Chapter 10: cognitive work: working with core beliefs and schemas

Question 1

consider therapy related to core beliefs for the following clients

Answer 1

• clients whose underlying beliefs create risk for relapse
• clients whose immediate symptoms or problems have been markedly reduced
• clients who are able to engage in more abstract discussions
• clients who are not at risk of current psychotic disorder
• clients who have the resources and interest to remain in longer-term treatment

Question 2

definition schemas

Answer 2

schema concept refers to cognitive structures of organised prior knowledge, abstracted from experience with specific instances; schemas guide the processing of new information and the retrieval of stored information

Question 3

discovering beliefs and schemas: strategies (10)

Answer 3

1. searching for themes
2. recurrent experience
3. the downward arrow
4. sharing the case conceptualisation
5. Behavioral experiments
6. hypothetical situations
7. historical perspective
8. emotional prime
9. reading materials
10. formal assessment

Question 4

discovering beliefs and schemas: strategies: searching for themes

Answer 4

• describe what you have observed in therapy and see whether client agrees to that pattern
• have the client provide a name or label for this pattern

Question 5

discovering beliefs and schemas: strategies: recurrent experience

Answer 5

• if client expresses the idea that the current experience reminds him or her of an earlier experience in life (my boss treats me the same way my father used to)
• good indicator that client has a schema triggered or activated by this memory

Question 6

discovering beliefs and schemas: strategies: downward arrow

Answer 6

• begins with situation specific automatic thought, then examine inferences and drill down all the way to central beliefs or schemas

Question 7

discovering beliefs and schemas: strategies: behavioural experiments

Answer 7

• e.g. client might hypothesise that she has a general belief that others will reject her if she is open and honest
• such an assumption is generally based on deeper belief about being socially undesirable
• to test out this prediction and to test out whether assumption becomes activated: set up experiment in which she is purposely more self-disclosing than typically
• key: See whether the situation provokes the expected automatic thoughts

Question 8

discovering beliefs and schemas: strategies: hypothetical situations

Answer 8

• construct hypothetical event and see how client would react
• useful when triggers are unusual or difficult to set up in behavioural experiment
• may not reflect actual experience in real life situations

Question 9

discovering beliefs and schemas: strategies: historical base

Answer 9

• ask about historical base
• core beliefs and schemas typically develop when they serve a useful purpose, to make sense of the world, to adapt to a certain situation
• if you can identify the approx. period in life when schema developed and understand why it was adaptive at that time, it might provide further evidence that you have accurately identified an early schema

Question 10

discovering beliefs and schemas: strategies: emotional prime

Answer 10

• employ techniques to trigger or activate schemas
• e.g., encourage client to recall sad time and feel that experience –> see if it activates beliefs that were present in the past

Question 11

discovering beliefs and schemas: strategies: formal assessment

Answer 11

• use of questionnaires, e.g. Young Schema Questionnaire

- ideally scales confirm your clinical case conceptualisation and serve as independent validation

Question 12

changing schemas: methods (2)

Answer 12

1. evidence-based methods

2. logical change methods

Question 13

changing schemas: evidence-based methods: strategies (10)

Answer 13

1. differentiating schema elements
2. recognizing continua
3. positive data log
4. evidence for the old and new schemas
5. what would it take to change the beliefs?
6. therapy role plays
7. therapy “confrontation”
8. behavioural experiments
9. acting as if
10. confronting the past

Question 14

changing schemas: evidence-based methods: strategies: differentiating schema elements

Answer 14

• rather than trying to modify the overall schema of being mistrusting for example, it may be easier to identify the key behavioural or emotional markers of the schema and move to change these

Question 15

changing schemas: evidence-based methods: strategies: recognizing continua

Answer 15

• often difficult to find contrary evidence in the face of categorical or absolute beliefs
• discuss likelihood and risk/value of any issue being categorical

Question 16

changing schemas: evidence-based methods: strategies: positive data log

Answer 16

• identify key markers of new and desired schemas
• then: client has to begin to notice and write down evidence that supports development of the new schema
• shifts focus of attention to positive evidence and fosters other positive actions or cognitions that support the more positive belief

Question 17

changing schemas: evidence-based methods: strategies: evidence for the old and new schemas

Answer 17

• log of evidence that supports new and old schema
• over time, the relative strength of belief in the old and new schemas can be contrasted so that the client can see shifts in their degree of endorsement

Question 18

changing schemas: evidence-based methods: strategies: what would it take to change the belief?

Answer 18

• discussion of the types of evidence the client requires to believe fully that the new schema has “taken root” and is starting to guide his or her behavioural choices and interpretations of situations
• helps to evaluate realistic prospects of a clients internalised, felt change
• establishment of benchmarks for change to make change more likely

Question 19

changing schemas: evidence-based methods: strategies: therapy role plays

Answer 19

• use therapy time to practice
• e.g., if the clients old schema was “incompetent” and the new one is “assured and competent”, practice acting assuredly and competent in session

Question 20

changing schemas: evidence-based methods: strategies: therapy confrontation

Answer 20

• therapeutic relationship can become vehicle to provide evidence that the schema is shifting
• you can discuss how the schema is affecting the therapeutic relationship
• identify signs that indicate that the schema is shifting within the relationship and provide positive feedback

Question 21

changing schemas: evidence-based methods: strategies: behavioural experiments

Answer 21

• discuss with client how they would act, think and feel if they truly internalised the new schema
• devise a behavioural experiment in which some aspects of the new schema gets acted out

Question 22

changing schemas: evidence-based methods: strategies: acting as if

Answer 22

• try to act as if the new schema has fully been incorporated into the clients belief system: fake it till you make it

Question 23

changing schemas: evidence-based methods: strategies: confronting the past

Answer 23

• determine the history of the emergence of the schema and confront the past in therapy
• use of imagery

Question 24

changing schemas: logical change methods: strategies (4)

Answer 24

1. imagining new self
2. soliciting social support and consensus
3. advantages and disadvantages of old and new schemas
4. time projection

Question 25

changing schemas: logical change methods: strategies : imagining new self

Answer 25

• even the process of imagining the new schema may have the effect of loosening up the clients commitment to old ways
• ask questions about the areas of their lives with which they are dissatisfied and seek change
• See changes through

Question 26

changing schemas: logical change methods: strategies : soliciting social support and consensus

Answer 26

• encourage client to obtain ideas and reactions from others in their social sphere about intended changes
• plan what they want to reveal to others, what types of reactions they hope for, and what they can realistically expect
• helps to predict what type of social reactions they can expect if they start to make change

Question 27

changing schemas: logical change methods: strategies : advantages and disadvantages of the old and new schemas

Answer 27

• examine new schema from a variety of angles
• recognise that old schema made sense at the time of its development
• some of the advantages and disadvantages of the old and new schemas have different time frames, e.g. new schema may have short-term disadvantages but more positive long-term advantages

Question 28

changing schemas: logical change methods: strategies : time projection

Answer 28

• let clients assume their new schema is in place and project themselves forward in time, imagining the person they want to be
• writing personal scripts (like a short story)
• list of developing attributes, notes to oneself, index cards
• imagine themselves at the end of their lives and think about how they want to be remembered

Question 29

changing schemas: acceptance-based interventions

Answer 29

• conscious joint decision not to pursue schema change at a given point in time
• undertake interventions that will increase resilience and likely reduce relapse, even in the absence of schema change
• develop compensatory strategies
• schedule a follow-up session
• engage in e.g. ACT