VULNERABILITY SCHEMAS

OF INDIVIDUALS IN COUPLES
RELATIONSHIPS: A COGNITIVE
PERSPECTIVE
Terje Tilden
Frank M. Dattilio

ABSTRACT: The professional literature has recently given attention

to addressing individual schemas in couples’ relationships, with par-
ticular emphasis on the fact that individual vulnerability has a sig-
nificant impact on couples’ relationships. This article addresses how
this vulnerability can be restructured during the course of couples’
therapy. Case vignettes are used to illustrate how the model can be
applied. Some of the implications of this model are considered in the
discussion section.
KEY WORDS: vulnerability schemas; cognitive behavioral therapy; couple therapy;
systemic perspectives.

Cognitive therapy has gained status throughout the world as one

of the mainstream approaches to treating dysfunctional relationships
(Goldenberg & Goldenberg, 2000; Nichols & Schwartz, 2001). How-
ever, this has come only after several decades of evolutionary change.

Terje Tilden, MA, LCSW, LMFT, is in the Family Therapy Department, Modum Bad
Vikersund, Norway (tilden@modum-bad.no). Frank M. Dattilio, PhD, is in the Depart-
ment of Psychiatry, Harvard Medical School, Cambridge, MA, USA (datt02cip@cs.com).
Author’s note: Portions of this article were published in Norwegian by the first
author and appear in Nordby, T.T. (2002): Kognitiv parterapi. En tilnærming som iva-
retar betydningen av den individuelle sårbarheten i samspillet. Reprinted by permission
of Fokus på familien 30, 46–60.

Contemporary Family Therapy 27(2), June 2005 Ó 2005 Springer Science+Business Media, Inc. 139
DOI: 10.1007/s10591-005-4036-4
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CONTEMPORARY FAMILY THERAPY

By way of history, Albert Ellis initially introduced the notion of

applying pure cognitive techniques to couples relationships almost a
half a century ago (Ellis & Harper, 1961). Ellis and his colleagues have
continually emphasized the important role that cognition plays in
couples’ problems, based on the premise that dysfunction occurs when
partners maintain unrealistic beliefs about their relationship and
make extreme negative evaluations about the sources of their dissat-
isfaction (Ellis, 1977; Ellis, Sichel, Yeager, DiMattia, & DiGiuseppe,
1989). Also in the 1960s and early 1970s, behavior therapists were
utilizing principles of learning theory to address individual proble-
matic behaviors of both adults and children. Many of the behavioral
principles and techniques that were used in the treatment of in-
dividuals were soon applied to distressed couples and families. For
example, Stuart (1969), Liberman (1970), and Weiss, Hops, and Pat-
terson (1973) described the use of social exchange theory and operant
learning strategies to facilitate more satisfying interaction in dis-
tressed couples. Similarly, Patterson (1971), Patterson, McNeal,
Hawkins, and Phelps (1967) applied operant conditioning and con-
tingency contracting procedures to develop parents’ abilities to control
the behavior of aggressive children. Later, behaviorally oriented
therapists added communication and problem-solving skills training
components to their interventions with couples and families (e.g.,
Falloon, Boyd, & McGill, 1984; Jacobson & Margolin, 1979; Stuart,
1980).
Research studies confirmed the premise of social exchange theory
(Thibaut & Kelley, 1959), indicating that members of distressed cou-
ples exchange more displeasing and less pleasing behavior than
members of non-distressed relationships, and that behavioral inter-
ventions (e.g., behavioral contracts, communication training) designed
to shift the balance toward more positive interactions increase part-
ners’ satisfaction (see Epstein & Baucom, 2002 for a review). Findings
by researchers such as Christensen (1988) and Gottman (1994) have
identified the importance of reducing distressing avoidant behaviors
in addition to aggressive acts.
Couple and family therapists came to recognize the importance
of intervening with cognitive factors as well as behavioral interac-
tion patterns long before most major theories of family therapy
came into existence (Dicks, 1953; Haley & Hoffman, 1968; Satir,
1967). However, it was not until the late 1970s that cognitions were
introduced as an auxiliary component of treatment within a
behavioral paradigm (Margolin & Weiss, 1978). During the 1980s
cognitive factors became an increasing focus in the couples research
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and therapy literature. Cognitions were addressed in a more direct

and systematic way than in other theoretical approaches to family
therapy (e.g., Baucom, 1987; Baucom, Epstein, Sayers, & Sher,
1989; Beck, 1988; Dattilio, 1989; Epstein, 1982; Epstein & Eidelson,
1981; Fincham, Beach, & Nelson, 1987; Weiss, 1984). Established
cognitive assessment and intervention methods from individual
therapy were adapted for use in couple therapy to identify and
modify distorted or inappropriate perceptions, inferences, and beliefs
that partners have about each other (Baucom & Epstein, 1990;
Dattilio & Padesky, 1990; Epstein, 1992; Epstein & Baucom, 1989).
As in individual therapy, cognitive-behavioral couples interventions
were designed to enhance partners’ skills for evaluating and mod-
ifying their own problematic cognitions, as well as skills for com-
municating and solving problems constructively (Baucom & Epstein,
1990; Epstein & Baucom, 2002; Rathus & Sanderson, 1999).
Substantial empirical evidence has accumulated from treatment
outcome studies indicating the effectiveness of cognitive-behavioral
couple therapy (CBCT), although most studies have focused on pri-
marily behavioral interventions and only a handful examined the
impact of cognitive restructuring procedures (see Baucom, Shoham,
Mueser, Daiuto, & Stickle, 1998 for a review). There has been less
research on generic CBCT, with the predominant literature con-
centrating on applications with individual disorders such as schizo-
phrenia and child conduct disorders. Outcome studies have
demonstrated the effectiveness of behaviorally oriented family inter-
ventions (psychoeducation and training in communication and pro-
blem-solving skills) with such disorders (Baucom et al., 1998).
The growing adoption of CB methods by couples therapists
appears to be due to several factors: (a) research evidence supporting
their efficacy; (b) their appeal to clients, who value the proactive
approach to solving problems and building skills that the family can
use to cope with future difficulties; and (c) their emphasis on a col-
laborative relationship between therapist and clients. Recent
enhancements of CBT (Epstein & Baucom, 2002) have broadened the
contextual factors that are taken into account, such as aspects of the
couples’ physical and interpersonal environment (e.g., extended
family, the workplace, neighborhood violence, national economic
conditions). So, although CBCT has become an established theoreti-
cal approach, it continues to evolve through the creative efforts of its
practitioners.
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ETIOLOGY OF CLINICAL PROBLEMS

Within a CB model, etiological factors in the development of

clinical problems commonly include aspects of the spouses’ cognitions,
emotions, and behavioral responses (Baucom & Epstein, 1990;
Dattilio, 1998; Epstein & Baucom, 2002). The following are some of the
major components of these factors.

Automatic Thoughts, Underlying Schemas, and Cognitive

Distortions
Baucom et al. (1989) developed a typology of cognitions implicated
in relationship distress. Although all of these human cognitions are
considered normal, all are susceptible to being distorted (Baucom &
Epstein, 1990; Epstein & Baucom, 2002). The typology includes (a)
selective attention, an individual’s tendency to notice particular
aspects of the events occurring in his or her relationship and overlook
others; (b) attributions, inferences about the factors that have influ-
enced one’s own and the partner’s actions (e.g., concluding that a
partner failed to respond to a question because he or she wants to
control the relationship); (c) expectancies, predictions about the like-
lihood that particular events will occur in the relationship (e.g., that
expressing feelings to one’s partner will result in the partner being
verbally abusive); (d) assumptions, beliefs about the natural charac-
teristics of people and relationships (e.g., a wife’s generalized
assumption that men do not have needs for emotional attachment);
and (e) standards, beliefs about the characteristics that people and
relationships ‘‘should’’ have (e.g., that partners should have virtually
no boundaries between them, sharing all of their thoughts and emo-
tions with each other).
Because there typically is so much information available in any
interpersonal situation, some degree of selective attention is inevita-
ble. However, the potential for couples to form biased perceptions of
each other must be examined. Inferences involved in attributions and
expectancies also are normal aspects of the human information pro-
cessing involved in understanding other people’s behavior and making
predictions about others’ future behavior. However, errors in these
inferences can have negative effects on couple relationships, especially
when an individual attributes another’s actions to negative charac-
teristics (e.g., malicious intent) or misjudges how others will react to
one’s own actions. Assumptions commonly are adaptive when they
are realistic representations of people and relationships, and many
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T. TILDEN AND F. M. DATTILIO

standards that individuals hold, such as moral standards about

avoiding abuse of others, contribute to the quality of couples’ rela-
tionships. Nevertheless, inaccurate or extreme assumptions and
standards can lead individuals to interact inappropriately with others,
as when a parent holds a standard that the opinions and feelings of
children and adolescents are not to be taken into account as long as
they live in the parents’ home.
Beck and his associates (e.g., Beck, Rush, Shaw, & Emery,
1979; Beck, 1995) refer to moment-to-moment stream of conscious-
ness ideas, beliefs, or images as automatic thoughts; for example,
‘‘My husband left his clothes on the floor again. He doesn’t care
about my feelings’’ or ‘‘My parents are saying ‘no’ again because
they just like giving me a hard time.’’ CBT’s have noted how indi-
viduals commonly accept automatic thoughts at face value rather
than examining their validity. Although all five of the types of
cognition identified by Baucom and associates (1989) can be re-
flected in an individual’s automatic thoughts, CBT’s have empha-
sized the moment-to-moment selective perceptions and the
inferences involved in attributions and expectancies as the most
likely to be within a person’s awareness. Assumptions and stan-
dards are thought to be broader underlying aspects of an individ-
ual’s worldview, considered to be schemas in Beck’s cognitive model
(Beck et al., 1979; Beck, 1995; Leahy, 1996).
The cognitive model proposes that the content of an individual’s
perceptions and inferences is shaped by relatively stable underlying
schemas, or cognitive structures such as the personal constructs
described by Kelly (1955). Schemas include basic beliefs about the
nature of human beings and their relationships, and they are as-
sumed to be relatively stable, perhaps even becoming inflexible.
Many schemas about relationships and the nature of couples’
interactions are learned early in life from primary sources such as
family-of-origin, cultural traditions and mores, mass media, and
early dating and other relationship experiences. The ‘‘models’’ of self
in relation to other that have been described by attachment theo-
rists appear to be forms of schemas that affect individuals’ auto-
matic thoughts and emotional responses to significant others
(Johnson & Denton, 2002). In addition to the schemas that partners
bring to a relationship, each spouse develops schemas specific to the
current relationship.
Schemas about relationships are often not articulated clearly in
an individual’s mind, but exist as vague concepts of what is or
should be (Beck, 1988; Epstein & Baucom, 2002). Previously
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CONTEMPORARY FAMILY THERAPY

developed schemas influence how an individual subsequently pro-

cesses information in new situations, for example, influencing what
the person selectively perceives, the inferences he or she makes
about causes of others’ behavior, and whether the person is pleased
or displeased with the relationship. Existing schemas may be diffi-
cult to modify, but repeated new experiences with significant others
have the potential to change them (Epstein & Baucom, 2002;
Johnson & Denton, 2002).
In addition to automatic thoughts and schemas, Beck et al. (1979)
identified cognitive distortions or information-processing errors that
contribute to cognitions becoming sources of distress and conflict in
individuals’ lives. In terms of Baucom and associates’ (1989) typology,
they result in distorted or inappropriate perceptions, attributions,
expectancies, assumptions, and standards.
There has been much more research on attributions and stan-
dards than on the other forms of cognition in Baucom and associates’
(1989) typology (see Epstein & Baucom, 2002, for a review of findings).
A sizeable amount of research on couples’ attributions has indicated
that members of distressed couples are more likely than members of
non-distressed couples to attribute their partner’s negative behavior to
global, stable traits, negative intent, selfish motivation, and a lack of
affection (see Bradbury & Fincham, 1990 and Epstein & Baucom, 2002
for reviews). In addition, members of distressed relationships are less
likely to attribute positive partner behaviors to global, stable causes.
These biased inferences can contribute to spouses’ pessimism about
improvement in their relationships and to negative communication
and problem solving. One area of research on schemas has focused on
potentially unrealistic beliefs that individuals may hold about mar-
riage (Epstein & Eidelson, 1981). Baucom, Epstein, Rankin, and
Burnett (1996) assessed one major type of relationship beliefs, en-
compassing the relationship standards that individuals hold about
boundaries between partners, distribution of control/power, and the
degree of investment one should have in the relationship. They found
that individuals who were less satisfied with the manner in which
their standards were met in their couple relationships were more
distressed in the relationships and communicated more negatively
with their partners.
A central part of standard cognitive therapy involves formulating
an individual case conceptualization as demonstrated in Figure 1
(J. Beck, 1995; d’Elia, 2000).
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T. TILDEN AND F. M. DATTILIO

FAMILY-OF-ORIGIN AND

EARLY CHILDHOOD EXPERIENCES

SELF-CONCEPTUALIZATION SCHEMAS AND

PROTECTING / COMPENSATORY COPING STRATEGIES

CRITICAL EVENT / SITUATION THAT ACTIVATES / TRIGGERS

MALADAPTIVE SCHEMA AND COPING STRATEGIES

AUTOMATIC THOUGHTS

FEELINGS AND BEHAVIOR

FIGURE 1

Individual case conceptualization

Case Example

Sue, a 42-year-old, married teacher, suffered from symp-

toms of depression, which appeared to be connected to nega-
tive thoughts that she maintained about herself (‘‘I am
worthless’’). Sue tended to generalize these feelings to her
surroundings or global issues (‘‘Nobody cares about me.
Everything is meaningless.’’), and toward future events as
well (‘‘Everything is hopeless.’’). Gradually, Sue became iso-
lated, withdrawing from others and overeating in order to
comfort herself (behavior). This vicious cycle became evident
after examining an upsetting quarrel that Sue had with her
husband (critical event/situation) where he, in affect, told
her that he no longer had any desire to be a part of her life.
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CONTEMPORARY FAMILY THERAPY

What clients often present as the chief complaint in therapy

involves unpleasant feelings/symptoms, (automatic) thoughts and
maladaptive behaviors, as a result of a critical event/situation. From
a cognitive perspective, a therapist will usually investigate this
relationship as much as possible and develop a conceptualization of
what elements evolve into a vicious, self-perpetuating cycle. In
developing such a conceptualization, it is important to understand
how Sue’s history and experiences have contributed to her own
efforts in helping herself. However, where these solutions cause
repeated patterns, the cycle of maladaptive behavior repeats itself.
This pattern may be functional to some degree for Sue, but, in turn,
is maladaptive to her relationships. Such a pattern may include the
dynamics of her individual vulnerability (core concepts of self
and maladaptive schemas) and her self-protection or compensatory
coping strategies.

Sue’s childhood and adolescent history was characterized by

unsafety and uncertainty, and as reported on the Young
Schema Questionnaire (YSQ) (Young and Gluhoski, 1997),
she suffered from the maladaptive schema of ‘‘Abandonment
/Instability.’’ This experience fostered negative assumptions
such as, ‘‘If I don’t agree with others who are significant to
me, I end up getting rejected.’’ As a way of protecting herself
against possible rejection, Sue uses the self-protection sche-
ma of ‘‘Emotional Inhibition/Overcontrol.’’ As a result, she
abides by certain mantras, such as: ‘‘I need to turn my coat
against the wind’’ and ‘‘speech is silver, but silence is gold.’’

It is very important that patients such as Sue are socialized to the

cognitive model in order to develop insight into the use of the model
and to use her own life events as a basis for the upcoming challenge to
her automatic thoughts. The subsequent step involves challenging the
patient to undertake different and more adaptive action where
behavioral experiments may stimulate accommodation.

Sue was challenged to test out whether the negative auto-

matic assumptions that were associated with her automatic
thoughts are true. She was urged to practice reorganizing
her own needs, feelings, wishes, opinions and expectations.
Therapy was centered on helping Sue to accept these as
legitimate, and further to increase her understanding of
how her history has contributed to a lack of validation of
her genuine feelings, needs, and expectations. Sue was also
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T. TILDEN AND F. M. DATTILIO

encouraged to practice expressing her feelings toward her

significant others.
Even though the focus of treatment is mainly here-and-now,
knowledge of the historical events that represent the origin for these
maladaptive schemas may facilitate a deeper understanding and
better way of processing Sue’s individual vulnerability. However, in
brief therapy, the aim typically is primarily to become familiar with
one’s own use of coping strategies that are connected to the
maladaptive schemas. Initially, the origin of the vulnerability and the
reason for her use of coping strategies must be acknowledged. If, after
this socialization, the patient agrees that the established coping
strategies represent unwanted consequences (the solution has become
the problem), this will strengthen the motivation to move toward a
critical position, both concerning the need of this schema and how the
coping strategy has become a matter of personal style. Investigating
and experiencing other, more adaptive coping strategies in the inter-
play with significant others will provide the patient with new knowl-
edge as to how she is perceived by the family and in other close
relationships. From a systemic perspective, this model has a relational
focus that fits well with relation-oriented therapies. Enhancing the
relational interplay with the aid of more adaptive coping strategies
will, it is hoped, contribute to a reduction in—or healing of—the ori-
ginal individual vulnerability.

Schema-Focused Cognitive Therapy

Young and Gluhoski (1997) developed a more specific variant of
treatment from the standard cognitive model, which is termed sche-
ma-focused cognitive therapy. Maladaptive schemas are defined by
Young as ‘‘broad, pervasive themes regarding oneself and one’s rela-
tionship with others, developed during childhood and elaborated
throughout one’s lifetime, and dysfunctional to a significant degree.’’
Young developed the YSQ as a specific measure for recording mal-
adaptive schemas.

Vulnerable Core Schemas and Protective Coping Schemas

Schemas may be conceptualized in two ways: (1) the vulnerable
core schema, or what Hoffart (1999) refers to as a split schema of self,
or a ‘‘wound’’ in the memory, and (2) the protective coping schema (or
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CONTEMPORARY FAMILY THERAPY

what Hoffart refers to as a protective belt of associated schemas

around the split schema of self). Welburn, Dagg, Coristine, and Pon-
tefract (2000) also differentiate among the schemas according to
assessment of hierarchy where some are regarded as having principal
importance due to the nature of basic needs, such as safety and
attachment, and others related to the principal schemas.
Vulnerable core schemas have mostly been established during the
early years of an individual’s life as a consequence of lack of validation
and confirmation of feelings and experiences, in addition not having
the child’s legitimate core needs covered. Such a schema may also be
established through traumatic events in adult life (Jind, 2000). To
protect and help oneself as much as possible, an individual carrying a
core vulnerability schema will be in need of a protective coping schema
(or strategies) to deal with upcoming critical and difficult life situa-
tions and events that trigger the vulnerable schema. However, the use
of these coping strategies may be maladaptive and cause unwanted
consequences and therefore become inappropriate. The inner rela-
tionship between the vulnerable core schemas and the protective
coping schemas will be possible to detect by using the YSQ and the
individual case conceptualization, as mentioned earlier.

The Cognitive Model From A Systemic Perspective

Since the cognitive and systemic models have a different episte-
mology, these two professional conceptualizations might be regarded
as dichotomous, causing one to exclude what is perceived as reflecting
vastly different points of view (Sundet, 2000). As a more constructive
term, Sundet introduces ‘‘dilemma,’’ which implies a consciousness
about the contradictions and differences that exist. This perspective
might encourage an investigation into the tension, possibilities, and
choices one might have, without rejecting either of the options. In the
following section, some expressions and theoretical constructions are
examined more closely within the cognitive model viewed from a
systemic perspective, which should lead more to ‘‘dilemmas’’ than
‘‘dichotomies.’’
The term ‘‘schema’’ is primarily used within the understanding of
the single person. One question here is whether this also makes sense
within a systemic framework of couples’ and family relationships.
Further, despite the epistemological boundaries between the fields of
psychiatry and family therapy, it is of interest to consider whether
some of the expressions from the postmodern theories are related to
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the word ‘‘schema’’ within the context of cognitive therapy. Following

are some examples:

1. The cognitive model already has a relational perspective,

since an individual’s problems are conceptualized within the
fields of somatic, thoughts, feelings, behavior, and areas of
interplay. Therefore, the relational perspective will always be
in place even within the mode of individual therapy because
of the notion of a mutually influencing system.
2. The expression ‘‘schema’’ may be compared to the concept of
‘‘structure-determinism.’’ According to Jones (1995), all living
systems are structure-determinated, which means that every
one of us will react in harmony with our inner structures,
deciding and specifying the options for acting, interplay, and
change.
3. The systemic expression ‘‘map’’ seems to be equivalent to
what the cognitive model claims to be every one’s ‘‘general
model of developing constructs of reality’’ (Hoffart, 1999).
4. The commonly used expression ‘‘repeating patterns of inter-
play’’ within cognitive therapy seems to be synonymous with
the systemic expression ‘‘redundans,’’ which is defined as
habitual patterns that are not always conscious. Jones (1995)
claims that it is important to observe such patterns in order
to understand their interplays.
5. The therapist’s perception of his or her own role and of how
change occurs illustrates a difference between cognitive mod-
el and systemic models. The cognitive model has an estab-
lished pre-understanding that forms a foundation for the
therapist’s hypotheses, because of (among other things)
manualized treatment descriptions for different types of dis-
tress. From a systemic point of view, this pre-understanding
causes one to run the risk of confirming only those hypothe-
ses that are being sought due to the perception of the origin
and influence of maladaptive schemas. Newer systemic mod-
els are instead based on the concept of a ‘‘not-knowing posi-
tion.’’ The cognitive therapist regards himself or herself as an
expert within a method to increase schema accommodation,
including socializing the patient to insight based on the terms
of maladaptive schemas and to guide the patient toward a
more adaptive way of coping. The patient is offered specific
tools for self-help after the termination of therapy.
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From a systematic perspective, the cognitive therapist is

regarded as an ‘‘objective observer’’ and an ‘‘agent of change,’’
who influences the patient through ‘‘instructive interaction.’’
A systemic therapist would instead regard his or her role as
one of several systems of meaning, being an expert in only
one area, namely to create a situation in which communica-
tion and cooperative change process can take place. The ques-
tions about the objectivity of the observer and what type of
interventions should be included in the therapeutic role
formed some of the main demarcations between first and sec-
ond order cybernetics (Jones, 1995). However, even though
these items indicate a dichotomy between the cognitive model
and systemic models, a central principal within the cognitive
model regarding ‘‘the Socratic dialogue’’ may instead regard
this as a dilemma: ‘‘The Socratic dialogue’’ gives implications
for the therapist’s attitude, role, and actions for change.
d’Elia (2000) writes that Socrates never wanted to force
knowledge upon his students. What he intended was to make
conscious and to activate the students’ already existing opin-
ions. In other words, within the cognitive model there is no
intention to detect a definitive truth or objectivity, but rather
to stimulate the patient’s self-reflection by questioning his or
her ‘‘maps’’ of understanding that have been created through
the daily interpretations of reality that may have been influ-
enced by schema activation. Perhaps this stance could have
been presented from a systemic perspective as well.
What may still represent a dilemma is that the cognitive mod-
el emphasizes socialization of the patient, which means that
the therapist presents his or her ideas of how the stated prob-
lems may be understood within a cognitive model. The pur-
pose of this is to invite the patient to determine if this is of
any interest and, thereby, construct a map of understanding.
Within a systemic model one avoids presenting any normative
understanding of reality. Instead, one seeks to develop a
working hypothesis and different ways of understanding the
problem within a cooperation with the patient that is per-
ceived as meaningful and useful for all the participants within
the system of therapy. Ways in which the contributions from
the therapist are suitable within a sliding scale from the same
as or different from one’s previous understanding are essen-
tial components of treatment (Andersen, 1994). In real life
therapy, these different therapist roles may not represent any
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T. TILDEN AND F. M. DATTILIO

major discrepancy. Both are dependent on a well-functioning

therapeutic alliance. A patient, couple, or family who does not
find the therapist’s ideas useful, will not contribute to a last-
ing alliance, regardless of the type of model used.
6. The expression ‘‘family premise’’ may be compared to the defi-
nition of ‘‘schema.’’ ‘‘Family premise’’ is understood as the
images a family may have about themselves and about each
other and perhaps core beliefs. These images will in turn be
instructive for the interplay among the family members
(Johnsen, 2000). The author also lists several other expres-
sions that may cover the same area: Themes, systems of
belief, family ideology, family myths, family motives, family
rules, family scripts. The expression ‘‘script’’ within affect
theory seems to overlap the cognitive expression ‘‘schema’’
(Nordby, 1998, 2002). Other authors use terms such as ‘‘inner
working model,’’ ‘‘conception of self,’’ and ‘‘assumption of self.’’
The term ‘‘theme’’ is used by Markman, Stanley, and Blum-
berg (2000), differentiated by two definitions—one overt (i.e.,
money, communication, and sex), and the other existing on a
deeper and hidden level affecting the relationship (i.e., confi-
dence, acknowledgment, love, confirmation). These themes
are often triggered by an actual and coincidental event. The
expression ‘‘schema’’ and the term ‘‘hidden theme’’ seem to be
in agreement. Welburn and associates (2000) refer to several
authors who claim that the expression ‘‘schema’’ may be inte-
grative across various therapeutic milieus. Therefore, discov-
ery and investigation of the schemas should be a target
within many therapeutic frameworks.

If this comparison seems reasonable, there are several terms and

expressions that appear to be more or less overlapping. When these
differences appear to reflect theoretical dilemmas and sometimes
dichotomies, the reason may sometimes be differences in language
traditions within the respective theoretical models rather than irrec-
oncilable theoretical boundaries.

From Individual to Relationship Conceptualizations

The procedure in schema-focused couple therapy may be to work
out two individual case conceptualizations and then in turn investi-
gate how the partners’ individual vulnerable core schemas and pro-
tective coping schemas are included in the exchange. In applying the
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CONTEMPORARY FAMILY THERAPY

She He

Emotions and behavior Actual event

Automatic thoughts Schema activation

Schema activation Automatic thoughts

Actual event Emotions and behavior

FIGURE 2

Individual case conceptualization in interplay

cognitive model, both partners need to have detectable individual

vulnerabilities as confirmed in the self report questionnaire YSQ. The
individual case conceptualization (Beck, 1995; d’Elia, 2000) adapted
for use in couple therapy is shown in Figure 2. Due to space limita-
tions, the terms ‘‘historical background and experiences’’ and ‘‘core
concepts of self (schema) and protective/compensatory coping strate-
gies’’ are included in the short-form ‘‘schema activation.’’
Such a presentation is experienced as pedagogic because it
structures the confusing events, feelings, thoughts, actions, and
interplay into a simple framework. To transfer these elements to
paper or a wallboard may imply a necessary distance as a prerequisite
for reflection and insight. However, this model has its limitations
because some patients are not comfortable scoring questionnaires and
do not have the capacity to reflect on their experienced reality in
abstract and theoretical ways. Further, not all patients will have a
core vulnerable schema confirmed, and not all therapists are familiar
with the model and the use of the YSQ. To simplify and make the
‘‘narrow’’ expressions wider and more general, this model may also
include common terms that most people recognize in their family life,
which may cause problems, without necessarily being related to some
extent of vulnerability.
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T. TILDEN AND F. M. DATTILIO

Continuing with the earlier example:

As previously mentioned, Sue reported a core vulnerability

schema of ‘‘Abandonment/Instability.’’ Her protective coping
schema was ‘‘Emotional Inhibition/Overcontrol.’’ A hypothe-
sis about the inner dynamics between vulnerability and pro-
tection may be: Sue does not express her feelings (especially
anger) openly toward people close to her (‘‘Emotional Inhibi-
tion/Overcontrol’’). This may be regarded as a protection
toward the core vulnerability schema of ‘‘Abandonment/Insta-
bility’’ since Sue derives assurance through this action of not
being the target of others’ aggression and possible rejection.

Sue’s husband, John, does not report any core vulnera-

bility schemas and reports few specific protective schemas.
Instead of dealing with his reports, John is asked if there
are any specific themes that he recognizes as repetitive for
him or for them and/or whether he sees that parts of his
self-conception/personality become typical contributions to
their interplay. John answers in a manner similar to many
men by stating that he feels uncomfortable dealing with
the way in which women communicate. More precisely, he
states that women, Sue in particular, may often speak in
incomplete sentences and talk about many subjects simul-
taneously. This confuses him, since he admits that he
needs more concrete communication to know how to inter-
pret her meaning. With respect to Sue’s communication,
John can easily notice when Sue’s not having a good time.
But from what she says, he doesn’t perceive congruence
between the words she’s using and how she communicates
nonverbally. Therefore, John is unable to comprehend her
true meaning, causing him to end up with different and
contrary interpretations: Is he supposed to understand this
as a critique of him, when Sue blames herself, or is it due
to ‘‘global’’ frustration, or is it caused by PMS (premen-
strual syndrome) that she suffers from on a regular basis?
All of these thoughts and options cause confusion and dis-
tress for John. According to his previous coping and self-
conception as a man, he feels an urge to be alone, calm
down, and sort out his thoughts and impressions in order
to return to Sue, and present her with a proposal for a
solution. Therefore, John goes for a walk by himself in the
forest, without leaving Sue a note as to why he has gone
and what his intentions are. When Sue becomes aware
that he has left, her maladaptive schema of abandonment
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CONTEMPORARY FAMILY THERAPY

Sue John

FEELING AND BEHAVIOR: ACTUAL EVENT:

Fearful that being evident may cause John sees that Sue is troubled, but he is

abandonment. Becomes unclear when she unable to perceive what she’s trying to

tries to communicate. communicate

AUTOMATIC THOUGHT: TRIGGERS A THEME:

“Now he’s going to leave me. This happens to John experiences distress when he doesn’t

me all of the time. I’m not worthy of anything understand Sue, and simultaneously perceives

better” (vulnerability) a tension between them. He is then urged to

“I can’t trust anyone else but myself. I need to find some explanations and proposals for a

be strong and maintain control. If I don’t have solution. This is something he is used to doing
control, I’ll end up unprotected when I’m left alone.

alone.” (protection)

1. TRIGGERS THE SCHEMA OF AUTOMATIC THOUGHT:

VULNERABILITY: “I don’t understand Sue. I get confused,

“Abandonment / Instability” irritable, and distressed: Why can’t she

2. MOBILIZATION OF PROTECTION communicate clearly so that I’m able to read

SCHEMAS: her? I need to be alone to sort things out.”

“Emotional inhibition / Overcontrol”

ACTUAL EVENT: FEELING AND BEHAVIOR:

Sue experiences that John is leaving her after John experiences confusion and distress. He

tension arose between them following a goes for a walk in the forest without telling

feeling of irritation. her why and how long he’ll be gone

FIGURE 3

Adapting Sue and John’s interplay in to a couple’s conceptualization

 155

T. TILDEN AND F. M. DATTILIO

is triggered, followed by the automatic thought: ‘‘Now he’s

leaving me. This happens to me all the time. So, this
proves that I’m unworthy of any better treatment.’’

Figure 3 of interplay conceptualizes Sue within a ‘‘schema-fo-

cused’’ approach (with John present so that he becomes familiar with
this working model), and John within a ‘‘theme-focused’’ approach. It
may also be helpful to outline the schematic on a whiteboard of how
the individual patterns occur.
The diagram shows that the individual solutions have more to do
with a relational problem. Therefore, the model includes both the view
of the individual vulnerability and personal style, as well as focusing
on how individual contributions are felt during their exchange. How-
ever, an unpredicted consequence of focusing on the individual vul-
nerabilities in couple therapy may be a reinforcement of blame toward
the identified patient, accompanied by a requirement to change. To
reduce such a risk, it is important to communicate an understanding
that both partners are doing the best they can, given their respective
dispositions, and are with good intentions. This is a crucial safeguard
for the partner who may be defined as the ‘‘identified patient,’’ as Sue
is in the above example. Acknowledging both the presence of the
vulnerability schemas and the need of the schemas for protection is
extremely important.
This method became clear and useful to John and Sue during the
course of treatment, at which point they stated that this pattern was
representative of them. As therapy progressed, this conceptualization
became the common reference for every new event that they reported
and it only served to confirm the same pattern of interplay. As a
consequence, treatment focused on working thoroughly on this one
example. This scenario illustrates how the cognitive model may be
viewed from a systemic perspective where interventions within one
limited area interfere with the neighboring fields in the system.
Another important issue is the amount of time used in therapy:
Brief therapy should not include too many themes. When patients are
introduced to an initial mastering experience within a limited area, it
may serve to be motivational, creating hope in the future process.

This History’s Impact on Attribution Styles

The anamnestic information as previously mentioned, contributed
to conceptualizing how the schemas of vulnerability and protection, as
well as themes associated with Sue and John’s personal style and
156

CONTEMPORARY FAMILY THERAPY

From To
“She doesn’t trust me” “There is too little trust in our

relationship”

“We argue because he doesn’t listen to “We argue because we don’t make an

what I try to tell him” effort to listen to each other”

“We argue because she suffers from a “We argue because parts of our individual

serious mental illness” histories keep interfering with our

relationship”

FIGURE 4

Change of attribution style

sense of self, were established. This may contribute to insight into

connections and causal relationships, and further on create a common
attribution that can unite the partners instead of alienating them from
each other. Theory and research on attributions conclude that couples
living in maladaptive relationships attribute their problems to traits,
responsibilities, and guilt on their own part and/or on the part of the
partner. With reference to ‘‘cognitive distortions’’ outlined in cognitive
theory, this is to be mapped as ‘‘personalization’’ (Beck, 1995). Well-
functioning couples attribute their problems to the relationship itself,
or to something outside their control. Simultaneously, they credit each
other for having good intentions (Ekeland, 1997). Therefore, it is
important to challenge Sue’s and John’s attribution style, steering
away from blaming the partner (or him-/herself) as the cause of the
problems and toward attributing the problems to the relationship
itself, or to matters outside of their control.
An example of this shift is outlined in Figure 4.
By becoming familiar with each other’s histories and reasons for
thought/interpretation, feeling, and action according to their individ-
ual dispositions, the couples’ capacity for empathy and tolerance will
be increased when experiencing irritation and hurt from their spouse.
They will also become aware of what conditions outside their control
contribute to establishing and maintaining their problems. As part
of this, socialization into the ideas of schemas, themes, habits, and
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T. TILDEN AND F. M. DATTILIO

patterns that have contributed to the relationship problems is crucial,

even when these originally may have been intended as efforts toward a
solution. Such knowledge about each other will stimulate and moti-
vate the couple to try out alternative solutions both individually and
through common efforts. Sue may be challenged to respond to the
automatic thoughts critically when she encounters them as in the self-
statement below:

Even now, when I feel a strong sense of discomfort, I don’t

need to interpret this as evidence of John leaving me. What
evidence from our previous exchanges can confirm or
disconfirm this thought? Could it be that my history is
deceiving me by interfering with what should be my ratio-
nale interpretation of what is happening here-and-now
between John and me? Should I blame John for leaving me
when this is really not his intent at all? If I’m in doubt, I
really should check this out by asking him in more detail!

John could be challenged to reflect on his own habitual style, for

example, when he needs to go for a walk by himself, by engaging in the
following self-statement:
‘‘What might happen if I don’t go for a walk in such a situation?
Perhaps I should try it out to get a sense of it myself? If I feel the
urge strongly that I need to go for a walk myself, what could I do to
prevent Sue from engaging in dramatic thoughts about me leaving
her? Since I prefer Sue to speak clearly, how could I contribute to
such a clear communication (for example, by telling her where I’m
heading, why I need to go for a walk, and when she can expect me to
return home)?’’

Reducing Stigmatization
One person within a family who suffers from a high degree of
individual vulnerability may easily become the ‘‘identified patient.’’
Whatever theoretical model is employed, it should be a priority to
reduce the negative consequences of this in whatever way possible.
From a systemic point of view, the cognitive model could be criti-
cized because it so openly identifies maladaptive schemas belonging
to one or more persons as causal to the problems. Even when this is
not the intention, a negative consequence of such a linear concep-
tualization may be a reinforcement of stigmatizing the identified
patient. Within the cognitive model, there are techniques that
can be used to work against such stigmatization (i.e., ways of
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CONTEMPORARY FAMILY THERAPY

externalizing) (Young & Gluhoski, 1997). One technique is ‘‘flash-

cards’’—a written reminder for use between the sessions in situa-
tions where maladaptive schemas become activated. The patient and
the therapist collaborate to come up with likely specific situations in
which maladaptive schemas might become activated. Together, they
write them down on flashcards and also include how the patient can
cope in more adaptive ways. The patient is reminded to identify the
maladaptive schema and its origin, and is given help to test
the ‘‘voice’’ of the maladaptive schema against an adaptive ‘‘voice.’’
The patient may then be helped to develop a more appropriate way
of thinking and acting according to the goals of treatment. This can
reduce stigmatization by attributing the activation of maladaptive
schemas to an influence outside the patient’s own control and not as
a quality of that person.

REDEFINING THE PROBLEM

A broader form of externalizing is to mobilize the network of

resources, such as partner, family, friends, colleagues, and profes-
sionals as a counterforce against the dominating maladaptive sche-
mas, as presented within narrative therapy (Lundby, 1998). In
applying this approach to our example, there is a risk that focusing on
Sue’s maladaptive schemas might become stigmatizing given that it
may reinforce the dominating history, indicating that Sue is the one
who suffers from individual distress, and that her problems are to
blame for the rest of the family being in distress. This can reinforce her
already fixed habit of self-blame whereby Sue believes she is the
problem. By talking about this in an externalizing way, the problem is
isolated as a figure not identical to any of the family members. To fight
against the problem, all the distress (also the individual maladaptive
schemas) is defined as a result of ‘‘the problem’s work,’’ victimizing and
splitting all the family members.
The task, then, for the entire therapy system is to detect and
disclose the dysfunction caused by the problem. By using a metaphor
chosen by the couple, their sense of ownership is established so that a
remedy is not only proposed by the therapist. Sue and Johns chose
‘‘The Evil Wolf’’ as their metaphor. By choosing a metaphor selected
from myths and adventures, the patients may also develop a meta-
relationship to their problems because this underlines a dimension of
playfulness, humor, and distance—something that helps them to view
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T. TILDEN AND F. M. DATTILIO

themselves eternally. For Sue and John, this technique contributed to

increased mutual understanding as to how their individual mal-
adaptive schemas and themes influence their relationship. This
enabled them to sort out when their reactions were legitimate given
the here-and-now situation, and what could be addressed regarding
the activation of maladaptive schemas with historic origins. As a
result, Sue felt relieved as her self-blame and guilt feelings dimin-
ished. Further, this new perspective alleviated some of the couple’s
distress, as John now understood more of Sue’s reactions, and this
increased his capacity for empathy and tolerance. In situations where
Sue and John were previously split due to a conflict, they could now
apply the externalizing metaphors as a reminder of their common
project in disclosing and fighting ‘‘The Evil Wolf.’’ They felt a common
responsibility, both to detect when ‘‘The Evil Wolf’’ was about to cause
harm, and to ask for a ‘‘time-out’’ when maladaptive schemas were
triggered. They could now ask for each other’s help to enter a meta-
position, analyzing what was about to happen.
They also introduced this method to their children, who were
invited to participate with them in this project. By attributing the
problem to something outside the family, their inner family bonds
were strengthened and they could unify their power in a common
fight. At the conclusion of therapy, Sue and John expressed satisfac-
tion with their experience and felt prepared to continue using this
technique outside of treatment each time ‘‘The Evil Wolf’’ would rear
its ugly head.

CONCLUSIONS

In this article, we point out some of the ways in which schema-

focused cognitive therapy is suitable for use in couple therapy. The
inclusive structure of the model makes it possible to integrate methods
from various theoretical origins, something that increases flexibility
and plurality. Even though there are differences and dilemmas when
comparing this model to systemic models, this presentation confirms
that there are also many similarities and overlapping areas between
the models. Further, it emphasizes knowledge about the single person
as well as the system, and therefore that knowledge from the fields of
psychology, psychiatry, and family therapy is needed to understand
the role of the individual vulnerability in the relationship. Thus, both
a linear and a circular point of view are acknowledged and seen as a
prerequisite in order to grasp the complexity of the problems
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CONTEMPORARY FAMILY THERAPY

presented. This model may be suitable for individuals suffering from

maladaptive schemas as well as for individuals influenced by prob-
lematic ‘‘themes.’’ Therapists working in inpatient or outpatient con-
texts may find the tools of this model quite helpful.

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