Clinician's Guide to Mind Over Mood (28 page)

Although behavioral experiments may have been recommended to individual clients in previous sessions, the sixth meeting is often a good time to discuss behavioral experiments in detail with the group as a whole. Group members can help each other plan interesting behavioral experiments to test alternative beliefs that are only partially credible or to try new behavioral coping strategies and evaluate their effectiveness. For example, Lupe might plan some experiments to face situations she has been avoiding; David might act more trusting in one or more situations and see what happens. Chapter 8 of
Mind Over Mood
describes how to plan these experiments, and Worksheet 8.1 can be used to structure client homework for the seventh session.

In eight-session group therapy, the seventh session is used to begin preparing for group termination. Clients are encouraged to ask questions regarding problems they are still experiencing, reassess progress toward their goals, and make plans for continued progress after therapy is over. This is a good session in which to formally introduce Action Plans (
Mind Over Mood,
Worksheet 8.2) because Action Plans can be used to plot continued progress toward goal attainment after the group sessions end. In addition to other skills learned in therapy, Action Plans may also be part of a relapse prevention plan.

If the group is meeting longer than eight sessions, the seventh session can be used to review concepts and provide additional skills practice. Action Plans are introduced and group members are encouraged to use Worksheet 8.2 to plan concrete steps which will help achieve therapy goals.

If the eighth session is the final one for the group, members review and consolidate the gains they have made, discuss individual plans for continued learning and practice, say goodbye to each other, and arrange individual post-group sessions (see
page 209
). Group members should be encouraged to continue using the treatment manual to guide their change efforts in the months ahead. It is helpful for group members to summarize which skills are most helpful to them and which skills need additional practice. Members can discuss their ongoing plans for change and offer each other advice and encouragement for future individual efforts. Some group members may offer to continue meeting informally after the group has ended to support change efforts and help solve difficulties.

The group leader may also comment briefly on Chapter 9 of
Mind Over Mood,
offering brief guidelines for clients who plan to continue using the manual to identify and change core beliefs. Clients should be told that, although the other chapters of the book were mastered in a week or two, Chapter 9 exercises are designed to be completed over a number of months. Some group members may already have identified core beliefs during the eight group meetings; these can be written down at the top of Chapter 9 as a reminder.

If the group is meeting for twelve sessions, the leader can spend more time on earlier topics. One recommendation is to spend two weeks on identification of hot thoughts (session 3 for an eight-session group), a skill that often requires more than a week to master. In fact, a bit more time can be allowed at each stage to fully master skills. If group members are mastering skills at the pace of an eight-session group, additional meetings can teach more advanced skills.

The ninth session may be used to explain and illustrate underlying assumptions and core beliefs. The downward arrow technique can be used to help clients identify their core beliefs, and members can provide examples to show how core beliefs operate in their lives.
Chapter 7
of the clinician’s guide and Padesky (1994a) describe how to help clients identify core beliefs and the importance of describing these beliefs in the client’s own words. Beliefs must be identified correctly before beginning schema change. Therefore, the homework assignment after the ninth session often includes asking group members to notice if the beliefs they identified in the session seem to be operating in their lives during the week. Clients are encouraged to change the wording of the belief if necessary to capture it accurately. They can also bring images or memories connected to the beliefs to the tenth group meeting for discussion.

The tenth session is designed to show how alternative core beliefs can be identified, developed, and strengthened. Again, the leader can refer to
Chapter 7
of this clinician’s guide and to Padesky (1994a) for an overview of how to construct and strengthen alternative core beliefs. It is important to state an alternative belief in words that are meaningful to the client, even if the alternative belief is not a linguistic opposite of a negative core belief. For example, if the negative core belief is “I’m no good,” alternative core beliefs can range from “I’m good” to “I’m acceptable to others” to “I’m my own person” to “My opinions count.”

The process of strengthening an alternative core belief usually requires months of practice, so group members are told that they will start the worksheets introduced in the second half of Chapter 9 of
Mind Over Mood
in the group but will continue them long after the group has ended. The Core Belief Record (Worksheet 9.6) is central to strengthening new core beliefs. It is designed to help a client actively look for data that support the new, alternative core belief. Although in the early weeks most clients have difficulty seeing evidence that supports their new core beliefs, eventually clients will add to this log on a daily basis.

Group members can help each other recognize data and categories of data that are relevant and can be written down on Worksheet 9.6. Clients who discount a relevant item of data are encouraged to write it down anyway and rate its believability. That is, a client might write, “A group member told me she liked me; 10%” to indicate a piece of evidence that is relevant to the new schema “I’m likable” but that she only partially believes.

The historical test of a core belief (Worksheet 9.9) is similar to Worksheet 9.6 except that it records past data rather than present data. This worksheet helps clients begin to reframe their life history in light of newly developing alternative schemas. If clients have years for which they have no memories, they can be encouraged to complete Worksheet 9.9 for those years for which they have memories. Even clients who have had particularly harsh lives usually can find some small bits of evidence for all age periods that support a new, more adaptive schema. Finding historical as well as present evidence helps the new schema gain strength.

The eleventh session continues to help group members identify and strengthen new core beliefs. In addition to searching out data that support the new schema, methods of using a scale are introduced that begin to counter the dichotomous view of experience that schemas portray. Worksheet 9.7 can be used to track growing confidence in a new schema. Often the new schema has close to 0% credibility to clients for a number of weeks. As evidence is collected on Worksheets 9.6 and 9.9, client confidence in the new core belief begins to increase.

Most clients believe the new core belief as much as 40 to 60% after several months of data collection. At this point, it has become easier for clients to regularly perceive evidence that supports the new core belief. Until that point, clients need encouragement to keep looking for data to record on Worksheet 9.6. Therefore, the final group sessions should emphasize the importance of continued work in Chapter 9 of
Mind Over Mood
even after the group has ended. Behavioral experiments are often assigned to individual members to help provide data to record. For example, the group could help a client with the negative core belief “Others can’t be trusted” to devise a series of small experiments to actively test this belief. Any positive outcomes of these experiments can be recorded on Worksheet 9.6 to support the alternative belief “Others can be trusted.”

Confidence in the validity of alternative core beliefs continues to grow until alternative core beliefs are just as strong as the original negative core beliefs. This is the ideal outcome of schema change work: Clients have fully developed opposing schemas, so they can perceive negative and positive data equally and make flexible choices regarding beliefs and behaviors in diverse circumstances (Padesky, 1994a). A client who believes “Others can be trusted” as well as “Others can’t be trusted” is in a better position to trust or not trust depending on person and circumstance.

Worksheet 9.8 helps clients by asking them to rate experiences on a scale, rather than in the all-or-nothing terms suggested by core beliefs. Ratings can be made for core beliefs about the self (“I am strong”), others (“Others can be trusted”), the world (“Good is as strong as evil”), or for underlying assumptions (“If I keep trying, I’ll succeed”). It is usually more helpful to rate the positive form of a belief on a continuum. For example, most clients experience a greater boost in self-confidence after rating themselves 10% strong rather than 90% weak.

Scale ratings are another key to the development of alternative core beliefs. Whereas positive data records overcome a client’s tendency to perceive only data that fit a negative core belief, a scale begins to weaken the dichotomous view supported by absolute core beliefs. Frequent use of a scale helps clients begin to evaluate experiences in a more balanced fashion. The more balanced view helps support the alternative core belief by demonstrating that the negative core belief does not capture whole experiences. A client who sees herself as weak, uses Worksheet 9.8 to rate her strength in various situations. The ratings help her discover that she is not totally weak and that she has strength, even if it is only partially present in life situations.