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Clinical Psychology and Psychotherapy, Vol. 1 (5), 267-278 (1994) Article reprinted with
permission of John Wiley &
Schema Change Processes in Sons. To learn more about
their journals, visit
Cognitive Therapy www.interscience.wiley.com
Christine A. Padesky*
Center for Cognitive Therapy, Newport Beach, CA, USA
Schemas are core beliefs which cognitive therapists hypothesize play a central
role in the maintenance of long-term psychiatric problems. Clinical methods are
described which can be used with clients to weaken maladaptive schemas and
construct new, more adaptive schemas. Guidelines are presented for identifying
maladaptive and alternative, more adaptive schemas. Case examples illustrate
the use of continuum methods, positive data logs, historical tests of schema,
psychodrama, and core belief worksheets to change schemas. Specification of
therapeutic methods for changing schemas can lead to the development of
treatment standards and protocols to measure the impact of schema change on
chronic problems.
INTRODUCTION the organism. It is the mode by which the environment is
In recent years, cognitive therapists have devoted broken down and organized into its many psychologically
increased attention to schemas, core beliefs which are relevant facets. On the basis of schemas, the individual is
hypothesized to play a key role in the maintenance of able to ... categorize and interpret his experiences in a
long-term psychiatric problems including personality meaningful way' (p. 283).
disorders, chronic depression, chronic anxiety disorders, This early definition was echoed in later works which
and chronic relationship difficulties. Case descriptions defined schemas as 'stable cognitive patterns' which
of treatment outcome with these disorders often credit provide a 'basis for screening out differentiating, and
positive results to changing maladaptive core schemas coding the stimuli that confront the individual' (Beck et al.
and building alternative, more adaptive schemas (Beck 1979, pp.12-13) and as 'specific rules that govern
et al., 1990). However, there are few detailed information processing and behavior' (Beck et a1., 1990, p.
descriptions in the literature of the clinical processes 8). In this latter book, the authors differentiate between
used to accomplish schema change. This paper describes core beliefs such as 'I'm no good' and conditional beliefs
schema change processes in detail with case such as 'If people got close to me, they would discover the
illustrations. "real me" and would reject me' (p. 43). Both core and
conditional beliefs are referred to as 'schemas' in their text.
In this paper 'schemas' will be used only to describe core
DEFINITIONS OF SCHEMA beliefs. For clinical purposes, this author finds it useful to
differentiate between schemas (core beliefs), underlying
Aaron T. Beck, MD introduced the concept of schemas assumptions (conditional beliefs), and automatic thoughts
to cognitive therapy. Beck's first book (1967) credits (cognitions that automatically and temporarily flow
Piaget (1948) with the origin of the word schema to through one's mind). Theoretically, core beliefs and
describe cognitive structures. Summarizing Harvey et al. conditional beliefs are similar in that they are both deeper
(1961), Beck added his own definition that 'a schema is cognitive structures than automatic thoughts. However,
a structure for screening, coding, and evaluating the different therapeutic processes are used to evaluate and
stimuli that impinge on change these two types of beliefs. Conditional
_____________________________________________________________________________________________
*Address for correspondence: Christine A. Padesky CCC1063-3995/94/050267-12
Website www.padesky.com ©1994 by John Wiley & Sons, Ltd.
Reprinted by permission of John Wiley & Sons, Ltd.
268 C. A. Padesky
beliefs are often best tested through the use of (Hastie, 1981; Marcus and Zajonc, 1985; Miller and
behavioural experiments. Core beliefs are best suited to Turnbull, 1986). A person who believes 'effort does not
the evaluation methods described here. pay off' will notice and remember failure experiences
more readily than success experiences. Someone with a
DEVELOPMENT AND MAINTENANCE OF self-schema, 'I am bad', will focus on personal defects,
SCHEMAS flaws, and errors, noticing and remembering these more
than strengths, positive gains, and successes. Once
Cognitive therapy is based on an information processing formed, schemas are maintained in the face of
theory which posits that schemas develop as part of contradictory evidence through the processes of
normal cognitive development. According to information distorting, not noticing, and discounting contradictory
processing theory, we group experiences into categories information or by seeing this information as an
to help us understand and organize our world. A child exception to the schematic, and therefore 'normative',
groups dogs, cats, and lions as 'animals' and may have a rule (Hastie, 1981; Bodenhausen, 1988; Beck et
more specific schema of 'pet' that includes the first two al.,1990).
animals but not the third.
The ease with which schemas are maintained even in the
The schemas that are of greatest interest in therapy are face of contradictory evidence poses a dilemma for
those closely related to affective states or behavioural cognitive therapists. Much of cognitive therapy relies on
patterns. Each person has self schemas as well as modifying beliefs through the review or production of
schemas about others and the world that affect emotional evidence that contradicts negative or maladaptive
and behavioural reactions. Schemas do not necessarily conclusions drawn by a client. With problems of relative
cause chronic emotional or behavioural difficulties. short duration (several months for a child or several
However, schemas seem to play a central role in the years for an adult), production of contradictory evidence
maintenance of chronic problems regardless of the often leads to a shift in belief. This shift in belief can
aetiological roots of these problems. occur quickly (within a therapeutic hour or over the
course of several weeks) if supporting alternative
For example, one person may have experienced lifelong schemas exist. That is, a depressed person who currently
depression due to a variety of factors including a strong has an 'I am bad' self-schema activated may be able to
positive loading for depression and serious life stresses shift this belief within a few weeks if this person has an
and strains (e.g. childhood abuse, familial deaths, and 'I'm OK' schema which is normally activated in the non-
multiple failure experiences). Along the way, this person depressed state.
is likely to have developed negative schemas such as 'I'm
no good' (self), 'Others can't be trusted' (others) and However, people with lifelong or chronic problems
'effort does not pay off' (world). often do not have an alternative schema available, and
therefore, no amount of contradictory evidence will shift
To overcome depression, it may be necessary for this their beliefs. A person whose only self-schema over the
person to make behavioural and cognitive changes. Even course of a lifetime has been 'I am bad' will look at a list
if environmental stressors and heredity are assumed to of data supporting an 'I'm OK' conclusion and say to the
play a primary role in the development of this depression, therapist, 'Yes, I see this evidence, but I am still bad'.
key therapeutic steps are unlikely to be attempted and
maintained by this person unless the schemas are For this reason, treatment of chronic problems within
evaluated and modified. This person's world-schema will cognitive therapy usually involves not only testing
erode motivation to attempt change, the self-schema may maladaptive beliefs but also identifying and
interfere with recognition of therapy progress, and the strengthening alternative, more adaptive schemas. An
schema regarding others may lead to difficulties in the alternative schema must be developed before the client
therapy relationship and in relationships with family and will be capable of looking at the evidence and saying,
friends who might otherwise support progress. 'Yes, this suggests I might be OK'. The remainder of this
article will focus on clinical methods that seem helpful
Schemas serve a powerful maintenance function for in accomplishing the dual goals of weakening
problems because schemas determine what we notice, maladaptive schemas and developing more adaptive
attend to, and remember of our experiences schemas.
Schema Change Processes 269
IDENTIFYING MALADAPTIVE SCHEMAS words. For another client, the same concept might be
Beck (1967) postulated that schemas and affect are stated as 'I am a zero'. A third might capture the schema
closely joined (pp.288-289). For this reason, a therapist with a phrase yelled at them by a parent, '[You're a] small
wishing to identify maladaptive schemas should follow piece of dirt'. By labelling the maladaptive schema in
the affect. A client who is feeling intensely depressed, words or images that come directly from the client's
anxious, angry, guilty or ashamed can be asked, 'What experience and mind, the affect associated with the
does this [internal or external event] say about you?' to schema will be greater and the meaning of any change
access self-schemas, 'What does this say about other achieved will impact the client more deeply. Therefore, if
people?' to access other-schemas, and What does this say the therapist identifies a potential schema and the client
about your life or how the world operates?' to access agrees the therapist has correctly captured the concept, it
world-schemas. is important to ask the client, 'How would you say this in
your own words?"Can you give me an example of how
It is important to identify all three types of schemas this works in your life?' 'Do any images or memories
because they will interact with each other to help explain come to mind associated with this belief ?'
a person's affect, behaviour, and motivations. For IDENTIFYING ALTERNATIVE SCHEMAS
example, two people may have self-schemas, 'I'm
inadequate'. The first may have an other-schema, 'Others After identifying key maladaptive schemas, therapist and
are critical', and, therefore, adopt avoidant behavioural client need to identify alternative, more adaptive
strategies and withdraw from challenging situations. The schemas. It is important to identify the desired schema as
second person may have an other-schema, 'Others are early as possible. As will be clear in subsequent sections,
protective', and adopt dependent interpersonal strategies clinical methods for schema change will be more
and be willing to enter any situation if accompanied by a effective if the alternative, more desirable schema is the
helpful other. focus of data collection and evaluation rather than the
While questioning the meaning of high affect events will maladaptive schema.
usually quickly lead to the identification of schemas, To identify the alternative, more adaptive schema, ask the
other methods can also be employed. Clients can be client, 'How would you like it to be?' For self-schemas
requested to do a simple series of sentence completions, 'I ask, 'If you weren't ____________________, how would
am _____________', 'People are ___________' and 'The you like to be?' For other-schemas ask, 'If people weren't
world is ______________'. Since schemas are usually ________, how would you like them to be?' For world-
stated as absolutes, these sentences can usually be schemas ask, 'If the world wasn't_________ , how would
completed with a single word to identify a schema. you like it to be?' For clients who cannot name an
Belief questionnaires can also be used as a starting point alternative, it may be necessary to ask further questions
to identify core beliefs. These include the Dysfunctional with a shift in perspective. For example, 'You see
Attitude Scale (Weissman and Beck, 1978; Weissman, yourself as worthless, how do you see other people whom
1979), the schema checklist in Appendix A of the text on you admire? Would you like to be more like that? If you
personality disorders written by Beck and colleagues were like that, would you still be worthless?'
(Beck et al., 1990), and the schema questionnaire The new, more adaptive schema also should be labeled in
developed by Young (Young, 1990). These the client's own words. Sometimes the alternative schema
questionnaires include a variety of core and conditional will be the direct opposite of the maladaptive schema.
beliefs and clients can be expected to endorse many of For example, 'I'm lovable' might be a desired alternative
the beliefs listed. For these reasons, these questionnaires to 'I'm unlovable'. Often, however, the alternative schema
are helpful for broadly conceptualizing a client's belief which the client chooses is quite different from what the
system. Further discussion with the client will be therapist or linguistics would predict. For example, one
necessary to determine which of the many beliefs client had a negative schema, 'Others are critical', and the
endorsed are most strongly held and central to the desired alternative was, 'Others are similar to me'.The
problem of focus in therapy. process of identifying maladaptive and alternative
Once a therapist and client have identified core schemas, schemas can take several weeks in therapy. Often, either
it is important that these be expressed in the client's the old or new schema concept will be
personal language and idiom. For one client, 'I am
worthless' may be expressed in those
270 C. A. Padesky
modified a number of times as interventions and SCHEMA CHANGE: CLINICAL METHODS
therapeutic discussions proceed. Changes in the words Schema change usually involves a simultaneous focus on
and images used to describe maladaptive and alternative weakening old schemas and strengthening new ones.
schemas will often clarify for both client and therapist Most clinical methods discussed here contribute to both
subtle nuances in meaning that can be quite helpful for tasks if the maladaptive and adaptive alternative schemas
identifying possible avenues for change. have each been well-defined by therapist and client.
For example, one client identified a schema, 'The world is These schema change methods are most usefully
dangerous and violent' which was maladaptive because it employed with a client who has already mastered basic
maintained an immobilizing depression and fear. In therapy skills such as identification of thoughts and
observing events which activated this schema over the emotions and testing automatic thoughts. Further, they
following weeks, she was able to clarify that her will have greatest impact when applied to schemas which
strongest affect actually came with a related schema, are closely related to the client's primary problems.
'Kindness is meaningless in the face of pain and Continuum Methods
violence'. Working with this schema and the alternative,
'Kindness is as strong as violence and pain', helped her Pretzer (1983) was among the first to recommend the use
cope better with the violent and painful realities she faced of a continuum to evaluate negative schemas. Since the
and sustained a spirit of hope and effort in her life. Her maladaptive and alternative schemas are absolutes, and
depression and anxiety were resolved over subsequent often opposites, a continuum charts the territory between
months. Moreover, this client considered her ability to these poles. In its simplest form, a client could be asked
develop new approaches for coping and transforming a to place themselves on a continuum between 100%
sometimes harsh world her most significant therapeutic unlovable and 100% lovable. Through questioning the
gain. evidence, the therapist could try to shift the client's self
Clinicians sometimes wonder whether the alternative evaluation to a midpoint on this continuum to reduce
schemas should be absolute in form or represent a more absolutistic thinking.
balanced conclusion. Should the alternative to 'I'm Extensive use of continuum by this author and her
unlovable' be 'I'm lovable' or 'I'm lovable sometimes to colleagues led to the development of strategies which
some people?' Since schemas are absolute, the alternative maximize the effectiveness of continua used for schema
used in therapy should be stated as an absolute statement. change. These strategies, summarized here, include:
A negative absolute will be paired with a more positive charting on the adaptive continuum, constructing criteria
absolute. This is important or the maladaptive schema continua, two-dimensional charting of continua, and
may not be shifted at all. 'I'm lovable sometimes to some using a two-dimensional continuum graph to illustrate
people' could be incorporated by the maladaptive schema interdependent schematic beliefs.
as merely evidence of occasional exceptions to the rule or Charting on the Adaptive Continuum
as evidence that some people are especially charitable (or
foolish) without making any shift in the core belief 'I'm Development of the alternative more adaptive schema
unlovable'. can be enhanced if continuum work is done on a
Interestingly, a negative absolute will be more absolute continuum which charts the presence of the adaptive
than a positive form of the same absolute. This is because schema only. Thus, rather than using a continuum which
negative schemas imply absence (e.g. unlovable means ranges from 100% unlovable to 100% lovable, it is often
never lovable under any circumstances) whereas positive more productive to use a continuum which ranges from 0
schemas imply presence which may not be perfect (e.g. - 100% lovable. A clinical example illustrates the
lovable means someone can love you but not necessarily advantages in this approach.
that everyone will love you). This semantic meaning One of the purposes of a continuum is to shift absolutistic
difference between positive and negative absolutes means beliefs to more balanced mid-range beliefs. Lydia
that a more positive alternative schema will, by its very believed she was unlovable. Lydia rated herself as 100%
nature, be more balanced and more capable of unlovable on an initial continuum which ranged from
summarizing a range of life experiences than a negatively 100% unlovable to 100% lovable. Her therapist asked her
stated schema. to place other
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