Schema Therapy

The fells and dales group met on Friday, 17/9/19 to discuss a paper on schema therapy which was published in the BACP journal, therapy today in March this year entitled “Attachment is key” by Dan Rivers. The article states that “ we all have schemas” and, similar to the notion of “drivers” in transactional analysis, these are imprinted from an early age.They are identified by the client filling in a questionnaire. Rivers suggests that there are 18 early maladaptive schemas and that these influence us for good or ill but mostly ill until recognised and worked through in a positive therapeutic relationship. The list is well worth perusing and reflecting on- the one that linked particularly for me with recent clinical work was “abandonment or instability “ when you fear constantly that relationships will end. Most point to low self- worth as the main underlying issue. Another useful one was “Defectiveness/ Shame” when the client feels a failure and has strong self- critical beliefs possibly stemming from harshly critical parents or failing at school perhaps due in part to being dyslexic – whatever the cause, we felt that these categories were a helpful way of conceptualising and making sense of distress while also being wary of pigeonholing or over- simplifying what  the client is bringing. They could also be a useful mirror or prism for reviewing and re- evaluating our own experience.
We liked Rivers’ emphasis on an integrative approach which acknowledges the value of different ways of working including object relations and attachment -he states that schema therapy is essentially a mixture of CBT, gestalt and psychodynamic theories and originated in the mid 1980’s in the work of Jeffrey Young who was an associate of Aaron Beck, the founder of cognitive therapy.
Our meeting then mainly focussed on an exploration of the power dynamic in therapy including transference and how the counsellor accepts and views their authority and/or are uncomfortable with this to the extent of denying and being blind to their own effectiveness when they have achieved “good” work with a client who has a positive outcome- an example given was a possible tendency( which most of us owned and recognised) to say to a client at the end of the work together that they, the client, had “ done most of the hard work” so avoiding/ denying our own positive input! We then discussed why this might be, stemming from our own childhood experience and conditioning.
Schema Therapy

Self Harm

Our meeting on March 23rd looked at several papers on self harm, with particular emphasis on self harm in adolescents. We learned something about the on line presence of websites and chat rooms dedicated to self harm and frequented by young people. The positive side being a source of support for young people in unbearable pain.  The negative being a peer group which might encourage self harm and could even promote it.

Chapter 3 of Antonia Murphy’s book ‘Out of This World’ discussed the relationship between self harm and suicide. She sees a difference in intentionality though they are both acts of self aggression. People harming themselves generally want to feel more alive whilst those who are suicidal wish to die. We quickly saw a blurred area where the two acts overlap where long term self harm can lead to ‘acquired capability’ of suicide. Both behaviours come, of course,  from psychic pain and we discussed the importance of investigating the pain and its origins by empathic atunement in therapy. Barent Walsh’s paper on Clinical Assessment of Self Injury concentrates on extracting the details of the client’s harmful behaviour in what he calls  ‘respectful curiosity’ , a term which did not sit well with all of us as it implies therapist distance rather than involvement. We were however agreed that seeking detail might make the behaviour feel more real for the client and conveys a willingness to bear this reality collaboratively. The client’s prior experience of other people is likely to have been avoidant or squeamish.

We came up with a very interesting new idea (for most of us) that morbid jealousy is itself a form of self harm stemming from early inadequate attachment –  the pain of feeling unloved  at the same time as feeling unworthy to be loved and re creating this distress in the self inflicted pain of jealousy.

 

Self Harm

ADULT TWIN RELATIONSHIPS

For our May meeting of Fells and Dales counsellors, we explored the relationship between twins, and in particular to what extent the twin bond is “special”. We read a research article by Tancredy and Fraley on ” The nature of Adult Twin relationships: an attachment-theoretical perspective” from  the Journal of Personality and Social Psychology,2006, vol.90,no1,78-93.

 The article defined the main characteristic of attachment relationships as comprising proximity seeking, separation distress, and the use of one another as a secure haven and safe base. Twins were then measured against non-twins to assess whether twins used each other as attachment figures rather than mother in the first instance and then siblings or other key figures.

 An interesting finding was that twins do not fully acknowledge the presence of their co-twin until the end of the separation-individuation process at around 36 months so until then are more focused on the mother to meet their needs. However, for identical twins who share the womb space, there can be ” an embodied sense of the other” which creates a lasting attachment greater than that between fraternal twins or non-twins.

 We then discussed the relevance of these findings for the therapeutic relationship and the extent of sibling rivalry between twins.

ADULT TWIN RELATIONSHIPS