SUMMARY:

In this symposium, the 4 speakers introduce current diagnostic and therapeutic approaches in ST-CA. In the first contribution, participants will get to know how fairy tales can be used not only for diagnostic, but also for developing and correction purposes (Presenter: Maria Galimzyanova). Afterwards, we will learn to investigate children’s maladaptive schemas in an age-appropriate way, first with 4-6-year-old children (Presenter: Christof Loose), second with 8-13-year old school children (Presenter: Frank Meyer). Finally, ST-CA is applied to a 15- year-old girl who has experienced peer-victimization (Presenter: Eva Dresbach).

Chairpersons: Christof Loose, Maria Galimzyanova 

1. Fairy tales in Schema Therapy by Maria Galimzyanova

Fairy tales in Schema Therapy can be used for diagnostic, developing and correction purposes. They stimulate children to use their imagination in a positive way, transforming distortions of reality into instruments which are able to generate new experiences and mental images. Special therapeutic fairy tales show enormous capacity to pass the psychological resistance of children and allow them to better identify and express inhibited emotions and unmet needs. Use of therapeutic fairy tales in group ST provides: useful information about the predominant schemas and modes of children and their developmental origins; better explanation to children the essence of schemas and schema-modes; expressive examples of efficient and inefficient behavioral patterns. Fairy tales allow children to talk in an impersonal or “detached” way about their schemas and modes, slowly letting defenses to drop, and provide alternative judgments, emotions and behavior in uncomfortable or maladjusted situations, help children to become aware of their own modes and mode triggers and find ways to control them. Within group ST sessions children can find themselves inside a fairy tale, which promises many wonders and surprises. Children, being invited as experts in resolving conflicts can exchange letters with the Wise dolphin, providing help to solve the problems. Schema-therapists observe carefully the reactions of children to different characters and situations and encourage them to discuss the fairy-tale characters, so that the children can better understand their own feelings and underlying motivations of their actions. Presentation will illustrate how an interactive fairy tale “Fishes of the Great Barrier Reef” was incorporated in group ST work and will give examples of children’s responses to it.

Additional speakers: Paul Kasyanik & Elena Romanova

2. Schema Penguin Interview - Assessment of EMS in Preschoolers by Christof Loose

This is the first explorative study aimed at assessing Early Maladaptive Schemas (EMS) in 160 preschool children by means of a newly-developed interview, the “Schema Penguin Interview” (SPI). Before conducting the interview, we used the Strengths and Difficulties Questionnaire (SDQ-Teacher and -Parents; Goodman, 1997) to identify the behavioral problems of preschool aged children and asked the main parental caregiver (in all cases the mother) to fill in the YSQ. 

Results: 

1. Comparing children with “behavioral problems/borderline“ and children without “behavioral problems“ (criterion: total difficulties score), grouped according to the SDQ-Teacher-Verdict, we discovered that children with “behavioral problems/borderline“ showed significantly higher values in the items of schema domain 3 (impaired limits) and 5 (overvigilance and inhibition). These two domains are often associated with expansive problems that might indicate a high degree of concordant validity. 

2. Results concerning the transmission of parental EMS to their children showed that there is little association between the schema dispositions of the child (according to SPI) and the EMS of the mother (according to YSQ). Possibly, parents (mothers) are able to avoid transmitting their EMS to their children, at least at this early age. 

3. When teachers scored the children’s behavior as problematic (SDQ-total difficulties score), the mother’s YSQ of these children showed higher EMS scores in all domains, in domain 1 (disconnection and rejection), domain 4 (otherdirectedness), and domain 5 (see above) even significantly. Therefore we can draw the conclusion that certain schema domains can be linked to behavioral problems already at preschool age.

3. Development and Evaluation of the Duesseldorf Illustrated Schema Questionnaire for Children (DISC) by Frank Meyer

Within the concept by J. Young, childhood experiences are considered of crucial importance in the formation of maladaptive schemas. Therefore, studying their early representations appears to be of particular clinical relevance. Stallard and Rayner (2005) and Rijkeboer and de Boo (2010) were among the first to provide insight on the prevalence of maladaptive schemas in children. Nonetheless, data on the subject are relatively scarce and the instruments used indicate differing schema structures with 8 to 12 identified factors. To obtain a deeper understanding of early maladaptive schemas an instrument based on Young’s 18 factor model was constructed. First, an initial pool of about 180 items was generated and ratings by a group of children’s psychotherapists were used to preselect 5 items per schema, which were then rated for comprehensiveness by primary school teachers and tested in interviews with children of the relevant age group. Additionally, cartoons were designed representative for each schema, providing children with a visual impression of what is meant by the schema’s items. The items are phrased as self-report statements and children’s approval is assessed using a 4-point rating scale. The resulting questionnaire (containing 18 cartoons, 90 items) was presented in classrooms across different school types (n = 569, 8-13 years). CFA showed a satisfying goodness of fit for a 36-item short form based on the original 18 factor model, providing a compact instrument to assess schema representations and evaluate dynamics of maladaptation during child development. The combination of thematically themed pictures with text items appears to be a promising approach. Results from a first application in a clinical sample of young ADHD patients are presented and discussed.

Additional speakers: Christof Loose, Reinhard Pietrowsky.

4. Schematherapy in Adolescents experiencing Peer-Victimization - Concept and Case Study by Eva Dresbach

Background: Emotional or behavioral problems increase an adolescent’s risk to be victimized by peers. Peer victimization is a risk-factor that contributes to a variety of internalizing and externalizing problems including lower self-esteem, higher levels of social anxiety, depression or aggression, deficiencies in social skills and adjustment problems. Group interventions and individual treatment of internalizing problems of victims mainly focus on cognitive interventions, general social problem solving and social skills training. From a schema- therapist’s perspective, an adolescent’s emotional need for social contact, friendship and cooperation is highly frustrated by peer-victimization. Such experiences may also contribute to the development of early maladaptive schemas like defectiveness/shame, social isolation/alienation, subjugation, self-sacrifice, approval-seeking and emotional inhibition (Calvete, 2014).

Method: Applications of ST-CA with young patients who have experienced or are experiencing peer-victimization are described. The integration of the ST-CA in the treatment-plan of standard cognitive-behavioral therapy is presented. A case study of a 15-year old girl with social anxiety and withdrawal after multiple experiences of peer-victimization is described. Apart from a schema-mode-screening, general emotional and behavioral problems, symptoms of social anxiety and depression are assessed. An individual mode-model is developed, which therapy-goals are derived from. Chair work and Imagery Rescripting are applied. Flash-Cards are developed and integrated in Social Skills training.
Results: Results of pre-post assessment of the current case-study are presented. Implications for further conceptualization and studies are discussed.

Bios:

Christof Loose: works at the Institute of Experimental Psychology, Department of Clinical Psychology, and in his own Private Practice in Dusseldorf, Germany. He is certified in ST-CA, the Chair of Child and Adolescent Committee (ISST e.V.), editor and author of ST-CA books and Video-Learning (DVD) in Germany. He conducts workshops and seminars in ST-CA worldwide.