Clinician's Guide to Mind Over Mood (20 page)

Construction and use of scales in session helps clients begin to use scales to evaluate their schemas outside session using
Mind Over Mood
Worksheets 9.7 and 9.8. These worksheets direct the client to rate the new schema rather than the old. Worksheets in the manual thus support therapeutic emphasis on strengthening new beliefs rather than simply weakening old ones.

Continuum work is central to schema change because schemas are dichotomous. Use of a continuum or scale helps the client learn to evaluate experiences in more graduated terms. Small changes in belief that might be missed on a Thought Record are captured on a continuum. Since schemas change gradually in response to an accumulation of experiences, clients usually need to use scales and other schema change methods for six months or longer before a new schema is fully developed.

Core Belief Records.
Since schemas shape our perceptions, they make it difficult for us to perceive information inconsistent with our current views. Therefore, clients do not see and remember experiences that could support alternative, more adaptive schemas. Sometimes called a positive data log (Padesky, 1994a), the Core Belief Record presented in Worksheet 9.6 of
Mind Over Mood
is designed to help clients notice and record experiences that support new schemas.
Figure 7.1
shows an example of Worksheet 9.6 as Gary completed it.

FIGURE 7.1
.
Gary’s Core Belief Record.

Notice that Core Belief Records are designed to collect very small daily experiences. Ideally, the client finds two or three examples per day to write in the log. The difficulty in this seemingly simple task is that clients cannot easily perceive data that contradicts schemas. Until the new schema is strengthened, the client does not have the lens to bring this data into focus. At the same time, the data are necessary to construct the new schema. The therapist must therefore be alert to small experiences that support a new schema and help make the client aware of them so that the client can begin noting and recording them. Gary and his therapist illustrate this process.

T:   Did you add any items to your Core Belief Record this week?

G:   No. I didn’t have anything happen to write down.

T:   So you didn’t make any mistakes or show any faults this week? It must have been a pretty good week!

G:   Not exactly. My truck broke down and I was late to work. And I was pretty depressed last weekend.

T:   When those things happened, did you get punished by your boss or by other people around you?

G:   No, not really.

T:   What happened?

G:   Well, I couldn’t call in to work because I wasn’t near a phone. But my boss was pretty understanding when he found out what happened. And Sally was pretty nice to me on the weekend. She tried to cheer me up and made an excuse for me so I didn’t have to go to her mother’s house.

T:   So, if you look at your new schema, “I’m safe even if others see my faults,” do you think either or both of these experiences might be small examples you could write on Worksheet 9.6 to show that this belief is sometimes true?

G:   I guess so. I didn’t think the events really related to being safe, though.

T:   But if you were always punished for your faults, what would have happened these two times?

G:   My boss could have given me a job warning and Sally could have gotten mad at me, I guess.

T:   Yes, those would be punishments of a sort. But they didn’t happen, did they?

G:   No. Both of them were pretty good about my problems.

T:   Do you think you could write these examples on your sheet for this week?

G:   Yes. (
Writes them on his worksheet.
)

T:   Maybe this week you could think each day what went wrong and notice any way you messed up. Then, if you weren’t punished for it, you could write it on the worksheet.

G:   OK.

T:   Let’s write this plan down on the top of the worksheet page as a reminder of what type of experience to write down.

Gary’s therapist helps look for data that could have been recorded on his log by asking about the type of experience Gary fears (making a mistake or having some sort of problem). The therapist assumes that Gary won’t notice experiences that contradict his schema and helps him to see that in fact in several instances during the week when things went poorly, he wasn’t punished. She asks Gary to write the instances down immediately in his log and then helps him construct a guideline to help him notice this type of experience in the future. The therapist has Gary write down the plan for noticing data that support his new schema on the worksheet because the therapist knows that Gary will forget information related to the new schema if he doesn’t write it down. By the time Gary can easily complete Worksheet 9.6 on a daily basis, his new schema will be formed; once the new schema is in place, he will easily perceive supportive data.

Most clients need to keep a new Core Belief Record for about six months before the new belief is firmly established and has credibility. Core Belief Records can be combined with continuum ratings to chart progress. For example, Gary kept weekly ratings of his confidence in his new belief, “I’m safe even if others see my faults” on Worksheet 9.7. Recall that he believed the new schema 0% when he first identified it. After one month of writing experiences on Worksheet 9.6, he believed the new core belief 10%. After three months his confidence in his safety when faults were revealed had increased to 30–40%. Six months after beginning the log, his belief in the new schema increased to 80% for most of his relationships.

Historical Test of Schema.
Worksheet 9.9 directs the client not only to consider current data in evaluating the credibility of a new belief but also to look for historical evidence that the new belief applies to his or her life. Most schemas are formed in childhood. Negative schemas skew our perceptions and recollections of our whole life. Therefore, it can be worthwhile to look back in our history for data we may have missed or ignored because they didn’t fit our predominant schemas.

Just as clients often need the therapist’s help in perceiving data to record on a new Core Belief Record, they often need help in identifying historical information that supports a new schema. A therapist can help a client recall information by considering what small bits of evidence might exist and asking questions to prompt memories of this information. It is helpful to ask about a variety of relationships and events as Gary’s therapist demonstrates.

T:   Today I’ll show you how to use Worksheet 9.9 to look for evidence from your past that might support this new idea you’re working on, “I am safe even if others see my faults.” You’ve told me this was not true with your dad when you were growing up, but I wonder if maybe it was true with any other people.

G:   What do you mean?

T:   Well, to begin this worksheet, who were the other important people in your life, let’s say between the time you were born and age two?

G:   My mother and my brother.

T:   Do you think you were safe with either of them as a baby?

G:   As a baby, I think I was OK. My dad was overseas in the army then.

T:   So what could you write for this age period? For example, if you tried to stand and you fell down, or if you cried or got sick, how do you think your mother and brother treated you?

G:   I think they were nice to me. I could write that down for those years. (
Pauses while he does so.
)

T:   What about ages two to four?

G:   My dad came home then and things got crazy. Whenever he’d drink, he’d start hitting us. I remember one time I was sick and cried and he hit me over and over again. I bet I was only three.

T:   So at home it wasn’t very safe when dad was there.

G:   No.

T:   Were you ever anywhere other than home?

G:   I went to my grandma and grandpa’s house every summer for a few weeks.

T:   What was it like there?

G:   It was fun. They lived in an apartment in Chicago and my grandfather used to take me to the zoo and to the train yards. We did lots of neat things.

T:   What happened if you were sick, or made a mistake, or showed a fault to your grandfather or grandmother?

G:   They were always nice to me. One time I broke a dish and I started to cry because I thought I’d get a whipping, but my grandmother just hugged me and said it was all right. My grandfather helped me clean it up and he said, “Dishes aren’t nearly as important as family.”

T:   Do you think these experiences fit more with your old core belief, “I’ll be punished for my faults,” or your new belief, “I’m safe even if others see my faults”?

G:   With the new one.

T:   Why don’t you write these experiences on Worksheet 9.9 in the age 2–4 row?

Like Gary, even clients who had pretty horrendous childhood experiences can benefit from the historical test of schemas. It is not necessary to identify many experiences that support the new schema; even a few are meaningful to clients. Ideally, clients find one or two experiences per age period. If a client has no memory for certain age periods (as happens sometimes when children were badly abused or sexually molested), he or she can benefit from completing Worksheet 9.9 for whatever age periods are remembered.

Rather than judging behaviors characteristic of personality disorders as pathological, cognitive theory describes them as coping strategies that make sense in the context of core schemas. For example, guarded behavior by the paranoid client is adaptive, not pathological, in the context of the client’s conviction that “others will always use or manipulate me if I’m not on my guard.” Dependent behaviors are sensible coping strategies if a client believes “I am weak and vulnerable to be hurt. Others are stronger and can protect me.”

Schema change is therefore accompanied by a therapeutic focus on learning and applying new behavioral responses. Chapter 8 of
Mind Over Mood
can be used to structure behavioral experiments designed to test old schemas and strengthen new ones. To evaluate his new schema, “I’m safe even if others see my faults,” Gary had decided it would be good if he could directly express irritation in his relationship with Sally. Like many clients, Gary initially avoided behavioral experiments because of anxiety and a conviction that new behavior was dangerous. In the following session, Gary’s therapist helps him overcome reluctance to complete the behavior experiment.

G:   I didn’t really say what I felt this week, like we talked about last week.

T:   Did you forget to do this or decide not to?

G:   I sort of decided not to.

T:   What thoughts and feelings led to that decision?

G:   Well, I felt scared. I thought it was too risky.

T:   Give me an example of a time that felt too risky this week.

G:   I was irritated with Sally on Saturday and I thought about telling her to back off and leave me alone for awhile. But I was afraid she’d get mad and it would be bad for me.

T:   So what did you do?

G:   I just worked on my car and turned up the radio so she couldn’t talk to me.

T:   And how did that work out for you?

G:   I felt mad the whole time and kept yelling at her in my head. Later she came out to talk to me and I was sort of cold to her and she got mad.

T:   So your old behavior didn’t really protect you from Sally’s anger?

G:   No.

T:   And yet saying what you felt in the beginning might have led to Sally getting angry, too.

G:   I think so.

T:   So maybe we need to plan one step beyond the new behavior.

G:   What do you mean?

T:   Do you think it would help if you had a plan for what to do if Sally gets mad when you tell her how you feel?

G:   Yeah. I don’t really do anything when she gets mad but maybe walk away or sometimes call her a name and then walk away.

T:   I think Worksheet 8.1 in your manual would help. Let’s find it and give it a try.

G:   I’ve got it.