This document summarizes Terry L. Ledford's presentation on using therapeutic stories and metaphors to convey cognitive behavioral therapy principles for overcoming negative self-esteem. The presentation reviews principles of cognitive therapy and schema therapy, provides examples of helpful stories, and allows participants to practice developing therapeutic stories and metaphors in small groups. Ledford has developed various programs and publications that incorporate storytelling to address dysfunctional schema and improve self-esteem.

1. Fusing Cognitive Behavioral Therapy
and Therapeutic Storytelling:
Overcoming Negative Self-Esteem
Terry L. Ledford, Ph.D.

2. Today's Workshop:
I will share my work using therapeutic stories and metaphors to
convey cognitive therapy principles with an emphasis on schema
development and maintenance.
To do this we will:
 Review principles/techniques of cognitive therapy and schema
therapy.
 Review some of the stories I have found helpful.
 Review techniques of therapeutic story development.
 Practice therapeutic story/metaphor development in small
groups.
 Review other techniques/tools I have developed to deal with
dysfunctional schema development.

3. Developmento Over 33 Years of Outpatient Practice
o Wrote: “Parables for a Wounded Heart”
o Developed course: “Reclaiming Your Positive Self-Esteem” for
adults and adolescents.
o Published that course as a webinar on Udemy.com.
o Developed “Finding Me” program for adolescents
o Published an eBook: “Teaching Tales for Teens.”
o Currently writing a free eBook for teachers.

4. Today's Presentation
Today we'll do the presentation with a dual focus.
Listen with one ear for the impact on your clients.
Listen with one ear for yourself. Making a personal
connection to the material will help you see how the materials
will connect with clients.

5. The Value of a Good Story
 “After nourishment, shelter and companionship, stories are the
thing we need most in the world.”
― Philip Pullman
 “It's like everyone tells a story about themselves inside their own
head. Always. All the time. That story makes you what you are.
We build ourselves out of that story.”
― Patrick Rothfuss, The Name of the Wind
 “The purpose of a storyteller is not to tell you how to think, but
to give you questions to think upon.”
― Brandon Sanderson, The Way of Kings

6. The Value of a Good Story
 “You may tell a tale that takes up residence in someone's soul,
becomes their blood and self and purpose. That tale will move
them and drive them and who knows that they might do because
of it, because of your words. That is your role, your gift.”
― Erin Morgenstern, The Night Circus
 “If history were taught in the form of stories, it would never be
forgotten.”
― Rudyard Kipling, The Collected Works

7. The Value of a Good Story
“Storytelling reveals meaning without
committing the error of defining it.”
Hannah Arendt
 The listener is free to take what they need and ignore the rest.
 It avoids resistance. There is nothing to resist.
 It speaks to the heart on a deeper emotional level.
 The principle is easier to remember. (My first teaching story: Random
Interval Schedule of Reinforcement.)

9. Paul Zak, Ph.D.
Neuroeconomist
• The Future of Storytelling
• www.futureofstorytelling.org

10. Cognitive Therapy
• Introduced by Aaron T. Beck, MD In 1960's
 Seeks to help the patient overcome dysfunctional thinking,
 behaviors and emotional responses.
 Focus is on addressing the maintenance of dysfunctional thinking, not the
development of such thinking.
 Provides tools to identify and correct dysfunctional cognitions,
schema/beliefs and perceptions. (Dysfunctional Thought Record, Thought
Stopping, etc.)
 Correcting these factors leads to improved behaviors, emotions and
relationships.
 Evidence-Based Therapy: Found effective in hundreds of clinical trials.

11. Techniques of Cognitive Therapy
Dysfunctional Thought Records
Thought Stopping (e.g. rubber band technique)
Validity Testing (Therapist challenges the client's thinking,
and the client tries to defend it. Also, role reversal where
therapist defends the dysfunctional thoughts, and the clients
tries to refute.)
Cognitive Rehearsal (Client recalls difficult situation.
Therapist and client rehearse healthy cognitions and
responses to the event.)
Guided Discovery (Therapist asks the client questions to
help the client discover for him/herself the error in thinking.

12. Techniques of Cognitive Therapy
Journaling (Diary, where the client writes about events,
cognitive reactions, behavioral reactions, questions and
outcomes.)
Modeling (The therapist role-plays the client in a particular
situation, exhibiting healthy reactions, and the clients then
models the behavior.)
Behavioral Techniques (e.g. desensitization, positive
reinforcement, relaxation training, mindfulness, exposure and
response prevention)
Cognitive/Behavioral Psychotherapy tends to be present-
focused, with only a brief focus on childhood/formative
experiences.
Techniques tend to be logical, rational and intellectual and
less emotive.

13. Schema Therapy
• A variant of Cognitive Therapy
• Developed by Dr. Jeffrey Young. Evidence-based.
• Concerned with the etiology of current
symptoms, and not only with the factors that
maintain them.
• Places a greater emphasis on the therapist-patient
relationship.
• Schema = a mental structure of preconceived ideas, a
framework representing some aspect of the world, or a
system of organizing and perceiving new information.
Schema were first introduced into Cognitive Therapy by
Beck in 1972.

14. Schema Therapy• Schemas create life patterns of perception,
emotion and physical sensation
• Focuses on changing client's negative schema
• Uses features of Gestalt Therapy as it seeks to create a
“corrective emotional experience.” (e.g. empty chair
technique)
• Recognizes a set of universal needs: safety, stability,
nurturance, acceptance, autonomy, competence, a sense
of identity, freedom to express one's needs and emotions,
spontaneity and play, and a world with realistic limits
which fosters the emergence of self-control.

15. Schema Therapy
• Psychological health is the ability to get one's needs met in
an adaptive manner.
• The central task of children's development is to get their
core needs met.
• The central task of parenting is to help the child get those
needs met.
• The central task of Schema Therapy is to help adults get
their own needs met, even though these needs may not
have been met in the past. (Rafaeli et al, 2011)
• Somewhat similar to Attachment Theory in this regard.

16. Schema
• Schema are often formed early in life, but continue to
be elaborated and developed throughout life.
• Schemas operate in a way that maintains our sense of
cognitive consistency, serving as shortcuts, bringing us
quickly towards what we think is likely to be true and
saving the need to carefully process every detail we
encounter. (ex. Dog)
• While schema may have accurately captured early life
experience, they are often applied to later life
experiences for which they are no longer applicable.

17. Maladaptive Schema
• Maladaptive Schema are self-defeating emotional and
cognitive patterns that begin early in our development and
repeat throughout life. (e.g. Abandonment Schema)
• They emerge from toxic early experiences, where the young
person's needs were profoundly not met.
• The schemas closest to the person's core generally develop
from experiences with the nuclear family.
• The therapy uses “limited re-parenting” as a tool provided
by the therapeutic relationship.
• It uses “empathic confrontation” where the therapist
confronts the patient on his maladaptive behaviors and
cognitions in an empathic, non-judgmental way. The
therapist has to have genuine compassion for the client for it
to work.

18. Strategic Family Therapy
• Founders included Milton Erickson, MD;
• Jay Haley and Cloe Madanes, etc.
• Erickson popularized use of therapeutic metaphors or
stories, therefore avoiding resistance. He would often
give an indirect answer to a direct question.
(Betty Alice Erickson, my builder, Stanley)
• Techniques of metaphor creation were expanded by
Stephen Lankton, M.A.
• Less research evidence.

19. Generating a Story
 Identify the concept, moral, principle or perspective you
are trying to convey.
 Try to tie into interests, experiences or feelings that are
already in the individual's world view.
 Identify the individual's level of maturity and cognitive
development.
 Then you can try to find or make up a story that
illustrates the concept you want to convey.
 You can collect stories from published sources, such as
the “Chicken Soup for the Soul” books.

20. Must Speak to the Client from
His Experience
 Tailoring: Adjusting the therapy to fit the client's
experiential language or focus the therapy through the
client's lens.
 What do they value, and how do you utilize those
values.
 How does the client perceive, understand and interact
with the world.

21. Speaking From The Client's
Experience
 Psychotherapy should be tailored to the uniqueness of
the individual, not to the procrustian bed of some
hypothetical theory of human behavior.
Milton Erickson
 You talk to a person in a language he understands, it
goes to his head. If you talk to him in his language, that
goes to his heart. Nelson Mandela

22. An Example of Milton Erickson

23. An Example of Milton Erickson
 What was his goal/objective?
 Did he tell her how to look at her scar?
 How did he normalize her scar?
 The young woman (my client) with the scar.
Told to illustrate perceptual distortions of physical appearance.

24. Concepts can be illustrated by...
 A story generated by the therapist.
 A traditional story.
 A variation of a traditional story.
 An actual therapist experience.
 An experience with a former client. (HIPPA
sensitive.)
 An historical figure or event.
 Actual Research.

25. Concepts are remembered best
if associated with:
 An emotional response
Schemas are most easily changed when the client's
emotions are activated in the moment. (David &
Szentagotai, 2006)
 A negative association
 A positive association
 Humor
 Surprise
 A common experience for the client

26. Stories That Stick
• Emotional Coloring: Stories that elicit strong emotional
reactions (Positive or Negative)
• Density of Sensory Details: Details are described vividly
stimulating the senses.
• Novelty: Stories that are unusual or challenge
expectations.
• Familiarity: Parts of the story are connected to familiar
names, events, images and experiences.
• Powerful Resolution: The ending is meaningful and
satisfying.
• No Resolution: An unfinished story can be powerful
because it isn’t satisfying.
• Redemption: The ending stimulates constructive change.
Kottler (2015)

27. An Excellent Resource

28. Stories Can Be Short
• Quotation, a song lyric or an old saying.
• “If they’ll do it with you, they’ll do it to you.”
• “What’s love got to do with it?” Tina Turner
• “I yam what I yam.” Popeye the Sailor
• Great authors have experimented with story
presentation in six-word capsules.
• “Longed for him. Got him. Shit.” Margaret Atwood.
• “For sale: baby shoes, never worn.”
Ernest

29. Purpose of Stories in Therapy
“Therapeutic stories are purposefully crafted to
feature transformations from victim to hero.”
Kottler (2015)
Isn’t that the purpose of therapy?

30. Metaphors to Illustrate
• Like the sailing ship getting off course.
• Like the tree that sways with the wind, but
doesn’t move because of its deep roots.
• Like drinking poison and expecting the other
person to die.

31. The Depression Troll
Decrease Physical Activity
WithdrawFromOthers
Stop Pleasurable
Activity
Criticize Yourself

32. Stories To Address Self-Esteem
Wounds

34. The Story of the Stupid Little
Girl

35. Thoughts that Impact
Self-Esteem
• EVENTS
• BELIEFS
• AUTOMATIC SELF-TALK
• SELECTIVE PERCEPTION

36. Stupid Little Girl Exercises
 Stupid Girl Exercise
 Do Part A
 Do Part B
 Do Part C

37. What is a Wound of the Heart?
• Heart = seat of emotion or the core (as in “the
heart of the matter”).
• A hurt or a series of hurts that affects:
a. the person's core being
b. the sense of self or self-concept.
• It alters the persons perception of self.
• The first wounds occur during childhood, when
the heart is most tender.

38. What is a Wound of the Heart
(cont.)
A wound of the heart tends to redefine the victim's
identity; not who they are, but who they believe
themselves to be.
We usually try to hide our wounds of the heart. We
try to present an acceptable facade to the world.
“How are you?” “Fine.”
We sometimes even hide the wound from ourselves.
We may realize we've been hurt, but not understand
the impact of that wound.

39. Who am I?

40. Why are children most
vulnerable?
Embarrassing moments
Hovering teachers
Actually incompetent.
Actually weak and helpless.
College Classroom example