This illustrates how a cognitive therapist can utilize events during the session to teach a patient to identify automatic thoughts and to consider alternative interpretations. In addition, the therapist provided a summary of a key theme he had identified from listening to Denise’s automatic thoughts about her hus- band and about therapy. The theme was her fear of being harshly judged and potentially punished for her statement (punitiveness schema). Cognitive therapists often identify and begin to correct EMSs during the first phase of treatment. More intensive work on changing schemas in a later phase of treatment may be required to inoculate against relapse. We elaborate on this process in the next section of this chapter. In the segment that follows, the therapist explained how he arrived at the conclusion that punitiveness was an important schema for Denise.
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