Treating Aggressive, Impulsive, and Anti-Social Patterns. Schema Therapy with Forensic Population

Transcription

1 Treating Aggressive, Impulsive, and Anti-Social Patterns Schema Therapy with Forensic Population December 2014 SAVE THE DATE David P. Bernstein, Ph.D. Professor of Forensic Psychotherapy, Maastricht University, The Netherlands

2 On Personality Disorders and Schema Therapy Schema Therapy (Young, 1990, 2003) is an integrative form of therapy that combines cognitive, behavioral, psychodynamic object relations, and humanistic/experiential approaches. Schema Therapy was developed to treat patients with personality disorders. According to the DSM-V, personality disorder is defined as:... Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Personality Disorders...The Essential features of a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture and is manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control.... Since PD is characterized by ego-syntonic and inflexible traits, most of the patients may seems un-cooperative or leave the therapy early. Part of the patients will even been involved in criminal activities and/or substance use disorder (SUD). According to research, about up to 70% of people suffering from SUD will suffer from al least one PD. The behaviors will be characterized by: verbal/physical violence, aggression, impulsivity, self-harm and manipulation. There is good evidence for the effectiveness of Schema Therapy for Borderline Personality Disorder (Giesen-Bloo et al., 2006; Farrell et al., 2009; Nadort et al., 2009) and Cluster C Personality Disorders (Bamelis et al., 2014). Schema Therapy and Forensic Population Bernstein and colleagues (2007) have adapted Schema Therapy for patients with aggressive and antisocial problems, including psychopathic patients who are often viewed as untreatable. They are now engaged in a randomized clinical trial at 7 forensic hospitals ( TBS clinics ) in The Netherlands to test the effectiveness of this approach. The preliminary findings of this study show evidence of effectiveness, including for some psychopathic patients (Bernstein et al, 2012). On the basis of these findings, the Netherlands Erkenningscommissie ( Recognition Commission ) has recently certified Schema Therapy as an evidencebased treatment for forensic patients with personality disorders, the only treatment so far to have earned this distinction. Workshop Presenter: David P. Bernstein, Ph.D. is Professor of Forensic Psychotherapy (endowed chair) at Maastricht University and Forensic Psychiatric Center de Rooyse Wissel. He received his doctoral degree from New York University in He joined the faculty of Maastricht University in 2004, where he now serves as Chair of the Forensic Psychology Section in the Faculty of Psychology and Neuroscience. He is a former Vice- President of the International Society for Schema Therapy, and is a past President of the Association for Research on Personality Disorders. His research spans a wide range of areas, including forensic psychology, psychotherapy, personality disorders, childhood trauma, and addictions. He is an internationally known expert on Schema Therapy, an integrative psychotherapy for personality disorders. He is the author or co-author of more than 100 publications, including Schema Therapy: Distinctive Features (Rutledge Press) and Schema Therapy: Working with Modes (DVD series; His current research focuses on developing, testing, and implementing innovative forms of therapy for forensic patients with personality disorders. He gives many national and international workshops on Schema Therapy for therapists working with forensic and addicted patients.

3 Workshop s Goals In this workshop, participants will learn the basics of the Schema Therapy approach as applied to a complex and challenging group of patients: those with personality disorders, impulsivity, anger, aggression, and antisocial and addictive behavior. In this workshop, participants will be introduced to the central concept of schema modes, emotional states or parts of the self that temporarily dominate a person s thoughts, feelings, and behavior. It is these moment-tomoment fluctuations that make individuals with personality disorders so challenging to work with. Schema Therapy describes these emotional states using simple, non-judgmental language that is easy for patients and staff to understand. Our experience in forensic settings for adults and youth shows that patients and staff can readily learn to use the mode language. This shared language takes conflict situations and turns them into learning opportunities, where people with personality disorders can look at their maladaptive behavior in a more objective and constructive way. Using lecture material, videos, live demonstrations, and exercises, participants will learn how to recognize schema modes, and to use this concept to understand, and more effectively respond to, the challenging behavior of these complex patients. Goals for Day 1 of the workshop: - Learn the Schema Therapy theoretical model as it is applied to forensic patients, with special emphasis on schema modes. - Learn to recognize modes and understand how they contribute to stuck points in therapy. - Use Schema Therapy and mindfulness to get in touch with modes that are triggered in you by the modes of the patient, and how to work with your own emotional reactions. - Learn how to make a case conceptualization and treatment plan based on schema modes. Goals of Day 2 of the workshop: - Learn how to motivate and engage patients, using schema mode work. - Learn how to work with patients emotional detachment. - Learn how to use imagery rescripting to help patients reprocess painful experiences, such as childhood trauma. - Learn how to work with anger and aggression. Who Should Attend Therapists such as psychiatrists, psychologists, social workers, criminologists, and psychotherapists who are in contact with patients manifesting aggressive, manipulative, impulsive and violent behavior. Preparation Participants should be prepared to play the role of a patient with anger, impulsivity, or aggression problems during the role play exercises. Ideally, the patient should be one with whom the therapist is working currently, or in the recent past, or remembers quite well. Participants do not need to write up the case. However, they should familiarize themselves with the main biographical details, and the central themes or issues of the case, and be ready to briefly summarize the case (in 5 minutes). Format Demonstrations will be in English. However, participants should feel free to do the exercises in their own language. Participants will do the exercises in pairs, with one participant playing the therapist and the other the patient, and then switching roles. The trainer will circulate among the pairs to observe and give feedback.

4 14 December :00-09:30 - Gathering and coffee 09:30-10:00 - Opening speeches Dr. Boaz Lev - Associate Director General, the Ministry of Health Dr. Yehuda Baruch - Hospital Director, the Abarbanel Mental Health Center Prof. Eshkol Rafaeli - Director of Adult Clinical Training Program, Department of Psychology, Bar Ilan University; the Israeli Institute of Schema Therapy Mrs Miri Froimovich - Head of Clinical Criminologists, the Abarbanel Mental Health Center 10:00-11:00 - Introduction to Schema Therapy for impulsive, aggressive, and antisocial patients 11:00-11:15 - Break 11:15-12:15 Early maladaptive schemas, coping responses, and schema modes 12:15-13:00 Recognizing schema modes. Exercise #1: Which mode is it? Rating schema modes with the Mode Observation Scale (MOS) 13:00-14:00 Lunch 14:00-15:00 Exercise #2: Therapists reactions to patients modes: A mindfulness approach 15:00-15:30 Schema mode stand-offs 15:30-16:00 - Break 16:00-17:00 Demonstration: Making a schema mode case conceptualization and treatment plan 17:00-17:30 Schema mode models 17:30 18:00 Wrap up: Day 1 15 December :00 10:00 Motivating and engaging impulsive, aggressive, and antisocial patients; general approach to schema mode work 10:00 10:15 Break 10:15 11:30 Demonstration and Exercise #1 Schema mode dialogue with the Detached Protector mode 11:30 11:45 Break 11:45 13:00 Demonstration and Exercise #2 Protecting and reparenting the Vulnerable Child in imagery 13:00 14:00 Lunch 14:00 15:15 - Demonstration and Exercise #3: Working with the Angry Child mode 15:15 15:45 - Break 15:45 16:45 Demonstration and Exercise #4: Limit setting with Bully and Attack mode 16:45 17:00 Wrap-up: Day 2

5 Registration Until the 06/11/14 Until the 07/12/14 After the 07/12/14 First Day 500 NIS 550NIS 600 NIS First & Second Day 850 NIS 1,000 NIS 1,200 NIS Notes: Due to the experiential nature of the workshop' second day: 1/ the number of the workshop s places is limited; 2/ attendance to the workshop second day will be possible only to the participants who will attend to the workshop s first day. The prices include, coffee breaks, and lunches. A personal certificate from the International Society of Schema Therapy (ISST) confirming your attendance at the two days workshop. Cancellation until the 06/11/14 will be charged 50 NIS only. After that date, cancellation will be charged up to 50% the amount of the reservation made. Place The workshop will take place at the Bar Ilan University on the 14 and 15 of December 2014, in the Gonda s conference room on the ground floor of the Leslie & Susan Gonda (Goldschmied) Brain Research Center (building #901). The entry to the University is through Gate #5. For Registration, please contact, Eychut Beshikum to: Tel: Mail: office@eychut.org.il

6 Requirements: No previous Schema Therapy experience is necessary. Readings: Bernstein, D., Arntz, A., & de Vos, M. (2007). Schema Focused Therapy in forensic settings: theoretical model and recommendations for best clinical practice. International Journal of Forensic Mental Health, 6, Bernstein, D.P., Keulen-de Vos, M., Jonkers, P., de Jonge, E., & Arntz, A. (2013). Schema Therapy in forensic settings. In van Vreeswijk, M. Broersen, J. & Nadort, M. (Eds.), Handbook of Schema Therapy. Routledge. Also recommended: Bernstein, D. (2014). Safe Path: An integrated, team-based approach for aggression, addiction, and antisocial behavior. Unpublished Document. Bernstein, D.P., Nijman, H., Karos, K., Keulen-de Vos, M., de Vogel, V., & Lucker, T. (2012). Schema Therapy for forensic patients with personality disorders: Design and preliminary findings of multicenter randomized clinical trial in the Netherlands. International Journal of Forensic Mental Health, 11, Chakhssi, F., Kersten, G., de Ruiter, C., & Bernstein, D.P. (2014, March 31). Treating the untreatable: A single case study of a psychopathic patient treated with Schema Therapy. Psychotherapy. Advance online publication. Keulen-de Vos, M., Bernstein, D.P., Vanstipelen, S., de Vogel, V., Lucker, T., Slaats, M., Hartkoorn, M., & Arntz, A. (2014). Schema modes in the criminal and violent behavior of forensic cluster B personality disorder patients: A retrospective and prospective study. Legal and Criminological Psychology, DOI: /lcrp Rafaeli, E., Bernstein, D.P., & Young, J. (2011). Schema Therapy: Distinctive Features. London & New York: Routledge. van der Wijngaart, R., & Bernstein, D. (2011). Schema Therapy: Working with modes, 2nd Edition. 5 DVD boxed series. Handouts: Mode Observation Scale (MOS) scoring form