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Arntz & Jacob's new book "Schema therapy in practice": some introductory comments

Arnoud Arntz & Gitta Jacob's new book "Schema therapy in practice: an introductory guide to the schema mode approach" was published last month.  The book's back cover states "Schema Therapy in Practice presents a comprehensive introduction to schema therapy for nonspecialist practitioners wishing to incorporate it into their practice. The authors - world leaders in the field - reveal how the goals of schema therapy are to heal self-defeating schemas, to help patients stop using maladaptive coping styles, and, instead, to have patients' emotional needs met in everyday life.  Within this broad framework, they show how schema modes are the moment-to-moment emotional states and coping responses that we all experience, how they are triggered by life situations that we are oversensitive to, and how they lead us to overreact in damaging ways.  While schema therapy was originally developed for clients with borderline personality disorder, this book takes a much broader approach and shows how it can be applied across different personality disorders, as well as to chronic axis-I disorders.  Featuring clear, straightforward language and numerous case examples and treatment guidelines, Schema Therapy in Practice is an invaluable resource for clinicians and therapists at all levels who wish to acquire practical knowledge of the latest schema-therapy techniques."

And in their introduction, the authors write "Schema therapy is increasingly attracting the attention of therapists and consumers.  This is partly based on the good effects reported by various studies, and partly on its appealing basis in the idea that children require fundamental needs to be met in order to develop psychologically in a healthy way.  The integration of insights, methods, and techniques derived from a range of schools, including attachment theory, cognitive behavior therapy, and experiential therapies into a comprehensive model formulated in terms of the most prominent current psychological paradigm, the cognitive model, also plays a role."  Certainly it's true for me that my attention was attracted to schema therapy "partly based on the good effects reported by various studies" and far and away the most important was the 2006 paper "Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy".  Other work by Arntz & his colleagues followed - "Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy", "Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial" & "An empirical test of schema mode conceptualizations in personality disorders".  Research teams from other centres were also exploring this territory.  Most startling were the results reported by Farrell & colleagues using a group format - "A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial"

Schema therapy was originally developed by Jeff Young predominantly for clients who did not respond well to "classical" CBT treatment.  I had never taken it seriously because there just didn't seem to be decent research showing it actually added value to the results obtainable with more standard approaches.  Then with the work from Arntz and Farrell, this picture was changing.  I went to four days of workshops with Arnoud Arntz & Marjon Nadort in 2007 and then to two days with Jeff Young.  I bought and went through various books too - Young et al's "Schema therapy: a practitioner's guide", Arntz & van Genderen's "Schema therapy for borderline personality disorder" and Farrell & Shaw's "Group schema therapy for borderline personality disorder: a step-by-step treatment manual with patient workbook". This year's publication "The Wiley-Blackwell handbook of schema therapy: theory, research & practice" is a bit dauntingly priced, but Amazon's "click to look inside" option allows one to get a good broad grasp of many of the issues currently exercising schema therapy clinicians, researchers & developers.  I realised that I was adapting and using techniques from Arntz's schema approach for borderline sufferers for a much broader range of clients with chronic psychological difficulties.  I awaited last month's publication of "Schema therapy in practice: an introductory guide to the schema mode approach" with a good deal of anticipation and I concur with & celebrate the authors comments (p.5):

"Compared to CBT, schema therapy has a more intensive focus on the following three issues: 1.) Problematic emotions, which are in the foreground, alongside the cognitive and behavioral aspects of the patient's problems and symptoms.  Schema therapy makes intensive use of experiential or emotion-focused interventions - ones that have previously been developed and used in gestalt therapy or psychodrama.  The main experiential intervention techniques consist of chair dialogues or imagery exercises ... 2.) Childhood issues, which are of much greater importance than in standard CBT ... Biographical information is mainly used to validate patients by enabling them to understand the childhood origin of their problematic behavioral patterns ... 3.) The therapeutic relationship, which plays a very important role in schema therapy ... the ... relationship is conceptualized as 'limited reparenting', which means the therapist takes on the role of a parent and displays warmth and caring behavior towards the patient - within the limits of the therapeutic relationship ... Particularly for patients with personality disorders, the therapeutic relationship is regarded as the place in which patient is allowed to and dares to open up and show painful feelings, try out new social behaviors, and change interpersonal patterns for the first time."  

In tomorrow's post, I write about "Arntz & Jacob's new book "Schema therapy in practice": links with attachment theory and with therapies for self-compassion?".

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