Recent theory and research developments in Schema Therapy: an update - Arnoud Arntz
In this presentation I will focus on some of the major developments in the theory underlying Schema Therapy and in research. As to theory, the reformulated theory connecting core needs, schemas, and schema modes will be discussed. It will be clarified why the reformulated theory helps us to better understand a wider range of psychopathology, and how it helps to choose appropriate foci and techniques in therapy. In the second part, recent research findings will be discussed, with an emphasis on therapy outcome research. Topics that will be addressed include the format of therapy (individual, group, or combined), the treatment of cases with complex comorbidities, and how schema therapy compares to other treatments for (borderline) personality disorder in terms of treatment retention and effectiveness.
afePath: Creating Healthier Teams with Schema Therapy - David Bernstein
Over the past ten years, I have developed and researched a form of Schema Therapy for teams, which I call "SafePath." My interest in teams grew out of my work in forensic, psychiatric, and addiction settings, where patients are often treated in multidisciplinary teams. In these institutional environments, the teams, consisting of psychologists, psychiatrists, nurses, and other professionals, have to contend with the daily challenges of the patients' behavior, as well as the complexities of the environments themselves. These stresses can sometimes lead to dysfunctional dynamics within teams, such as "splitting." SafePath is a method for strengthening teams to help them build resilience for this difficult work, and create safer and healthier climates for their patients. Through SafePath trainings and coaching, the teams learn to put the principles of Schema Therapy and Positive Psychology into their day-to-day practice. Our research shows that SafePath improves teams' functioning, leads to more positive ward climates, and reduces the need for severe, physical interventions with patients (van Wijk-Herbrink et al., 2019). Our train-the-trainers program has certified SafePath trainer/coaches in 12 different countries. Once they have completed our program, they return to their institutions to teach SafePath to their teams. In this presentation, I will provide a short overview of SafePath, illustrated by case material of teams that work in challenging environments.
Brief ST-inspired interventions: Working with needs in a modular way - Eshkol Rafaeli
Emotional distress and behavioral/functional difficulties (e.g., avoidance) are common features of various psychological difficulties, including relatively common ones such as anxiety and depression. The prevention of such features or the intervention with them does not always necessitate long-term psychotherapy. Moreover, a substantial gap exists between population needs and treatment availability, a problem leading to substantial under-treatment and long waiting periods. With these considerations in mind, various approaches have been proposed and are being tested for providing “precision mental health” – person-specific approaches that (a) rely on analysis of individuals' data (e.g., diaries collected many times and with high frequency over the span of several weeks during waiting periods); (b) construct personalized prediction models for the target symptoms; and (c) guide brief person-specific interventions. In this talk, I will describe early results from an ongoing bi-national project in which we use a schema-therapy inspired model focused on psychological needs to apply personalized single-session intervention modules and compare their efficiency to non-personalized application of these modules. The modules themselves address six different psychological needs identified by Young and colleagues (Young et al., 2001; Rafaeli et al., 2010) as well as by Dweck (2017). Of course, the interventions themselves can be used in a modular way in any therapy, not only in single sessions.
What do we need to be Healthy? Schema Therapy work promoting healthy sides - Alessandra Mancini
What prevents us from being Healthy? Is Imagery Rescripting enough to strengthen the Healthy Modes of our patients? Which cognitive and emotion focused techniques can we use to build and strengthen the Healthy Modes in our clinical practice? Here we connect recent empirical findings to clinical practice. Research supports the role of meta-emotional variables, such as depressive rumination and self-compassion in mediating the relation between Early Maladaptive Schemas and Healthy Modes (i.e. the Healthy Adult and the Happy Child). Furthermore, new evidence showed that while Imagery Rescripting reduces dysfunctional coping Modes and the Demanding Parent Mode, it does not enhance the Healthy Adult and Positive Self-Compassion. Taken together these data seem to indicate that in ST the recognition of critical messages and the reduction of dysfunctional strategies should be paralleled by a specific work directly aimed at strengthening the Healthy Modes. A series of cognitive and experiential exercises will be proposed, aimed at facilitating the recognition of the Healthy Modes and their promotion since early therapy phases.
The frustration of therapy with shifting sand: Therapeutic Competency with Addictive Protector Modes - Elizabeth Lacy
Addictive Disorders can be some of the most difficult to treat. Modes shift like sand on a beach from session to session. Patients seem to have PhDs in avoidance and are "stuck" in contemplation stages. In this short talk, I will help you make sense of and conceptualize what is happening in the treatment room. You will be able to more confidently conceptualize an accurate mode map to guide treatment and more effectively be able to help them heal!
Schema Therapy for Obsessive Compulsive Disorder and the power of play in imaginative work - Filippo Tinelli
The purpose of this presentation is to illustrate how Schema Therapy can help to understand the phenomenology of Obsessive Compulsive Disorder even more deeply and how it can be a particularly effective therapeutic approach for its resolution. According to Schema Therapy, the primary emotional needs most frustrated in the histories of people with this disorder are those of unconditional acceptance and love, validation of emotions and primary needs, and that of spontaneity and play. The frustration of these needs leads to the development of recurrent Maladaptive Schemas in these patients, such as: Defectiveness/shame, Punishment, Social Exclusion, Severe Standards and Hypercriticism and Emotional Inhibition. It will be illustrated how these Maladaptive Schemas, are manifested through different Schema Modes characteristic of the Disorder (Demanding and Punitive Parent, Vulnerable Child, Hypercontrolling Perfectionist, Detached/Eviting Protector) and how they alternate and interact to determine the symptom. Finally, the deployment of treatment through relational techniques (limited reparenting), cognitive techniques, experiential techniques (Chairwork and Imagery Rescripting), and behavioral techniques (breaking behavioral patterns) will be made explicit. It will be specified how these techniques can be adapted to the peculiarities of the Disorder in order to maximize their effectiveness. In particular, it will be highlighted how to respond to the primary emotional need for play and spontaneity in imagery rescripting in order to catalyze the patient's emotional change.
Schema Therapy for Dissociative Identity Disorder - Harold Dadomo
Dissociative Identity Disorder is part of dissociative disorders and is specifically characterized by the manifestation and activation of two or more distinct identities, characterized by distinct ways of perceiving, feeling and relating unshared on the level of awareness. This phenomenon is called identity fragmentation and can often lead to the phenomenon of asymmetric amnesia i.e., not remembering events experienced by the distinct identities; or dissociative amnesia, in which one is unable to recall important events in one’s life. This fragmentation and the presence of amnestic barriers leads the individual to experience their existence in a distressing way. In fact, depression, anxiety, substance abuse, self-harm, and suicidal behavior are often observed in these patients, which is also why the diagnosis of the disorder itself is often difficult. It is also known that this disorder occurs in individuals who have experienced severe trauma or long and significant periods of stress during childhood. Beyond the diagnostic difficulty that characterizes this disorder, psychotherapy is far from having defined a standard intervention, although cognitive behavioral psychotherapy and dynamic psychotherapy seem to be the most cited treatment options to date. Given the characteristics of the disorder, its etiology, and given its integrative features in relation to its explanatory abilities or the use of tools derived from different approaches, schema therapy seems to be a more than valid therapeutic option in the treatment of dissociative disorders and dissociative identity disorder in particular. In this regard, in recent years schema therapy has shown an increasing development of interest and an important adaptation of various therapeutic tools ad hoc for this category of disorders. This talk will discuss in detail how to manage this disorder at various stages of therapy.
Group and Individual Schema Therapy: Effective Treatment for Borderline Personality Disorder - Joan Farrell
Dr. Joan Farrell and Ida Shaw began working on effective treatment for patients with borderline personality disorder i(BPD) in the 1980s. They wrote the first book on Group Schema Therapy (GST) (Wiley-Blackwell, 2012). They found that Schema Therapy groups could harness therapeutic factors like universality and belonging, leading to reductions in the severity of core schemas like defectiveness/shame and abandonment. The Schema Therapy group experience also provided additional corrective emotional experiences (re-family effects), adding to the essential limited reparenting effects of ST for BPD patients. They published a transdiagnostic protocol for integrated group and individual sessions “The Schema Therapy Clinician’s Guide,” 2014. This protocol has been empirically validated in a large international randomized controlled trial (JAMA-Psychiatry, 2022). It is utilized clinically in research (e.g., AvPD, Mixed PD, Self-Practice for therapists) and practice internationally. This foundation Schema Therapy program is adaptable for various treatment lengths, time limited and more extensive and has been translated into many languages. Over the last 12 years, Farrell and Shaw have trained therapists live in over 20 countries and now provide international training and supervision online. They will present a short summary of their approach to treating BPD with Schema Therapy.
Transformational Chairwork: Using the Four Dialogues in Schema Therapy - Scott Kellogg
This presentation will explore the following issues: the history and development of Chairwork with its roots in Dr. Jacob Moreno’s Psychodrama work and Dr. Fritz Perls’ 1960s, West Coast Gestalt Therapy. The Four Dialogues Model of Chairwork Practice:
- Giving Voice - Deeply expressing a feeling and interviewing a part or a mode to better understand its purpose, history, role, and desires.
- Internal Dialogues - Creating encounters between different parts of the self.
- Telling the Story - Using the Three-Person Storytelling approach to work thought traumas or difficult experiences.
- Relationships and Encounters - Using the Cycle of Emotions or the expression of Love, Anger, Fear, and Grief/Sorrow to people from one’s past, present, or future to work through trauma, to resolve unfinished business, to heal from loss, and to claim power in ongoing problematic relationships.
The interaction between the Four Dialogues Model of Chairwork and Schema Therapy. This will take the form of six core dialogues:
- Evidentiary Dialogues - Creating an encounter between the evidence that supports the schema and the evidence that challenges the schema (Internal Dialogues);
- Mode Interviews - Interviewing a coping mode to better understand its origins and role in the patient’s life (Giving Voice);
- Cost-Benefit Analyses - The Using Chairwork to more deeply explore the benefits of a coping mode and the costs of coping mode which will set the stage to increase the power of the Healthy Adult mode to develop a new relationship with the mode and to be able to modulate it more effectively (Internal Dialogues);
- Mode Dialogues - Creating dialogues between the Healthy Adult Mode and the Child, Coping, and Inner Critic Modes; special attention will be given to work with the Inner Critic modes (Internal Dialogues);
- Third-Person Storytelling - This is an approach to trauma work that I have adapted from Contextual Schema Therapy (Roediger, Stevens, & Brockman, 2018) as a way for patients to more easily engage with traumatic experiences and the burden of secrets (Telling the Story);
- Confrontation Dialogues - Using the Relationships and Encounters structure, patients can have imaginal dialogues with people who hurt, mistreated, and/or abused them as a way to work through unfinished business and claim power.
Exploring vulnerable narcissism through Schema Therapy - Nicola Marsigli e Duccio Baroni
The Schema Therapy model (Young et al., 2003), since its inception, has been interested in Narcissistic Personality Disorder by identifying the pathological core of the disorder in the nuclear frustration of needs for unconditional acceptance and realistic limits. Narcissistic Personality Disorder is a complex disorder with sometimes contradictory features. Recently, two phenotypes have been identified within the clinical presentations of such personality functioning: the grandiose phenotype and the vulnerable phenotype (Pincus & Lukowitsky, 2010; Soleimani et al., 2022). The latter is less studied in the literature, with limited intervention protocols (Pincus et al., 2014). Schema Therapy provides a useful key to the development of specific interventions to the vulnerable phenotype. Indeed, while maintaining the nuclear aspects of frustrating needs for unconditional acceptance and realistic limits, it uses different coping modes from the grandiose narcissist. Through the concept of mode proper to Schema Therapy, a specific treatment protocol was developed for the vulnerable narcissistic patient.
Targeted interventions to connect with and care for the Vulnerable Child - Elena Rosin
In Schema Therapy, one of the fundamental goals of treatment is to take care of the patient’s Vulnerable Child mode, the part that contains all the emotional pain and dysfunctional beliefs that have formed due to negative childhood experiences. It can often be difficult for the patient to connect with this part, he may deny its existence, minimize its importance, or he may be frightened of it. If he does not get in touch with this part of himself, however, he will not be able to meet his basic emotional needs and will not be able to change the dysfunctional coping modes that often interfere in his life. In this intervention we will discover how to help the patient effectively connect with his Vulnerable Child, consciously care for it, and guide it toward a greater sense of self-acceptance, compassion, and psychological integration. There are several strategies for connecting with this mode and a variety of therapeutic methods for caring for it.
Schema Therapy for Children and Adolescents (ST-CA) - Christof Loose
Schema Therapy for Children and Adolescents (ST-CA) has become a hot topic within Cognitive Behavioural Therapy (CBT) and the world of psychotherapy in general. The approach has quickly gained popularity among clinicians and mental health services for it‘s high success rates for difficult to treat children, adolescents and parents with more severe, chronic, entrenched difficulties who do not respond to first line approaches. This includes the significant proportion of children and adolescents who do not engage in CBT, or don't respond to CBT (or showed an initial response and then relapse). The aim of the 45-minute Online-Seminar is to give an overview of the techniques and approaches for younger clients and their parents, and therefore a better understanding of what ST-CA look like in day-to-day practice.
Symbolism and deconstruction: Where to go with the modes in a simplified Schematherapy case conceptualization? - Eckhard Roediger
The founder of Schema Therapy, Jeffrey Young, in the late 80ies of the last century built his approach on the idea of schemas and schema coping. Schemas are the imprint in the neural networks resulting from need frustration primarily in early childhood. Schema coping are overarching strategies how clients deal with these painful schemas. Once schemas are triggered in the present, we react with transient activations called Modes. To make case conceptualization manageable with Borderline clients suffering from many schemas, in his studies around the turn of the century he focused solely on Modes. The disconnection from the underlying schemas bears the risk that Modes are regarded as “parts of the self”, e.g. an “inner child” developing a life of their own. From a Relational frame theory (RFT) perspective, this symbolization turns a transitory state into a persisting “inner person”, which is neurobiological not existent. To avoid these symbolizations, an RFT-informed Contextual schematherapy case conceptualization deconstructs the Modes into the primary emotional activation felt in the body once a schema is triggered and the underlying core beliefs (or maladaptive values) internalized in childhood as internal drivers of our displayed behavior (in terms of Modes). In therapy, we bypass the Modes on “front stage” and work with these internal “backstage” activations. This leads to a limited set of key processes and overcomes strategies to work with each Modes individually.
Fine-tuning imagery rescripting - Remco Van der Wijngaart
This workshop is aimed at participants with at least a basic knowledge of imagery rescripting who would like to become more proficient and confident in dealing with challenging situation when using imagery rescripting. Imagery rescripting is nowadays regarded as an evidence-based technique for treating different disorders, such as PTSD, social anxiety disorder, and personality disorders (Morina et al., 2017). The therapeutic goal is to generate corrective emotional experiences in aversive memories/images using mental imagery. However, it is not always easy to identify and target the core need in the image effectively. For example, an image of childhood abuse can be rescripted in many ways. Should the client strive for safety or for rebuttal in the image? When should they imagine themselves halting the antagonist, or should a helper rather be called in? Is it better to wait till the most traumatic parts of the experience, or will it be wiser to step in at an earlier stage? Apart from these questions, therapists might be confronted with other challenges when doing imagery rescripting, e.g. patients who say they do not have any images, or dealing with so much guilt and shame that rescripting the images available becomes difficult or seemingly impossible. This presentation uses the model of basic emotional needs as a guiding compass for effective imagery rescripting. The workshop focuses on three components: Correctly identifying and targeting the basic emotional needs in the image; Identifying the right moment for rescripting; Dealing with some of the most common challenges.
Addressing the dysfunctional parent in Imagery: the hierarchy of interventions - Ambra Malentacchi
In schema therapy we help the patient to identify the devaluing, demanding, or punishing messages of the dysfunctional parent mode, which continues to make the person feel deeply wrong, unlovable, inadequate, guilty, or never up to par, and to link them to childhood origins, to lead them back to something outside themselves. The focus of the intervention for the therapist is to protect the vulnerable part from the attacks of this mode, addressing it directly to invalidate its messages and gradually replace them with a more functional perspective. The best suited tools for this purpose in schema therapy are experiential strategies, especially Imagery Rescripting, through which the therapist, by entering the image, directly interacts with the parental part, having a confrontation for the purpose of neutralizing it. In the light of the most recent international contributions in the field of Schema Therapy and the clinical experiences with which we are often confronted, it is becoming increasingly evident that in this direct confrontation it is necessary for the therapist to adapt to the severity of the parental style and the characteristics of the relative internalized mode of each patient, and to know how to pose in front of it in a commensurate manner with its aggressiveness, rather than with his possible naiveté, anxiety or excessive permissiveness. Paying attention to be attuned to the needs to be met and the specific situation that arises in Imagery, with the vulnerable child’s eyes observing, the treatment of the dysfunctional parent does not turn out to be so unambiguous, but rather can swing from the most classic contrast, to the softest confrontation, through a hierarchy of interventions that do not necessarily aim to neutralize it.
Schema therapy in child developmental age: theoretical-practical explication of psychotherapeutic intervention in a case with externalizing disorders - Stefano Terenzi
Schema Therapy with Children and Adolescents (ST-CA) is a recent declination of the Schema Therapy (ST) psychotherapeutic model. ST is a cognitive-behavioral theoretical-practical approach that integrates theoretical assumptions, empirical findings, methodologies and therapeutic procedures derived from different psychological and psychotherapeutic orientations and has proven to be one of the most effective psychotherapies for treating patients with personality disorders or highly resistant to change. Specifically, the work presented illustrates the procedural steps of the theoretical-practical model of the specific expansion for children and adolescents (ST-CA) and the peculiar interventions of the therapeutic procedures that constitute the treatment of a clinical case with problems of aggression, conduct and dysregulation.
Attachment and autonomy - Jeff Conway
Attachment and Autonomy are two of the most basic and universal of human needs. At a deep neurological level, we are wired to form attachments and to behave autonomously. When our need for attachment is well-met, we feel safe, secure, and nurtured. When our need for autonomy is well-met, we feel empowered, confident, and better able to build competencies. This talk will look at the interaction of these two important needs and consider how these needs can be confounded by the relational interactions that deny these needs which then engender Early Maladaptive Schemas that undermine both attachment and autonomy. We will also consider ways to heal such Schemas and allow the needs for attachment and autonomy to be more fully expressed.
Something really traumatic happened to me a few days ago! - Patricia Escudero Rotman
Schema Therapy was not originally created to treat patients in crisis and/or patients who have been recently traumatized (Young, Klosko & Weishaar, 2003). We were supposed to use evidence based interventions for what we named Axis I Disorders. Since then, some therapeutic models (e.g., CBT, EMDR) have shown that they can help these individuals using adapted protocols. In addition, some mental health professionals argue that we should only use Psychological First Aid guidelines (PFA). There seems to be some confusion about "what to do". Schema Therapy is a rich integrative model. Its conceptualization and clinical strategies can offer a clear path to help acutely traumatized individuals. This presentation will include a clinical video that demonstrates one of the recommended clinical interventions.