1. Understanding the Principles of Counseling and Psychotherapy
Chapter 9

2. Chapter 9 Overview
Non-Linear Listening and Core Schemas
Assessment and Schema Dynamics
Therapeutic Alliance and Core Schema Dynamics
Early Childhood Recollections
The Formulations
Working with Client Schemas

3. Schema Dynamics and Psychological Disorders
Cognitive Distortions
CBT practitioners look for these in clients thinking
Reflect rigid and unrealistic schema dynamics
Understanding the schema dynamics can help address the distorted thinking

4. Cognitive Distortions
Selective Abstraction
Overgeneralization
Magnification
Minimization
Personalization
Dichotomous Thinking
Please turn to p. 204, “Information Box: Common Methods of Distorting Cognitions”

5. Schema Dynamics and Axis I Disorders
When cognitive distortions become problematic
Schema dynamics may be unrealistic
Individuals aware that there is a problem
Old patterns not useful anymore
Non-linear thinking starts here

6. Disorder Systematic Bias Depression
Negative view of self, experience, and future
Hypomanic
Positive view of self, experience, and future
Anxiety disorder
Physical or psychological threat—Negative view of others & life/world
Panic disorder
Catastrophic misinterpretation of bodily or mental experiences—Negative view of self
Phobia
Threat in specific, avoidable situations— Negative view of life/world
Paranoid State
Attribution of negative bias to others— Negative view of others & life/world
Hysteria
Belief in motor or sensory abnormality— Negative view of self
Obsession
Repetitive warning or doubting about safety—Negative view of life/world

7. Please turn to p. 204“Clinical Case Example: A Drinker with “Bumps” in His Childhood”

8. Schema Dynamics and Personality Disorders
Definition
An enduring pattern
deviates markedly from the expectations of the culture
is inflexible and pervasive across a broad range of personal and social situations
lead to clinically significant distress or impairment
In other words, personality disorders are simply disorders that arise from one’s schemas.

9. Schema Dynamics and Personality Disorders
Coded on Axis II
Half of all Clients have a Personality Disorder
Majority of Manuals focus on Axis I
Axis II goes undiagnosed or “deferred”
Why?
Because practitioners are not taught the non-linear thinking necessary to understand them!

10. Please turn to p. 207 “Clinical Case Exercise: Anxious and Dependent”

11. The “Narrative” of Client Schema
Understanding “What makes a client tick.”
Listen to client’s story and define the “plot”
Both Linear and Non-Linear Listening
Who are the main characters?
Hero and Villain
Contains recurring patterns
Themes provide meaning for client and help therapist make sense of behavior.

12. Linear Listening and Client Schemas
Linear Listening for Content
What is the client saying about view of self, others, world
Listen for “injunctions”
Linear Listening for Feelings
Shading and punctuating story
Please turn to p. 185, Exercise 9.1: Linear Listening for Schema

13. Non-Linear Listening and Schemas
“What if…”
Personal “domino theory”
Attempt to control and predict
“If…,then…”
Logic behind the behavior
Non-linear listening provides clues
All flows to schema dynamics

14. Formal Assessment and Schema Dynamics
Readiness for Change
Client Resources

15. Themes & Schema Dynamics
1. Desperation Positive or Negative view of self; Negative View of World
2. Helplessness Negative view of self
3. Hopelessness Negative view of self, Others, and World
4. Defensiveness Positive view of self; Negative View of World
5. Exhaustion Negative view of self and World
6. Despair Negative view of others and/or World
7. Double Bind Positive view of self; Negative View of World

16. Therapeutic Alliance and Schemas
Alliance is strengthened by therapist recognition of schema dynamics
Ruptures can bee deepened or repaired more quickly based on schema dynamics.

17. Family-of-Origin and Schema Dynamics
Schema Dynamics (View of Self/Others/World) all originate from Family-of-origin interactions.
Sibling position (and relationships) play important roles.
Please turn to p. 193, Clinical Exercise 9.2

18. Please turn to p. 216, and review “Clinical Case Example: An Unhappy Couple in Crisis”

19. Early Childhood Memories
Method for collecting data on schema dynamics
Circumvents defensiveness by asking about childhood memories
Obtaining several recollections will allow for patterns to be evident regarding view of self, others, and world
Please turn to p. 197, Clinical Exercise 9.3

20. Puts the client’s story together
The Formulation
Puts the client’s story together
The Plot
The Characters
Their Motivation
The Narrative
All by understanding schema dynamics
See p. 219, Clinical Exercise: Working with ECRs to Determine Schema Dynamics

21. Working with Client’s Schema
Where does change fit in?
Assimilation
new experiences are interpreted in terms of a current framework or schema
Accommodation
psychological process of adjusting schema
Remember Sherlock’s warning!!!
Go back to Susan and Bob (p. 216)

22. Non-Linear Methods of Working with Client Schema
Please turn to p. 224, Clinical Case Example: Overly Sensitive

23. Working with Client’s Schema
Metaphor
Non-Linear
Describe complex issues with simple stories
Helps clients see their schema dynamics differently
Facilitate accommodation
e.g., House, M.D.
Turn to p. 226, “Clinical Exercise: Imagination and Metaphor”

24. THANK YOU.
Any Questions?