tag cloud"Although I'm primarily a cognitive therapist by training, I've pointed out before - e.g. in the post "Orlinsky & Ronnestad's 'How psychotherapists develop': three key recommendations for maintaining effectiveness" - that therapists seem to be more likely to thrive, maintain their enthusiasm, and help clients to better outcomes, when they stay theoretically broad & integrative in their approach.  And learning more about EFT over the years has helped in a whole series of areas of my work - for example in "Compassion-focused therapy" and challenging our "internal critic", and in working with trauma, abuse & complex PTSD.  Arntz & colleagues' very successful schema therapy also draws heavily on EFT - see their book "Schema therapy for borderline personality disorder" and extending the approach out to other personality disorders and to some chronic Axis I disorders as well - their recent publication "Schema therapy in practice"

At this evening's EFT therapists' support group, we have agreed to look a bit more deeply at "Self-interruption splits".  Last night I read over the fairly brief section on this particular two-chair technique in Elliott, Watson, Goldman & Greenberg's classic book "Learning emotion-focused therapy" (pp. 236-241).  The authors comment "In a self-interruption split, emotional expression is blocked or suppressed.  The experiencing part of the person begins to express a primary adaptive emotion or associated need or action but is interrupted by a self-censoring part of the person (the 'interrupter') that attempts to prevent the person from doing so.  In comparison to self-criticism splits, self-interruption splits typically have a larger nonverbal, bodily aspect and are sometimes expressed in an entirely nonverbal manner, such as a sudden headache or choking sensation.  Self-interruptive processes are formed at key developmental stages and generally are responses to environments that did not allow for the full expression of emotions and needs.  Although these processes are no longer adaptive, they continue into adult life and, at an automated level, prevent experience and expression.  They are learned responses designed to cope with an unsafe environment or an internalized lack of entitlement.  They are often accompanied by episodic memories that contain images of the time and location when the beliefs were formed."  The authors go on to discuss "Clinical indicators of self-interruption splits" suggesting that they may be relevant in a whole series of situations from inhibition of our ability to clearly express emotions & needs to others, to blocking expression of anger for fear of losing control (I remember this one & and my amazement at seeing it doesn't have to be this way in my early experiences of group therapy), to going numb/dissociating when remembering emotionally charged traumas, to the internalization of a whole series of taboos learned in childhood.

Now here's the thing.  My personal experience of the emphasis placed on "self-interruption splits" in EFT is that it's a rather dusty, infrequently used approach, much overshadowed by its big brother the "internal critic split".  And as I got up this morning, I thought "What about outdated dysfunctional coping modes" in schema therapy?  We're talking about the same kind of territory here.  The "Dysfunctional triad" diagram (see below) is one that I put together to help clients understand some of what we do in schema-focused work.  The dialogue between "Toxic beliefs" and "Wounded child" is very much an "internal critic split" approach.  This is well trodden therapeutic ground.  My impression though is that it's often harder to work with the deeply entrenched "outdated coping modes" - see the adapted Alice Miller quote at the top of this page.  These outdated modes are the prisons we can become so used to that we may hardly notice how they no longer protect us helpfully (for example from painful early family and school environments) but actually shrink our lives and keep us from flourishing.  And in schema therapy, as far as I have seen, the powerful dialogue techniques are largely focused on the "Toxic beliefs/Wounded child" dyad.  How about extending dialogue work to the "Outdated coping/wounded child" dyad by using a "self-interruption split" approach? 

Toxic parent-adult-child triad 
(this diagram is downloadable as a Powerpoint slide or as a PDF file)

I'm not going to go into the details of the EFT technique for "self-interruption splits" in this blog post.  I have already mentioned the helpful description in the book "Learning emotion-focused therapy" and there is information also freely available on the web.  It's the cross-breeding that I want to highlight here.  Biological cross-breeding often results in hardier, more thriving organisms.  I hope the same can be true through applying the not so widely used "self-interruption split" approach to the extremely common problems thrown up by outdated coping modes in schema therapy.  I would take the cross-breeding even further. Self-interruption work often looks particularly at how the block to expression occurs in the body.  How does this interact with our blossoming understanding of another field - "embodied cognition"?  See the post "Embodied cognition: posture & feelings" for more on this and, if you want to explore further, clicking on the "embodied cognition" tag will bring up a dozen or so posts.  It's time for breakfast ... but great to see how different fields (here EFT, Schema Therapy, and Embodied Cognition) can inform & enrich each other producing new applications that can be used to approach well-known & tricky therapeutic challenges.

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