Observations on the Vertical Descent Technique

The purpose of this technique is to uncover the client’s underlying schema or assumptions. This is a very powerful and effective technique when used properly. In many ways it is a markedly psychodynamic technique in that it seeks to make the unconscious (in this case implicit) conscious.

Generally to begin with the client is not aware of their schema and using the technique becomes aware of implicit underlying meanings or assumptions about themselves.  The method for this technique is well outlined in Robert Leahy's book, Cognitive Therapy Techniques: A Practitioner's Guide.

In supervising interns I observe a number of common pitfalls in utilising this technique. Most of the problems with this technique stem from a failure to continue to apply the questions to the level required. The therapist begins the downward arrow technique but fails to go deep enough or get right down to the underlying schema or assumptions. This can happen for a number of reasons.

Therapist Issues

Sometimes the therapist fears offending the client or feels embarrassed by the repetitive questioning involved. The way around this is to have some variation in the questions asked. Leahy has a number of examples of this in his outline of this technique.

Client Resistance Issues

 

To go psychodynamic again, the old psychoanalytic maxim; of ego before id, resistance before content, and start with the surface is highly pertinent. Managing this involves dealing first with the resistance. Chasing the content (the schema) only increases the client’s anxiety, shame or avoidance behaviours.

Comment directly on what is happening in front of you

I am aware than when I ask what this means to you, then you change the subject and when I bring it back to what it means to you, you change the subject again. I wonder what is going here?

When we start to understand what meaning this has for you on a deeper level I am aware that your arms are folded and you are frowning and becoming quite agitated. Tell me what is going on?

This starts to enable the client to self reflect on their avoidance behaviours and/or secondary affect and often allows them to put this to one side and lets the therapist proceed with the downward arrow.

Another resistance for some clients is that as their schema becomes increasingly exposed they find there is a large amount of affect attached to it. This is not uncommon for people with schemas around being unlovable. These clients may have immense feelings of sadness when they become aware of their schema.

The therapist may sense the rising affect and if they (the therapist) are not comfortable with intense affect move the client to another topic.

The client may avoid, become anxious or change focus because they do not feel comfortable with the affect or they do not feel safe enough to express it or they have fears ( or projections) about what the therapist will think of them if they breakdown.

Again the simplest way through this type of resistance is to comment directly on what is happening.

When I ask what this means to you, I am aware it begins to bring up some strong feelings for you and you change the topic. Tell me what is going on inside for you?

The issues around the client’s direct expression of affect need to be addressed before proceeding with the vertical descent again.

Keeping Focus Issues

These issues are when the therapist allows the client to get off track often without realising it. The client is talking about clinically relevant material but has moved away from what the meaning is for the client.

This typically happens in two ways. Firstly the client shifts from meaning to affect. This may happen because the therapist inadvertently asks how the client feels rather than what it means for them. Or the client becomes aware of affect connected to what they are saying and begins to focus on the feeling instead of the meaning. Use the interrupt, validate, refocus technique.

I need to stop you there, what you are saying about your feelings is really important and I would like to come back to that. Right now I would like to hear what it means to you?

Or more simply, validate and refocus

I hear that is how it feels but what does it mean to you?

The second common shift of focus is start to talk about what it means for other people in the client's life.

Again validate and refocus

I hear that is what it means for your husband but what does it mean for you?

Young’s idea, in his book Schema Therapy: A Practitioner's Guide of how a person manages their schema is relevant to this technique. Those people who are schema deniers e.g. perfectionists compensating for a defective or incompetent schema maybe become increasingly uncomfortable as their underlying schema becomes exposed. Secondary feelings of guilt, embarrassment or shame may further heighten the pressure to avoid the topic. This may lead the client to changing the topic or to some increase in general anxiety that then becomes the focus for the clinician.