Schema Therapy Bulletin

June 2016: Experiential Elements in Schema Therapy

Schema Therapy relies on Cognitive, Behavioral and Experiential Strategies as well as Limited Reparenting.  In this issue we are pleased to highlight some new and creative approaches to Experiential work.

Ofer Peled proposes eight different presentations of dysfunctional parent modes, and has a developed a hierarchy of confrontational interventions to address each presentation. Identifying both the the characteristics and the intensity of each dysfunctional parent mode, and understanding the patients unmet needs enables therapists to assume a stance in imagery or in mode work using chairs that will be most effective in helping patients get core needs met in a healthy way. 

Christof Loose works with children and adolescents. His article describes a very creative technique he uses with children, in which he and the child identify the child’s modes, and write them down. The child then creates his own “mode sketch”, and assigns a finger puppet to each mode. Through the finger puppets the child is able to understand his modes, and work with them to find ways to get his needs met.

Rita Yonan works extensively within a group schema therapy framework.  She looks at novel creative and experiential opportunities that are available within group schema therapy context. In addition, she discusses how experiential and emotional components of therapeutic work can be enhanced within a group format. 

Chris Hayes is involved in research investigating the use of imagery respiting for childhood trauma. His article discusses imagery re-scripting within schema therapy context, and looks at practical ways therapists can improve imagery techniques and skills.

Bruce Stevens and Pierre Cousineau contributed an article about Memory Reconsolidation and the brains ability to unlearn or relearn at the level of Emotional Learning. They describe recent findings which may help to explain why imagery is such a powerful intervention in Schema Therapy. 

As these innovative techniques demonstrate, Schema Therapy remains a dynamic and evolving model. We look forward to continue to share our members creativity with you in future issues.

Editors, 

Lissa Parsonnet, PhD., LCSW (USA)  

Chris Hayes, Clinical Psychologist (Australia)  

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— FEATURE ARTICLES INSIDE JUNE'S ISSUE —

CONFRONTATIONAL INTERVENTIONS

A Hierarchy of Confrontational Interventions Facing 8 Dysfunctional Parent Modes 

Ofer Peled, The Schema Therapy Center Raanana, Israel, Bar-Ilan University

Young et al. (2003) refer to the critical punitive and the demanding parent modes as negative internalized representations of parents and other significant figures. Since there are several parental styles (e.g. Maccoby & Martin, 1983) it is conceivable that there are much more internalized dysfunctional parent modes than the two suggested by Young. 

Young et al. (2003) instruct therapists to help patients battle and defeat their internalized dysfunctional parent modes. Many patients and therapists find combating the parent voices makes them needlessly critical and punitive themselves. The hierarchy of confrontational interventions enables matching the intervention to the severity of the dysfunctional parent mode. As with real parental coaching, when the parent-child relationship is not that devastating, the hierarchy starts with empathic confrontation.  CONFRONTATIONAL INTERVENTIONS

CHILDREN AND ADOLESCENTS

Schema Therapy with Children and Adolescents an Extract of Mode Work 

Dr Christof Loose 

Child and Adolescent Psychotherapist

Heinrich-Heine-University Dusseldorf

Institute of Experimental Psychology dept. Clinical Psychology

Let‘s imagine, there is a boy named Felix. His parents notice that something is wrong with him. His teacher says that he tends to be aggressive. They decide that he needs some help. They look for a therapist who can help Felix. Then, Felix gets to know Chris. He is a psychologist and therapist for children and adolescents. After Felix‘s parents have asked him to help, he meets up with Felix. Chris encourages Felix to talk about himself and his world.  He is especially interested in all the different sides of Felix that come out at different times. He calls these different sides „parts“ or „modes“. He asks him: Felix, I am really interested in finding out about you, and about all of your different sides, or „modes“ as I call them. Which different sides of yourself have you noticed? Let‘s write that down, okay?“ Felix creates his own mode-sketch. CHILDREN & ADOLESCENTS

EXPERIENTIAL STRATEGIES

Experiential Strategies in Group Schema Therapy 

Dr. Rita Younan

Clinical Psychologist

ISST Advanced Certified Schema Therapy Trainer – Supervisor

The Victoria Clinic, Melbourne Australia

When I was asked to write this paper on “how to do experiential strategies in group” it got me thinking – what is different about implementing Schema Therapy experiential interventions in a group versus individual? This is something I do day to day, (for the last four years in fact) as part of my role as the Program Director of a Group Schema Therapy Program at a private psychiatric hospital in Melbourne, Australia (The Victoria Clinic). Although GST is theoretically consistent with individual ST and most individual interventions can be adapted to use in groups, a group does offer some additional creative opportunities. GST strategically uses the therapeutic factors of the group modality as described by Yalom. We also know from the Farrell, Shaw & Webber (2009) rct and the published pilot done in the Netherlands (Dickhaut & Arntz, 2014) that a group seems to catalyse the therapeutic effects of ST for patients with BPD. For this article, I discussed the issue with Joan Farrell and Ida Shaw, the developers of Group Schema Therapy for Borderline Personality Disorder and the creative minds behind the imaginative ways in delivering emotion focused techniques within the group setting. GROUP EXPERIENTIAL TECHNIQUES

MEMORY RECONSOLIDATION

Memory Reconsolidation: Can we Unlearn Emotional Learning?

Dr Bruce A. Stevens 

Advanced Schema Therapist, Australia

Dr Pierre Cousineau, 

Advanced Schema Therapist, Canada

In over 25 (Bruce) and 40 (Pierre) years of being  therapists, we have sat for countless hours with patients who have struggled with accepted ‘truths’ about themselves, beliefs that have governed their lives, limited their choices and flooded their relationships with ugly emotions. We have agonized with our patients in the slowness of the change process. 

One of the most important questions in therapy is how can the brain unlearn something? Think of one of your patients with early abuse or neglect. Or trauma. Or low self-esteem. Or dysfunctional relational patterns. This is often the focus of therapeutic efforts and it is frustrating how much the brain resists any change, even of early learning which is inherently irrational and completely dysfunctional. And it can last a lifetime driving dysfunctional patterns of behaviour. MEMORY RECONSOLIDATION

IMAGERY RESCRIPTING

Imagery Rescripting: Practical Way to Improve Skills

Chris Hayes 

Senior Clinical Psychologist, Accredited Schema Therapist 

Sexual Assault Resource Centre, Department of Health, Western Australia 

Director - Schema Therapy Training Australia  

“How about we do some imagery work today?” I said to my client, expecting a predictable imagery rescript where I enter the image, stick up and protect the child, and provide the safety that they had long been deprived. My supervisor at the time had been encouraging me to “do more experiential work." It had worked well in other clients and I was up for the challenge. 

“Close your eyes and get an image of you as a child when you felt unsafe”, I said to my client. My client replied, “I’m walking into my house, I’m about 5, and as I walk in there are five big bikers who are drunk sitting in my lounge room…. I’m scared."

Taken by surprise, I go through the imagery process trying my best to look calm and collected, but secretly thinking….“WHAT ON EARTH AM I GOING TO DO WITH FIVE BIKERS?!”. I looked around the room as if I was looking for an invisible guiding colleague to appear! IMAGERY RESCRIPTING

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