Schema Therapy in Forensic Settings

Bernstein, David P.; Clercx, Maartje; Vos, Marije Keulen-de

doi:10.1002/9781119139980.ch41

Cited by 12 publications

(10 citation statements)

References 39 publications

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“…Until recently, there has been widespread therapeutic nihilism towards anti‐social presentations. Many clinicians report that anti‐social patients' poor attendance, co‐morbid substance use and persistent boundary violations leads to staff feeling overwhelmed, often resulting in poor therapeutic outcomes (Bernstein et al, 2019; O'Brien et al, 2009) and staff feeling demoralised (Warner & Keenan, 2021). Taking this professional nihilism into account, I considered the recent developments in Mentalisation Based Therapy (MBT), which has offered hope for treating ASPD.…”

Section: Understanding Larrymentioning

confidence: 99%

Denigration or Decline: Reflections on Offering Staff Consultation Focussing on End‐of‐Life Care In a Homeless Hostel

Day

2023

Brit J Psychotherapy

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People experiencing homelessness are subject to entrenched health inequalities and obstacles to accessing care. Numerous studies have highlighted that structural and organisational obstacles result in people experiencing homelessness living with unmet healthcare needs. Over time, this is associated with a reduced life expectancy compared with the national average in the UK. Although combating health inequalities has become a mandate for many healthcare providers, attempts to improve parity and access for people experiencing homelessness has stalled. This article utilises a case study method to highlight instances of psycho‐social exclusion that homeless patients can be subject to and examples where healthcare staff can collude in this exclusion. The article concludes with highlighting the benefits of psychologically informed staff consultation, which creates reflective spaces to gain a better understanding of people experiencing multiple disadvantage and exclusion. In addition, staff consultation allows space to process feelings that are stoked in professionals who struggle to comprehend why it is difficult for some people to accept offers of care.

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Section: Understanding Larrymentioning

confidence: 99%

Denigration or Decline: Reflections on Offering Staff Consultation Focussing on End‐of‐Life Care In a Homeless Hostel

Day

2023

Brit J Psychotherapy

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“…They help achieve intellectual distance from one's own schemas and emotional difficulties, but are usually insufficient because patients remain highly susceptible to emotional distress [17]. The schema therapist uses experiential techniques to enable the patient to emotionally process the maladaptive schemas -abandonment, emotional deprivation, distrust, shame -which, when triggered, can lead to criminal behaviour [17]. A typical example is chair work and a dialogue between the Vulnerable child and Demanding parent modes.…”

Section: Work Techniques and Therapeutic Stylementioning

confidence: 99%

“…the need for warmth, protection, attention). Such therapeutic interventions reduce the activation of schemas on a daily basis (schema healing) [17].…”

Section: Work Techniques and Therapeutic Stylementioning

confidence: 99%

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Schema Therapy in the treatment of detention patients with antisocial personality structure. Effectiveness and management methods.

Oleśniewicz¹

2022

Psychoter

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Autorka przedstawia modyfikację terapii poznawczo-behawioralnej, jaką jest tzw. terapia schematów, opracowana w latach 90. XX w., i jej zastosowanie w leczeniu antyspołecznego zaburzenia osobowości w środowisku kryminalnym. Celem terapii schematów przeznaczonej dla pacjentów detencyjnych ze strukturą osobowości antyspołecznej jest zredukowanie wczesnych nieprzystosowawczych schematów, które odpowiadają za psychologiczne czynniki ryzyka przestępczości i przemocy, oraz zbudowanie zdrowszych strategii radzenia sobie i poszerzanie czynników ochronnych. Skuteczność terapii schematów została częściowo potwierdzona empirycznie. W artykule krótko opisano cechy charakterystyczne pacjentów z antyspołecznym zaburzeniem osobowości. Przedstawiono możliwe interwencje terapeutyczne i korekcyjne, które mogą ograniczyć społeczne szkody kryminalne w omawianej grupie pacjentów. Podkreślono podstawowe założenia terapii schematów, jakimi są ograniczone korektywne rodzicielstwo i empatyczna konfrontacja. Opisano stosowane w trakcie terapii tryby schematów, proces budowania relacji terapeutycznej i zaufania, a także umiejętne wyznaczanie granic. Wskazano na różnice i pewne modyfikacje terapii schematów w tej grupie, przytoczono też konkretne techniki i narzędzia pracy, nakreślając przy tym pewne istotne kwestie i zalecenia oraz ograniczenia.

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“…We adapted ST for forensic PD patients (Bernstein, Arntz, & de Vos, 2007 ), with the aims of motivating and engaging patients, ameliorating PD symptoms, lowering risks and building strengths (i.e. protective factors), and facilitating re-entry into the community (Bernstein, Clercx, & Keulen-De Vos, 2019 ; Chakhssi, Bernstein, & De Ruiter, 2014 ). ST focuses on changing ingrained patterns of cognition and emotion ( early maladaptive schemas ; EMS) and maladaptive emotional states ( schema modes ) (Young et al, 2003 ), constructs associated with personality disorders in forensic (Keulen-de Vos et al, 2017 ) and non-forensic (Bamelis et al, 2014 ) populations.…”

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confidence: 99%

Schema therapy for violent PD offenders: a randomized clinical trial

Bernstein

Vos²,

Clercx³

et al. 2021

Psychol. Med.

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Background Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005). Conclusions These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

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Schema Therapy in Forensic Settings

Cited by 12 publications

References 39 publications

Denigration or Decline: Reflections on Offering Staff Consultation Focussing on End‐of‐Life Care In a Homeless Hostel

Denigration or Decline: Reflections on Offering Staff Consultation Focussing on End‐of‐Life Care In a Homeless Hostel

Schema Therapy in the treatment of detention patients with antisocial personality structure. Effectiveness and management methods.

Schema therapy for violent PD offenders: a randomized clinical trial

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