The art of empathic confrontation and limit-setting

Behary, Wendy T.

doi:10.4324/9781351171847-14

Cited by 5 publications

(5 citation statements)

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“…Analysis of the imagery exercises revealed two broad categories of triggers for therapists, namely, Perceived resistance to change and clients perceived as having a demanding and superior attitude (Superiority) along with two other particular categories, Client immobilized by conflict and Abusive. Previous research supports the idea that dysfunctional overcompensation coping modes are particularly difficult for therapists to manage (4,38,39,44). The conceptualization of obsessive-compulsive functioning from the ST perspective identifies the Obsessive-Compulsive Overcontroller mode (18,21) and the Selfaggrandizer mode (5) as dysfunctional overcompensatory modes of coping.…”

Section: Discussionmentioning

confidence: 72%

Therapists’ problematic experiences when working with obsessive-compulsive disorder: a qualitative investigation of schema modes, mode cycles, and strategies to return to healthy adult mode

Semeniuc,

Sterie,

Soponaru

et al. 2023

Front. Psychiatry

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IntroductionObsessive-compulsive disorder (OCD) is one of the most challenging pathologies for therapists, being chronic and often characterized by frequent relapses. The therapeutic relationship plays a critical role in the outcome of therapy. The dynamic interaction between therapist and client schema modes determines the quality of the relationship.The objectiveof the present qualitative research is to investigate and conceptualize the triggers for therapists when working with OCD clients, the therapists’ schema modes that are activated, and the strategies they use to get back into the Healthy Adult mode.MethodUsing the in-depth interview technique, we interviewed 15 psychotherapists of various therapeutic orientations. After several demographic items, the therapists answered some introductory questions about their general perceptions of working with this pathology. They were then guided to go through a specific therapeutic situation in imagery that they identified as particularly difficult to manage in the therapeutic relationship. For data analysis, we used the interpretative phenomenological analysis (IPA) method and thematic analysis.ResultsFor therapists working with clients with OCD, two main categories of triggers have been identified: Perceived resistance to change and Superiority. Two other categories, Client immobilized by conflict and Abusive, emerged from our analysis. Therapists’ reactions to triggers were synthesized into mode processes that (1) were not acted on and (2) were displayed in relation with the client. For mode processes that therapists did not explicitly act on, there was triggering of the Vulnerable Child in relationship with a Demanding Parent, followed by various coping modes, depending on the category of trigger, and in the displayed mode, most therapists operated in the Healthy Adult mode. With respect to the process, strategies used by therapists to return to Healthy Adult mode that stood out were: focusing on the process, self-acceptance, self-compassion, and somatic grounding strategies, and focusing on the client’s resources.

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Section: Discussionmentioning

confidence: 72%

Therapists’ problematic experiences when working with obsessive-compulsive disorder: a qualitative investigation of schema modes, mode cycles, and strategies to return to healthy adult mode

Semeniuc,

Sterie,

Soponaru

et al. 2023

Front. Psychiatry

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“…Thus, buying into avoidant individuals’ characteristic tendencies and cognitions during therapy is likely to increase the likelihood that such core emotional needs remain unmet. In working with avoidant clients, it may be worthwhile for schema therapists to help them realize that their capabilities can be channeled toward exploring past experiences that made them so self-reliant and to appreciate the acknowledgement and exploration of hidden vulnerabilities as a sign of strength (Behary, 2020; Rafaeli et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

The associations between early maladaptive schemas and adult attachment styles: A meta-analysis.

Karantzas¹,

Younan²,

Pilkington³

2023

Clinical Psychology: Science and Practice

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This article reports on the first meta-analysis into the relationships between attachment styles and early maladaptive schemas (EMS). Fifteen studies were included. All associations were estimated using a random-effects model. Overall, insecure attachment styles were significantly positively associated with EMS (anxious attachment r = .36, avoidant attachment r = .22, fearful attachment r = .28) and significantly negatively associated with secure attachment (r = −.13). Subgroup analyses revealed differences in the magnitude of the associations between attachment styles and specific EMS. Anxious attachment demonstrated larger associations with EMS (compared to avoidant attachment) within the schema domains of disconnection/rejection (r = .49 vs. r = .31) and other-directedness (r = .32 vs. r = .12). The findings have important implications for the advancement of theory, research, and clinical practice in the fields of adult attachment and schema therapy.

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“…Schema Therapy utilizes cognitive, behavioral and emotion focused interventions to achieve its goals of meeting core developmental needs in the patient’s current life; achieving healthy attachments; minimizing use of dysfunctional coping modes; and the strengthening the patient’s healthy adult mode ( Rafaeli et al, 2015 ; Thalmayer and Andreas, 2022 ). The use of empirically proven interventions such as imagery rescripting, cognitive restructuring, psychoeducation, behavioral exposure, empathic confrontation of dysfunctional modes, chair work and the like are employed ( Arntz, 2015 ; Behary, 2020 ; Thalmayer and Andreas, 2022 ).…”

Section: Schema Therapy: What It Has To Offermentioning

confidence: 99%

“…The extent to which this is necessary will depend on the case conceptualization. Clinicians must use flexibility within each session: they must balance empathic confrontative approaches with limited reparenting that meets core needs and heals painful schemas ( Skewes et al, 2015 ; Behary, 2020 ), and behavior change techniques with emotion-focused approaches.…”

Section: Schema Therapy: What It Has To Offermentioning

confidence: 99%

“…On the other hand, it involves recognizing and confronting how these modes and behaviors work against the client’s real needs. Empathic confrontation is particularly crucial in working with individuals who struggle with addictive disorders, but requires great skill, as patients may be sensitive to perceived criticism due to their maladaptive schemas, internal critic, and societal stigmas surrounding addiction ( Behary, 2020 ; VanVresswijk, 2020 ).…”

Section: Schema Therapy: What It Has To Offermentioning

confidence: 99%

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STAT: schema therapy for addiction treatment, a proposal for the integrative treatment of addictive disorders

Lacy

2024

Front. Psychol.

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The nature and origins of addictions and of their adjunctive behaviors, as well as their chronicity, call for treatments that conceptualize and treat them as the long-term and complex processes that they are. Addictions are often comorbid with personality problems and with trauma histories. Patients suffering from these disorders often show poor engagement with treatment and high rates of relapse, possibly because available treatments have yet to address the patient suffering from addiction in a more integrated or holistic manner. In particular, comprehensive treatment models for addictive disorders – like treatments for personality disorders or trauma – are likely to require the integration of behavioral, cognitive, and emotion-focused interventions within a facilitative therapeutic relationship. However, most current treatment models, including ones which are highly effective in stabilization or behavioral change, lack one or more components of treatment that could sustain longer term recovery, wellness, and health for a higher percentage of patients. In this article, I propose approaching addictions and their treatment from the perspective of schema therapy, an integrative, developmental model with a strong track record of positive outcomes in addressing personality disorder symptoms and long-standing trauma histories, commonly comorbid with addictive disorders. In advancing this proposal, I begin by providing some background tying together addictions, attachment, and personality, suggesting they be treated simultaneously to achieve improved outcomes. Then, after briefly reviewing the leading approaches to the treatment of addictions, I introduce the idea that schema therapy is well-situated – both theoretically and practically – to address many of the shortcomings of existing treatment options. In particular, I note how addictive and co-occurring colluding behaviors are deeply intertwined with both early and continued frustration of core developmental needs. I illustrate how the addictive cycle is perpetuated through the process of schema reinforcement and through the operation of schema modes. I then demonstrate how these key terms (i.e., needs, schemas, and modes) inform the patient’s assessment and case formulation, guiding treatment interventions from a strong therapeutic relationship that focuses on integrating recovery behavior change, healing dysfunctional schemas and modes, and preventing relapse.

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The art of empathic confrontation and limit-setting

Cited by 5 publications

References 0 publications

Therapists’ problematic experiences when working with obsessive-compulsive disorder: a qualitative investigation of schema modes, mode cycles, and strategies to return to healthy adult mode

Therapists’ problematic experiences when working with obsessive-compulsive disorder: a qualitative investigation of schema modes, mode cycles, and strategies to return to healthy adult mode

The associations between early maladaptive schemas and adult attachment styles: A meta-analysis.

STAT: schema therapy for addiction treatment, a proposal for the integrative treatment of addictive disorders

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