Lecture 6 Flashcards
Mixed cluster C - treatment
- psychodynamic psychotherapy: confrontational or supportive
- dynamic and cognitive therapy
- schema therapy (effective for elderly patients)
Avoidant PD - treatment
- behavioural strategies: exposure and social skills training
- cognitive therapy
- CBT
Borderline PD - treatment
- Cognitive-behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Schema-focused therapy (SFT)
- Transference-focused therapy (TFT)
- Mentalization-based therapy (MBT)
CBT
identify and modify core dysfunctional beliefs that automatically organize biased perceptions of self, others, and the future.
DBT (Dialectical Behavioural Therapy)
- -> developed for chronically suicidal and severely dysfunctional BPD individuals and has its roots in behavioral and biosocial theories of personality and research, and in Eastern contemplation and dialectical philosophy
- emotional dysregulation: biological vulnerability + invalidating environment
- Acceptance, mindfulness and dialectics
- -> The patient needs to be alive and well (target a), productively collaborating on the tasks of treatment (target b), and on issues that interfere with their effective functioning (target c)
Schema-focused therapy (Core emotional needs)
a. The development of secure attachment to others
b. The development of autonomy, competency, and sense of identity
c. The freedom to express valid needs and emotions
d. Spontaneity and play
e. Realistic limits and self-control
Four types of early life experiences that foster the acquisition of schemata
- Toxic frustration of needs (–> deprivation)
- Traumatization (–> mistrust/abuse)
- Overindulgence (–>entitlement and dependence)
- Selective internalization (–>subjugation)
Three types of coping behaviors
- Overcompensation
- avoidance
- Surrender (kapitulacja)
Schema modes
- abandoned/abused child
- Angry and impulsive mode
- detached protector mode
- punitive parent mode
- underdeveloped healthy adult
Abandoned/abused child mode
frightened isolation, rooted in the abandonment and abuse the patient experiences as a child; an intensely painful mode, patients report feeling fragile, lost, and helpless when in this mode; patients believe the pain will never end, that they will be alone forever, with nobody to care for them.
Angry and impulsive mode
the part of the child that knows that she didn’t have her core emotional needs met, that she was mistreated; the mistreatment can refer to abuse, deprivation, abandonment, rejection, neglect, etc.; situations that trigger memories of these various sufferings can elicit intense, and often ultimately self-detrimental rage.
detached protector mode
patient “shuts down” and adopts a style of emotional withdrawal, disconnection or behavioral avoidance through addictive self-soothing or sensation-seeking; patients tend to feel numb or empty when in this mode; as a child, detachment was effective in protecting/isolating against painful interpersonal attachment experiences and other negative emotional experiences.
punitive parent mode
identification and internalization with the parent who devalued and rejected the patient in childhood; perpetuates the abuse internally as patients adopt an extremely harsh, self-punishing attitude; when in this mode, patients experience themselves as fundamentally “bad”, defective, and unlovable; these experiences may give rise to self-injurious behaviors.
underdeveloped healthy adult mode
the healthy part that helps the individual in getting her needs met by nurturing and affirming the vulnerable child, by setting limits to the angry/impulsive child, and by fighting maladaptive coping and self-persecution; first modelled by the therapist and patients can progressively internalize this agency.
SFT phases
- bonding and emotional regulation
- schema mode phase
- Development of autonomy
