Abstract:

In schema therapy, corrective emotional experiences are an important ingredient of the treatment. These experiences are thought to be particularly effective in addressing the vulnerable child mode and strengthening the healthy adult mode. Results from a recent study into mechanisms of change support the importance of addressing these modes, as it was found that these two modes play a pivotal role in effective therapy. Two groups of techniques aim to directly offer corrective emotional experiences: experiential techniques and therapeutic relationship techniques. In this contribution the empirical evidence for these two groups of techniques is discussed. While the evidence for the effectiveness of imagery rescripting is growing, the evidence for the other main set of experiential techniques, the chair (mode) work, is lagging behind.

Likewise, while indirect quantitative evidence and qualitative research support the idea that the specific qualities of the therapeutic relationship (i.e., limited reparenting, a more personal connection to the patient) are effective ingredients of schema therapy, there is lack of direct evidence for the therapeutic effects of them. Limited reparenting might even have adverse effects, at least in a subgroup of patients, as was discussed in a panel at the ISST conference in Coimbra. Thus, it is important that we study limited reparenting better and find out how it should be applied, and how not. Two potential ways in which limited reparenting can become detrimental will be discussed: (i) when there is not a good balance between support and frustration, and the therapeutic relationship becomes a self-soothing tool for the patient; and (ii) when processing painful childhood memories is avoided, for instance because the therapists believes that the corrective experiences offered in the therapeutic relationship are sufficient.

The qualitative studies conducted with participants in the international trial of group plus individual ST for BPD compared to TAU shed some light on the importance of safety and reliability in the group therapy relationship. Therapist difficulty in managing conflict and aggression in GST and the need for focused practice of limit setting interventions will be discussed.

About the Presenters:

Arnoud Arntz

Arnoud is a professor of Clinical Psychology at the University of Amsterdam, the Netherlands, with an affiliation at Maastricht University, the Netherlands. His main research interests lie in the fields of PTSD and personality disorders, both applied and fundamental. He also practices as a psychotherapist at PsyQ in Amsterdam, where he treats patients with trauma and personality disorders. Together with Adam Radomsky he was editor of the Journal of Behavior Therapy and Experimental Psychiatry.

His research focuses on psychological processes underlying personality disorders (PDs), especially borderline personality disorder (BPD), and anxiety disorders, especially PTSD; and their treatment. Using the approach of experimental psychopathology he tested psychological theories of anxiety disorders and PDs and contributed to the development of their psychological treatment. In developing and testing psychological theories and treatments he aims to connect basic research and clinical work. He is perhaps best known for his contributions to the development of Schema Therapy and Imagery Rescripting. He was project leader of the multicenter RCT that compared schema therapy (ST) to Transference Focused Psychotherapy as treatments of Borderline PD, and of another multicenter RCT that compared ST to treatment as usual (TAU) and CCT for 6 other PDs. Currently he is PI of an international RCT comparing working mechanisms of Imagery Rescripting and EMDR for PTSD that originated from childhood traumas, and together with Dr Joan Farrell PI of the international RCT that compares group-ST to TAU for Borderline PD. Professor Arntz also chairs a Dutch-German collaborative study investigating basic brain and cognitive processes in BPD and their change during treatment, which is associated with the international RCT on group-ST.

Joan Farrell, Ph.D

Joan is a licensed clinical psychologist and an advanced level Schema Therapist and Trainer/Supervisor. She co-directs the Schema Therapy Institute Midwest-Indianapolis. The Indianapolis Center specializes in Group Schema therapy. Joan is an Adjunct Professor in Clinical Psychology at Purdue University (IUPUI) and was clinical faculty at Indiana University School of Medicine (IUSM) for 25 years. She is Research and Training director of the IUSM/Eskenazi Community Mental Health Center for Borderline Personality Disorder Treatment & Research. She was the elected Executive Board Member, Coordinator for Training & Certification of the International Society for Schema Therapy (ISST) 2012-2018 and currently chairs the ISST Training Program and Trainer Development Committee. She has written three books with Ida Shaw on ST and published a DVD series Group Schema Therapy for Borderline Personality Disorder.