Artikeln är publicerad i International Journal of Cognitive Therapy, IACP Newsletter 2010
The assessment of schemas is an important part of case formulation in CBT and contains a longitudinal view of cognitive and behavioural factors influencing symptom expressions. By schemas we usually mean core beliefs, underlying assumptions and associated strategies (Beck, Freeman, Davis, et al., 2004, Kuyken, Padesky, Dudley, 2009). Longitudinal conceptualizations provide an understanding about how core beliefs, underlying assumptions and coping strategies were learned and what factors contributed to maintenance patterns. These conceptualizations usually emerge in later stages in CBT when focus of therapy is on the treatment of low self-esteem or personality disorders or when a therapist is working with clients who report chronic, multiple and overlapping problems. There are different methods for schema assessment such as guided discovery utilizing the downward arrow technique, spotting patterns of automatic thoughts, conducting a life history review, or using schema inventories such as Dysfunctional Attitude Scale (Beck et. al., 1991) and Young Schema Questionnaire (Young, 1999).
In my work as a therapist over the past two decades, I have found that we lack an idiosyncratic method to assess schemas early in therapy to (a) improve the conceptualization of low self-esteem or a dysfunctional personality and (b) capture patients who can be difficult to treat in short-term therapy because of problems with establishing a therapeutic alliance.
The method, which I called a Star Chart (see Figures 1 & 2), consists of 12 statements which a client is supposed to end in a way that describes the characteristic way he or she usually feels about self. Two of the statements usually capture core beliefs (no 7 and 9), two capture underlying assumptions (no.11 and 12) and two (no. 1 and 2) provide information about associated (e.g., coping) strategies. The remaining six items may or may not reveal the issues relevant for longitudinal conceptualization. The statement which the client considers the most characteristic is then written in the circle in the middle of the star. Usually the Star Chart is given to patients as one of many different assessment forms after the first visit and is discussed during the second or third interview. At the end of the therapy the Star Chart can again be administered again to patients as a way to evaluate the results of therapy in terms of changes in cognitive organization/schema change.
Figure 1 illustrates a Star Chart from a woman seeking help for stress-related problems and instable self-esteem. This figure shows how the method can effectively help understand a dysfunctional histrionic schema. Her core beliefs are: “I am terrified of being excluded and” I avoid feeling lonely”. Her underlying assumptions are: “at all times I must be heard” and “at all times, I want to be seen and noticed” which she also considers the most central statement in her self-description. Her behaviour strategies are: “at all times I must be heard” and “I constantly feel forced to assert myself”.
Figure 2 illustrates a Star Chart from a 50 year old man without psychological problems, who is functioning very well and could deal with major life crises in the past in a healthy way. This figure illustrates how the method can capture a healthy schema.
Figure 1
Star Chart
Complete the sentences in the boxes below according to how you see yourself. Think of what you consider most characteristic of you.
Having completed the twelve sentences, choose the statement most applicable to you and write that in the circle in the middle.*
Figure 1 illustrates a Star Chart from a woman seeking help for stress-related problems and instable self-esteem.
Figure 2
Star Chart
Complete the sentences in the boxes below according to how you see yourself. Think of what you consider most characteristic of you.
Having completed the twelve sentences, choose the statement most applicable to you and write that in the circle in the middle.*
Figure 2 illustrates a Star Chart from a 50 year old man without psychological problems, who is functioning very well and could deal with major life crises in the past in a healthy way.
Conclusion
Star Chart is a potential promising idiosyncratic method for assessing schemas. This strategy may help clinicians to capture dysfunctional schemas early in therapy and may differentiate persons with healthy schemas from those with dysfunctional schemas. Future research is necessary to determine whether this method is a sensitive way to evaluate schema change and to assess its specificity.
References
Beck, A.T., Freeman, A., Davis, D.D., et al. (2004). Cognitive Therapy of Personality Disorders. Second edition. The Guilford Press.
Beck, A.T., Brown,G., Steer, R.A., Weissman, A.N. (1991) Factor analysis of the Dysfunctional Attitude Scale. Psychological Assessment, 3, 478-483.
Kuyken, W., Padesky, C.A., Dudley, R. (2009). Collaborative Case Conceptualization.New York. Guilford.
Young, J.E.(1999). Cognitive Therapy for Personality disorders: A schema-focused approach (3rd ed. Sarasota, FL: Professional Resource Press).