Once the therapist and patient have settled on a specific target behavior, the therapist works on helping the patient build motivation for behavioral change.
In order to help patients feel more empathic and supportive toward themselves and thus more able to make positive changes, the therapist helps them link the target behavior to its origins in childhood. Patients understand why the behavior developed in the first place and learn to forgive themselves instead of blaming themselves for the behavior. For example, a patient who is about to give up alcohol might connect the urge to drink to his Defectiveness schema, which began in childhood with his critical and rejecting father. It is to escape feelings of worthlessness and unlovability that the patient drinks. Instead of viewing himself as weak for becoming an alcoholic, the patient can understand why it happened. Drinking was his way of avoiding the painful emotions connected to his Early Maladaptive Schema.
In addition, linking the behavior to childhood helps the patient connect the behavioral component to the prior cognitive and experiential work.
To strengthen motivation, the therapist and patient review the advantages and disadvantages of continuing the maladaptive behavior. Unless patients believe it is worth the effort, they are not going to undertake behavioral change.
Alan comes to therapy at the urging of his fiancée, Nora, who is expressing uncertainty about going ahead with their wedding. Alan does not understand what is wrong with their relationship. From his point of view, everything is fine. “The only problem is that Nora isn’t happy,” he says. At the therapist’s request, Nora comes in for a session. She tells the therapist that she feels as though her relationship with Alan is “missing something.” “We don’t have real intimacy,” she says.
In the Assessment Phase, the therapist and Alan agree that he has an Emotional Inhibition schema that is preventing him from connecting deeply with Nora. Alan goes through the cognitive and experiential components of treatment and then begins behavioral pattern-breaking. His goal is to express more emotions—both positive and negative—in his relationship with Nora.
Alan is intensely ambivalent about this goal. In his view, his emotional inhibition is an intrinsic part of who he is. To help him build motivation to change, the therapist asks Alan to list the advantages and disadvantages of remaining unemotional toward Nora. The list of advantages include such items as (1) avoiding discomfort; (2) being true to myself; (3) I like to stay in control; and (4) I don’t like confrontations. The list of disadvantages includes one item only: (1) Nora will be unhappy and may even leave me. However, contemplating this one disadvantage helped Alan build the motivation to change his behavior. Knowing that, unless he changes, he will lose Nora is enough to motivate Alan to change.