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“Beyond Empathy:  The Therapeutic Relationship in Forensic Schema Therapy”

by David Bernstein


Most therapists are taught that empathy is the foundation of a therapeutic relationship.  But what if the patient is indifferent to, or rejects, our attempts to empathize with him?  This is frequently the case in working with forensic patients, where mistrust of therapists and the institutions where they work can be extreme.  In Forensic Schema Therapy, limited reparenting focuses on two seemingly opposite emotional needs: attachment and limit setting.  Warmth, availability, and empathy, while essential, are not enough.  They must be combined with firm, fair, and non-punitive limits to counter patients’ transgressive crossing of boundaries.  Moreover, to counter the patient’s mistrust, the therapy relationship must be grounded in authenticity.  Finally, we use a form of motivational interviewing which incorporates schema modes to overcome the many obstacles that patients place in the way of treatment.  The methods that we have developed appear to be effective for many forensic patients, as supported by our recent randomized clinical trial supporting the effectiveness of Forensic Schema Therapy.  Our approach to the therapy relationship can be applied to any patient, forensic or non-forensic, in which attachment difficulties, boundary violations, and motivational issues are central.

About the Presenter:

David Bernstein

Dr. David Bernstein is a Clinical Psychologist (PhD, New York University, 1990) and Associate Professor of Psychology at Maastricht University in the Netherlands, where he has served as Professor of Forensic Psychotherapy (endowed chair, 2010-2018), and Chair of the Section on Forensic Psychology(2010-2015). He is a former President of the Association for Research on Personality Disorders (2001-2005) and Vice-President of the International Society for the Study of Personality Disorders (2003-2007). He was also Vice-President of the International Society of Schema Therapy(2010-2012) and is an Advanced Level Schema Therapist and Schema Therapy Supervisor. He is the author or coauthor of more than 120publications on psychotherapy, personality disorders, forensic psychology, childhood trauma, and addictions. He is the coauthor of Schema Therapy: Distinctive Features with Eshkol Rafaeli and Jeffrey Young and the DVD series, Schema Therapy: Working with Modes, with Remco van der Wijngaart.He is also the author of the Childhood Trauma Questionnaire, a reliable and valid self-report questionnaire for child abuse and neglect, used worldwide. He is the creator of the iModes, a cartoon-based system for working with schema modes (www.i-Modes.com), and the founder of SafePath Solutions, a team-based program for adults and youth with personality disorders, aggression, and addiction (www.SafePath-Solutions.com). He was the Principal Investigator on a recently completed randomized clinical trial of Schema Therapy for forensic patients with personality disorders in the Netherlands.

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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