"forensic schema therapy: research and practice"
SYMPOSIUM by simon draycott, marjolein van wijk-herbrink, limor navot, louise sainsbury & David bernstein
Schema therapy has become a popular intervention within forensic services across Europe. It is accepted as an empirically validated treatment in the Netherlands, and "forensic" schema modes have been recognised theoretically and integrated into the overall schema therapy model. This symposium will explore some aspects of how schema therapy is influencing current research and practice in forensic settings. The talks will take in a mode model analysis of offending behaviour, the application of the mode model in externalising behaviour in adolescents, an understanding of guilt, shame and regret through the lens of the mode model, and attention to the role of avoidant modes and self-narratives in therapeutic work in forensic settings.
Chairperson: David Bernstein
1. SCHEMA MODE FORMULATION OF OFFENDING BEHAVIOR by SIMON DRAYCOTT
Schema therapy is increasingly popular across Europe within forensic services. One of the reasons for this is the flexibility it provides in understanding a wide range of behaviour patterns, including offending behaviour. Developments in the mode model have suggested the presence of “forensic” modes e.g Angry Protector, Paranoid Over-controller, Predator, Conning and Manipulative (Bernstein, Arntz and de Vos, 2007). These add to the power of this model to understand the challenging behaviour expressed in these treatment settings. Traditional psychological work within forensic settings has often focused on the development of formulations of offending behaviour, which might be termed “offence analysis”. In this talk I will make use of a number of anonymised case studies drawn from my own practice in Broadmoor Hospital in the UK in order to discuss how the mode model allows for sophisticated and empathic understanding of offending behaviour when compared to a more “traditional” CBT analysis. We will discuss how this more nuanced understanding of offending behaviour can engage the individual in the therapeutic process and open up new options for treatment, as well as how it can be used to encourage empathy amongst staff working with these individuals.
2. SCHEMA THERAPY IN ADOLESCENTS WITH DISRUPTIVE BEHAVIOR DISORDERS by MARJOLEIN VAN WIJK-HERBRINK
Adolescents with disruptive behavior disorders are difficult to treat. They often come from traumatic backgrounds and suffer from personality pathology, which interferes with the most common treatment approaches that are primarily focused on behavioral change. Schema therapy (ST) could help to link current behavior problems to childhood adverse experiences, which provides an explanatory model for disruptive behaviors. The focus on the therapeutic relationship and validation of dysfunctional schema modes could help to establish a working alliance through which early experiences can be rescripted and behavioral change can be achieved, even in adolescent patients who are reluctant to engage in therapy. We have conducted/are conducting several studies on (a) the efficacy of ST in this adolescent population, and (b) the key concepts of ST and their associations with internalizing and externalizing behavior problems in this specific population and in the adolescent population in general. In this presentation, I will discuss the most important results of these studies and I will demonstrate (video) the empathic confrontation of an angry protector mode in a reluctant adolescent patient.
3. SHAME, GUILT AND REMORSE: THEIR RELATION TO SCHEMA MODES by LIMOR NAVOT
Pleading guilty and expressing remorse after committing a crime play a major role in the way the judicial system, as well as society, perceives the offender. As therapists in the forensic field, we are also highly sensitive to the concept of remorse, and to its other related emotions, such as shame and guilt, as part of dealing with someone who hurts others and violates the rules of society. However, our main focus as clinicians, as well as the focus of academic research in the past years, has been on the absence of these emotions, rather than their presence: Is this 'shameless' or 'remorseless' person a psychopath? Does he have neural deficiencies that explain his remorselessness? The purpose of this lecture is to shed some light on the opposite side of the equation: what are the unique ways in which these emotions appear, and what is their relationship to schema modes? The lecture deals first with the differentiation between three kinds of moral emotion: shame, guilt and remorse - a differentiation which is often neglected. Despite the tendency to use these terms interchangeably, numerous studies have shown that each one has a unique nature, involving different attributional styles, motivational tendencies, and patterns of coping. Some clues as to how to identify a genuine expression of these emotions and implications for treatment will be discussed. Further, the ways in which these emotions can express themselves through different schema modes will be explored through an illustrative case study of a prisoner sentenced for murder.
4. SCHEMA THERAPY AND INVISIBLE PATIENTS: FINDING THEIR SELF-NARRATIVE by LOUISE SAINSBURY
This paper describes the use of the schema therapy (Young et al, 2003, Arntz & Jacob, 2012) with individuals whose avoidance of people, including themselves, is their primary self-narrative and a central risk factor for offending. Individuals with strong avoidant presentations typically receive diagnoses such as avoidant and or schizoid personality disorder, and ‘negative symptoms of schizophrenia’. The use of schema therapy in the challenging process of developing a shared understanding of self-narratives (overt and hidden), narratives about other people, and their coping and offending modes is described. A schema formulation of the avoidant selfnarrative and their offending process is presented, including the identification of dynamic risk factors. Difficulties that the therapy raised in interaction with his self narratives and the initial response of attempting to maintain the highly avoidant and detached self narrative are described. The development and generalization of new self narratives through the use of metaphor and play, the therapeutic relationship, and other relationships and the role of this in reducing/managing risk is discussed. References Arntz, A., & Jacob, G. (2012). Schema therapy in practice: an introductory guide to the schema mode approach. John Wiley & Sons. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press.
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