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Developing An Attachment Bond with Your Client In An Online Environment

by Hagara Feldman, Xi Lui, Sally Skewes, and Diana Kleijzen


Online therapy and applications are expanding rapidly as technological advancements allow for more stable and secure platforms for online communication. This skill class will be divided into two parts – the first part will focus on how to deliver schema therapy online (also known as telehealth), while the second part will focus on integrating technology to support face to face (or online) schema therapy practice.   

In the first part of the skill class we will highlight the different aspects of delivering therapy online using 1:1 secure video conferencing - addressing general Online Therapy issues, and specific Online Schema Therapy issues. We will share some ideas and techniques that create a strong therapeutic alliance, address mode and schema activation specific to the online meetings; as well as how to safely and creatively adjust emotional focused work in an online environment - including imagery rescripting and chair work. 

In the second part of the skill class we will demonstrate how Secure Nest functions as a transitional object, illustrated by a case example. Reaching out between sessions can be quite difficult. For us as therapists, because of our workload and the boundaries we want to provide, and especially for clients. There are situations in which we wish we could have a stronger connection between sessions. Each therapy session can feel like an island in the ocean for clients. With no solid ground and strong storms between sessions, this time can evoke powerful and overwhelming emotions. Participants in this skill class will engage in an experiential exercise to experience the strength of developing an attachment bond with clients in an online environment.

Teaching Methods:

The workshop will include experiential exercises facilitated by the presenters and case studies to demonstrate opportunities and challenges in terms of therapeutic relationships online. Discussion time will be facilitated following the presentations.

Learning Objective:

-     Explore the potential for therapists to use technology to meet core emotional needs, enhance the therapeutic alliance and attachment bond

-     Recommend ways to assess client safety and appropriateness when working in an online environment

-     Recommend ways to address pitfalls when working in an online environment

-     Recommend ways to manage mode and schema activation specific to working in an online environment

-     Demonstrate strategies to enhance the therapeutic alliance in an online environment

-     Explore benefits to client care unique to working in an online environment

-     To incorporate technology in schema therapy, providing therapists and clients with more energy in and outside of the treatment room

Workshop Intended For:
Therapists with an interest in exploring innovative ways of enhancing the therapeutic relationship using technology.

The workshop is suitable for any level of experience in schema therapy.

Relevant Background Readings on Topic:

Simpson, S., Bell, L., Knox, J. & Mitchell, D. (2005). Therapy via Videoconferencing: A Route to Client Empowerment? Clinical

Psychology and Psychotherapy, 12, 156-165.

Backhaus, A., Agha., Maglione, M. L., Repp, A., Ross, B., Zuest, D., Rice-Thorpe, N. M. (2012). Videoconferencing Psychotherapy: A Systematic Review. Psychological Services, 9 (2), 111-131. DOI: 10.1037/a0027924

Joint Task Force for the Development of Telepsychology Guidelines for Psychologists (2013). Guidelines for the Practice of Telepsychological. American Psychologist, 68 (9), 791-800 DOI: 10.1037/a0035001

Simpson, S. G., & Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. The Australasian Journal of Rural Health, 22, 280-299.

Goss, S., Anthony, K., Stretch, L. S. & Nagel, D. M. (2016). Technology in Mental Health: Applications in Practice, Supervision and Training (2nd Ed). Illinois. Charles C Thomas.

About the Presenters:

Hagara Feldman:

Hagara is an accredited Cognitive Behavioral Therapist and an Advanced Schema Therapist, Supervisor and Trainer. Since 2009 she has been practicing schema therapy and has received the ISST certification in 2013. Over time schema therapy became the solid foundation of her therapeutic practice, integrating with CBT and with some ideas and interventions from additional experiential focus therapies (EFT, AEDP).  She has practiced CBT in both the public and the private sectors, in mental health and in bariatric services. Since 2007 she has been providing therapy in her private practice based in Kfar-Saba, Israel. She also supervises clinicians and students from varied training programs for Schema Therapy and CBT in Israel. Specializes in Axis I disorders, personality disorders, work with holocaust survivors and LGBT related issues. She also has an extensive experience with a wide range of patients and supervisees from different cultures, in and outside of Israel (on-line). 

Xi Lui:

Dr Xi Liu is an advanced accredited ISST schema therapist and trainer/supervisor. She is a Sydney based Clinical Psychologist who delivers face to face therapy from her practice in Newtown, as well as working online with clients across five continents. She regularly provides therapy to staff deployed with Doctors without Borders (MSF) while on mission and around the world. She is the Chair of the Online Schema Therapy Special Interest Group and have presented at symposiums at the International Society for Schema Therapy Conference in Amsterdam and Rome on adapting Schema Therapy for Online Treatment. She has also presented on the topic of Digital Technologies in Mental Health at the Black Dog Institute in Australia. Xi specializes with creative, multicultural and LGBTQ clients on complex trauma, grief, personality disorders and Axis I mood disorders. In her previous working life, Xi has also worked in User Interface, Data Management and Website Design in the Corporate and Not for Profit Sector. 

Diana Kleijzen:

A Clinical Psychologist and senior Schema Therapist with the Dutch Schema Therapy Society, based in the Netherlands. She works in a private practice. Diana has a special interest in the strength and weakness of our body and tries to integrate that in her therapy and daily life. In 2019 she joined the Secure Nest team, a company based in Australia, in their mission to increase the accessibility of Schema Therapy to enrich the wellbeing of individuals.

Sally Skewes:

Coming soon.

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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