"how did mode work make a difference in schema therapy"
case presentation by lydia tineo & jordi cid
History and Ethiology:
Johanna, 32 year old woman, single, seeks help for recurrent depressive episodes related with partner relationships, characterized by subjugation, frustration and ideas to of abandonment for not being good enough by those partners and friends.
Joanne, the middle child born between two boys, 3 years younger than her big brother and 2 years older than her little one, was raised in a well-off traditional catholic family. Strict family rules imposed by the mother, were followed even by the father, and promoted unfair differences between boys and girls punishment and requirements, being that way until adulthood.
Mixed Personality Disorder:
a) Borderline 1) frantic effort to avoid abandonment; 2) pattern of unstable and intense interpersonal relationship alternating intense idealization and devaluation; 3) unstable self-image or sense of self; impulsively spending extreme amounts of time working, neglecting her basic needs (eat, rest, sleep); 6) affective instability due to marked reactivity of mood, irritability, anxiety; 7) inappropriate, intense anger and difficulty to control it, frequent rants of temper, at work in particular; 7) chronic feeling of emptiness; 8) stress related paranoid ideas about “the others”.
B) PD not specified
Specific objectives of treatment:
Make Johanna aware about the relation between interpersonal conflicts with schemas and Mode reactions.
Evaluation in schema terms inside conflictive interpersonal situations using cognitive, emotional and imaginery technics identification of Schema, modes and early memories to turn in new understanding and change the basis and patterns of her relationships with friends, work colleagues statements, parents and partner.
After recognition and new understanding of interpersonal conflicts we began to include the new information found to analyse and change her Mode reactions and schemas, starting with the more distant relationships and gradually moving towards the most intimate.
Results of treatment:
All objectives of treatment plan were accomplished.
Final Evaluation and Discussion:
The Schema mode conceptualization and the inside inner dynamic played between schema and modes play a crucial role in working on modify the historical persistence of Johanna difficulties along her life.
The complex relation between early unmet needs, schemas and Mode reactions shows, in an explicit way, how and when the patient, learning from the development, periods is reactivated in automatic way by some interpersonal situations. Recovering the lost sequence allows the therapist to know how to work in each particular patient in order to promote the change needed when the actual situations reactivate the old original learning, promoting the same kind of problems and conflicts once and again. The real challenge is how to find the best way to break the vicious circle in order to help the patient to discover by himself, aided by the therapist, the sequences activated and promote new answers on the base of the new knowledge about him/herself.
I invite you to discuss what other alternative treatment means you would suggest to treat this case.
EXPECTED POINTS OF DISCUSSION:
1. Relations between early needs, schemes and modes of the patient.
2. Sequence between EMS and Modes Reactions
3. Alternatives strategies to work on Modes in this case.
4. Analysis of evaluation results; conceptualization of the case, SMI and YSQ.
5. Alternative proposals to overcome the negative reaction of the patient to use the emotional
strategies to work with modes. How to overcome therapeutic situation: negative reaction about emotional strategies.
1. Jordi Cid
Lydia Tineo Bio:
Lydia Tineo, Ph.D. in Psychology, oriented in Applied Cognitive Neuropsychology.
Clinical Work practice in Schema Therapy since 1988, after a 40-hour intensive Training in Schema Therapy with Jeffrey Young. Certified in Advanced Schema Therapy-ISST (2009); Advanced Trainer and Supervisor (2010).
Executive Performance: Training and Certification Committee, ISST representative for Spanish speaking countries; Founder and Director of the first Schema Therapy Center in Argentina and Latin America; co-Founder, former Vice-President and Research Area Coordinator of CTC (1992-2011); AATC (1993-2011); Scientific Committee Member in ALAPCO (2004-2007), DC President (2002-2009) and Chairman of the Organizer Committee of the VI Latin American Congress of Cognitive Psychotherapies. More than 10 Science Articles about research and develop in Schema Therapy published since 1999, and 8 book chapters in Argentina, Italy, Spain and Brazil.
Lydia comes from a psychoanalytic background, and was seeking a better way to help patients suffering from Personality Disorders. She had tried using cognitive therapy, and started using schema therapy in 1992 after taking an intensive training with Jeff Young, the founder of schema therapy. Working with patients using schema therapy, and found the addition of the mode conceptualization to complete the understanding of the inner dynamic dysfunction of early schemas. In her work, she has found that modes make a dramatic difference in schema therapy work. She finds that the most important issue about the mode concept is the congruent relationship with advances in neuroscience, understanding how the brain processes emotion, cognition, and behavior.
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