Abstract:

In schema therapy, corrective emotional experiences are an important ingredient of the treatment. These experiences are thought to be particularly effective in addressing the vulnerable child mode and strengthening the healthy adult mode. Results from a recent study into mechanisms of change support the importance of addressing these modes, as it was found that these two modes play a pivotal role in effective therapy. Two groups of techniques aim to directly offer corrective emotional experiences: experiential techniques and therapeutic relationship techniques. In this contribution the empirical evidence for these two groups of techniques is discussed. While the evidence for the effectiveness of imagery rescripting is growing, the evidence for the other main set of experiential techniques, the chair (mode) work, is lagging behind. Likewise, while indirect quantitative evidence and qualitative research support the idea that the specific qualities of the therapeutic relationship (i.e., limited reparenting, a more personal connection to the patient) are effective ingredients of schema therapy, there is lack of direct evidence for the therapeutic effects of them. Limited reparenting might even have adverse effects, at least in a subgroup of patients, as was discussed in a panel at the ISST conference in Coimbra. Thus, it is important that we study limited reparenting better and find out how it should be applied, and how not. Two potential ways in which limited reparenting can become detrimental will be discussed: (i) when there is not a good balance between support and frustration, and the therapeutic relationship becomes a self-soothing tool for the patient; and (ii) when processing painful childhood memories is avoided, for instance because the therapists believes that the corrective experiences offered in the therapeutic relationship are sufficient.

About the Presenters:                   

Arnoud Arntz:

Is professor of Clinical Psychology at the University of Amsterdam, the Netherlands, with an affiliation at Maastricht University, the Netherlands. His main research interests lie in the fields of PTSD and personality disorders, both applied and fundamental. He also practices as a psychotherapist at PsyQ in Amsterdam, where he treats patients with trauma and personality disorders. Together with Adam Radomsky he was editor of the Journal of Behavior Therapy and Experimental Psychiatry.

His research focuses on psychological processes underlying personality disorders (PDs), especially borderline personality disorder (BPD), and anxiety disorders, especially PTSD; and their treatment. Using the approach of experimental psychopathology he tested psychological theories of anxiety disorders and PDs and contributed to the development of their psychological treatment. In developing and testing psychological theories and treatments he aims to connect basic research and clinical work. He is perhaps best known for his contributions to the development of Schema Therapy and Imagery Rescripting. He was project leader of the multicenter RCT that compared schema therapy (ST) to Transference Focused Psychotherapy as treatments of Borderline PD, and of another multicenter RCT that compared ST to treatment as usual (TAU) and CCT for 6 other PDs. Currently he is PI of an international RCT comparing working mechanisms of Imagery Rescripting and EMDR for PTSD that originated from childhood traumas, and together with Dr Joan Farrell PI of the international RCT that compares group-ST to TAU for Borderline PD. Professor Arntz also chairs a Dutch-German collaborative study investigating basic brain and cognitive processes in BPD and their change during treatment, which is associated with the international RCT on group-ST.

Joan Farrell:

Joan Farrell, PhD, (with her partner Ida Shaw) has facilitated self-therapy groups for over 30 years leading to their book Experiencing Schema Therapy from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. Guilford Press, 2018.

She is an advanced level ISST Certified Trainer/Supervisor in individual & Group ST. She co-directs the Indianapolis Center of the Schema Therapy Institute Midwest, a training, research and practice center with ISST approved training programs in individual, Group and Child-Adolescent ST. She offers training nationally and in collaboration with ISST Training programs internationally – thirteen countries so far. She has published research articles, book chapters, a training DVD and three books on Schema Therapy. Group Schema Therapy for Borderline Personality Disorder, Wiley 2012 and The Schema Therapy Clinician’s Guide: A Complete Resource for Building and Delivering Individual, Group and Integrated Schema Mode Treatment Programs, Wiley, 2014.

Joan is a licensed Clinical Psychologist, Ph.D., an adjunct professor of clinical psychology, at Indiana University-Purdue University Indianapolis and was a faculty member of the Indiana University School of Medicine (IUSM), in Psychiatry for 25 years. She is the Research Director of the Center for BPD Treatment & Research of the IUSM/Eskenazi Community Mental Health Center. She is an investigator on a number of international schema therapy outcome studies and was awarded a National Institute of Mental Health (USA) award for a randomized controlled trial of Group Schema Therapy. Joan was a member of the Executive Board of ISST as the Coordinator for Training & Certification from 2012 to 2018.