General Commentary ARTICLE
Commentary: Short-term group schema therapy for mixed personality disorders: an introduction to the treatment protocol
- 1School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia
- 2G-kracht Psychomedisch, Centrum BV, Delft, Netherlands
by Simpson, S. G., Skewes, S. A., Samson, R., and van Vreeswijk, M. (2014). Front Psychol. 5:1592. doi: 10.3389/fpsyg.2014.01592
The evidence base for schema therapy (ST) has grown rapidly in recent years, as applied to a wide range of clinical groups (Masley et al., 2011); for ST with groups see Farrell et al. (2009), Simpson et al. (2010), Farrell and Shaw (2012), van Vreeswijk et al. (2012), Renner et al. (2013), Videler et al. (2014). Variations exist between group schema therapy protocols utilized across clinical settings and client groups. It is therefore imperative that researchers describe treatment protocols in detail.
A recent pilot study was published on the outpatient treatment of mixed personality disorders (Skewes et al., 2015), which demonstrated low attrition and clinical improvement over 20 weekly 60-min sessions. In addition, up to 5 × 30-min individual sessions are provided through the duration of the group for those who require additional support, especially during crises. This also includes a session provided at mid-therapy in order to provide feedback on progress to date and to focus goals for the second half of therapy. The purpose of this paper is to describe the treatment protocol utilized in this trial.
The group is led by two therapists who alternate the role of taking the lead in session exercises, with the other focused on maintaining connection between participants, mainly through the use of eye-contact and non-verbal gestures. Therapist couples are able to model connection and confrontation through the way in which they communicate with each other and with group members. Therapists must balance the need to be “genuine” and consistent with their own individual therapeutic “style,” with the need to collaborate as a cohesive “parent couple,” guiding the group according to schema therapy “limited reparenting” principles.
The schema model is applied in a flexible manner that requires group leaders to respond to modes as they appear on a moment-to-moment basis. Whereas participants with BPD often experience frequent mode “flipping,” those with cluster C personality disorders, tend to be overly fused to an avoidant or overcompensatory coping mode (e.g., “Detached Protector”; “Perfectionistic Overcontroller”). Therapists are required to respond to the needs of clients flexibly, and to be guided by sophisticated case conceptualizations that facilitate recognition of the range of modes present in a mixed personality disordered group. In order to ensure treatment fidelity and to check that all four aspects of the schema model (cognitive, behavioral, experiential, and limited reparenting) are covered adequately, sessions are monitored regularly by an accredited group trainer using the Group Schema Therapy Competency Rating Scale (Zarbock et al., 2014). A condition of participation in the group is that contact with external mental health professionals is limited to medical or psychiatric monitoring only.
Mode “check-in points” are used at regular intervals during sessions, which involves a 5 minute mindfulness exercise to facilitate moment-to-moment awareness of modes and associated feeling-states (van Vreeswijk et al., 2014).
This protocol forms the basis for ongoing research into short-term treatment of mixed personality disorder population.
This project was funded by the University of South Australia.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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van Vreeswijk, M. F., Spinhoven, P., Eurelings-Bontekoe, E. H. M., and Broersen, J. (2012). Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short term schema cognitive-behavioural group therapy: a naturalistic pre-post treatment design in an outpatient clinic. Clin. Psychol. Psychother. 21, 29–38. doi: 10.1002/cpp.1813
Videler, A. C., Rossi, G., Schoevaars, M., van der Feltz-Cornelis, C. M., and van Alphen, S. P. J. (2014). Effects of schema group therapy in older outpatients: a proof of concept study. Int. Psychogeriatr. 26, 1709–1717. doi: 10.1017/S1041610214001264
Zarbock, G., Farrell, J. M., Schikowski, A., Heimann, A., Shaw, I., and Reiss, N. (2014). Group Schema Therapy Rating Scale – Revised (GSTRS-R). Avaliable online at: http://www.schematherapysociety.org/Resources/Documents/GSTRS-R-fin-2014-07-07.pdf
Keywords: Schema therapy, personality disorder, treatment protocol, pilot study, group therapy
Citation: Simpson SG, Skewes SA, van Vreeswijk M and Samson R (2015) Commentary: Short-term group schema therapy for mixed personality disorders: an introduction to the treatment protocol. Front. Psychol. 6:609. doi: 10.3389/fpsyg.2015.00609
Received: 06 February 2015; Accepted: 23 April 2015;
Published: 08 May 2015.
Edited by:Elena Faccio, University of Padua, Italy
Reviewed by:Chiara DiFrancesco, Healing International, Inc., USA
Neele Reiss, Goethe University Frankfurt, Germany
Copyright © 2015 Simpson, Skewes, van Vreeswijk and Samson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Susan G. Simpson, firstname.lastname@example.org