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EDF4605 Schema Therapy

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sophie mao

on 15 May 2013

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Transcript of EDF4605 Schema Therapy

Evidence Base Self-Reflection References Schema Therapy Would I use the therapy? Why?

> Empirical evidence supporting schema therapy for a range of psychological disorders

> Requires high level of abstract intelligence to be able to see patterns and themes in someone’s life.

> Well-suited for difficult, resistant clients with entrenched, chronic psychological disorders, including personality and eating disorders- effective for patients who have experienced lack of progress in psychodynamic treatments Sophie Mao EDF 4605 Outline Background of Theory Techniques Evidence Base Self-Reflection - Description of theory
- Where it fits alongside other therapies
- Target groups - Demonstration - Empirical Evidence - Would I use therapy? Background of Theory Techniques Questions? Five core emotional needs Early maladaptive schemas Early life experiences Maladaptive coping styles Schema Modes Where it fits alongside other therapies Target groups Integrative theory developed by Jeffrey Young

Combines elements from cognitive-behavioural therapy, attachment therapy, gestalt therapy, and psychoanalytic object relations.

Patients with entrenched, chronic psychological disorders who are considered difficult to treat and those with personality disorders.

Aids patients in to make sense of chronic, pervasive issues and to organise them in a comprehensible manner. Schema therapy addresses the core psychological themes called early maladaptive schemas, which are characteristic of patients with personality disorders

There are three main constructs in the conceptual model:

Schemas
> Result from unmet core emotional needs in childhood and a child’s innate temperament

Coping styles

Modes A broad, pervasive theme or pattern
Comprised of memories, emotions,
cognitions and bodily sensations
Regarding oneself and one’s relationship with others
Developed during childhood or adolescence
Elaborated throughout ones lifetime
Dysfunctional to a significant degree

> Self-defeating emotional and cognitive patterns that begin early in our development and repeat throughout life. Secure attachments to others (includes safety, stability, nurturance, and acceptance)
Autonomy, competence, and sense of identity
Freedom to express valid needs and emotions
Spontaneity and play
Realistic limits and self control Toxic frustration of needs
> Child experiences too little of a good thing

Traumatisation or victimisation
> The child is harmed or victimised

Too much of a good thing
> The childs core emotional needs for autonomy or realistic limits are not met

Selective internalisation
> The child selectively identifies with and internalises the parents thoughts, feelings, experiences and behaviours. Surrender:
When patients surrender to a schema, they accept that it is true. They do not try to avoid it or fight it.

Avoidance:
Patients attempt to live without awareness, as though the schema does not exist.

Overcompensation:
Patients go to the opposite extreme in fighting the schema "Schema modes are mind states that we can shift into quickly or more stably that cluster schemas and coping styles into a temporary way of being." (Young, 2003) Schema Modes Schema Modes Innate Child mode

> Vulnerable Child: lonely, isolated
> Angry Child: enraged, infuriated
> Impulsive/Undisciplined Child: acts in selfish and uncontrolled manner
> Contended Child: feels loved, fulfilled

Maladaptive Coping modes

> Compliant Surrenderer: submissive, tolerates abuse or bad treatment
> Detached Protector: detaches emotionally and rejects help, withdrawn
> Overcompensator: arrogant, dominant, and manipulative Maladaptive Parent Modes

> Punitive parent: feels that one self or others deserve punishment or blame > Demanding or critical parent: be perfect, achieve at a very high level, strive for high status

Healthy Adult Mode

> Healthy adult: nurtures, sets limits for the angry and impulsive child modes, combats and replaces maladaptive coping modes. Psychodynamic Approaches

> Exploration of the childhood origins of current problems
> Need for emotional processing of traumatic material

Bowlby Attachment Theory

> Attachment instinct that aims at establishing a stable relationship with the mother
> Excessive separation anxiety is a consequence of aversive family experiences, such as a loss of parent or abandonment from a parent Patients who have some of the origins of their problems are early on life, and their problems include recurring negative life patterns that relate to current life situations

Chronic depression and anxiety
Eating disorders
Difficult couple problems
Preventing relapse among substance abusers Cognitive techniques

> Patients list all the evidence supporting and refuting the schema throughout their lives and therapist and patient evaluate the evidence.

Experiential techniques

> Imagery and dialogues, patients can express their anger and sadness about what happened to them as children. In imagery, they stand up to the parent or significant childhood figures and the protect and comfort the vulnerable child. Behaviour-pattern breaking

> Behavioural homework assignments in order to replace maladaptive coping responses, with new more adaptive patterns of behaviour.
> Rehearsing new behaviours in imagery and role plays.

Therapist-patient relationship

> The patient internalises the therapist as a ‘healthy adult’ who fights against schemas and pursues an emotionally fulfilling life.

Empathic confrontation - involves showing empathy for the patients schemas and coping styles, while still highlighting the reasons for change.

Limited parenting - involves supplying within the appropriate bounds of the therapeutic relationship, what patients needed from their parents as children but did not get. Demonstration Activity Rebecca’s core schema is Defectiveness/Shame. She believes that there is something basically wrong with her and that if anyone gets too close, they will reject her. She chooses partners who are extremely critical of her and confirm her view that she is defective (______________). Sometimes she has an excessive defensive reaction and counterattacks when confronted with even mild criticism ( ______________). She also makes sure that non of her partners get too close, so that she can avoid seeing her defectiveness and rejecting her (________________). Borderline personality disorder:

Giesen-Bloo et al. (2006) study directly compared the effectiveness of schema therapy to transference-focused therapy in 88 patients with a diagnosis of borderline personality disorder.

Eating Disorder:

In a study conducted by Simpson, Morrow, van Vreeswijk & Reid (2010) examined a schema therapy group specifically adapted for the eating disordered population. Findings suggested that most participants made clinically important improvements in terms of severity of schemas, eating disorder symptoms, anxiety levels, and quality of life. Personality disorder/substance abuse:

Ball (2007) compared dual focus schema therapy to a 12 step facilitation therapy in 30 participants with a diagnosed personality disorder (antisocial, borderline, avoidant and dependent) and concurrent substance misuse.

Post traumatic stress disorder:

The study by Cockram, Drummond and Lee (2006) aimed to determine whether the group schema therapy would reduce post traumatic stress disorder in war veterans in comparison to CBT group. Overall this study suggests that the schema therapy group had significantly better outcomes than the CBT group in reducing PTSD symptoms and anxiety. Ball, S. A. (2007). Comparing individual therapies for personality disordered opioid dependent
patients. Journal of Personality Disorders, 21(3), 305-321.

Bernstein, D. P., Nijman, H. L. I., Karos, K., Keulen-de Vos, M., de Vogel, V., & Lucker, T. P. (2012).
Schema therapy for forensic patients with personality disorders: design and preliminary findings of a multicentre randomized clinical trial in the Netherlands. International Journal of Forensic Mental Health, 11(4), 312-324. doi: 10.1080/14999013.2012.746757

Cockram, D. M., Drummond, P. D., & Lee, C. W. (2010). Role and treatment of early maladaptive
schemas in Vietnam veterans with PTSD. Clinical Psychology and Psychotherapy, 17(3), 165-182.

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I.,
...Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trail of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649-658. Retrieved from http://www.cbttraining.com.au/uploads/images/documents/Nadort_paper_3.pdf

James, I. A. (2001). Schema therapy: The next generation, but should it carry a health warning?.
Behavioural and Cognitive Psychotherapy, 29(4), 401-407. doi: 10.1017/S1352465801004015

Masley, S. A., Gillanders, D. T., Simpson, S. G., & Talyor, M. A. (2012). A systematic review of the
evidence base for Schema Therapy. Cognitive Behaviour Therapy, 41(3), 185-202. doi: 10.1080/16506073.2011.614274 Oldham, J. M., Skodol, A. E., & Bender, D. S., (Eds.). (2005). The American Psychiatric Publishing
textbook of personality disorders. Arlington, VA, US: American Psychiatric Publishing.

Rafaeli, E., Bernstein, D. P., & Young, J. (2010). Schema Therapy distinctive features. (1st ed.).
London: Taylor and Francis.

Simpson, S. G., Morrow, E., van Vreeswijk, M., & Reid, C. (2010). Group schema therapy for
eating disorders: A pilot study. Frontiers in Psychology. 1, 182. doi: 10.3389/fpsyg.2010.00182

Thim, J. C. (2010). Relationships between early maladaptive schemas and psychosocial
development and task resolution. Clinical Psychology and Psychotherapy, 17, 219-230. doi: 10.1002/cpp.647

Vreeswijk, M. V., Broersen, J., & Nadort, M. (Eds.). (2012). The Wiley-Blackwell handbook of
Schema Therapy, theory, research and practice. doi: 10.1002/9781119962830

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: a practitioner’s guide. New
York; London: The Guilford Press. Avoidance Surrender Overcompensation
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