After completing the Assessment and Education Phase described in the previous chapter, the therapist and patient are ready to begin the Change Phase. This phase incorporates cognitive, experiential, behavioral, and interpersonal strategies to modify schemas, coping styles, and modes. We usually begin the change process with cognitive techniques, which are the focus of this chapter. 1
As part of the Assessment and Education Phase, the therapist has already filled out the case conceptualization form and educated the patient about the schema model. The therapist and patient have identified the patient’s dysfunctional life patterns and Early Maladaptive Schemas, explored the childhood origins of the schemas, and linked the schemas to the presenting problems. They have also identified the patient’s coping styles, emotional temperament, and modes.
Cognitive strategies help the patient articulate a healthy voice to dispute the schema, strengthening the patient’s Healthy Adult mode. The therapist helps the patient build a logical, rational case against the schema. Usually patients have not questioned their schemas: They have accepted them as “givens” or as truths in their lives. In their internal psychological worlds, their schemas have reigned supreme. There has been no strong Healthy Adult mode to counter the schema. Cognitive strategies help patients step outside the schema and evaluate its veracity. Patients see that there is a truth outside of the schema and that they can fight the schema with a truth that is more objective and empirically sound.