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SATURDAY MORNING SYMPOSIUM 2 (S1SP2): 10.30 AM - 12.00 PM

From Vulnerable Child to Vulnerable Infant: Can We Access and Work with the Very Earliest Maladaptive Schemas

by Bruce Stevens, David Edwards, and Galit Gilad





General Abstract:

Early maladaptive schemas develop within the structures of the attachment system, most of which develop in the first three years of life. Schema therapists are used to working with memories from middle childhood or adolescence that are often relatively easy to access as a movie-like sequence of unfolding steps within which it is easy to understand how the child’s needs were not met by the adults around him/her. This in turn provides a basis for a rescript in which the needs are appropriately met. However, many distressing memories do not present in such a clear and accessible way and this is particularly true for events in infancy and early childhood. Yet, as Young, Klosko, & Weishaar (2003, p. 29) argue, “preverbal schemas come into being when the child is so young that all that is stored are the memories, emotions, and bodily sensations. Cognitions are added later, as the child begins to think and speak in words.” The focus of this panel is on whether and how we can access very early schemas and bring about much needed corrective experiences. Each of the presenters will describe clinical examples of how such early memory material can come into awareness in the therapy process as a Vulnerable Infant mode (or another early mode such as an Enraged Infant), and how it can be worked with therapeutically. They will also examine the conditions that are needed in the relationship between therapist and client as it seems that accessing and working with such early memories depends on a deep level of trust on the part of the client in the holding offered by the therapist in the reparenting relationship.

We propose three 20 minute presentations with 30 minutes allowed for discussion of ideas. This is highly relevant to the conference theme of Re-inventing the Therapeutic Relationship because the idea of infant modes re-conceptualizes our current understanding of modes and what is offered in the therapeutic relationship.

Presentation 1

Title: 

Memory for very early events in infancy and toddlerhood: How it works and how we can use it therapeutically

Presenter's Name: 

Professor David Edwards

General Abstract for Presentation 1:

Memory is not typically a movie-like sequence that reproduces what happened. It is always a reconstruction from abstracted material. From middle childhood memories may become more movie-like particularly for events that are told and retold as a narrative, but in schema therapy we don’t expect to work with an exact reconstruction of particular events. This is particularly the case with memory material from infancy and toddlerhood. It is not the phenomenon of so-called “infantile amnesia” means that nothing has been learned or can be recalled. There is increasing evidence from cognitive science that memory processes are active, as indeed they must be if the working models central to Bowlby’s attachment theory are to be constructed. Emotion-focused work and attention to somatic experience can enhance access to such early material and allow it to be experienced by the client in a manner that allows the therapist to empathize and understand what went wrong and what needs were not met at a crucial developmental period. This in turn provides a basis for a meaningful process of reparenting and rescripting. Several clinical examples will be given of early maladaptive schemas formed from age 3 and before, including an example of the impact of hospitalization and separation from parents in the first few months of life. These will show how the remembered material presents itself and how it can be worked with to promote a corrective experience.

Presentation 2

Title: 

Introduction to Infant Modes

Presenter's Name:

Professor Bruce A Stevens

General Abstract for Presentation 2:

I proposed the concept of infant modes in the book Schema therapy for couples: A practitioner’s guide to healing relationships (2015). A developmental trajectory was charted with the possibility of progress being stalled through experiences of neglect or trauma. Infant experience was distinguished in terms of unstable or flooded affect, early cognition which lacks reality testing, and infantile behaviors such as gaze aversion and tantrums. It is possible to identify infant dimension in child, coping and critic modes. The characteristics of these are described in the book pages 82-84. There will be information given on how to assess and work with infant, child and adolescent modes in schema therapy.

Presentation 3

Title:

Infant Modes in Practice

Presenter's Name:

Galit Gilad

General Abstract for Presentation 3:

Schemas are beginning to form from birth and even before. Yet little attention was given so far to portraying, identifying and reparenting vulnerable infant modes. The therapeutic relationship is changed when addressing vulnerable infant modes, since the reparenting required here is very different in reparenting vulnerable child modes: the expressions of vulnerable infant mode being non-verbal, emotionally unregulated, and oftentimes obscured by powerful and rigid infant coping modes. Consider, for example, the difference between an abandonment schema created in childhood (e.g. by a loss of a parent) and the same schema created in infancy and thus described as an anxious attachment style.

Schema therapy in its traditional form, is aimed at reparenting child modes, that is, reparenting using language, symbolic gestures and clear logic. Chair-work is relying on the patient’s conceptual ability – which is dormant while entering a vulnerable infant mode – and imagery relies on episodic memory which is non-existent before the age of three. Still, missing the opportunity to reparent these early modes of our patients may result in the persistence of some severe symptoms even after a significant amount of therapy.

This being argued in this short presentation, I will proceed by showing the main properties of vulnerable infant modes using clinical examples. Finally, two main directions for reparenting will be suggested. The first one, inspired by the work of D.W. Winnicott, is more demanding for the therapist, addressing the infant physical needs (e.g. physical proximity or presence) and may involve frequent contact with the patient between sessions, as well as physical regulation during the sessions (e.g. wrapping patient with a warm blanket). Another direction, inspired by Daniel Siegel's ideas, involves mindfulness techniques, and relies on building and then recruiting the healthy adult mode for reparenting and for emotional and physical regulation.

About the Presenters:

Bruce Stevens: 

Professor Bruce A Stevens (PhD, Boston University, 1987) Endorsed Clinical and Forensic Psychologist in Australia, ISST full member with advanced certification in Individual and Couple. He has written four books in schema therapy including Schema therapy for couples: A practitioner’s guide to healing relationships, with authors Chiara DiFrancesco (USA) and Eckhard Roediger (Germany), Walden, MA: Wiley-Blackwell, 2015 and Contextual Schema Therapy, with Eckhard Roediger and Rob Brockman, New Harbinger 2018. He is a professor at Charles Sturt University and has dozens of peer reviewed papers in psychology and related disciplines. He has presented workshops and skills sessions in at the previous three international ISST conferences, workshops at the Australian Clinical College conference (2010-present) and countless professional development workshops.


David Edwards: 

David Edwards lives in Cape Town, South Africa, where he runs a training program in schema therapy through the Schema Therapy Institute of South Africa. He presents basic and advanced training workshops in schema therapy in South Africa and internationally. He also has an active private practice offering psychotherapy and clinical supervision. He is registered as a Clinical Psychologist in South Africa and the United Kingdom and is currentlyPresident of the International Society of Schema Therapy (ISST). He trained in cognitive-behavioural, humanistic and transpersonal approaches to psychotherapy, and has a longstanding interest in psychotherapy integration. He was fortunate to be introduced to schema therapy by Jeffrey Young, the founder of schema therapy, in the 1980s and has followed its development from its beginnings. He is an Emeritus Professor at Rhodes University, where, for over 25 years, he taught cognitive-behavioural therapy (including schema therapy) to trainee clinical and counselling psychologists, and offered intensive workshops to students using expressive therapies including psychodrama, clay sculpture, drawing and dance. Since his retirement at the end of 2009 he continues to work as a researcher and research supervisor. He has over 100 academic publications in the form of journal articles and book chapters.

The focus of many of these is trauma and complex trauma. Several of them are clinical case studies and he is one of the editors of Case studies within psychotherapy trials: Integrating qualitative and quantitative methods (Oxford University Press, 2017). He has also written articles and book chapters on imagery methods in psychotherapy and is the author, with Michael Jacobs, of Conscious and unconscious in the series Core concepts in psychotherapy (McGraw Hill, 2003). The focus of his current work is on the phenomenology of schema modes and understanding the deep structure of modes. This is reflected in a recent pair of articles on modes in a case of anorexia nervosa (Edwards 2017a and Edwards 2017b).

Galit Gilad: 

Galit Goren Gilad is a Clinical Psychologist. She is a couple therapist and a certified schema therapist. She works in a private clinic, and had taught schema therapy in psychiatric hospitals, psychotherapy training programs and educational psychology centers. She is a co-founder of the Israeli Schema Therapy Society and a member of its board.



Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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