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Cognitive hypotheses should be applied to every single problem that you encounter because all problems and solutions are influenced by the unique cognitive map and thinking style of the individual. A large section in Chapter 2, Exploration
of the Cognitive Domain, provides the foundation for this chapter. Table 6.1 lists the four hypotheses in this category.
In most cases, after ruling out C1 (Utopian Expectations), the remaining cognitive hypotheses are integrated, as shown in the following:

Catherine, a 62-year-old successful at torney, is very frustrated with her failure to lose weight and keep it of f. Her therapist asked what her weight goal was to check out whether she had utopian expectations (C1) of regaining the figure
she had when she young. However, Catherine’s goal was realistic and losing 20 pounds would put her in the desired weight range for her age and height. She described how she brings low calorie frozen meals to work for lunch, but then
tells herself “I’m working hard. I deserve to eat what I like” (C4). When her therapist asked her to talk about her childhood eating pat terns, she recalled that her mother made her stay at the table, alone, with a plate of cold vegetables,
and not leave until her plate was clean. She discovered, suddenly, a core element in her faulty cognitive map (C2): “I get it. I must have decided, ‘When I grow up, no one is ever going to tell me what to eat ’.” The therapist pointed out that she was engaging in faulty information processing (C3): All-or-nothing thinking was demonstrated by her treating all rules about eating as if they were bad, instead of distinguishing the ones that she freely chose and were in her own best interest.
Very often, students and professionals, alike, assume that cognitive-behavioral therapy (CBT) is the automatic choice of treatment when faulty cognitions are identified. By understanding the role of cognitive factors in a variety of theories, we become more open to seeing that cognitive hypotheses integrate the thoughts of diverse thinkers and that techniques can come from many different sources. Table 6.2 gives examples of cognitive terminology.

KEY IDEAS FOR C1 UTOPIAN EXPECTATIONS
The term “utopian syndrome” comes from the very important book Change (Watzlawick, Weakland, & Fisch, 1974) and is very similar to one of Adler’s “basic mistake”—a misperception of life and life’s demands. Expectations for an easy, effortless, pain-free life actually cause more pain than just accepting the reality of the human condition. When people learn that effort, disappointment, and painful experiences are a natural part of life, they can cope better
with whatever is bothering them. In avoiding the utopian, it is important not to discourage people from pursuing goals that are difficult, but not impossible, by misusing the term utopian to deflate the ambitions of people who are idealistic and set high standards.

WHEN IS THIS HYPOTHESIS A GOOD MATCH?
In the initial sessions, the Utopian Expectations hypothesis is intended to be a screening tool to help recognize when a person is mistakenly seeking therapy for difficulties that she is already coping with quite well. This hypothesis must be considered during the processes of problem definition (Chapter 11) and outcome goal setting (Chapter 12) to define solvable problems and set realistic goals. Because there is no disorder, DSM diagnoses should not be used at the same time as this hypothesis: You have a normal, healthy individual who just needs a reminder of life’s realities. However, if the client continues to hold on to faulty illusions rather than readjust expectations, there is a problem that needs to be addressed and C2 (Faulty Cognitive Map) becomes the appropriate choice of hypothesis.

Here are examples of how problem titles then might be worded:
Excessive bitterness and resentment over normal life dif ficulties
Dif ficulty accepting normal limits and frustrations of life

TREATMENT PLANNING
Therapists need to remember that sometimes “no therapy” is the treatment of choice. It may seem disrespectful, rude, and unprofessional to ever take the position “you don’t need to be here,” but in fact it can be a very positive message to a person who is feeling demoralized.
The following list provides guidelines for the therapeutic conversation:
Focus on the discrepancy between what is and how the person wants life to be. You want the client to understand that disappointments, unpleasant emotions, misunderstandings, and conflict in relationships are a normal part of living.
Be very empathic and supportive. Be careful not to shame clients by implying
that they were stupid to have such utopian expectations.
Discuss probabilities: If you choose to marry a person of a dif ferent culture from your parents, what is the probability that they will instantly rejoice and embrace your partner as one of the family? What are the odds that a person of 55 will have the same weight, the same body, the same energy, the same athletic performance, as he did when he was 25?
Use humor when appropriate. People often challenge each other’s utopian hopes with questions such as What have you been smoking? or comments like When you die and go to Heaven. You can judge when a joking comment or a humorous anecdote would be well received.

INTEGRATION OF HYPOTHESES
The concept of utopianism is especially useful when applying the following three hypotheses.

ES2 Avoiding Freedom and Responsibility
Mistaken assumptions about what is possible can prevent a person from taking responsibility to pursue realistic goals. For instance, a mediocre athlete who refuses to get a job but instead persists in training for the Olympics is operating with utopian expectations.

P3 Immature Sense of Self and Conception of Others
Standards of maturity can often be very utopian. For instance, Bowen’s (1994) theory of “differentiation of self ” may set expectations for independence that are unrealistic.

SCE2 Cultural Context
Expectations need to be examined in a cultural context.What is unrealistic in one culture may be normal in another (e.g., the expectations of parents to have control over the choice of a child’s spouse and to be taken care of by children in old age).

KEY IDEAS FOR C2 FAULTY COGNITIVE MAP
Through the use of language, each person creates a personal reality. Many different terms are used for this concept: model of the world, schemas, assumptive world, perceptual system, narrative, construct system, and cognitive map. These cognitive models provide meaning and purpose, a rule book on how to behave in the world, and a framework that provides predictability and stability in our daily lives.

Cognitive Maps
The term cognitive map allows us to use a metaphor that is easily explained to clients. Bandler and Grinder (1990), integrating ideas from many theories and philosophies in The Structure of Magic, taught the slogan: “The map is not the territory.” The “real territory,” discovered through sensory experiences, refers to objects with a separate existence from our minds—roads, rivers, mountains,
and bridges. A map is a representation of the territory. Laborde (1987) wrote:

Once we have perceived the real world with our senses and coded experiences in our brains on a map or series of maps, then this coding or representation determines our behaviors. Often people’s frustration or unhappiness is the result of limitations in their coding, in their representation of the real world.
Sometimes, the very thing to bring about their happiness is available once that thing (or person) is placed on their maps of reality.
Faulty cognitive maps create impossible goals and imaginary obstacles. A person might direct a lifetime of energy toward the goal of “finally winning my father’s approval.” The father may be incapable of expressing approval or may even be dead, yet the behavior directed toward an impossible goal persists. Imaginary obstacles may be beliefs like “I’m not smart enough to go to college”; “I need the approval of others to feel good”; and “men shouldn’t show feelings.”

Behavior Makes Perfect Sense
Cameron-Bandler (1985) wrote, “Human behavior, no matter how bizarre or resistant it may seem, makes sense when it is seen in the context of the choices generated by a person’s map or model.” Without the concept of a cognitive map, we would be unable to explain how different people go through the same experiences and end up with radically different feelings and behaviors. Whenever our clients’ positions seems irrational or inexplicable, we have to stop ourselves from making judgments or trying to persuade them to a more rational point of view. We must first get inside their model of the world, and see how their choices make perfect sense. Cameron-Bandler explains:

It is not that our clients are making the wrong choices, it is just that they do not have enough choices available when needed. Each of us makes the very best choice available to us from our model of the world. (pp. 223–224)
In working with a suicidal client, it is especially important to understand how the wish to take her own life can make perfect sense. People commit suicide over the breakup of a relationship, failing grades in college, and rejection letters from medical school not because of the events, but because of how they interpret them in terms of their self-worth and possibilities for future happiness. Here is a cognitive formula for suicide: A person experiences a thwarted need (which we all do in our lives), judges the need to be the most important, believes that there was only one way to satisfy it, concludes that it will never be satisfied, decides that life is not worth living without it, and evaluates the pain as unbearable. With this tunnel vision, suicide is the only logical choice.

Maps Must Be Updated

A map that inaccurately represents the territory will mislead and confuse rather than help. It is probably worse than no map at all, because the existence of the map carries an aura of authority and inhibits the explorer’s willingness to trust his senses and rely on his own exploratory skills.
Maps become outdated because change is inevitable: New roads are built, empty fields are converted to housing developments, and a freeway can be severed by an earthquake. A map developed in childhood cannot be completely valid in adulthood, not only because of change in the world and in oneself, but because it was constructed with the cognitive capacity of a child.

Bridges we used to rely on no longer get us where we want: Throwing a tantrum no longer gets other people to take care of me.
People still drive the same old bumpy roads, even though new super highways have been constructed: We select friends and partners who are difficult in the same way as our parents and siblings, when we can find others who are easygoing, comfortable, and fun to be around.

The midlife crisis refers to the need for a major overhaul of the map. Failure to attain a deeply desired goal would lead to a permanent state of misery if people were not able to create a map toward a different goal where there is possibility of success. Successes and failures bring the need for new maps. Attainment of a desired goal, such as getting an advanced degree, marrying, or retiring, terminates the usefulness of the map that guided us toward that end.

Normal Resistance to Change
Before you rush in to change clients’ maladaptive maps you need to realize that these models serve important needs. Stable models of reality provide guidelines on how to behave, how to predict consequences, how to maximize satisfaction, and how to reduce pain and anxiety. Models make life easier and allow people to function efficiently, because each new situation can be categorized as something familiar rather than treated as completely novel. Without understanding how a faulty cognitive map fills emotional needs, you will have difficulty dealing with the resistance people have to changing these maps.To varying degrees, people fear the unknown and want to hold on to the familiar. Given the need for stability, some resistance to change is expected and adaptive. When people recognize the shortcomings of their map, they experience anxiety, tension, uncertainty, and confusion. These emotions interfere with openness to change. Furthermore, the recognition that much of their own suffering came from their own failure to update their maps leads people to feel
foolish and become angry with themselves: “Why didn’t I realize this sooner? What a childish, stubborn, and irrational fool I have been.” The awareness of lost time and opportunities can awaken feelings of loss, sadness, grief, and self-blame.
Therapists need to understand the emotional issues in relinquishing old maps and creating new ones. Often, when the therapist explores the painful childhood context in which a child developed the cognitive map, it becomes easy to admire the child’s resourcefulness, resilience, and intelligence. A client will be less resistant to challenges to faulty thinking when she has first experienced your appreciation for her creative, if outdated, solution to getting her needs met, reducing pain, and protecting her vulnerable self in difficult circumstances.

Alfred Adler’s Cognitive Approach
Adler, an early follower of Freud, created his own theory of individual psychology, which emphasized the cognitive domain, and was an important influence on both Viktor Frankl and Albert Ellis. By studying Adler (e.g., Adler, Ansbacher, & Ansbacher, 1989), we remind ourselves that cognitive therapy did not begin as an offshoot of behavior therapy. According to Adler, the roots of neurotic functioning lie in the dogmatized guiding fictions and the basic mistakes of childhood.
Adler used the term lifestyle for “the convictions individuals develop early in life to help them organize experience, to understand it, to predict it, and to control it” (cited in Mozak, 2000, p. 55). Table 6.3 presents Mozak’s examples of Adler’s basic mistakes (p. 73).

Albert Ellis’s Rational Emotive Therapy
Albert Ellis, creator of Rational Emotive Therapy (now called Rational Emotive Behavioral Therapy [REBT]) believed that core irrational ideas are at the root of emotional disturbance. Table 6.4 presents a version of one of these lists from Ellis and Grieger (1977).
More than just teaching a list of faulty beliefs, Ellis provided an ABC model for teaching clients the role of cognitions in determining their emotional reactions. We usually operate on the assumption that events or people make us feel a certain way: “I got depressed because he didn’t call.” “She makes me mad when she asks where I’m going.” “He told me I had to work on the weekend, so I snapped.” This cause-effect assumption can be drawn with the letters A and C:
[A] Event ® Causes ® [C] Feelings

Then the therapist can explain why this isn’t so: The same event can cause different feelings. There is something that intervenes between A and B, and that’s what you think:

[A] Event ® [B] Thinking ® [C] Feelings

Once this model is understood, clients become collaborators in searching for the thoughts that cause their feelings. Their cognitive map undergoes a radical change from “I am controlled by my emotional responses” to “I have control over my thinking, and therefore I can alter the way I feel.”

Aaron Beck’s Cognitive Bases for Emotions
The ABC model is particularly powerful when the presenting problem is an extreme emotional state, such as depression, excessive anxiety or anger, or paranoid feelings. Aaron Beck and his associates (e.g., Beck, 2000; Beck, Emery, & Greenberg, 1985; Beck, Rush, Shaw, & Emery, 1979) used a similar framework, but instead of focusing on irrational thoughts, they helped people discover the deeper assumptions that laid the foundation for emotional reactions. For instance,
the belief that good things happen to good people, and bad things happen to bad people is a core assumption shared by members of our culture, which states a principle that is frequently violated by experience, leading to extreme reactions of anger or depression. Table 6.5 shows some associations between types of emotional experiences and the cognitive elements that support them.

Jeffrey Young’s Early Maladaptive Schemas
Jeffrey Young (1999), a cognitive-behavioral therapist, developed a list of schemas for personality disorders, presented in Table 6.6. Schemas are the link between early childhood experiences and the cognitive map of the adult and can be the focus of treatment.
If the wording of the schema is softened, these schemas are typical of people who do not suffer from personality disorders but instead have problems with work, relationships, self-esteem, and emotional regulation.

Narrative Therapy
Narrative Therapy is a relatively new school of therapy, but its core hypothesis of faulty cognitive maps is familiar. A narrative is a cognitive map extended through time. White and Epston (1990) explain:

In striving to make sense of life, persons face the task of arranging their experiences of events in sequences across time in such a way as to arrive at a coherent account of themselves and the world around them. . . . This account can be referred to as a story or self-narrative. The success of this storying of experience
provides persons with a sense of continuity and meaning in their lives, and this is relied upon for the ordering of daily lives and for the interpretation of further experiences.
(p. 10)

Unfortunately, the self-narratives do not only provide benefits; they also limit choices and create pain. Success in helping people to change their narratives requires the ability to take a postmodern perspective. A comparison of three baseball umpires describing their job illustrates what postmodernism means:

First umpire: There’s balls and there’s strikes, and I call ’em the way they are.

Second umpire: There’s balls and there’s strikes, and I call ’em the way I see ’em.

Postmodernist umpire: There’s balls and there’s strikes, and they ain’t nothin’ until I call ’em.

The typical client is like the first umpire, believing that the stories she tells are accurate descriptions of reality. After listening and understanding the stories without trying to squeeze them into preexisting categories, the therapist helps the client to deconstruct them, which means to realize (a) they are not reality, (b) they have been influenced by stories available in the society and culture,
and (c) there are alternate stories possible. Freedman and Combs (1996) explain that therapists help clients develop new narratives that offer “new selfimages, new possibilities for relationships and new futures,” noting:

in any life there are always more events that don’t get “storied” than there are ones that do—even the longest and most complex autobiography leaves out more than it includes. This mean that when life narratives carry hurtful meanings or seem to offer only unpleasant choices, they can be changed by highlighting different, previously un-storied events or by taking new meanings from alreadystoried events, thereby constructing new narratives. (p. 32)

WHEN IS THIS HYPOTHESIS A GOOD MATCH?
It is hard to imagine any human situation that is not profoundly influenced by an individual’s cognitive construction of reality. For example, according to McCullough (2005), the outcome of the Revolutionary War depended on the interpretation that the Battle of Trenton was a huge success and a major turning point for the Americans rather than on an objective measure of any military advantage accomplished by that small victory.
Therefore, you can apply this hypothesis with every single client. Although this hypothesis contains the word faulty in its title, the therapist must recognize the healthy, functional, and rational elements of the cognitive map, as well as the elements that lead to problems.

TREATMENT PLANNING
In Persuasion and Healing, Frank and Frank (1991) explain that the prescribed treatment (or therapeutic ritual) must match the belief system of the person who is seeking help: A pilgrimage to Lourdes is only beneficial to people who believe in the power of that location to produce miracles. A client who believes that “problems are resolved by following guidance from experts” needs a different therapeutic approach than one who believes “I need to find my own answers.”
When the treatment of choice is discrepant from the client’s cognitive map, the therapist needs to address that issue and offer a rationale that the client will accept. This stage of persuasion is important when a somatizer is referred for psychotherapy. The client believes that the problem is medical and thinks that being“sent to a shrink” means that the doctor does not believe that the pain is real. The therapist needs to explain the beliefs of health professionals regarding the effects of stress on physiology, providing a link between psychological interventions and physical benefits. When the client comes from a different culture, therapists need to understand the beliefs about healing and the available indigenous healing rituals, and integrate them into treatment planning.

Cognitive-Behavior Therapy
Training in CBT will give tools for working with faulty cognitive maps and will build competence in cognitive formulations. The approach of CBT is to use an agenda, a didactic approach, and structured activities. However, an exclusive reliance on CBT will limit your treatment options. Reinecke and Freeman (2003) make the point that:

Any intervention or technique that alters a patient’s perceptions or beliefs might be viewed as cognitive. The number of techniques that are potentially available is virtually infinite. . . . The effective cognitive therapist is able to provide patients with experiences in a creative, f lexible manner that will refute their maladaptive
beliefs. (p. 245)

Create a Collaborative Relationship
In terminology from Transactional Analysis (TA), you want to “hook the Adult” in your client, or to use a Freudian term, you want to make an alliance with the client’s “observing ego.” In Aaron Beck’s language, you are engaging in “collaborative empiricism,” helping the client learn how to test beliefs against empirical reality and learn to function as a “personal scientist.” Instead of taking the attitude that you have to change the client, assume that an adult of normal intelligence will want to make changes when he discovers that his own patterns of thinking are creating and maintaining problems. Monitor the process of the relationship and be able to switch to an empathic, responsive style when the alliance is threatened by ill-timed cognitive challenges.
In TA terms, it is essential to maintain an “Adult-Adult” alliance with the client, and to avoid slipping into the role of “Critical Parent” by criticizing or shaming the client for illogical or primitive thinking. Even when you are careful to avoid the pitfall of sounding like a Parent, clients may easily distort your intentions and react defensively. Catch yourself when you begin to lecture or preach to a client who appears bored, sullen, or uninterested. You can avoid Parent-Child dynamics by creating a contract or agenda with the client for each session, in which the client makes the choice about the desired target of change.

Use Metamodel Questions

Table 2.7 in Chapter 2 presented the nine types of metamodel violations and the specific questions for challenging them. These skills should become automatic: They serve not only as data-gathering tools but also as interventions for faulty cognitive maps. For instance, the belief “I have to try my hardest and never give up” is a lost performative and can be challenged by asking, According to whom?
This question leads to an understanding that (a) this is an arbitrary rule, not a statement of fact; (b) it is too rigid to be an adaptive approach to all situations; and (c) the client can create a new principle for how hard to work and when it’s okay to quit.

Explanations and Teaching
Educate your client about the concepts of faulty cognitive maps and maladaptive schemas and teach the client how to evaluate beliefs by examining empirical evidence, effect on mood, rationality, or impact on achieving goals. For instance, you can explain Ellis’s ABC model (described previously) and give examples of how thinking—attributing meaning to the event, or putting it into a category— affects feelings. Explain to the client that (a) it is her own thinking that is creating
pain and frustration, and (b) she has control over how she thinks and therefore can choose to think differently. It is helpful to use an example of how the same event produces different emotional reactions.
Rejection letter from a graduate school
Three people can have very different reactions:

Person 1: It means a catastrophic proof of worthlessness, leading to depression.

Person 2: It is an unfortunate but impersonal event, understood as a reasonable outcome given the high number of applicants for few positions and the arbitrariness of admissions procedures. This person decides to apply again, this time to more schools.

Person 3: The rejection letter means that he is now free to pursue what he loves
instead of pleasing his parents, so he feels relief and elation.

Persuasion and Direct Inf luence
Sometimes when clients uses absolutistic, inflexible thinking, therapists directly instruct them to substitute more flexible and realistic terms:
Change always to often.
Change never to rarely.
Change I need to I prefer.
Change I must to I want to.
Change I shouldn’t to It would be preferable not to or I choose not to have the
consequences of.
Change I can’t to I won’t or I would find it dif ficult or I am afraid of. Therapists also teach clients about the cognitive concept of “rights” and about how beliefs about the rights of the self and others contribute to either unassertiveness or aggressiveness instead of an appropriate level of assertiveness. Lange and Jakubowski (1978) illustrate how socialization messages that are more commonly given to girls than boys can limit their sense of personal rights:

I have no right to place my needs above those of other people.
I have no right to do anything that would imply that I am better than other people.
I have no right to feel angry or to express my anger.
I have no right to make requests of other people.
I have no right to do anything that might hurt someone else’s feelings.


Here are some examples of rights that empower people to speak up and express
their thoughts and feelings, ask for what they want, and say no to what they
do not want:

I have the right to assert my needs because they are as important as those of other people.
I have a right to show my abilities, enjoy my accomplishments, and take pride in myself.
I have a right to my angry feelings, and I have a right to express them appropriately at the time they occur so they won’t build up and explode.
If my rights are violated, I have the right to make demands for change.
I have the right to express my thoughts and feelings, even if occasionally someone’s feelings get hurt, as long as I am not deliberately trying to inflict hurt.

How to Challenge Schemas, Assumptions, and Beliefs
Very often, when clients actually see or hear their faulty beliefs, they spontaneously realize—sometimes as a dramatic epiphany—how irrational they sound. There are several approaches that will get the client to recognize and challenge
faulty cognitive maps:

Discuss a list of faulty schemas: Tables 6.3, 6.4, and 6.6 provide items that can be directly presented to the client, or the therapist can prepare an individualized list. The client can select the items that she identifies as her own way of thinking.

Interpretation: The wording of a schema or belief is offered to the client after listening to what is said and observing the client’s behavior: I get the idea that you are expecting your boyfriend to meet the needs that your mother never met. You seem to have the expectation that I will provide you
answers and that this problem can be solved without your having to expend any ef fort. The wording and tone of voice show that the therapist is tentative, awaiting the client’s agreement or disagreement.

Challenging questions: The metamodel gives one approach to asking questions. The therapist can use variety in framing questions, to help the client recognize faulty thinking. Was there ever a time when you did confide in someone and it was a positive experience? That belief that you’re not good enough—Where specifically does it come from?

Conversations
Cognitive maps will be changed in the course of any type of therapeutic conversation. Sometimes the conversation is a philosophical discussion of the client’s view of the world and an evaluation of its tenets in terms of truth, morality, expediency, and other values. Narrative therapists encourage clients to tell stories about their lives and use techniques that they call externalizing or reauthoring
conversations. Therapists can tell stories of their own lives and struggles, talking about their own schemas and how they were changed through experiences and choices.

Reframing
This is a cognitive technique that helps the client shift the category in which an event or behavior is placed. Table 2.8 in Chapter 2 provides a foundation for the skills of this technique. The metaphor of frame is used because we know that the same picture can look very different in a different frame. When the client has created a frame that causes pain and limits choice, the therapist helps her shift
to a new frame, which creates positive feelings and contributes toward achieving desired goals. Milton Erickson’s therapy (Haley, 1993) gives many examples of this technique. Here is an example adapted from one of his cases:

A woman in her 70s lives alone and spends a great deal of time keeping her house in per fect order. Whenever her children and grandchildren come to visit, they mess up her house, and she feels very angry, resentful, and helpless. The therapist asks her to use visual imagery and picture a time in the future when the house is perpetually spotless. Af ter completing this visualization exercise, she repor ts feeling lonely and isolated. She realizes that the clean house is not that impor tant and that what she values is the company of her family.


In reframing, the behavior or event is unchanged—it is the interpretation that is modified. In the original frame, “messy house” is part of the category things people do which show lack of consideration and make my life more dif ficult. In the new frame, “messy house” has shifted to the category proof that I am part of a loving, connected family, and that my family members are comfortable, relaxed, and enjoying themselves when they visit me. Reframing is a very appropriate
technique for this case because the client’s goal, “to have my family visit and keep my house perfectly neat every minute of their visit,” was impossible—a perfect example of utopian thinking (C1). Reframing, as a technique, carries the risk of making the client feel misunderstood
and invalidated, as in this example: The client says, “My daughter fights me every step of the way,” and the therapist responds, At least you know that you brought up a strong and independent person. Whether that response would be helpful to the client depends on the timing, the context, and the relationship between client and therapist.
A very effective approach to reframing is to ask questions about the purposes and benefits of a behavior that the client has framed as a self-defeating and stupid behavior, over which I have no control.
What purpose does this behavior serve?
What benefits (payof fs, positive consequences) do you get?
How does this behavior help you?
When you were young, how did this behavior help you survive?
Is there any other way of looking at this?

The answers to these questions can help the client shift the behavior to a positive frame: protection, positive intentions, attempts to get my needs met, or things I do to survive and reduce pain. Once in the new frame, the negative feelings and self-blame are reduced, and the client can examine whether there are better ways to achieve those benefits.

Downward Arrow Technique
By repeating the same questions (And that means? And then? And next?), a series of responses lead the client from the original thought to deeper schemas and core beliefs. When the questions do not produce a “deeper” response, then the core belief has been identified and then the therapist can move on to challenging that belief. Once this technique has been demonstrated in a session with the
therapist, the client is able to use it as a homework assignment. Drawing a downward arrow on paper as each successive response is written is helpful in showing that the movement is toward a deeper, fundamental level. When the client identifies a negative thought that leads to anxiety about performance, good questions to ask are If that thought were true, why would it be upsetting? or What would that mean to you? A client will move from “I might make a mistake” to “My colleagues will think I’m stupid” to “They will know that I don’t deserve this job” to “That would mean I’m worthless.” Clum (1990) provides an example of a person with panic attacks who has a
fear of driving on the interstate.

Identifying the Irrational Belief
Therapist: What will happen?
Client: I will have a panic attack.
Therapist: What will happen next?
Client: I will have to pull of f the road.
Therapist: And next?
Client: I will be there forever. Challenging the Belief
Therapist: How likely is it that you will be there forever?
Client: Of course I wouldn’t be there forever. Either my panic attack would subside and I’d drive off, or someone would come to help me. Panic attacks always end, so I’ll be able to drive away. And the police always stop to help cars stopped alongside the road.
Cost-Benefit Analysis
Instead of addressing whether a core belief is rational or true, this method engages the client in an examination of whether it is useful to continue to maintain that belief. The belief is written down, and then under it are drawn two columns, one for advantages or reasons for maintaining and the other for disadvantages or reasons for changing. Then, when the two lists are finished, the client divides 100 points between the two columns to indicate the relative weight given to each
argument. Burns (2005) provides an example for the belief “I need everyone’s approval to be worthwhile.”

Advantages
I’ll work hard to get people to approve of me; I’ll respect other people and pay careful attention to what they say and how they feel; I’ll sell lots of life insurance and make lots of money; I’ll be a people person and have lots and lots of friends. I’ll feel great when people do approve of me.

Disadvantages
Other people will control my self-esteem; I’ll get upset when people criticize me; I may try too hard and turn people off; I may not know what I believe in or stand for; My emotions will go up and down like a roller coaster depending on whether people like me. In the example, the client gave 30 points to the advantages and 70 to the disadvantages.

Focus on Changing Behaviors
Behavior change can precede schema change. To change poor self-esteem, the person needs data that he or she is behaving in a way worthy of esteem. Get the person to break a task into small steps and succeed, and he or she will begin to view the self as competent and masterful. If the cognitive map creates fear by labeling many situations as “threatening and dangerous,” it can be very beneficial to help the person engage in risky behaviors, doing what is difficult, in spite of fear. Then when the client masters those situations, the cognitive map will change and the situations will no longer be labeled dangerous. For instance, Albert Ellis gave this assignment to a client who had catastrophic beliefs about the consequences of appearing silly in public: Take the New York subway and as you approach each station, shout out the name of the stop.

INTEGRATION OF HYPOTHESES
The C2 hypothesis is almost always a useful partner to the following hypotheses. BL3 Skills

Deficits or Lack of Competence
Therapists have a tendency to want to build self-esteem, instead of considering that low self-esteem is justified. Often people have negative beliefs about their competence and adequacy because they lack the level of competence expected of people at their age or in their occupation. The appropriate approach is to help the client improve his skills and competence, thereby earning a positive evaluation from others and the self.

ES1 Existential Issues
People who are struggling with existential issues are searching for a new cognitive map, a term that embraces philosophy of life. Whereas the original cognitive map provided meaning that was derived from parents and society, the therapist is helping the client create her own meaning and discover that she is free to choose her response to events that are imposed.

ES2 Avoiding Freedom and Responsibility
Freedom, limits, and responsibility are topics for cognitive exploration. Therapists help people relinquish their fictions, illusions, and self-deceptions to enjoy the benefits of freedom, recognize aspects of the world that cannot be controlled, and accept responsibility for the consequences of their actions. Existential therapists believe that adults can make the choice to think in more mature
ways once they recognize their errors in thinking and the price they pay for them.

P1 Internal Parts and Subpersonalities
Different parts of the personality hold on to different cognitive maps of reality. It is a very common experience that people have a rational part that can recognize faulty thoughts, although there is an emotional part that continues to act as if they are true. When therapists find that cognitive therapy is not working, they should suspect that the Adult part of the personality is not as powerful as other parts. It is essential to engage the “Adult-in-the-Child” (the “little professor” from TA) because this could be the part that originated and still believes the
maladaptive schema.

P2 Reenactment of Early Childhood Experiences
In gathering data about early childhood, you are not looking for disconnected facts, but are trying to learn specific information that helps explain how the client constructed the faulty cognitive map that directs his or her way of living. By tracing the roots of faulty schemas back to childhood and the dynamics of the family of origin, we can discover how they “make sense” and served survival
functions for the little child. To relinquish them, the client must be able to tolerate painful feelings and to have more mature strategies for getting emotional needs met. It is also important to integrate C2 with P2 so that psychodynamic formulations do not remain vague and overly general. A formulation that states She is bringing elements of her early experience into the present needs to
go further and describe the specific elements, for instance the belief that she is unlovable, the assumption that men can’t be trusted, or the decision, “I’ll make them sorry.”

P3 Immature Sense of Self and Conception of Others
Clients will differ in their ability to separate thinking from the sense of self. If clients do not have the capacity to critically examine their own thinking, they will construe your efforts to challenge their model of the world as if they are personal attacks and failures of empathy. If that happens, the psychodynamic hypothesis P3 should be considered. Items 6, 8, and 10 from Jeffrey Young’s list of maladaptive schemas (Table 6.6) are capturing what psychoanalytic psychotherapists would consider developmental defects, narcissistic disturbances, or character disorders.

SCE2 Cultural Context
Many terms that we use to describe culture are cognitive in nature: for example, norms, values, beliefs, rules, and expectations. An exploration of cultural issues involves many cognitive frameworks: How the person views his own culture, how he thinks others view his culture, how norms and rules for behavior differ between cultures, and how people from different cultures have different stories or narratives about the same historic periods. You must respect the diversity of cognitive maps stemming from culture and seek to increase choice and improve cognitive
skills, not indoctrinate people with your preferred beliefs. Goals for cognitive change must be supported by specific problems and desired outcomes; otherwise, the judgment that certain patterns of thinking are dysfunctional can be driven by cultural and personal bias.

KEY IDEAS FOR C3 FAULTY INFORMATION PROCESSING
All thinking has distortions. The minute we impose meaning on the raw data of our senses, we call it perception instead of sensation. There are always different ways of perceiving the same events. We are bombarded with information from the environment as well as from our internal world; it would be impossible to attend to and process everything. When you sit on a park bench, reading a book, thoroughly absorbed, you are not hearing the birds or seeing the trees: There is always selective attention. Thus, the goal in using this hypothesis is not to aim for perfection in thinking; rather, you want to identify those patterns of thinking that result in psychological pain, poor problem-solving and coping skills, and interference with achieving goals. Furthermore, therapists need to be aware of their own tendencies toward faulty thinking. Levy (1997) teaches tools of critical thinking for clinicians—essential skills in developing effective case formulations.

Common Errors in Thinking
Therapists can help clients correct their faulty information processing and acquire tools for avoiding future difficulties by teaching them to recognize specific errors in thinking. Table 6.8 gives names and examples for some of the most common of these errors (Beck & Weishaar, 2000).

Maturation of Cognitive Capacities
Many problems of adults stem from their immature thinking: They are egocentric, concrete, rigid, and confuse fantasy and reality, as do young children. Piaget’s (2002) theory of cognitive development in children explains that children’s cognitive capacities develop in stages: Styles of thinking that are normal at one age are considered immature at a later age. For instance, a little child may have the word “daddy” for all men. Then that term gets restricted to one man, and new labels are developed for other men. A 3-year-old child is naturally egocentric: Events are interpreted from one point of view—the self—and the child is unable to switch to the point of view of other people. The capacity for abstract thinking does not arrive until adolescence: At this stage, the individual can think of hypothetical situations and use the scientific method to gather evidence and test the validity of conclusions.
Piaget is the source of the term schema, which is commonly used for cognitive structures. When the data of experience are consistent with the schema, the schema assimilates the data and remains unchanged. However, when the data are inconsistent and cannot be assimilated without distortion of reality, the schema must undergo accommodation and change to be consistent with the data. Cognitive dissonance is a term for the inconsistency between preexisting beliefs and new information, and this state needs to be resolved, either by modifying beliefs or by
screening out and avoiding the discrepant information. Reality testing is a process of checking the match between schema and the sensory data from reality. In healthy maturation, schemas are constantly revised. If the individual does not independently recognize that the schema is faulty, other people—parents, teachers, friends, police—give corrective experiences. If schemas fail to change despite confrontation with inconsistent data, the person is going to be ill equipped to deal with challenges of life.

Parataxic Distortions and Transference
Freud used the term transference for the client’s distorted view of the therapist and Sullivan (1968) recognized the same process in all relationships, calling it parataxic distortion. A distorted perception of other people is a common experience:
We meet a new acquaintance and respond based on similarity to someone we knew in the past. However, as we spend more time with that person, we are supposed to process the information that reveals who that person is in reality, not fantasy, and adjust our beliefs, expectations, and assumptions. When distortions are extreme and the adult cannot effectively test reality, there are likely to be severe problems in relationships. Examples include an adult woman who expects
her boyfriend to meet the needs her father never met and a competent professional man who stammers with anxiety when his reasonable and friendly boss asks a question.

There are two ways of clearing up parataxic distortions and transferences:
1. Get to know the real person, for who he or she is in reality, which involves listening to that person describe his or her internal process, intentions, and feelings, as well as observing behavior and drawing inferences from the facts of that behavior rather than from fantasies about the person.
2. Check out perceptions and assumptions with a group of other people. Group therapy is an effective modality because it provides the opportunity for a client to compare perceptions with a group of people, not just the therapist (Yalom, 1995). If others agree with the perception—yes, the person did insult you and treat you rudely—you have achieved consensual validation
for your hunch, but if they disagree, then you need to correct your faulty thinking.

Cognitive Styles
People differ in their style of processing information, and a variety of theories and tools exist that classify these styles. Differences in cognitive styles have implications not only for defense mechanisms and pathology but also for talents, interests, preferred learning modalities, occupational choice, and creation of compatible relationships. Jung developed a typology for modes of processing— sensing, intuition, thinking, feeling; a personality assessment tool, the Myers-
Briggs Type Indicator (MBTI ), identifies sixteen personality types, based in part on those differences (Hammer, 1996):

Sensing: Using physical senses of seeing, hearing, touching, smelling,
and tasting.

Intuition: Using past experiences and more abstract thinking.

Thinking: Making decisions objectively and impersonally, based on laws,
principles, and factual information.

Feeling: Making decisions subjectively and personally, based on relationships
and values.

An important distinction in cognitive style is whether a person thinks in global, undifferentiated terms or focuses on details, differentiating the whole into component parts. This difference can be assessed with the Rorschach test: Some people will respond to the whole card, with little attention to details, whereas others have many responses for details without forming a concept for the whole card. Although people have a preference for one style or another, the most effective individuals have the flexibility to use both styles, and make deliberate choices about which style is most adaptive for a specific situation. David Shapiro (1965) identified several “neurotic styles” and noted how people’s style determines what they search for and attend to in the environment:
Compulsive individuals seek technical data; paranoid persons search for clues; and hysterics notice “the immediately striking, vivid, and colorful things in life” (p. 119). Shapiro describes individuals with the two most common styles as having the following characteristics:

Hysterical style: Gives answers in terms of impressions rather than facts; lacks focus on detail; seems incapable of persistent or intense intellectual concentration; distractible; satisfied with relying on hunches and intuitions; lacks intellectual curiosity; highly suggestible; fails to see things that are obvious to others; and able to keep unpleasant experiences on the periphery.

Obsessive-compulsive style: Attention has a sharp, intense focus; concentrates on detail; seems unable to allow his attention to wander; rarely seems to get hunches; seems incapable of a relaxed, impressionistic cognition; attempts to reach a decision by invoking a rule or principle; and alternates between uncertainty and dogma.

WHEN IS THIS HYPOTHESIS A GOOD MATCH?
Techniques of cognitive therapy have received strong research support (Reinecke & Freeman, 2003) for the following targets: depression, Generalized Anxiety Disorder (GAD), Panic Disorder, Posttraumatic Stress Disorder (PTSD), Social Anxiety, Body Dysmorphic Disorder, Obsessive-Compulsive Disorder (OCD), anger management, psychotic disorders, and eating disorders.
Table 6.9 presents the biases in information processing that Beck and Weishaar (2000, p. 251) have noted for various psychological disorders.

A focus on faulty information processing is effective in marital therapy. For instance, partners need to distinguish between behaviors in each other that are volitional and therefore are able to be changed, and those characteristics that reflect genetics, personality, and core attributes and therefore need to be accepted (Christensen & Jacobson, 2000).

TREATMENT PLANNING
The following strategies focus directly on faulty thinking; be aware that errors in thinking or rigidity in cognitive style can also be modified indirectly, through therapeutic conversations.

Collaborative Empiricism
Aaron Beck encourages the client to function as a “personal scientist” and examine the data of reality to see if it fits the client’s beliefs and predictions. He recommends:
Teach the client about the relation of thoughts to feelings and behavior.
Use questions to get the client to assess the validity of thinking.
Give the client specific homework assignments.

Teaching
One treatment method is to teach the client about common errors in thinking, using an educational approach to correct errors and teach better reasoning skills, perhaps giving the client a copy of Table 6.8. Here is an example of how a therapist might present this strategy to the client: “People often make certain kinds of errors in the way they look at situations and these errors in thinking may contribute to arriving at premature or incorrect conclusions, which cause (insert the clients specific problem).”

Questions
The metamodel questions that were presented in Chapter 2, Table 2.6, are interventions to correct faulty information processing. They promote changes, not only as a result of helping the client to access information that has been ignored, but because you are teaching the client the metaperspective—that his cognitive map probably contains distortions and errors that create limitations and interfere with the range of opportunities and choices that are available. You may challenge the mind reading in the client’s statement: “My husband feels resentful of my success” by asking, How specifically do you know? Three different kinds of change can result:

1.Specific change: I need to ask my husband how he really feels.
2. Pattern change that generalizes to new situations: I have this pattern of mind reading that gets me into trouble. I need to catch myself and remember to gather data from the other person.
3. Ability to change other patterns: I need to understand the map I’ve constructed and how I often distort my experience. I need to challenge my thinking and test reality on an ongoing basis.

Socratic Dialogue
The therapist asks questions that will help the client arrive at logical conclusions and process the data of experience more effectively, as in the following situations.

Consider alternate explanations:
—So when she didn’t invite you, you concluded that she doesn’t want to be your friend any more. Can you think of any other possible explanations?
—Could there be other reasons for the way she behaved, which had nothing to do with you?
Test conclusions by examining evidence:
—You say he loves you, but how does he treat you?
—How do you know that the teacher won’t give you an extension on your paper?
Recognize distortions by examining experience:
—You said you believe that if you try hard and are loving enough and anticipate
all his needs, he will have to love you. You have been acting on that belief for a long time. What have you noticed about his behavior?
—Has anyone else ever experienced that same event and reacted in a different
way?
Increase imagination and f lexibility:
—Could you imagine any other way of reacting?
—What other kind of information would you need?
Confrontation
In a confrontation, the therapist draws attention to contradictions and inconsistencies and allows the client to draw his own conclusions.

You say that you can’t count on anybody, but hasn’t your sister been there for you during this crisis?
You say you don’t need to study but last time you got a C on the test.
By challenging faulty information processing you can help the client modify schemas and assumptions and update the cognitive map, as in this example:

The therapist confronted the client: You say that you have to be perfect to be loved; how did your boyfriend respond when you told him about your mistake? When the client examines data of the boyfriend’s response, she develops a new schema: “When I show my fallibility, flaws, and weaknesses, my boyfriend still loves me; in fact, he becomes even more loving in his behavior.”

Homework Assignments
One helpful type of homework assignment is the use of structured journal keeping using a chart format (see Table 2.9 in Chapter 2 for an example). The client writes down a situation or event in the first column, and then writes down what he thought about it. Other columns are used to record the resulting feelings or Subjective Units of Discomfort Scale (SUDS) level and an alternate adaptive way of appraising the situation.

INTEGRATION OF HYPOTHESES
The recognition of faulty patterns of thinking will be very useful when you use the following hypotheses.

B3 Mind-Body Connections
The way a person processes the information from the environment affects the development of neural networks in the brain. Catastrophizing, an exaggerated response to perceived threat, results in fight-flight arousal states. Misinterpretation of bodily states is a component of Panic Disorder. The immune system may be affected by whether a person has positive or negative interpretations
of experiences: Pollyannaism is better for your health than pessimism.

CS2 Situational Stressors
The interpretation of a stressor affects how a person copes and whether crisis develops. Table 4.4 includes “perception of the event” as one of the three factors that predict the response to stressors. Crisis intervention techniques include a focus on thinking processes. In dealing with trauma, attention is paid to helping victims process their experience in words to avoid an overgeneralization
of affect to new situations and the magnification of threatening stimuli in the future.



BL3 Skill Deficits or Lack of Competence
Faulty information processing represents skill deficits in logic, scientific method, and analytic abilities. Therapist can directly teach problem-solving and decision-making skills.


P1 Internal Parts and Subpersonalities
We assume that in the client there is a part capable of competent information processing, rational reasoning, and effective scientific thinking, which can be labeled as the Adult or the personal scientist. The Child state engages in immature thinking and misinterpretations of reality. The Parent state carries arbitrary rules and dogma, plus the metarule: “Obey me without thinking.”

P3 Immature Sense of Self and Conception of Others
Certain people are unable to separate their thinking from their sense of self. Therefore, when the therapist challenges the client’s thinking, the person reacts defensively as if he, himself, rather than the faulty thinking, is being attacked. A good way to test the goodness of fit of hypothesis P3 is to challenge faulty thinking and examine the client’s responses.

P4 Unconscious Dynamics
When a client maintains faulty thinking despite the best tools of cognitive therapy, it is useful to consider the hypothesis that unconscious defense mechanisms are involved. For instance, a person who distorts social cues to mean rejection may be protecting herself from the vulnerability that accompanies trust, and is hence avoiding emotional pain and a repetition of early childhood situations.

KEY IDEAS FOR C4 DYSFUNCTIONAL SELF-TALK
When people are asked, What were you thinking? or What did you say to yourself then? they give an answer that describes internal speech. There are various ways of describing it: “A voice in my head tells me to be careful”; “I keep telling myself that something bad is going to happen”; or “It’s like a broken record, saying over and over again, don’t trust him.” This level of cognitive functioning is easy to identify and work with; some therapists focus on this level without getting into deeper layers of the cognitive map. Others, like Aaron Beck, stress the importance of connecting automatic thoughts to underlying schemas (C2).

Behavioral Approach to Covert Speech
Internal speech can be treated as an ordinary behavior and is part of every comprehensive behavioral analysis. In addition to being the identified problem behavior, covert speech can be an antecedent to the problem behavior, or something that follows a behavior and serves as a reward or punishment (BL1). Mahoney (1974) and Meichenbaum (1977) developed a focus on the cognitions as behaviors, which was originally called cognitive behavior modification, now known as CBT. Meichenbaum used the term selfstatements and developed a self-instructional approach that teaches clients how to become aware of and modify their own self-talk. Thus, the modification of internal speech is viewed as a coping skill (BL3). He used the term stress-inoculation for a strategy of having clients practice four stages of positive self-statements with minor stressors to be prepared for dealing with more severe real-world stressors. Novaco (1986) developed a similar approach for
anger management.

WHEN IS THIS HYPOTHESIS A GOOD MATCH?
Table 6.10 gives examples of when dysfunctional self-talk is likely to be an important contributor to the problem.

TREATMENT PLANNING
Table 6.11 shows the different phases in a therapy plan to modify dysfunctional self-talk.

Three Techniques to Modify Self-Talk
The three options on page 224 allow the therapist to help the client modify self-talk.

1. Thought-Stopping: The client learns to terminate the troublesome thought, perhaps by saying “stop” when the thought begins.
2. Aversive methods: The client inflicts a painful stimulus on himself when he begins to think the thought he wants to eliminate. Snapping a rubber band against the wrist can be sufficient.
3. Reinforcing positive alternative: The person chooses an alternate sentence to substitute for the dysfunctional self-talk, practices it, and rewards herself for using it.




Stress Inoculation
A stressful situation—one that triggers anxiety, anger, or depression—is broken into four stages, and the client is taught to identify dysfunctional thought at each stage and then to create and practice more adaptive alternatives. Here are examples of positive self-talk at each stage:

1. Preparing for the stressor or provocation: I can handle it. Just take it one step at a time. Remember to breathe deeply. I’m prepared.
2. Confronting and handling the stressor or provocation: Find a friendly face in the audience. He’s trying to get your goat, don’t give him the satisfaction of losing control. Count to 10. Use that “broken record technique.”
3. Coping with arousal and feeling overwhelmed: Take a few deep breaths. It’s okay to tell them you need a little time to collect your thoughts. Take a time-out. you don’t have to stay in the room. It’s okay not to be perfect the first time you try something new.
4. Ref lecting on the situation and reinforcing positive change: I handled that really well. It’s a small step, but it’s important progress. It was a setback, but I won’t brood about it; next time, I’ll handle it better.

Homework Assignment
Homework is an essential part of a program to modify self-talk. Between sessions, the client keeps a chart, writing down self-talk in response to specific situations, and showing the corresponding feelings and behaviors. Then the client creates “alternate self-talk” that will lead to more adaptive feelings and behavior. The information from this chart is also helpful for C3 and C4. Table 6.12
shows a sample homework chart for the problem behavior: Dif ficulty controlling intake of food and drink.

Role-Play Activities
If the self-statements say negative things about the self, it is useful to externalize the voice and then challenge it. If the message is not already in a “you” form (You’re no good), then suggest the person change “I’m no good” to “You’re no good.” Ask the client to move to another chair and talk to “herself ” from that voice. The client switches back to the original chair and disputes the
message. Another activity is to ask the client to imagine that she is talking to another person, perhaps a young child, and to say the internal message to that person: “You’re no good. You’re a hopeless loser.” This helps the client see how destructive the inner voice is; he can then develop more constructive and caring self-messages.

INTEGRATION OF HYPOTHESES
Be sure to examine internal speech when using the following two hypotheses.

P1 Internal Parts and Subpersonalities
There is a very natural integration of P1 and C4. As you identify different internal messages, you often notice that they are spoken in different voices and actually represent different subpersonalities or inner parts. It becomes more appropriate to talk about an internal dialogue or group discussion rather than just a monologue.

ES2 Avoiding Freedom and Responsibility
Often, people argue that external events do cause their responses, claiming, “I can’t help the way I think.” But they can be persuaded that, even in uncontrollable external circumstances, they have a choice regarding the activity in their own minds: The example of Victor Frankl, a survivor of the Nazi concentration camps, provides compelling illustrations of how people could exercise the freedom to create their own thoughts.

SUGGESTED READINGS
These suggestions are for all cognitive hypotheses.