Improved Mood

By the beginning of the third session, Denise’s mood had visibly improved. She had registered for a lecture series at the museum and was looking forward to attending the first lecture. She also had called her friend Diane with very positive results. She was catching negative and punitive thoughts toward others and herself and was challenging these thoughts. The pri- mary agenda item Denise chose to work on was “how I back away from other people,” an as- pect of her unrelenting standards, punitiveness, and social isolation/alienation schemas.

DENISE: I want to stop withdrawing from peo- ple. I want to be more accepting and engaged with others.

THERAPIST: What holds you back?

DENISE: I guess I believe that I have to be a bit removed and strict in relation to others or they’ll just behave in whatever way they want. People have to know my rules and abide by them if they want to have a rela- tionship with me.

The therapist continued probing to under- stand why Denise believed she had to have oth- ers adhere to such a strict set of rules to have a relationship. As the discussion progressed, it became obvious that, in the abstract, she could see that such hard and fast rules were not necessarily conducive to having a good relationship—in fact, such rules sometimes put others off. But in real-life situations, Denise never felt she was wrong. The therapist’s next task was to help Denise bring her rational thinking to bear on her distorted thinking in the context of a concrete event. At the thera- pist’s request, Denise then described a conver- sation with her friend Diane, and how her in- tolerance for Diane’s deviation from her rules created distance. Denise had wanted Diane and her husband to come for a visit the following summer. Diane, however, told her that their

dog had been quite sick, and that if the dog was still alive she could not leave it. Denise thought this was ridiculous. She believed a relationship with a pet should never take precedence over a human relationship. This occurred when Denise actually had wanted and hoped to get closer to Diane again. The therapist helped her use logic to evaluate her maladaptive schema.

THERAPIST: You had the thought “I’m right to set the record straight with her. She can’t put me in second place to her dog. She can’t do that without consequence.” It seems likely that you believed that thought, and that you believed the thought was right. And since you believed that thought was right, you then felt you had to withdraw your affection from her if she didn’t abide by your wishes.

DENISE: Right.

THERAPIST: Now, let’s look at it. Do you think that thought is correct?

DENISE: Well, yes, it’s insulting.

THERAPIST: What’s insulting?

DENISE: She’s putting her dog in a higher prior- ity position.

THERAPIST: Have you ever had a pet?

DENISE: No.

THERAPIST: Do you think that maybe Diane feels like her dog is a part of her family?

DENISE: I never thought of it that way.

THERAPIST: If you look at the situation from that perspective, how do you feel?

DENISE: I feel like I’m being a little insensitive. . . . That’s not right. I’m not allowing for any other perspective. I’ve never had a pet, so I don’t really know what it’s like to have a pet. It’s not right for me to be so judgmental of Diane. I need to be more understanding. I wasn’t very caring. I am actually behaving in a way that goes directly against my deepest values.

THERAPIST: So, according to your own values, was this right?

DENISE: No, it’s not right. I wasn’t respecting her feelings. I was just demanding that she respect mine. That wasn’t right.

THERAPIST: OK, now this is one of the prob- lems. If you want to get over this sense that you should never give in or bend your rules for others, one of the things you can do is look for this thought, “I’m right and you should have a negative consequence for your ‘wrong’ decision”—and refer back to this conversation we are having now and decide for yourself whether, indeed, you were right. Now, if every time you approach a conflict in a relationship and allow for the possibility that you might not fully understand, but re- ally think underneath, “But I know I’m right,” you are going to feel put out, and then you are not going to want to engage with that person. Is that right?

DENISE: Yeah, that sounds right.

THERAPIST: So we have to decide here and now. Do you indeed think that you are right to suspend your initial negative judgment to leave open the possibility of reevaluating your reaction to her behavior?

DENISE: Yes.

THERAPIST: Now, the next time you get the thought, “I’m right and I’m going to make sure this other person knows it,” how are you going to answer that thought?

DENISE: If I’m right? But I’m not necessarily right. I need to consider the other person’s perspective. I need to try to understand them and then see if what I’m thinking fits.

THERAPIST: Now are you saying that because that is the correct answer, or because you re- ally believe it?

DENISE: No, I really believe it.

The therapist followed this discussion with a technique called “point–counterpoint” to help Denise practice rational responses to her auto- matic thoughts even more intensively. In this excerpt, the therapist expressed Denise’s own negative thinking as Denise tried to defend her- self more rationally.

THERAPIST: Now I am going to be like the pros- ecuting attorney, and I’ll say, “Now I under- stand you let your friend violate one of your rules of friendship. Is that true?”

DENISE: Yes.

THERAPIST: “Now it seems to me that that was a very bad thing for you to do.”

DENISE: No, it wasn’t.

THERAPIST: “You don’t think it was?”

DENISE: No, I should try to understand her per- spective.

THERAPIST: “Well, you can sit there and say you

should be more understanding, but I thought you said before that you wanted people to respect you.”

DENISE: I do, but I also need to respect others.

THERAPIST: “I know, but now you are saying that you are going to let her get away with this. What’s next?”

DENISE: What’s next can only be a better under- standing of one another. We’ll feel closer.

THERAPIST: “But how can you feel closer if she’s not respecting your rules of friendship?”

DENISE: Maybe my rules are not appropriate in this situation. I need to learn to be more un- derstanding, flexible, and tolerant of some deviations from my rules.

THERAPIST: “But then you’ll lose control of the situation.”

DENISE: No, that’s an exaggeration. I don’t need to control the whole situation. I can still decide what makes sense. I am still in control of what’s important.

THERAPIST: “How can that be?”

DENISE: Because I can respect myself and re- spect my friend, as well. I don’t have to turn everything into an either–or situation to try to make her see and do it my way. That just makes it difficult for her to get along with me, and I’ll lose out on the relationship in the long run if I keep on insisting that she ei- ther do it my way or we do nothing.

Finally, the therapist returned to the schema and asked the patient how much she believed the new perspective.