"clarification of a work stress issue and a proposal for schema therapy with histrionic patients"
case Discussion by ZACHARIOS zachariou, ECKHARD Roediger & Alexandra schosser
The original complaint of a patient can be sometimes a real enigma that requires a thorough work out for its solution. We hereby propose a Schema Therapy (ST) approach, facilitating the progressive deployment of various psychosocial issues. It tackles them successfully by the application of its own appropriate diagnostic and intervention techniques but also combined with other psychotherapeutic strategies specific to the current situations. The involvement of situational factors and their complications is taken into account and a fairly weighted treatment on individual, especially personality’s, aspects is granted. The key point for this presentation concerns a ST application on Histrionism which is a therapeutic challenge on the one hand and a classic intervention field for psychoanalytic and psychodynamic approaches on the other. It is treated in other psychotherapeutic paradigms rather rarely in a trouble specified manner. In this presentation, specific interventions will be presented and illustrated by a study case of a mid-life, male histrionic out-patient having a middle management position at work. Among other motives, he also sought specialized treatment for a work stress and psychosocial risks prevention issue. We hereby proceed to an overview of the schema modes conceptualization. The modes, their biographic function and the empathetic confrontation will be detailed. The systematic observation of the speed change of dysfunctional modes appears crucial for the adaptation of the various intervention techniques. These ones are progressively introduced because of patient’s numerous resistances deserving consideration and enlightenment. We point them out as indicators and treat some emergences of self aggrandizing compensation coping mode but also the impulsive and undisciplined mode. Clarification of an arbitrary punishing mode and reduction of inappropriate compliant surrender are beneficial for the patient in order to better cope with current life’s situations, especially social interactions and behavior at work place. Introduction of patient’s spouse into the psychotherapy is presented under the modes circles perspective. In principle, the dysfunctional modes are treated by the usual ST techniques such as imagery rescripting, chair work and dysfunctional pattern breaking. In the mean time, metaphors and symbolic work are used to facilitate the reinforcement of the healthy adult mode. The last one will finally become an “autonomous and efficient new life’s screenwriter”. Such an achievement can also be counted as the result of patient’s creating skills and resources reactivation by the treatment. Debate about the use of all these techniques and therapist’s stance toward speed mode change may have the ambition to promote the use of ST in rather new application fields and considerations. The positive outcome of this patient shows a promising application of such a therapeutic setting. Further, openness for existential choices for a better life quality seems to be a natural consequence of the therapeutic impact.
EXPECTED POINTS OF DISCUSSION:
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