100 COGNITIVE THERAPY IN CLINICAL PRACTICE

Figure 7.2 Ted’s underlying assumptions

these assumptions. He responded favourably to the idea of discussing how these beliefs might be doing him more harm than good, though he did not admit to any structured attempts to change them.

Self-schemas in addiction

With Ted and several other drug abusers the underlying assumptions seemed to form a ‘cognitive constellation’ (Beck 1985) for which the self-schema was the integrating construct. For Ted the meaning of ‘being a man’ was the integrating factor. For some patients the concept of ‘junkie’ served a similar function. Jane described how she gradually built an image of herself through her adolescence as a sensitive young woman who could not stand the traumas of the real world. She had always been ‘special’ as one of a pair of identical twins. They looked alike, dressed alike, and were treated identically through childhood. As she grew up she still felt special but no longer had her twinship to provide her with that status. Like many people in this situation she developed beliefs about her value based on approval. As mentioned earlier, she believed she could only be happy if she had people’s approval. Heroin provided a convenient way of integrating these assumptions about herself into a stable schema. The myth went: ‘I am a sensitive, intelligent, and romantic individual who cannot stand the harsh real world without