Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

Klerk, Noor de; Abma, Tineke; Bamelis, Lotte; Arntz, Arnoud

doi:10.1017/s1352465816000357

Cited by 25 publications

(29 citation statements)

References 32 publications

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“…The treatments specified in the studies were delivered in an individual or group format, or a combination of both; these included DBT, MBT, art therapy, peer support group, and standard community mental health services [ 22 ]. However there has only been one qualitative paper on the experiences of participants receiving ST for treatment of a personality disorder [ 24 ]. In that study participants described helpful aspects of the treatment as the therapy relationship, specific schema techniques, and self-understanding facilitated by the schema model.…”

Section: Introductionmentioning

confidence: 99%

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Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions

et al. 2018

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Schema therapy (ST) has been found to be effective in the treatment of borderline personality disorder (BPD). However very little is known about how the therapy is experienced by individuals with BPD including which specific elements of ST are helpful or unhelpful from their perspectives. The aim of this study is to explore BPD patients’ experiences of receiving ST, in intensive group or combined group-individual format. Qualitative data were collected through semi-structured interviews with 36 individuals with a primary diagnosis of BPD (78% females) who received ST for at least 12 months. Participants were recruited as part of an international, multicenter randomized controlled trial (RCT). Interview data (11 Australian, 12 Dutch, 13 German) were analyzed following the procedures of qualitative content analysis. Patients’ perceptions of the benefits gained in ST included improved self-understanding, and better awareness and management of their own emotional processes. While some aspects of ST, such as experiential techniques were perceived as emotionally confronting, patient narratives informed that this was necessary. Some recommendations for improved implementation of ST include the necessary adjunct of individual sessions to group ST and early discussion of therapy termination. Implications of the findings are also discussed, in particular the avenues for assessing the suitability of patients for group ST; management of group conflict and the optimal format for delivering treatment in the intensive group versus combined group-individual formats.

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Section: Introductionmentioning

confidence: 99%

“…Unhelpful aspects reported included perceived lack of preparation for strong negative emotions generated in the therapy and insufficient number of sessions. Whilst these patients all met criteria for a personality disorder, none of them had BPD [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions

et al. 2018

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“…We used their 75th percentile as a cut-point for the global Eating Disorder Examination Questionnaire (EDE-Q 6.0) (Fairburn and Beglin, 2008 ) score, indicating “probable eating disorder case.” However, we extended their criteria to additionally include participants who reached the 75th percentile on any of the 4 EDE-Q subscales. Specifically, to be included in the final data set, participants were required to meet at least one of the 2 inclusion criteria: (Young et al, 2003 ) a global EDE-Q score of 2.3 or higher, in conjunction with repeated bingeing episodes and/or use of exercise or other compensatory behavior over the past 4 weeks (Mond et al, 2004 , 2006 ); and/or (de Klerk et al, 2016 ) a mean score at or above the 75 percentile on at least one of the EDE-Q subscales—Restraint: 2.2; Eating Concern: 1; Weight Concern: 2.8; Shape Concern: 3.5.…”

Section: Methodsmentioning

confidence: 99%

“…Schema Therapy (ST) was developed to address long-standing psychological disorders and entrenched personality traits (Young et al, 2003 ), and a growing number of studies have demonstrated its effectiveness (Masley et al, 2012 ; Jacob and Arntz, 2013 ; de Klerk et al, 2016 ). ST is based on the notion that Early Maladaptive Schemas (EMS) develop as a result of the interaction between temperament and unmet core emotional needs during childhood.…”

Section: Introductionmentioning

confidence: 99%

Factorial Structure and Preliminary Validation of the Schema Mode Inventory for Eating Disorders (SMI-ED)

et al. 2018

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Objective: The aim of this study was to examine the psychometric properties and factorial structure of the Schema Mode Inventory for Eating Disorders (SMI-ED) in a disordered eating population.Method: 573 participants with disordered eating patterns as measured by the Eating Disorder Examination Questionnaire (EDE-Q) completed the 190-item adapted version of the Schema Mode Inventory (SMI). The new SMI-ED was developed by clinicians/researchers specializing in the treatment of eating disorders, through combining items from the original SMI with a set of additional questions specifically representative of the eating disorder population. Psychometric testing included Confirmatory Factor Analysis (CFA) and internal consistency (Cronbach's α). Multivariate Analyses of Covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED modes, while controlling for possible confounding variables.Results: Factorial analysis confirmed an acceptable 16-related-factors solution for the SMI-ED, thus providing preliminary evidence for the adequate validity of the new measure based on internal structure. Concurrent validity was also established through moderate to high correlations on the modes most relevant to eating disorders with EDE-Q subscales. This study represents the first step in creating a psychometrically sound instrument for measuring schema modes in eating disorders, and provides greater insight into the relevant schema modes within this population.Conclusion: This research represents an important preliminary step toward understanding and labeling the schema mode model for this clinical group. Findings from the psychometric evaluation of SMI-ED suggest that this is a useful tool which may further assist in the measurement and conceptualization of schema modes in this population.

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“…Studies on other patient populations, such as forensic patients, patients with cluster C PD and patients with cluster B PD, also confirmed the efficacy of ST on these patient populations (Bernstein et al 2007). Other studies are shifting their focus to how ST can be used to treat depression (Renner et al 2017), on what makes it such an efficient multidiagnosis therapeutic model (Lemmens et al 2016), and on exploring different perspectives of ST from the patient and the therapist's point of view (de Klerk et al 2017).…”

Section: Introductionmentioning

confidence: 99%

A Contribution to Validation of the Short Schema Mode Inventory in an Italian Clinical Versus Non-clinical Population

Panzeri

Fontanesi

Busà

et al. 2018

J Rat-Emo Cognitive-Behav Ther

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Schema therapy (ST) has been proven to be an effective psychotherapy model in the treatment of complex personality disorders. ST helps analyze causes of emotional, cognitive, and behavioral alteration in patients using schemas and modes (i.e., sets of emotional states, coping responses and schemas active in a given moment). ST finds its empirical validation in the short Schema Mode Inventory (SMI), a practical tool consisting of 14 subscales assessing 14 different mode categories, grouped in 4 (child, coping, parent and adult modes) high-order categories used to assess different modes at different times. We introduced the Italian validation of the short SMI to a sample of 707 participants, of whom 230 were psychiatric patients. Confirmatory factor analysis (CFA) provides evidence that the 14-dimensional model best describes the SMI's structure at a lower level. Higher-order CFA provides evidence for both four higher-level mode categories and one higher-level mode category, the four-mode category being the best approach. Internal reliability, test-retest stability and the relationship between the SMI's subscales have been evaluated with promising results. Clinical vs nonclinical subjects were compared with a multigroup CFA in order to test invariance and with a MANOVA and Bonferroni post hoc comparisons in order to test mean differences. A linear thread was found for all modes except Bully/Attack. While contributing to international research and to the diffusion of SMI and schema therapy, our results also suggest that SMI is a powerful tool for the assessment of modes in ST, both in therapeutic and diagnostic contexts.

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Schema Therapy for Personality Disorders: a Qualitative Study of Patients’ and Therapists’ Perspectives

Abstract: Patients and therapists found some aspects of the schema therapy protocol helpful. Their views about which aspects are unhelpful and their recommendations need to be taken into consideration when adjusting the protocol and implementing schema therapy.

Cited by 25 publications

References 32 publications

Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions

Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions

Factorial Structure and Preliminary Validation of the Schema Mode Inventory for Eating Disorders (SMI-ED)

A Contribution to Validation of the Short Schema Mode Inventory in an Italian Clinical Versus Non-clinical Population

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