In the behavioral pattern-breaking stage of treatment, patients attempt to replace schema-driven patterns of behavior with more adaptive patterns. The behavior patterns that are the focus of change are the maladaptive coping styles patients use when their schemas are triggered. These maladaptive coping styles are generally surrender, avoidance, or overcompensation, although each Early Maladaptive Schema has its own characteristic coping responses.
Behavioral pattern-breaking begins with defining specific behaviors as possible targets of change. The therapist and patient accomplish this in a number of ways: (1) refining the case conceptualization they developed in the Assessment Phase; (2) developing detailed descriptions of problematic behaviors; (3) conducting imagery about trigger events; (4) exploring the therapy relationship; (5) obtaining reports from significant others; and (6) reviewing the schema inventories.
Next, the therapist and patient prioritize behaviors for pattern-breaking. We believe that it is important for patients to attempt to change behaviors within a current life situation before making major life changes. Unlike traditional cognitive-behavioral therapy, patients begin with the most problematic behavior they are able to tackle.
In order to build motivation for behavioral change, the therapist helps the patient link the target behavior to its origins in childhood. The therapist and patient review the advantages and disadvantages of continuing the behavior. They develop a flash card that summarizes the main points. In sessions, the therapist and patient rehearse the healthy behavior in imagery and role-plays. They agree on a behavioral homework assignment. The patient carries out the homework, and the therapist and patient discuss the results thoroughly in the next session.
We make several suggestions for overcoming blocks to behavioral change. First, the therapist and patient develop a concept of the block. The block is usually a mode, and the therapist and patient can ally in facing this mode. The patient conducts dialogues between the block and the healthy side. The therapist and patient compose a flash card for the patient to read. If, after reassigning the homework, the patient is still unable to comply, then the therapist can set contingencies for not completing behavioral homework assignments.