The content and development of schemas and scripts of narcissistic investors are described. These patients view themselves as highly visible, with special talents and destiny, excessive obligation to others, and avoidant of satisfaction. Their investment styles focus on regret, immediate outcomes and the use of recent, salient and irrelevant information. Envy is interpreted as reflecting a market value of the self, reflecting a belief in scarcity of respect and lack of intrinsic value. Developmental analysis indicates threats of abandonment, compensation for earlier inferiority, and family myths of uniqueness. Techniques for challenging narcissistic assumptions and a developmental cognitive treatment of a patient’s schemas and scripts are described.

A multi-dimensional model of decision making, based on modern portfolio theory, is advanced that proposes that individuals consider in making behavioral decisions and contemplating risk. This model is specifically applied to depressive decision making. According to this model, depressed individuals view themselves as having few current and future resources, low predictability and control, less maximization of positives, greater minimization of negatives, less utility for gains, more disutility for losses, higher stop-loss criteria, higher information demands, more regret, and more reliance on waiting as a strategy. Participants were 153 adult psychiatric patients who were tested on a 25-item Decision Questionnaire that assessed 25 dimensions of decision making and these responses were correlated with the Beck Depression Inventory. The results substantially supported the assumptions of a general portfolio theory of risk. Risk aversion and depression were related to most of the dimensions and depression was related to risk aversion. Less depression was related to maximizing positives as a goal, but was unrelated to minimizing negatives. Four factors accounted for most of the variance: General efficacy, discouragement, unpredictability, and risk aversion.

Individuals with different personality disorders are hypothesized to approach decision making with a variety of concerns related to their perception of their general efficacy, information demands, risk aversion, and utility of gains and losses. A variation of modern portfolio theory is employed to examine decision-making in a clinical population of adult patients. Variations along personality dimensions were related to a number of decision-making concerns and strategies. The implications of these findings are examined in the clinical treatment of personality disorders.

Normative models of decision making imply that individuals will utilize a hedonic calculus about future utility ratios (subjective utilities) in considering current alternatives. In contrast, descriptive models of actual decision making indicate that individuals utilize heuristics, ignore base rates, and consider previous decisions when considering future choices. Sunk costs are reflected in basing future decisions on previous commitments or investments, thereby ignoring subjective utility expectations. The effects of sunk costs on resistance to change are discussed and interventions to overcome these effects are examined.

Scripts are identified as role patterns which provide self-consistency and consistency in the behavior of others. Script holders construct an interpersonal reality which reaffirms their automatic thoughts and self-other schemas. Consequently, scripts are difficult to modify using traditional cognitive therapy techniques. Two scripts—the Victim and the Acquisitor Narcissist--are described and cognitive-systemic interventions suggested. The implications of scripts for transference interpretations and interventions are indicated. Finally, developmental analysis of these scripts is advanced as a therapeutic strategy.

Beck’s cognitive theory of psychopathology is integrated with Piaget’s and Bowlby’s structural cognitive-developmental theories. Automatic thought distortions, maladaptive assumptions, and early maladaptive schemas are formed at the preoperational level of intelligence and are marked by structural limitations of moral realism, imminent justice, dichotomous and intuitive thinking, and magical causality. The specific negative content of self-other schemas is based on early object representations reflecting pathology in the attachment process. Personality disorders are described as the persistence of preoperational structure and early object representations which are submitted to compensation and avoidance through maladaptive life-scripts. A case formulation based on this model is described.