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  • 21 Dec 2017 2:39 AM | Travis Atkinson (Administrator)

    The December solstice is always a time of huge contrasts between different parts of the planet.  We just had a heat wave in Cape Town (very early in our summer) and I just saw TV coverage of snow storms that closed several airports in the United Kingdom. Whether it’s the summer solstice (in Southern Hemisphere countries) or the winter one (in the Northern hemisphere) it’s holiday time for many of us.  But not for all  -  in China the main holiday is still a couple of months away and Christmas is not the focus of holidays in those countries where the calendar has not been shaped by Christian traditions. In South Africa, despite the range of religions we have, Christian symbols dominate the summer shopping season and are ruthlessly deployed for marketing purposes. Long ago, in Europe, particularly Northern Europe, elaborate winter festivals evolved in the dark and cold of winter as people hoped and prayed that the days would indeed lengthen and Spring would come again. It’s easy to imagine how, feeling cold and depressed, one might fear that the summer sun would never return. They just didn’t have fancy labels like “seasonal affective disorder” back then. The consequence is that, here in South Africa, we have been eating mince pies since October, and being subjected to a melée of Santa Claus outfits and Christmas carols in the supermarkets.

    I know I’m repeating a theme from last year, but I am again reminded that the Christian tradition invites a focus on a powerful image of parenting  -  a loving family providing a safe and secure attachment experience for an infant born into adverse circumstances. The Christian story of the birth of Jesus focuses on a child whose basic developmental needs are going to be met because of the strength, commitment, patience and gentleness of a mother and father who have the personal resources to deal with a newborn baby under difficult conditions away from home. Given the pervasiveness of threats to secure attachment throughout history, perhaps the power and lasting quality of this scene is simply that, at an implicit level, it has offered comfort and perhaps even lasting healing to those who would take the time to meditate and reflect on it.

    My own experience within the Christian tradition, and continuing struggles with my own early schemas, reminds me of the limits of this. In schema therapy we can aim to go several steps further, potentiating the healing process by working actively and experientially with images and early memories.  I am reminded of an intervention developed by Antonio Madrid and colleagues in California and described in a 2012 article that moved me deeply when I read about it. It is entitled “The mother and child reunion bonding therapy: The four part repair.” They use it for behavioural problems in children where it was clear that the child never bonded with the mother from the beginning. There is a careful assessment to establish what interfered with the bonding at birth (family crisis, maternal depression, medical complications etc).  This is used to plan a rescript in which the mother gives birth to the child in an atmosphere of love and support and where the bonding with the infant can take place in a wholesome way, without the obstacles that interfered with it when the child was born.  Madrid and colleagues (2011, 2012) report two case series in which offering this treatment to mothers had a direct impact on the subsequent behaviour and physical health of their children. One of my colleagues used the intervention and was amazed by its impact.  I’d be interested to hear from any other schema therapists who try it.

    Meanwhile, an article in Time Magazine that reminded me of the challenge of finding the balance between a bottom up therapy focus (changing early schemas by providing corrective experiences in the memory systems that hold our early emotional patterns) and a top down therapy focus (building new schemas by changing patterns in current behaviour). Media interest in “5 chimps theory” (http://time.com/4830653/10-things-successful-people/?xid=newsletter-brief )seems to have come from interviews with Naval Radikant, a successful entrepreneur from Silicon Valley in California (e.g. see http://www.killingbuddha.co/blog/2016/2/19/naval-ravikant-on-who-he-admires ).  It’s based on studies in ethology  -  perhaps some of our members know the original study?  The basic finding is that you can make a lot of predictions about the behaviour of a chimpanzee based on knowing which five other chimpanzees it mostly hangs out with. 

    This makes a lot of sense. We know you can’t help people much who are in chronically abusive environments.  We have to help them get out. In Kubany’s research in Honolulu on Cognitive Trauma Therapy for Battered Women with PTSD (Kubany et al, 2004), treatment was only offered to “battered women who are not currently in an abusive relationship, have no intention of reconciling with an abusive partner, and are considered safe” (p. 5).  On this basis, they were able to bring about clinically significant change in the women they worked with. Similarly, it’s well nigh impossible to help someone overcome an addiction when most of their friends and associates are active addicts.  You will probably have to help them change their friends and social activities. Similarly, there is a lot of research showing that marital discord is not only associated with depression but probably a significant causal factor in depression. I am always particularly dismayed when I hear that someone in a discordant marriage who is depressed has been prescribed antidepressant medication.  How can that help?  That doesn’t necessarily mean if you are depressed you should leave your marriage and look for a different chimp but it does mean that the discord in the relationship needs attention. To this end, schema therapy for couples elegantly combines bottom up schema level work (with each partner) with top down work with a here and now focus on mode cycles and processes within the relationship, within and outside the therapy session.

    5 chimps theory suggests that not only will we be happier if we get out of the orbit of mean and abusive people, but that we should seek to spend more time with balanced and caring ones.  As Radikant puts it, “You should choose your friends very wisely. You shouldn't choose them haphazardly based on who you live next to or who you happen to work with. The people who are the most happy and optimistic chose the right 5 chimps.” Helping our patients see and accept this is often a challenge.  Practical and financial problems may pose obstacles, as may longstanding beliefs about loyalty and obligation.  In turn, those beliefs may be rooted in complex enmeshment and deeply co-dependent relational schemas in which a child has been trained to pity and take care of a self-pitying parent.  Then it is difficult to bring about top down change without bottom up work at the early schema level. 

    It’s a central pillar of schema therapy is that it is often impossible to bring about behavioural change if we don’t change the underlying schemas. I am still taken aback when, despite what looks like effective work with imagery rescripting and reparenting within the therapy relationship, a patient’s Vulnerable Child remains trapped within the orbit of memories of abusive, uncaring and neglectful parents.  As a therapist, I easily get bogged down when patients can’t extricate themselves from dysfunctional and abusive relationship situations. When that happens, I am going to tell them about 5 chimps theory.  It might help to motivate them.  But I also understand that they may not really get it unless we can access the underlying maladaptive schemas and bring about deep schema change.  As I suggested. in my workshop in Barcelona, the problem is exacerbated by dissociation.  One child part may be able to trust and respond to reparenting but other less trusting parts remain to be uncovered and, hidden in the background, undermine progress until we can find them and invite them into the reparenting experience too.

    So, there’s plenty of work to do and being a schema therapist is a lifelong learning process. So, I wish you all in the schema therapy community the very best for the turn of the year, and, if you are taking a summer or winter holiday, enjoy some well-earned rest and relaxation -  and find some friendly chimps to hang out with.

    References

    Kubany, E. S., Hill, E. E., Owens, J. A., Iannce-Spencer, C., McCaig, M. A., Tremayne, K. J., & Williams, P. I. (2004). Cognitive trauma therapy for battered women with PTSD (CTT-BW). Journal of Consulting and Clinical Psychology, 72(1), 3-18.

    Madrid, A., Morgan, A., Taormina, A., Laforest, L., & West, E. (2012). The mother and child reunion bonding therapy: The four part repair. Journal of Prenatal and Perinatal Psychology and Health, 26(3), 165-184.

    Madrid, A., Pennington, D., Brown, G., & Wolf, M. (2011). Helping asthmatic children through bonding therapy. Journal of Prenatal and Perinatal Psychology and Health, 26(2), 65-85.

  • 11 Nov 2016 9:05 AM | Travis Atkinson (Administrator)

    Dear ISST Colleagues

    I appreciate the confidence you have shown in me in electing me as President for the next two years. It is an honour and a privilege.  As outgoing President, Eckhard Roediger, showed at the Vienna conference in July, our Society is going from strength to strength and I hope I can contribute to promoting that further.  I am very much aware that I am part of a team and that we have great continuity as Eckhard has taken over the considerable responsibilities of the position of Treasurer (and legal issues), Joan Farrell will be continuing her sterling work in the Training and Certification portfolio, Travis Atkinson, who made such a massive contribution in developing and maintaining the website and promoting the Vienna conference, will continue in the Public Affairs portfolio, and Chris Hayes continues to contribute his experience as Secretary.  I also have the pleasure of welcoming Remco van der Wijngaart (Vice President) and Paul Kasyanik (Research and Scientific Issues) to the Board. We are a truly international organization and it is good to see this reflected on our Board with members from Germany (Eckhard), the Netherlands (Remco), Russia (Paul), the USA (Joan and Travis), Australia (Chris) and South Africa (myself).  I would also like to express my appreciation to the outgoing Board members Alexandra Schosser, Kristin Zickenheimer and Eshkol Rafaeli for their significant contributions to the running of the ISST during the past two years.  I also thank those who made themselves available in the election but who were not elected this time.  Being a member of the board is only one way of contributing to the Society.  Many other members are involved as part of Special Interest Groups (see http://www.schematherapysociety.org/Special-Interest-Groups ) or on various committees appointed by the Board.  If there is an area you would like to be involved in please let me know.

    Being a schema therapist is a challenging lifestyle!  Each client we work with faces us with important questions.  I know that I expect to find new challenges and learn something new every day and I know from having the privilege of working with some of you in supervision that this is the kind of commitment you bring to your role as a psychotherapist, and, in particular, as a schema therapist.  As schema therapists we can draw on the practical interventions of the cognitive and behavioural arms of therapy, the rich emotion-focused work of the experiential and hypnotherapeutic traditions, and relational work pioneered by so many psychodynamic traditions. But this very diversity is itself makes big demands on us.  Working with the relationship can be particularly challenging especially for cases where there are obstacles to establishing a reparenting bond.  It is perhaps then most of all that we recognize the pervasiveness and implicit quality of schemas and just how great is the challenge of articulating them and making them explicit.  Such cases that are most likely to trigger my supervisees’ schemas  -  and my own  (though mine get triggered by other things too!) and I need to give attention to trying to jump off the schema roundabout myself

    I have been involved in editing a book that focused on the role of case based research in developing clinical knowledge as a complement to running clinical trials. In it, there are several references to Gordon Paul’s (1967, p. 111) oft quoted question: “What treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances?”  This is a call to an idiographic approach in science and clinical practice, one that recognizes the limitations of general principles that apply to the average person (who of course does not really exist at all).  It reminds us that every case is different and that what worked well for one client may not work at all for the one I am sitting with now.  In the same spirit, schema therapists will be asking, “What approach, what focus, what intervention, will meet the needs of this client today?”  We also know that whatever we have planned may not be appropriate when the client arrives in a crisis or with unexpected emotions in the foreground.  In facing these complexities, the schema therapy model reminds us that schema therapy is not just about specific techniques, but about how we work with the case conceptualization to choose interventions that will help the client on a journey to finding a less distressed  and more meaningful life.  We know that the conceptualization will evolve and change over time.  For some clients, emotion focused work and imagery rescripting may be the heart of the therapy. But for others we need to focus on building the Healthy Adult because, without that, emotion focused work may get little traction. Time and again, with a complex case, we may discover our conceptualization has failed to address the client’s problem and we are guided to go back and look even deeper!

    It is clinically focused discussions of these kinds of challenges, and the creativity of the therapists at the front line, that allow schema therapy to evolve and grow to address ever more complex clinical presentations.  I have been privileged to see this in action in the meetings of the Couples and Trauma SIGs and I am sure members of other SIGs have the same experience.  The ISST is a wonderful meeting place for supporting and promoting these developments, at its conferences and summer schools, through its SIGs, the Schema Therapy Bulletin, and other forms of networking and through the structure it provides for maintaining standards of training and certification. I look forward to seeing how this creativity continues to infuse our Society over the next two years. 

    David Edwards

    Schema Therapy Institute of South Africa

    01 November 2016

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