2021  ISST REQUIREMENTS FOR CERTIFICATION  AS A SCHEMA THERAPIST (INDIVIDUAL) V. 2.0

1. Qualifications required to begin Individual Schema Therapy (ST-I) Certification TRAINING, and also for then applying for ST-I CERTIFICATION for those beginning training on, or after 1st of September 2021.

a.  To meet the eligibility criteria to begin Individual Schema Therapy Certification, training a person must fulfill the following two requirements:

i.    Academic training: Hold at least a Masters degree in psychology, clinical social work, psychiatric nursing or a counseling area that leads to licensing; or a medical degree with psychiatric residency (or residency equivalent if it is defined differently in that country).

ii.  License or certification for the independent practice of psychotherapy (independent psychotherapy practice): In countries that certify or license the above professions, a person must be certified or licensed by either the government body or professional organization which grants this. If no such control exists in a country, the standard of one of the national or international professional psychotherapy organizations must be met to fulfill this requirement. In a regulatory body where both registered membership and accredited membership exists, accredited membership is mandatory.

b.  If you belong to another group that is licensed or certified to practice psychotherapy in your country, please include this information along with your academic qualifications to be considered for certification training when you submit your application. Some countries have described in detail how the ISST qualifications need to be applied for their country. The UK is one example of this and for exception requests these standards are used.

c.  Directors of ISST Approved Training Program(s) and ISST Certified Trainer- Supervisors involved in delivering the workshops are responsible for making the eligibility requirements described above clear on their websites and literature, and during workshops. Several countries have been granted permission from the ISST to fine-tune the eligibility criteria to fit with existing national practice requirements. Therefore, it is insufficient for Directors of ISST Approved Training Program(s) and ISST Certified Trainer-supervisor(s) to direct queries from participants or potential participants to the broad guidelines. Directors of ISST Approved Training Program(s) should give details of the precise national requirements to their applicants.

d.  It is important to note that if the above requirements are not followed, a candidate, on achieving the required schema therapy training, supervision, and rating(s) of recorded session(s), might have their application for certification rejected by National/Regional Certification Coordinator(s) on the grounds that they did not meet eligibility criteria to either begin, or complete a certification program. This highlights the shared responsibility of ensuring that eligibility requirements are met, between the ISST Approved Training Program Directors and aspiring schema therapists.

e.  Participants (or potential participants) should be made aware by ISST Approved Program Directors that although they can attend (at the discretion of the Training Program concerned), or are attending, training workshops on a ‘stand-alone’ basis, they cannot then use this training to progress towards certification as a schema therapist at a later date if they did not meet the eligibility criteria described above before beginning the training workshops.

2021 ISST Minimum Certification Training Requirements

Chart 1.

(To understand this chart, please be sure to read the explanations below it.)

Important Explanations & Notes

2. Explanation of the 2 Certification Levels

a.  Standard International Certification: Therapists at this level are certified to practice schema therapy, participate in outcome studies, and to train other therapists at a basic level only with the supervision of an Advanced level Trainer-Supervisor within an ISST-approved training program. They are not qualified to run a training program, rate sessions, or offer supervision on difficult cases.

b.  Advanced International Certification: Certified to treat all patients and participate in outcome studies. An advanced level Individual Schema Therapist is also eligible to apply for certification as a Trainer/Supervisor in order to provide supervision, rate the recordings of others and to run training programs, after the required years of practice (see other documents on the ISST website for specific details) as a Certified Schema Therapist.

c.  Each Training Program can decide which of these 2 levels of training it wants to offer (including other non-certification courses).

3. Approved Certification Training

a.  The only type of workshops or trainings that the ISST accepts Certificates of Attendance from are those from ISST Approved Certification Training Programs in which the approved curriculum is instructed by ISST Certified Trainer-Supervisor(s), affiliated with the program.

b.  All other trainings, even if about ST and/or given by Certified ISST Trainer- Supervisors, do not count toward ISST certification. Workshops on ST by ISST Certified Trainer-Supervisors given outside of the certification curriculum can only count toward the Continuing Professional Development requirement to maintain certification as a Schema Therapist (see paragraph 10).

c.  The only possible exception to the above is if a candidate has completed the entire compulsory workshop curriculum for certification and then subsequently exceeds the three-year time limit for completing all certification requirements and submitting an application for certification to the relevant National/Regional Certification Coordinator. See details in the Time Limits for Completing Accreditation section, paragraphs 8.a. & 8.c.

d.  There are currently two routes to meet the Training Requirement for ISST Certification:

i.  Attend an approved ISST ST training program in its entirety. In this case, the program is responsible for ensuring that all parts of the ISST Certification curriculum are covered in your training. They will also provide you with the ISST-approved module certificate form (Certificate of Attendance) that lists the curriculum components covered and the number of trainees present. These will be needed when you are ready to apply for certification as a Schema Therapist. When you do apply for certification you send all the certificates as either PDFs or scans of them, to the relevant National/ Regional Certification Coordinator, along with your application.

ii.  Assemble your own certification training program by independent study. In this option you would need to carefully combine trainings from the various ISST Approved Certification Programs to meet all of the ISST Certification-required curriculum. In addition, you would need to submit the certificates of training modules (Certificates of Attendance) from those trainings. In some countries – e.g., Germany – this can be done rather easily as a shared curriculum and workshop plan are used. In other places this may be more complicated. It is your responsibility when applying for certification through the Independent Studies route to procure all of the needed certificates and send PDFs or scans of them to the relevant National/ Regional Certification Coordinator.

e.  For the Independent Studies programs, only workshops given by Certified Trainer-Supervisors who are part of an ISST Approved Training Program or have been invited by an approved program to provide a particular module of the ISST certification curriculum can be counted towards the required minimum of didactic training hours and the required minimum hours of supervised role-playing in dyads required for certification, covering the entire curriculum. In addition, they must provide you with the ISST module certificate form (Certificate of Attendance) that lists the curriculum components covered, and the number of trainees present.

f.    It is the responsibility of the Independent Studies candidate to ensure they attend training modules that cover all elements of the curriculum and the required minimum amount of training hours, and that proof of the above is provided on their certificates. It is imperative that the Independent Studies candidate checks the training document on the ISST website for specific details of the minimum training requirements, including the required minimum didactic training hours, the required minimum of supervised role-playing in dyads hours and coverage of the entire curriculum for certification.

g.  It is the responsibility of anyone embarking on the Independent Studies route to ensure that they meet the eligibility criteria to begin certification training of the country in which they practice psychotherapy  before they begin their training. This eligibility criteria, described earlier in this document, comprises academic and license or certification for the independent practice of psychotherapy (independent psychotherapy practice) qualifications. If in doubt, guidance can be sought from the Director(s) of the ISST Approved Training Program(s) from which they are planning to receive their workshop training. Any training or supervision done before meeting the eligibility criteria  will not count towards certification.

4. Supervision Requirements

a.  A minimum of 20 hours of supervision is required for Standard level certification. Supervisors must also view/listen to a minimum of 2 hours of recorded sessions (2 patient sessions) and review them. Time spent by the supervisor listening to, and reviewing recordings does not count towards the required minimum of 20 hours of supervision. The feedback from the reviews can, however, be discussed during supervision.

b.  A minimum of 40 hours of supervision is required for Advanced level certification. Supervisors must also view/listen to a further 2 hours (making a total of 4 hours over 4 patient sessions) of recorded sessions and review them. Time spent by the supervisor listening to, and reviewing recordings does not count towards the required minimum of 40 hours of supervision. The feedback from the reviews can, however, be discussed during supervision.

c.  The above required minimum hours of supervision and recorded sessions viewed/listened to by the supervisor is a minimum only, and additional session recordings might need to be viewed/listened to by supervisors and more hours of supervision provided, if sufficient competency has not been achieved.

d.  In the same way that all recordings submitted to an Independent Rater must be accompanied by a Case Conceptualisation and a Session Recording Background and Information Summary form, the same procedure must be followed when submitting recordings for review to their supervisor. The supervisor is required to review both the session recording and Case Conceptualisation and give feedback using the STCRS & STCCRS forms.

e.  Supervision undertaken by a candidate that can count towards standard and advanced accreditation must be carried out by an ISST Certified Supervisor who has maintained their membership of the ISST and their Certified Supervisor status. It is up to the Certified Supervisor to maintain their Certified Supervisor status and up to the candidate (supervisee) to check this on the ISST website.

f.   Supervision sessions provided by an ISST Certified Supervisor can only count towards accreditation if a candidate has started (i.e., the first day of Certification workshop training) an approved training program, or approved workshop if they are following the Independent Studies route.

g.  A candidate does not need to have completed all workshop training before starting supervision. If supervision towards certification is provided before the workshop training is completed, it must be done so sparingly in order to maximize learning.

h.  Duration of supervision must be at least 1 year after a candidate has started (i.e., the first day of Certification workshop training) an approved training program or approved workshop if they are following the Independent Studies route.

5. Content of Supervision

a.  All supervision should include supervisees looking at their own schema activation in the context of their work with patients and with their supervisor during supervision.

b.  All supervision should include supervisees looking at their own surrender, avoidant/detached and/or overcompensating mode activation in the context of their work with patients and with their supervisor during supervision.

c.  Handling obstacles related to schema and mode activation during their work with patients and during supervision.

d.  Empathically confronting supervisee’s avoidance, detached protector and overcompensating modes.

e.  Respectfully providing both positive and critically constructive feedback to candidates.

f.   Additional self-therapy should be encouraged when needed and should be related to counter-transference issues in the treatment of patients.

g.  The Schema Therapist Competency Rating Scale (STCRS) & Schema Therapy Case Conceptualization Rating Scale (STCCRS) should be covered in terms of what will be expected for final rating(s) of recorded session(s).

h.  Comprehensive use of the case conceptualization forms / case summaries.

i.    Prerequisites for Schema Therapy – (Assessing contextual “road blocks” like limited finances, limited access to patient, blending other therapies, suicidal tendencies, crisis intervention, medication evaluations).

j.   Implementing role plays with candidates.

k.  Use exercises from the training program to help trainees “experience” their own schema triggering and maladaptive coping modes.

l.   Emphasis on mode work, including mode labelling, mode dialogues (in chairs) and using a mode map.

m. Separate from recordings which are submitted to the supervisor for review (a minimum of 2 for standard level certification training and 4 for advanced level certification training), the supervisor and supervisee listening together to segments of recorded sessions with a patient, during a part of supervision sessions is a valuable use of supervision time. It also means that the supervisee can get immediate feedback from their supervisor.

6. Converting Group Supervision Hours to Individual Supervision Hours

a.  There is a system for converting group supervision hours into individual supervision hours (applies to supervision groups with 2 to 6 members). The basis of the conversion is that 3 group hours (180 minutes) with 6 members in the group, is approximately equivalent to 1 individual supervision “hour” (50 minutes).

b.  For example, if a group has 6 trainees, then we assume that each group member gets 1/6 of the group time. Thus, if the group is 2 hours long (120 minutes), then each member gets 20 minutes of direct supervision time in the group. This is equivalent to 20 minutes of individual supervision time. The remaining 100 minutes is spent observing the supervision of other group members. It was decided that the time spent observing supervision of another member is equivalent to 20% of the time spent receiving supervision on one’s own cases. Thus the 100 minutes observing others is equal to 20 individual supervision minutes (20%).

c.  Using this formula, the chart below allows you to compute the number of supervision credits for each size of group. You should use the calculator on the ‘Training’ or ‘Certification’ pages on the ISST Website.

 

Chart 2.

For each 60 minutes of group supervision time:

2 trainees in group = 36 minutes of credit

3 trainees in group = 28 minutes of credit

4 trainees in group = 24 minutes of credit

5 trainees in group = 22 minutes of credit

6 trainees in group = 20 minutes of credit

(60 minutes of individual supervision = 60 minutes of credit)

d.  Note that, to be certified, trainees may receive a combination of supervision in groups and individual supervision. Individual supervision is recommended, but not mandatory.

7. Patient Session Recording Ratings by Independent Rater(s)

Final Required Recorded Session Ratings by Independent Raters

a.  For Standard Certification the recorded session must show a patient who is appropriate for Schema Mode work due to complication, chronicity, failure to respond to treatment or relapse. The recording must show the application of emotion-focused change techniques at a high level (i.e., item 11-Application of Emotion-Focused Change Techniques in the STCRS must achieve a minimum score of 4.0) in the form of imagery rescripting for change or mode dialogues (in chairs) for change. As specified above, the demonstrated emotion-focused change technique must be drawn from the change phase of therapy and NOT be, for example, assessment imagery or mode dialogues (in chairs) for assessment.

b.  For Advanced Certification the recorded sessions must show one patient with a personality disorder or significant personality disorder features and one who is appropriate for Schema Mode work due to complication, chronicity, failure to respond to treatment or relapse. One recording must show the application of emotion-focused change techniques at a high level (i.e., item 11-Application of Emotion-Focused Change techniques in the STCRS must achieve a minimum score of 4.0) in the form of imagery rescripting for change or mode dialogues (in chairs) for change. The second recording must show a different form of emotion-focused change technique to that in the first recording and must also achieve a minimum score of 4.0 on item 11 on the STCRS. So, one recording must demonstrate imagery rescripting for change and the other must demonstrate mode dialogues (in chairs) for change. As specified above, the demonstrated emotion-focused change technique must be drawn from the change phase of therapy and NOT be, for example, assessment imagery or mode dialogues (in chairs) for assessment.

c.  In addition to the required minimum average score of 4.0 (Standard) and 4.5 (Advanced) a candidate must receive individual ratings of no less than 4.0 on items 6 (if scored), 7-9 and 11 on the STCRS.

d.  For security and privacy guidelines for sharing clinical information refer to ISST privacy policy and guidelines, accessible on the ISST website.

e.  On rare occasions when candidates in forensic settings cannot record sessions or when recorded sessions cannot be removed from a forensic institution, the candidate is encouraged to see a patient outside of that environment to record. If that is not an option and it is possible for the candidate to arrange, they can organize an approved independent rater to view a live session. In this situation, you must contact the ISST Training Coordinator to request an exemption before this alternative to a recorded session is taken, so that circumstances can be investigated, and a decision made. It is stressed that this provision is very rarely utilized.

f.  All recordings submitted to Independent Raters should be accompanied by a completed Case Conceptualisation and Session Recording Background and Information Summary Form. The submitted recording must be of one complete session. It is not permissible to send parts of different sessions. The Independent Rater is required to rate both the session recording and Case Conceptualisation and give feedback using the STCRS & STCCRS forms.

g.  Submitted recordings must show a continuous and complete session of a minimum of 45 minutes and usually a maximum of 60 minutes.

h.  For Advanced certification applicants are expected to demonstrate competence with overcompensating modes and avoidant or surrender modes, spread over the two recordings rated by independent raters. This means that one recording should demonstrate competence with a client with an avoidant mode and/or surrender mode and the other recording should demonstrate competence with a client with an overcompensating mode. The demonstrations of such competence need not be the main focus of the session, but must be evident during it, by for example the therapist drawing attention to the modes. These modes must also be clearly identified and comprehensively explained in the Case Conceptualisations and details of the modes rated must be subsequently specified on the certification application form.

i.  The two required recorded sessions for Advanced certification must be scored by two different independent raters and be from two different patients.

j.  Access to Independent raters will normally be arranged by the site offering the training program.

k.  A candidate may work either towards advanced certification, achieving a minimum of 40 hours of supervision and two qualifying recordings and case conceptualizations, or first gain standard certification and then continue to work towards advanced certification.

l.  A recording that has been used to gain standard certification may also be counted as one of the two required recorded session ratings for advanced certification provided it meets all of the advanced level requirements, including a required minimum score of 4.5 on both the STCRS and STCCRS.

m. Regardless of whether or not a candidate is working directly towards advanced level certification or chooses to first achieve standard certification, they must comply with the time limits explained below.

n.  Recordings can only be submitted once to an independent rater. If the recording does not achieve the required scores, it cannot then be sent to a different independent rater for a ‘re-rating’. If, however, the candidate wishes to appeal the result of the rating, it can be done so by contacting the ISST Certification Coordinator who can appoint another independent rater. The cost of this second independent rating will be covered by the applicant. If this provision is utilized, a mean score of the two ratings will be used for a final result.

o.  Although a recording can only be submitted once to an independent rater, the Case Conceptualisation can be resubmitted (to the same independent rater). This means that if the recording meets the requirements of the STCRS laid out above, but the Case Conceptualisation does not, the independent rater can draw attention to the areas that need strengthening and offer the candidate the opportunity to resubmit it when it has been improved for a re- rating. The independent rater might charge for such a procedure, so this is at the candidate’s own expense. For Advanced level certification at least one of the Case Conceptualisations has to reach the required standard without directed corrections from the independent rater.

p.  Definition of “independent rater” for the STCRS & STCCRS ratings required for certification. In the ISST Executive Board Meeting 5-28-2013 a clarification of the independent rater was defined as being an ISST Certified Supervisor/Trainer who is not the director of the applicants training program, or a Supervisor or a Trainer involved in didactic or role-play portions. A subsequent and additional decision was made that if the candidate has had, or has a professional or personal relationship with someone, that person cannot be an independent rater either. We realize that there will be situations where this definition cannot be met completely – for example, a country with only one training program or very limited number of certified supervisor/trainers, forensic settings with limitations regarding recordings or the removal of recordings from the institution. In those situations, please write to the ISST Training Coordinator to request an exemption. This position was taken to remove the possibility of naturally occurring bias when the trainer and independent rater roles overlap.

q.  Following on from the point above if you believe you have grounds for requesting an exemption on the basis that you are practicing in a country with only one training program or a very limited number of certified supervisor/trainers you are strongly encouraged to attempt to locate an independent rater (through the ISST website) who speaks your native language and who is living outside the country providing ST training, prior  to contacting the ISST training coordinator for exemption. Exhausting this possibility before contacting the Training Coordinator for an exemption will reduce their workload, as this is something they will check.

r.    The STCRS is still a pilot scale, as are the cut-off scores. We expect to refine the STCRS and cut-off scores over the next 1 or 2 years based on research data. We are also in the process of having the STCRS validated empirically and establishing an inter-rater reliability standard for independent raters to meet.

s.  While video recording is strongly preferred, audio only is acceptable.

8. Time Limits for Completing Accreditation

a.  Candidates have a maximum of 3 years after completing the workshop training (see the training document on the ISST website for specific details of the minimum required hours of didactic training, supervised role-playing in dyads and the curriculum to be covered) to meet all of the certification requirements and apply (to send the application to the relevant National / Regional Certification Coordinator) for their first certification level (Standard or Advanced).

b.  If a candidate achieves Standard Certification within 3 years they then have an additional maximum of 2 years to complete the further supervision and recorded session requirements needed for advanced level, and apply for Advanced Certification. This additional two-year period begins from 3 years after the final date of the workshop training. This means that a candidate has a total maximum of 5 years from the date they completed the workshop training to qualify at Advanced level if they achieve Standard Certification first at any time before the three-year point.

c.  If candidates do not meet the deadline of 3 years for the first certification or the additional 2 years for Advanced Certification, they have to provide proof of one, or a mix of, the following:

i.  Attendance at schema therapy certification training or schema therapy Continuing Professional Development (CPD) workshops for a minimum of 6 hours for each year (or 12 hours for each 2 years) exceeding the limit. These workshops should be conducted by ISST-Certified Trainers and the didactic and dyadic elements of the training must be 'live' and interactive. Pre-recorded training or courses, even if there is a form of questioning afterwards, of any type do not count. Brief video illustrations and demonstrations of clinical work within this 'live' and interactive training are permissible. Certificates of Attendance must be presented to the relevant National/Regional Certification Coordinator at the application stage.

ii.  Extra supervision provided by an ISST Certified Supervisor (this could be either their existing Supervisor or a different one) for 6 hours for each year (or 12 hours for each 2 years) exceeding the limit. Confirmation of additional supervision hours must be provided by the supervisor directly to the relevant National/Regional Certification Coordinator at the application stage.

iii.  Case presentation at scheduled on-line meetings of one of the Special Interest Groups (SIGs) accredited with the ISST. These presentations should not exceed 3 hours per one year and may be combined with the training workshops or supervision. The leader of the SIG should confirm such presentations in a letter to the relevant National/Regional Certification Coordinator on request from the applicant.

d.  The above rules make any ‘extensions’ unnecessary except for exceptional and extraordinary circumstances.

9.  Applying for Certification

a.  All applications for certification in individual schema therapy go to Regional/National Coordinators who are the Reviewers for the country you live in and/or are licensed in and in which you practice independent psychotherapy. Once you have achieved all the certification requirements you will need to submit your application form and associated documents to the appropriate National/Regional Certification Coordinator.

b.  You can find the appropriate (for your country) National/Regional Certification Coordinator on the ISST website using the ‘Certification’ tab and then scrolling down to ‘National Certification Coordinators’. If two people are listed for your country, and you have been trained or supervised by one of them or they have completed an independent rating for your certification or you have, or have had a professional or personal relationship with one of them, please send your application to the other for the sake of Coordinator’s independence.

c.  All of the certification related forms are accessible on the ISST website using the ‘Certification’ tab and then scrolling down to the ‘Certification Forms’. The forms you will need are the ‘Certification Application form’ and the ‘Checklist of Documentation form’. Please use the most recent, up-to-date forms and follow the instructions scrupulously, completing the forms comprehensively and accurately, otherwise they will be returned to you for modification before they can be processed.

d. The Independent rater(s) must send confirmation of the scores, along with the summary sheet from the STCRS form and the completed STCCRS form by email directly to the National/Regional Certification Coordinator. The procedure for this is detailed in the application form.

e. The supervisor must send confirmation that the supervisory requirements (duration of supervision, number of supervision hours, number of cases, type of cases and number of treatment hours) have been met, directly to the National/Regional Certification Coordinator. The procedure for this is detailed in the application form.

f.  Your application for certification will not be reviewed by the National/Regional Certification Coordinator without your ISST membership number. To become a member of the ISST and get a membership number, download an application for membership form from the ISST website, complete and submit it. For certification as a schema therapist (individual) you will first need to be a Full ISST Member.

g.  You are eligible to apply for ISST Full Membership when you begin certification training; you do not have to wait until you apply for certification as a schema therapist to join the ISST as a Full Member.

10.    After Becoming a Certified Schema Therapist

a.  To maintain certification as a schema therapist the following requirements apply, and if any are not met, certification can be withdrawn by the ISST:

i.  A person must continue to be a fully accredited member of their countries regulatory body that conferred the right to practice one-to-one psychotherapy in their country, and their clinical practice must continue to be regulated by it. For example, in the UK, if an applicant achieved full accreditation with the British Association for Counselling and Psychotherapy (BACP) and used this to meet the eligibility criteria to begin certification training as a schema therapist, they must continue to be accredited with the BACP both during schema therapy certification training and after becoming a certified schema therapist at any level.

ii.  The person must continue to be an ISST member and pay his/her annual fees on time.

iii.  Meet the annual Schema Therapy Continuing Professional Development Requirements (see the ISST website for details of the Continuing Professional Development policy).

b.  It is possible that you might be contacted by the ISST to give feedback on the supervision that you received during the certification program, by completing anonymously the Schema Therapy Supervision Rating Scale (STSV-RS).