The process of limited reparenting is the heart of the treatment in schema therapy and is one of its most unique and defining elements. Its centrality and power has been gaining strong empirical support through the results of two randomized control trials of schema therapy. These outcome studies have found that a large percentage of patients with Borderline Personality Disorder can achieve full recovery across the complete range or symptoms. The drop out rate in these studies was extremely low. The patients in these studies attributed a great deal of the effectiveness of the treatment and the low drop out rate to limited reparenting.
Limited reparenting flows directly from schema therapies assumption that early maladaptive schemas and modes arise when core needs are not met. Schema therapy’s aim is to meet these needs by helping the patient find the experiences that were missed in early childhood that will serve as an antidote to the damaging experiences that led to maladaptive schemas and modes. Limited reparenting, paralleling healthy parenting, involves the establishment of a secure attachment through the therapist, within the bounds of a professional relationship, doing what she can to meet these needs. Research spanning a wide range of disciplines supports the notion that secure attachment is at the root of adaptive functioning, well-being and flourishing.
The focus of limited reparenting spans a broad range of needs including early connection, joy, adequate limits, and autonomy. Just as the process of parenting takes widely different forms, limited reparenting may involve warmth and nurturance, firmness, self-disclosure, confrontation, playfulness, and setting limits amongst other things. It takes the form of simultaneous tenderness and firmness through what is called “empathic confrontation”. It will also vary depending upon the phase of treatment. For this reason, schema therapy cannot be typified by a particular stance such as neutrality, firmness or nurturance. It is best typified by the broad range of responses and inclinations on the part of the therapist it incorporates, its flexibility, and the organization of these responses around the core needs of the patient.
The limited reparenting approach to early needs for connection sets schema therapy apart from most other approaches to psychotherapy. The prevailing view is that autonomy is most effectively promoted by teaching patients to regulate their affect through teaching skills or remaining therapeutically neutral and thus keeping the patient from becoming dependent upon the therapist for this regulation. The process of limited reparenting involves welcoming and encouraging this dependency. The therapist’s regulation of the patient’s affect becomes internalized by the patient and forms a healthy adult mode modeled on the therapist’s. This healthy adult mode becomes a strong foundation for the establishment of autonomy. In this way limited reparenting is based upon more trust of these early dependency needs and a belief that is more effective to gratify than fight them.
Limited reparenting involves reaching the Vulnerable Child Mode and reassuring, being firm with or setting limits on the avoidant and compensatory modes or coping styles that block access to the Vulnerable Child Modes or schemas. In the midst of this, the therapist helps to provide constructive outlets for what is called the Angry Child Mode. In addition, it often requires that the therapist help the patient fight punitive, demanding, or subjugating parent modes or schemas. These steps are usually facilitated by the use of guided imagery; an experiential technique that allows the therapist to establish more direct contact with the various modes and schemas.
(by George Lockwood, Posted on Dec 27, 2008)
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