- We have observed that individuals can function at a normal level when they are totally engaged in a play, sport, or other group activity; however, it is obvious that they still remain vulnerable as indicated by the fact that they return to a regressive mode when they are not thoroughly engaged.
- The adaptive mode and the regressive mode are situation specific; however, regressive mode represents the default, and thus, comes to the fore when the individual is not constructively engaged.
- In order to help the individual to sustain improvement, it is important to undermine the dysfunctional (negative) belief
Tounderstand, thus, what is going on, we need to recognize that individuals can have a setsof contradictory beliefs. These beliefs are consolidated into the individual’s self-image (what I think of me), rejected self-image (what other people think of me), and image of others (they are dangerous, controlling, demeaning, etc.). When the individual is in the adaptive mode, the functional beliefs are activated and the dysfunctional beliefs are deactivated and become latent. It is like a seesaw, when one side is up, the other side is down. This is most clearly seen in bipolar patients.
- The images and incorporated beliefs, thus, have a charge: the functional beliefs are charged in the adaptive mode and the maladaptive dysfunctional beliefs are deactivated. Thus by altering the situation, one can now activate the positive image and deactivate the negative image, however, and this is of crucial importance, the negative image does not go away. It remains in a latent stage, thus we need to think of another construct, namely the density or robustness of the images. A negative dysfunctional image may not be apparent in a specific situation, but it can be controlling when the situation changes.
- Since the dysfunctional images (schemas) are robust in our patients, we should not be misled by the fact that they are not apparent when the individual is engaged. From a therapeutic standpoint, the engagement tends to reinforce the positive functional image but does not necessarily subtract from the negative dysfunctional image, which is latent at the time.
- In order to attenuate the negative dysfunctional schemas, it is necessary to deal with them when they are activated. For example, we are already using this in our treatment of the swallowers and other borderline patients, through imaging and roleplaying, we attempt to activate the dysfunctional beliefs, such as (I need to cut myself or swallow an object, in order to feel better). This may not get at the negative self-image, which is driving the maladaptive behavior. To get at the negative self-image, we need to introduce a dysphoric mood. We can do this by inducing an image of being rejected. When the negative self-image is activated, the individual feels rejected, alone, helpless, etc. It is at this point that the craving or impulse to cut oneself is activated. The therapist can induce control strategies at this point. The therapist also helps the patient to evaluate the negative self-image and he lists information that contradicts this belief. In depressed patients, these beliefs are right on the surface and are notably dealt with through Cognitive strategies such as, “what is the evidence that people don’t like you?” or “If somebody doesn’t like you does that mean you are a bad person?” etc. We do have to contend with a host of bad memories, which backup the negative image; however, it is not necessary to get a perfect result. We simply need to buttress the positive self-image and diminish, to some degree, the negative dysfunctional image, make it less robust. We know we are hitting pay dirt when the individual is in a dysphoric state. To quote myself, “Change occurs in the crucible of the negative affect.”
- The transformation tends to be very situation oriented. When the transforms adaptive mode, which is situation dependent, changes, the default condition is activated.
- In order to sustain the transformation over time, it is necessary to pinpoint the individual’s vulnerabilities. This can be managed by a good case conceptualization, which specifies an addition to the yearnings, strengths, and positive attitudes. One specifies the sensitivity, dysfunctional attitudes, and dysfunctional behavior. Dysfunctional attitudes can be best obtained through questionnaire. Just as a physician can determine an individual’s health profile through laboratory tests, it is possible to determine the patient’s profile through tests of negative attitude, motivation, etc.