Skip to main content
SpringerLink
Log in

Self-Understanding, Empathy, Guided Discovery, and Schema Belief in Schema-Focused Cognitive Therapy of Personality Problems: A Process–Outcome Study

  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

The aim of this study was to examine the dispositional and/or episodic influences of the process variables of self-understanding, empathy, guided discovery, and convictions about primary early maladaptive schema, which are central concepts in the schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week inpatient program. Patients, therapists, and an expert observer rated individual therapy sessions. Greater patient-rated self-understanding the first session was related to greater decreases in schema belief and of emotional distress throughout therapy. Greater therapist-rated empathic experience the first session was related to greater decreases in distress throughout therapy. Session-by-session analyses revealed few sequential relationships. However, a greater in-session reduction of schema belief weakly predicted lower level of presessional distress the next session, and vice versa. The study illustrates how to intensively measure and model change in psychotherapy, using both growth curve and time series analyses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  • Alden, L. E.,Wiggins, J. S., & Pincus, A. L. (1990). Construction of circumplex scales for the inventory of interpersonal problems. Journal of Personality Assessment, 55, 521–536.

    Google Scholar 

  • Barber, J. P., Crits-Christoph, P., & Luborsky, L. (1996). Effects of therapist adherence and Competence on patient outcome in brief dynamic therapy. Journal of Consulting and Clinical Psychology, 64, 619–622.

    Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator- mediator variable distinction in the social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Google Scholar 

  • Beck, A. T. (1997). The past and future of cognitive therapy. Journal of Psychotherapy Practice and Research, 6, 276–284.

    Google Scholar 

  • Beck, A. T., Freeman, A., & Associates. (1990). Cognitive therapy of personality disorders. New York: Guilford.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.

    Google Scholar 

  • Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive- behavioral therapy: A structural equation model. Journal of Consulting and Clinical Psychology, 60, 441–449.

    Google Scholar 

  • Burns, D.D., & Spangler, D.L. (2000). Does psychotherapy homework lead to improvements in depression in cognitive- behavioral therapy or does improvement lead to increased homework compliance? Journal of Consulting and Clinical Psychology, 68, 46–56.

    Google Scholar 

  • Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear among agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 6, 1090–1097.

    Google Scholar 

  • Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985). The Mobility Inventory for Agoraphobia. Behavior Research and Therapy, 23, 35–44.

    Google Scholar 

  • Chambless, D. L., & Gillis, M. M. (1993). Cognitive therapy and anxiety disorders. Journal of Consulting and Clinical Psychology, 61, 248–260.

    Google Scholar 

  • Clark, D. M., Salkovskis, P. M., Hackmann, A., Middelton, H., Anastasiades, P., & Gelder, M. (1994). A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. British Journal of Psychiatry, 164, 759–769.

    Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (en). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • DeRubeis, R. J., Evans, M. D., Hollon, S. D., Garvey, M. J., Grove, W. M., & Tuason, V. B. (1990). How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal for Consulting and Clinical Psychology, 58, 862–869.

    Google Scholar 

  • Elliot, R., & Wexler, M. (1994). Measuring the impact of session in process-Experientiel Therapy of depression: The session impacts scale. Journal of Counseling Psychology, 41, 166–174.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured Clinical Interview for DSM-IV Axis I Disorders - Patient edition (SCID-I/P) (Version 2.0). NewYork: New York State Psychiatric Institute.

    Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., & Benjamin, L. (1994). Structured Clinical Interview for DSM-IV Axis II Personality Disorders - Patient (SCID-II/P) (Version 2.0). NewYork: New York State Psychiatric Institute.

    Google Scholar 

  • Hawton, K., Salkovskis, P., Kirk, J., & Clark, D. M. (Eds.). (1989). Cognitive behaviour therapy for psychiatric problems: A practical guide. Oxford: Oxford University Press.

    Google Scholar 

  • Hoffart, A., & Hedley, L. M. (1997). Personality traits among panic disorder with agoraphobia patients before and after symptom-focused treatment. Journal of Anxiety Disorders, 11, 77–87.

    Google Scholar 

  • McGinn, L. K., & Young, J. E. (1996). Schema-focused therapy. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy (pp. 182–207). New York: Guilford.

    Google Scholar 

  • Monsen, J. T., Odland, T., Faugli, A., Daae, E., & Eilertsen, D. E. (1995). Personality disorders: Changes and stability after intensive psychotherapy focusing on affect consciousness. Psychotherapy Research, 5, 33–48.

    Google Scholar 

  • Muran, J. C., Gorman, B. S., Safran, J. D., Twining, L.W., & Winston, A. (1995). Linking in-session change to overall outcome in short-term cognitive therapy. Journal of Consulting and Clinical Psychology, 7, 651–657.

    Google Scholar 

  • Norusis, M. J. (1993). SPSS Trends Release 6.0. Chicago: SPSS.

    Google Scholar 

  • Orlinski, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy—Noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (Vol. 4, pp. 270–336). New York: Wiley.

    Google Scholar 

  • Overholser, J.C. (1993). Elements of the Socratic method: I. Systematic questioning. Psychotherapy, 30(1), 67–74.

    Google Scholar 

  • Perry, J. C., Banon, E., & Ianni, F. (1999). Effectiveness of psychotherpy for personality disorders. American Journal Psychiatry, 156, 1312–1321.

    Google Scholar 

  • Persons, J.B., & Burns, D.D. (1985). Mechanisms of action of cognitive therapy: The relative contributions of technical and interpersonal interventions. Cognitive Therapy and Research, 9, 539–551.

    Google Scholar 

  • Robins, C. J., & Hayes, A.M. (1993). An appraisal of cognitive therapy. Journal of Consulting and Clinical Psychology, 61, 205–214.

    Google Scholar 

  • Safran, J.D.,Vallis, T. M., Segal, Z.W., & Shaw, B. F. (1987). Measuring session change in cognitive therapy. Journal of Cognitive Psychotherapy, 1, 117–128.

    Google Scholar 

  • SAS Institute. (1993a). SAS/ETS user's guide. Cary, NC: Author.

    Google Scholar 

  • SAS Institute. (1993b). SAS technical report P-229. Cary, NC: Author.

    Google Scholar 

  • Schmidt, N. B., Joiner, T. E., Young, J. E., & Telch, M. J. (1995). The Schema Questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas. Cognitive Therapy and Research, 19, 295–321.

    Google Scholar 

  • Sexton, H. (1993). Exploring a psychotherapeutic change sequence: Relating process to intersessional and posttreatment outcome. Journal of Consulting and Clinical Psychology, 61, 128–136.

    Google Scholar 

  • Sexton, H. (1996). Process, life events and symptomatic change in brief eclectic psychotherapy. Journal of Consulting and Clinical Psychology, 64, 1358–1365.

    Google Scholar 

  • Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420–428.

    Google Scholar 

  • Spielberger,C.D. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto,CA: Consulting Psychologists Press.

    Google Scholar 

  • Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive- behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67, 894–904.

    Google Scholar 

  • Teasdale, J. D., & Barnard, P. J. (1993). Affect, cognition, and change: Re-modelling depressive thought. Hove, England: Erlbaum.

    Google Scholar 

  • Vallis, T. M., Shaw, B. F., & Dobson, K. S. (1986). The cognitive therapy scale: Psychometric properties. Journal of Consulting and Clinical Psychology, 54, 381–385.

    Google Scholar 

  • Watson, J. C., & Greenberg, L. S. (1996). Pathways to change in the psychotherapy of depression: Relating process to session change and outcome. Psychotherapy, 33, 262–274.

    Google Scholar 

  • Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Exchange.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Research Institute, Modum Bad, Vikersund, Norway

    Asle Hoffart & Sivert Versland

  2. Psychiatric Research Center for Finnmark and Troms, Troms, Norway

    Harold Sexton

Authors
  1. Asle Hoffart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sivert Versland
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harold Sexton
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoffart, A., Versland, S. & Sexton, H. Self-Understanding, Empathy, Guided Discovery, and Schema Belief in Schema-Focused Cognitive Therapy of Personality Problems: A Process–Outcome Study. Cognitive Therapy and Research 26, 199–219 (2002). https://doi.org/10.1023/A:1014521819858

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1014521819858

Search

Navigation