Оглавление
Hannie van Genderen. Schema Therapy for Borderline Personality Disorder
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Schema Therapy for Borderline Personality Disorder
About the Authors
Preface
Acknowledgments
Introduction
1 Borderline Personality Disorder. What Is Borderline Personality Disorder?
Prevalence and Comorbidity
Development of BPD
2 Schema Therapy for Borderline Personality Disorder. The Development of Schema Therapy for Borderline Personality Disorder
Research Results
(Contra‐) Indications
Rationale of Treatment/Theories Supporting Treatment
Schema Modes
The detached protector
Sample dialogue with a patient in the protector mode
Sample dialogue with patient in the angry protector, the bully and attack mode, the self‐aggrandizer, and the punitive parent mode (See ST step by step 5.11, 5.12, 5.13, 5.14, and 5.20)
How to recognize a detached protector mode during a session
The abandoned/abused child
How to recognize the abandoned/abused child during a session
The angry/impulsive child
How to recognize the angry/impulsive child during a session
The punitive parent
Sample dialogue with a patient in the punitive parent mode
How to recognize the punitive parent during a session
The healthy adult
How to recognize the healthy adult during a session
The happy child
How to recognize the happy child during a session?
Summary
3 Treatment
Structure of Treatment
Sample of listening to a recorded session
Phases in Treatment
Preliminary: treating comorbid disorders
Starting phase and case conceptualization
Information about Nora
Diagnostic interview
Downward arrow technique
Questionnaires
Information from the therapeutic relationship
Experiential techniques
Case conceptualization
Explaining the treatment rationale
Crisis management
Treatment phase: therapeutic interventions with schema modes
Structure of sessions during active treatment
Final phase of therapy
Changing behavioral patterns
Ending therapy
Frequently Asked Questions About Treatment
4 The Therapeutic Relationship
Limited Reparenting
Good care
Giving direction
Empathic confrontation
Sample dialogue: empathic confrontation
Setting limits
Sample dialogue: setting limits
Role playing and role reversal
Imagery rescripting
Therapists' Schemas
Self‐Disclosure
Example:
Cognitive Techniques and the Therapeutic Relationship
Behavioral Techniques and the Therapeutic Relationship
Example of behavioral techniques and the therapeutic relationship
Example of behavioral experimentation in the therapeutic relationship
Summary
5 Experiential Techniques
Imagery
Applications and aims of imagery
Rationale of Imagery Rescripting
Imagery of a safe place
Using imagery in search for the roots of modes
Instruction imagery for the case conceptualization
Sample dialogue of searching for the roots of modes
Imagery Rescripting
Basic model for imagery rescripting during the first part of the therapy
Phase 1: Imagining the original situation
Example of phase 1 imagery
Phase 2: Rescripting by the therapist
Example of phase 2: the therapist appears in imagery
Example of phase 2: the therapist appears in imagery and intervenes (continued)
Example of phase 2: the therapist helps and comforts during imagery
Example of phase 2: the therapist takes the patient to a safe place during imagery
Imagery Rescripting in the Final Phase of Treatment
Phase 2: Rescripting by the patient as a healthy adult
Sample of imagery with Big Nora as a healthy adult rescripting
Variations with a patient only partially capable of being in the healthy adult mode
Phase 3: Rescripting experienced by the child
Example of imagery rescripting, phase 3: The little child is asked if she has further needs
Imagery Rescripting: Changing Behavior Patterns in the Future
Imagery rescripting: changing behavior patterns in the future if the detached protector is interfering
Imagery rescripting: changing behavior patterns in the future if the vulnerable child is becoming too overwhelming
Frequently Asked Questions About Imagery Rescripting
Role Play
Historical role play
Phase 1: The original situation
Sample of historical role play phase 1: enacting the situation
Phase 2: Role switching
Sample of historical role play phase 2: role switching
Sample of discussing phase 2
Sample of reflection phase 2: personal share
Phase 3a: Rescripting when the interpretation about the other person changes
Sample of historical role play phase 3a: trying out new behaviors
Example of a historical role play
Phase 3b: Rescripting when the interpretation about the other person doesn't change
Frequently Asked Questions About Historical Role Play
Role play of a current situation
Sample of role play of a present situation
Two‐or‐More‐Chair Technique
Two‐chair technique for the punitive parent
Example of two‐chair technique with the punitive parent
Empty chair technique for the demanding parent mode
Frequently Asked Questions About the Two‐chair Technique With the Punitive or Demanding Parent
The two‐chair technique with the detached protector
Example of the two‐chair technique with the protector
Frequently Asked Questions About Using the Two‐chair Technique With the Detached Protector
Multiple‐chair technique
Two‐or‐more‐chair technique in the final phase of therapy
Experiencing and Expressing Emotions
Dealing with anger
Example of dealing with anger
Dealing with frustration
Experiencing and Expressing Other Emotions
Example of concentrating on physical symptoms in order to acknowledge feelings and naming them
Experiential techniques for the happy child
Letter writing
Frequently Asked Questions About Experiential Techniques in General
Conclusion
6 Cognitive Techniques
The Socratic Dialogue
Evaluation on a Visual Analogue Scale
Multidimensional Evaluation
Two‐Dimensional Reproductions of Supposed Connections
Pie Chart
Courthouse Method
Historical Testing
Self Monitoring Circle
Flashcards
Positive Logbook
Frequently Asked Questions About Cognitive Techniques
7 Behavioral Techniques
Experiments
Skills Training and Role Play
Problem Solving
Discussing Dangerous Behaviors
Discussing New Behaviors
Frequently Asked Questions About Behavioral Techniques
8 Specific Methods and Techniques. Homework
Pharmacological Therapy
Crisis
Example of handling a crisis
Suicide and Self‐Injury
Self‐injury and other self‐destructive behaviors
Suicide
Trauma Processing
Frequently Asked Questions About Processing Traumas
9 Methods per Mode
Treatment Methods for the Detached Protector
Therapeutic relationship
Feeling
Thinking
Doing
Pharmacotherapy
Frequently Asked Questions About the Detached Protector
Treatment Methods for the Abandoned/Abused Child. Therapeutic relationship
Feeling
Thinking
Doing
Box 9.1 Imagining comforting your abandoned/abused child mode
Frequently Asked Questions About the Abandoned/Abused Child
Treatment Methods for the Happy Child. Therapeutic relationship
Feeling
Thinking
Doing
Frequently Asked Questions About the Happy Child
Treatment Methods for the Angry Child. Therapeutic relationship
Feeling
Thinking
Doing
Pharmacotherapy
Frequently Asked Questions About the Angry Child Mode
Treatment Methods for the Undisciplined/Impulsive Child
Therapeutic relationship
Feeling
Thinking
Doing
Frequently Asked Questions the Undisciplined/Impulsive Child
Treatment Methods for the Punitive Parent. Therapeutic relationship
Feeling
Thinking
Doing
Frequently Asked Questions About the Punitive Parent
Treatment Methods for the Healthy Adult. Therapeutic relationship
Example of talking with the healthy adult when the patient wants to stop therapy
Feeling
Thinking
Doing
Frequently Asked Questions About the Healthy Adult
A Simultaneous Chess Play in a Pinball Machine
Example of reactions to quickly changing modes
Example of dealing with different modes during one single intervention
10 Schema Therapy in Other Settings and Modalities. Schema Therapy in Day‐Treatment and Inpatient Settings
Schema Therapy and Nonverbal Therapies
Group Schema Therapy
The advantages of group schema therapy
Tasks and roles of the therapists
Therapy phases
Differences between working in a group and individual therapy
Group rules
Working with the happy child mode
Use of techniques derived from nonverbal therapies
Creative therapy with all modes
Detached protector
Abandoned/abused child
Angry/impulsive child
Punitive parent
Healthy adult
Developing identity
Adjusting schema therapy techniques for use in a group setting
Imagery rescripting
Role play
Two‐or‐more‐chair technique
Cognitive and behavioral techniques
Difficulties with GST
Summary
Schema Therapy for Couples
Indication for Schema therapy with couples where one partner has BPD
The advantages of couples therapy
The therapeutic relationship
Case conceptualization
Adjusting schema therapy techniques for couples therapy
Imagery rescripting
Role play
Two‐or‐more‐chair technique
Cognitive and behavioral techniques
Difficulties with ST with couples
Summary
11 Final Phase of Therapy. Behavioral Pattern‐Breaking
Ending Therapy
12 Conclusion
Appendix A Brochure for Patients: Schema Therapy for People with Borderline Personality Disorder. What Is Borderline Personality Disorder?
What Is Schema Therapy?
Description of BPD from the Perspective of Schema Therapy
The abandoned and abused child
The angry and impulsive child
The happy child
The punitive side
The detached protector
The healthy adult
Goal of Schema Therapy
What does the therapy consist of?
Relationship with the therapist
Experiential techniques
Cognitive techniques
Behavioral techniques
What you can expect?
Appendix B Cognitive Diary for Modes
Appendix C Positive Logbook
Appendix D Historical Testing
Appendix E Experiments
Appendix F Homework Form
Appendix G Problem Solving
Appendix H Changing Behavioral Patterns
Appendix I Eighteen Schemas
Disconnection and Rejection
Abandonment/instability
Mistrust/abuse
Emotional deprivation
Defectiveness/shame
Social isolation/alienation
Impaired Autonomy and Performance
Dependence/incompetence
Vulnerability to harm or illness
Enmeshment/undeveloped self
Failure
Impaired Limits
Entitlement/grandiosity
Insufficient self‐control/self‐discipline
Other‐Directedness
Subjugation
Self‐sacrifice
Approval‐seeking/recognition‐seeking
Overvigilance and Inhibition
Negativity/pessimism
Emotional inhibition
Unrelenting standards/hypercriticalness
Punitiveness
Appendix J Coping Strategies
Surrender (Schema‐Affirming Behavior: Freeze)
Avoidance (Schema‐Evasive Behavior: Flight)
Overcompensation (Showing the Opposite Behavior in Order to Fight the Schema: Fight)
Appendix K Form for the Historical Role Play
References
Index
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