Dependence/Incompetence

A brief introduction to schema therapy

Schema therapy is an integrative therapy initially developed for treating complex, longstanding, and diffuse psychological difficulties. It combines cognitive behavioral, attachment, gestalt, object relationships, constructivist, psychoanalytic, and neurobiological approaches within a unifying conceptual model (Young, 1990, 1999; Young et al., 2003). Additional interventions have since been outlined, such as EMDR (Young et al., 2002), mindfulness (van Vreeswijk et al., 2014), and body-focused methods (Briedis & Startup, 2020). Schema therapy expands on CBT by emphasizing the developmental origins of psychological problems, incorporating relational and experiential interventions, and targeting the maladaptive coping styles that perpetuate these difficulties (Young et al., 2003).

Early maladaptive schemas

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, referred to as ‘coping styles’.

Schemas are enduring, foundational mental structures that play an essential role in cognitive processing, enabling humans to represent the complexities of the world (Rafaeli et al., 2016). By simplifying reality, they make the vast array of information we encounter manageable, enabling quick and automatic action. Schemas also act as shortcuts that help us reach conclusions without unnecessary processing. However, while these shortcuts are efficient, they can produce distorted interpretations of reality. For this reason, schemas can be adaptive or maladaptive, and positive or negative, depending on their output (Young et al., 2003). Research confirms the existence of both adaptive and maladaptive schemas, the former being associated with positive functions and adaptive behavioral dispositions (Louis et al., 2018).

In schema therapy, EMS are defined as negative, pervasive themes or patterns regarding oneself and one’s relationship with others that are dysfunctional and self-defeating. Structurally, EMS are believed to consist of thoughts, memories, emotions, bodily sensations, and the meanings ascribed to them (Van Genderen et al., 2012). Importantly, behavior is not a component of schemas, but a response to their activation. In other words, EMS activation results in schema-driven actions (Young et al., 2003).

Interactions between a child’s temperament, parenting, sociocultural context, and significant life experiences (e.g., traumatic events) can give rise to unmet emotional needs, which form the basis of EMS. EMS are usually accurate representations of these early environments and lead to responses that help the child survive and adapt to these contexts (Farrell et al., 2014; Young et al., 2003). However, EMS become dysfunctional when they are indiscriminately and repeatedly applied to later life experiences.

EMS are elaborated and strengthened throughout their lifespan, becoming the ‘filters’ through which individuals understand and make predictions about themselves, others, and the world (Young & Klosko, 1994). Accordingly, EMS developed in early life are superimposed on current events (even when they are not applicable), leading to dysfunctional patterns of thought, feeling, and behavior (Young et al., 2003).

[EMS] become dysfunctional because… they render all new situations, even ones that are profoundly different from the toxic early experiences, similarly toxic (even when in reality they are not), and… lead the person to maintain particular types of [toxic] environments or relationships, even when they can exert influence or choice and create other kinds of experiences.

(Rafaeli et al., 2011)

Schema development

Core emotional needs

Satisfying core emotional needs during childhood leads to the development of healthy schemas, while unmet needs give rise to EMS. Young and colleagues (2003) originally outlined 5 core emotional needs based on Bowlby’s (1977) attachment theory and clinical observation (Bach et al., 2018). While they are believed to be universal, the strength of these needs can vary across individuals and, potentially, across cultures (e.g., Hahn & Oishi, 2006). They are:

• Secure attachments (e.g., safety, protection, acceptance, stability, and belonging).
• Autonomy, competence, and sense of identity.
• Freedom to express needs and emotions.
• Spontaneity and play.
• Realistic limits and self-control.

Given that core needs initially relate to the child’s primary attachments, difficulties within the nuclear family are often the principal source of EMS (Rafaeli et al., 2011). Young acknowledged that attachment needs were of primary importance for the developing child, laying the foundation for the satisfaction of other needs (Brockman et al., 2023). However, as children mature, needs arising other arenas such as school and the wider community become important (e.g., stable friendships, peer group acceptance, etc.). While unmet needs in these later contexts can lead to EMS, schemas emerging in adolescence are usually less pervasive (Young et al., 2003). EMS can also develop in later life (such as in response to deeply disturbing events), although this is much less common (Louis et al., 2018).

Other core needs have also been proposed, such as fairness, self-coherence (Arntz et al., 2021), novelty, self-comprehension (Flanagan, 2010), self-esteem (Loose et al., 2020), meaning (Meier, 2019), and connectedness to nature (O’Sheedy, 2021) (see also Kudryavtsev, 2011, for the importance of creativity). However, these core needs have not yet been fully incorporated into the schema therapy model. Core needs are described in more detail in the Psychology Tools Unmet Emotional Needs information handout.

Early experiences

Interactions between a child’s early environment and innate temperament can frustrate their core emotional needs, leading to EMS development. Young and colleagues (2003) identify 4 childhood experiences that contribute to EMS:

• Toxic withholding. The child is given too little of what they need (e.g., insufficient attention, affection, protection, etc.).
• Toxic excess. The child is given too much of what they need (e.g., they are over-indulged, overprotected, granted excessive freedoms, etc.).
• Traumatization. The child is harmed, victimized, or humiliated (e.g., parental abuse, bullying, discrimination, etc.).
• Selective internalization. The child internalizes maladaptive attitudes that are modeled by a significant other (e.g., perfectionism, pessimism, etc.).

Emotional temperament

Temperament refers to enduring differences in children’s behavioral style and reactivity (Zentner & Bates, 2008). Temperament can contribute to EMS formation by influencing parenting styles (Eisenberg et al., 1999; Kiff et al., 2011; Pekdoğan & Mehmet, 2022). For example:

• Irritable children tend to elicit punitive parenting, leading to increased anger.
• Fearful children tend to elicit protective parenting, leading to increased anxiety.
• Impulsive children tend to elicit controlling parenting, increasing impulsivity.

Moreover, children have a ‘differential susceptibility’ to their childhood environments and experiences (Belsky, 2013). For example, reactive children are more likely to flounder in response to poor parenting. This partly explains why some individuals develop EMS in the absence of severe trauma (Lockwood & Perris, 2012).

Schema perpetuation

EMS are remarkably obstinate and “fight for survival”. Young and colleagues (2003) suggest the durability of EMS partly stems the need for ‘cognitive consistency’: people strive to maintain a stable view of themselves and the world, even if it is inaccurate and distressing. Moreover, EMS are often central to an individual’s sense of self, making the idea of a schematic “paradigm shift” extremely threatening (Beck et al., 2004; Young & Klokso, 1994):

“Although [the client’s] schematic structure may be unrewarding and lonely, change means that [they] are in new territory... They are being asked not just to change a single chain of behaviors, or reframe a simple perception, but rather to give up who they are and how they have defined themselves for many years, and across many contexts.”

(Beck et al., 2004)

Several other factors account for why EMS persist and are strengthened over time.

• Cognitive factors. EMS act as cognitive filters, distorting information and generating unhelpful thinking styles (Young et al., 2003). For example, schema-consistent information is exaggerated, while schema-inconsistent information is filtered out (i.e., magnification and minimization). Other cognitive distortions linked to EMS perpetuation include selective abstraction, overgeneralization, and labeling (Da Luz et al., 2017; Young, 1999). Research indicates schema activation not only generates negative automatic thoughts, but that these appraisals in turn reinforce EMS (Calvete et al., 2013).
• Affective factors. Individuals often block painful emotions linked to their EMS. Consequently, EMS do not reach conscious awareness which prevents their disconfirmation (Young et al., 2003). Affect can also make schema-congruent perceptions feel true. Finally, schema maintenance processes and their centrality to the individual’s sense of self can also engender hopelessness about change (Young, 1999).
• Behavioral factors. EMS lead to self-defeating behaviors, referred to as ‘coping responses’ (see below). For example, individuals might remain in toxic situations, provoke negative responses from others, or select partners that reinforce their EMS (Rafaeli et al., 2011).

Maladaptive coping styles

Coping styles refer to the characteristic ways individuals manage their EMS. Coping styles develop in childhood and operate outside of awareness, helping individuals adapt to their EMS, the intense affect accompanying them, and the environments in which they were formed (Rafaeli et al., 2011; Young et al., 2003). Much like EMS, factors that may influence the emergence of coping styles include temperament, modeling, conditioning, and culture (Loose et al., 2020; Nia & Sovani, 2014). While they are apparent in all individuals, coping styles tend to be more rigid, extreme, and ‘overlearned’ in clinical groups (Beck et al., 2004). Most importantly, coping styles play a central role in EMS perpetuation.

Coping styles, in turn, give rise to idiographic ‘coping responses’ – the situation-specific manifestations of the client’s coping style. While coping styles are repetitious, coping responses are more variable and can take the form of behavioral, cognitive, or emotional reactions to EMS activation (Simeone-DiFrancesco et al., 2015).

Young and colleagues (Young & Klosko, 1994; Young et al., 2003) identify three coping styles, recently reformulated by an international working group (Arntz et al., 2021). While most individuals use a mix of coping styles, some disorders are characterized by the predominance of one coping style (e.g., overcompensatory control in narcissistic personality disorder; Rafaeli et al., 2011):

• ‘Surrender’ (Young et al., 2003) or ‘Resignation’ (Arntz et al., 2021). Corresponding to the evolutionary ‘freeze’ or ‘fawn’ response, the individual responds to their EMS by accepting its core message and behaving as if it is true. Consequently, they experience the pain of the EMS directly.
• ‘Avoidance’ (Young et al., 2003) or ‘Escape’ (Young & Klosko, 1994). Corresponding to the evolutionary ‘flight’ response, the individual arranges their life such that their EMS is not triggered. The pain of their EMS is avoided or suppressed. Avoidant coping may be overt (e.g., escaping from schema activating situations or individuals) or covert (e.g., using substances or dissociation to dull schema-related distress).
• ‘Overcompensation’ (Young et al., 2003) or ‘Inversion’ (Arntz et al., 2021). Corresponding to the ‘fight’ response, the individual responds to schema activation by attacking, overcorrecting, or externalizing their EMS (Greenwald & Young, 1998). The pain of the EMS is masked with other thoughts, emotions, and actions (e.g., the individual replaces feelings of inferiority with superiority).

Three additional coping styles (indolence, mockery, and gaucherie) have also been proposed (Askari, 2021). Coping styles and responses are described in more detail in the Psychology Tools Coping Styles And Responses information handout.

Young (1990) originally described 15 EMS, which were later increased to 18 schemas (Young et al., 2003). Additional schemas have since been proposed (e.g., Arntz et al., 2021; Brockman et al., 2023; Yalcin et al., 2023). The 18 EMS described by Young and colleagues (2003) were subsequently clustered into ‘schema domains’ corresponding to specific unmet emotional needs. Dependence/incompetence is grouped with EMS in the ‘impaired autonomy and performance’ domain (Bach et al., 2018 Young et al., 2003), which is characterized by difficulties performing successfully, functioning independently, and expressing oneself freely (Young, 2014).

Dependence/Incompetence

Clients who struggle with dependence/incompetence experience a pervasive sense of helplessness, ineptitude, and inadequacy (Young et al., 2003). They feel incapable of managing their lives independently and heavily rely on others for care and guidance. As a result, they often struggle with low self-esteem, self-criticism, and inferiority to others (Overholser, 1997).

Life seems overwhelming. You feel that you cannot cope. You believe that you are incapable of taking care of yourself in the world, and that therefore you have to turn to other people for help. It is only with such that you can possibly survive… You simply do not have what it takes. It is a feeling of something lacking, of inadequacy… of being a small child in a world of adults.

(Young & Klosko, 1994)

This schema has two elements. First, the client lacks faith in their judgments and abilities, and minimizes their personal strengths (incompetence). As a result, they seek out individuals who can provide support or reassurance, who are often idealized (dependence) (Overholser, 1997; Young et al., 2003). Unfortunately, this reliance on others reinforces their perceived incompetence, creating a cycle of helplessness and rescue (McLemore & Brokaw, 1987).

While dependence/incompetence is often pervasive (the client is unable to cope with routine tasks or everyday problems), some individuals experience this schema in specific domains (e.g., professional or financial decisions; Rafaeli et al., 2011). However, it is often the case that dependent clients seek treatment for their anxiety or depression rather than their reliance on others (Overholser, 1997).

Dependence/incompetence usually manifests in clients’ day-to-day lives. Individuals with this schema often struggle with everyday tasks or decisions. Due to a lack of faith in their judgments, they turn to others for guidance and direction. This is sometimes apparent in therapy: the client appears needy or self-doubting and seeks excessive reassurance or contact outside of therapy sessions. Furthermore, some clients are fearful that addressing their dependence/incompetence may result in additional responsibilities being thrust upon them (Overholser, 1997).

Avoidance is common with this EMS. Individuals with dependence/incompetence will often avoid unfamiliar or challenging situations that require independent action, perpetuating their incompetence. It has also been observed that many clients with dependence/incompetence struggle with anxiety disorders (e.g., panic disorder and agoraphobia), which are reinforced by their refusal to confront these fears (Young & Klosko, 1994; Overholser & Freiheit, 1994). In extreme cases, these individuals may lack basic everyday skills, such as paying bills, due to their longstanding avoidance of adult responsibilities.

Clients with this schema tend to seek stronger individuals they can rely on. To protect these attachments, they often adopt a subordinate or deferential role in their relationships. However, this can lead to resentment, entrapment, and sometimes depression.

You like the security of these relationships, but you feel angry toward the people who provide it. And usually you do not dare express your anger openly. That might drive people away, and you need them too much. The dark side of this lifetrap is that you feel trapped in dependent role… Dependence exacts a high price in terms of freedom and self-expression.

Young & Klosko, 1994.

For others, ‘schema chemistry’ (Young et al., 2003) replicates the interpersonal conditions that fostered dependence/incompetence: individuals with this EMS are sometimes drawn to individuals who are infantilizing, undermining, or critical.

While dependence/incompetence tends to manifest as passivity and helplessness, Young and Klosko (1994) highlight two presentations that are less common:

• Counterdependence. The client overcompensates for their dependence/incompetence by behaving as if they do not need help and refusing any kind of guidance or support.
• Dependent entitlement. The client believes that are entitled to have their dependency needs met and punish others when they are not (e.g., sulking or being overtly angry).

As with all EMS, dependence/incompetence has multiple structural components. Individuals with this schema are prone to several cognitive distortions or ‘unhelpful thinking styles’ (Lorzangeneh & Issazadegan, 2022; Young et al., 2003), including:

• Catastrophizing (e.g., “If no one is there to help me, I won’t survive”).
• Discounting the positives (e.g., “I did that on my own, but that was a long time ago”).
• Emotional reasoning (e.g., “I might be an adult, but I feel so helpless”).
• Fortune-telling (e.g., “I can’t cope on my own”).
• Labeling (e.g., “I’m so inept”).
• Mental filter (e.g., “I only succeeded because someone was there to guide me”).
• Overgeneralization (e.g., “That mistake shows I’m incapable”).
• Personalizing (e.g., “The journey went wrong - it shows I shouldn’t travel on my own”)
• “Should” statements (e.g., “People should take care of things for me”).

Emotions associated with dependence/incompetence include:

• Helplessness associated with everyday tasks and responsibilities.
• Anxiety associated with acting independently or separation from supportive others.
• Overwhelm associated with challenges, changing circumstances, or important decisions.
• Depression associated with perceived inadequacy and/or entrapment.
• Anger associated with being reliant and subordinate to others.

As a result, people with dependence/incompetence may experience difficulties when it comes to:

• Managing routine tasks and their personal affairs.
• Acting independently.
• Trusting their judgments and intuitions.
• Recognizing their personal strengths, capabilities, and successes.
• Making decisions.
• Being assertive.
• Problem-solving.
• Tolerating risk, change, or uncertainty.
• Facing new challenges, responsibilities, or situations.
• Asking for help, guidance, or support (for counterdependent individuals).

Clinical observation suggests that dependence/incompetence often co-occurs with other schemas (Young & Klosko, 1994; Young et al., 2003). EMS that are sometimes associated with dependence/incompetence include:

• Defectiveness. The client sees themselves as inadequate or inferior due to their dependence and/or incompetence.
• Emotional deprivation. Both schemas originate from a lack of empathy, attunement, and appropriate guidance.
• Enmeshment. Both schemas share an origin in overprotective parenting and limited opportunities to separate/individuate.
• Entitlement. The client demands that other people provide help and support (dependent entitlement; Young & Klosko, 1994).
• Failure to achieve. The client’s parents were intrusive, undermining, or threatened by their accomplishments. Consequently, the child fears a loss of connection if they are independently successful.
• Self-sacrifice. The client sacrifices themselves to ensure they will continue to be cared for.
• Subjugation. The client adopts a submissive role in relationships to protect connections to the individuals they rely on.
• Social isolation. A lack of independence/competence leaves the client with a sense that they little to contribute during social interactions, leading to withdrawal.
• Unrelenting standards. The client tries to avoid feeling dependent/incompetent by pursuing very high standards.
• Vulnerability to harm. The client believes they will not function or survive in such a dangerous world without other people’s support. Both schemas are likely to originate from parental overprotection.

Dependence/incompetence is associated with a range of difficulties, including addictions (Azemet et al., 2016), body image problems (Abedi et al., 2018), bipolar disorder (Ak et al., 2011), borderline personality disorder (Barazandeh et al., 2016), burnout (Kaeding et al., 2017), childhood trauma (Pilkington et al., 2021), chronic pain (Voderholzer et al., 2014), dependent personality disorder (Nordahl et al., 2005), depression (Bishop et al., 2022), obsessive compulsive disorder (Kwak & Lee, 2015), paranoid personality disorder (Nordahl et al., 2005), post-traumatic stress disorder (Price, 2007), relationship problems (Janovsky et al., 2020), sexual problems (Quinta Gomes & Nobre, 2012), somatoform disorders (Henker et al., 2019), and suicidal ideation (Pilkington et al., 2021).

Development origins

Dependence/incompetence may have a genetic component (e.g., Gjerde et al., 2012). However, developmental experiences are likely to play a more important role.

Dependence/incompetence is associated with unmet emotional needs relating to autonomy, self-reliance, and appropriate support and guidance. Formative experiences that play a role in the development of this EMS may include:

• Anxious, intrusive, or overprotective parenting.
• Critical and undermining parenting.
• Early physical health problems (e.g., epilepsy) (Hartlage et al., 1972).
• Underprotective parenting (e.g., the child is parentified or given limited support).

Research confirms that specific developmental experiences are associated with dependence/incompetence, including emotional and sexual abuse (Lumley, 2007; May et al., 2022; Pilkington et al., 2021). Punitive and overprotective parenting styles have also been associated with this EMS (Bruysters & Pilkington, 2022; Sheffield et al., 2005).

"Many people struggle with feeling dependent and incompetent, and it sounds as though this might be relevant to you too. Would you be willing to explore this schema more with me?"

Clinicians might begin by providing psychoeducation about dependence/incompetence and EMS more generally:

• Schemas are negative themes and patterns that start in your childhood and continue throughout your life. Some are very common.
• Schemas usually get stronger as time passes, becoming the negative filters people use to understand and predict the world. You could think of them as dark sunglasses – they color and distort our experiences in unhelpful ways.
• Schemas operate ‘behind the scenes’: we’re not usually aware of them or when they are active. However, with practice, you can become more aware of them. It is a bit like a theatre – you can learn to bring your backstage schemas to the main stage.
• One common schema is ‘dependence and incompetence’. If you have this schema, you believe that you are incapable of taking care of yourself and managing tasks on your own, so you rely on other people for help, guidance, and support.
• Signs that you have a dependence and incompetence schema include feeling helpless and overwhelmed by everyday tasks, asking other people to manage your affairs or make decisions, or avoiding challenges or independent activities. Alternatively, you might be so self-reliant that you refuse any kind of help or guidance.
• People develop schemas because some of their emotional needs were not met while they were growing up. As children, schemas help us make sense of early experiences and to get by. If you have a dependence and incompetence schema, your parents might have been very protective of you, so you didn’t get to do things independently. Alternatively, your parents might have criticized or undermined your judgments as a child. Some people with this schema have had the opposite experience: their parents were unprotective and gave them very little guidance or support.
• Schemas are painful, so people learn to cope with them in different ways. You might cope with dependence and incompetence by being extremely reliant on other people (you surrender to your schema), avoiding challenges or doing things on your own (you escape your schema), or depending only on yourself (you counter-attack your schema).

Standard treatment techniques for working with dependence/incompetence are listed below. Some of these are described in more detail in the Psychology Tools Healing Your Schemas information handout. They include:

• Self-monitoring (e.g., schema diaries).
• Cognitive interventions (e.g., historical review, decentring, flashcards).
• Emotion-focused interventions (e.g., imagery rescripting, chairwork, letter-writing).
• Relational interventions (e.g., limited reparenting, empathic confrontation).
• Behavioral interventions (e.g., experimentation, behavioral pattern-breaking).

In light of the unmet needs associated with dependence/incompetence, individuals with this EMS also require a specific ‘need-meeting’ style of interaction from the outset of therapy (Cutland Green & Balfour, 2020). This includes encouragement, compassion, and empowerment: therapists will need to recognize and celebrate the client’s capabilities, while simultaneously guiding, promoting, and respecting their autonomy (Lockwood & Perris, 2012; Lockwood & Samson, 2020).

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