Download Group Schema Therapy for Borderline Personality Disorder: A Step by Step Treatment Manual with Patie PDF

Group Schema Therapy for Borderline Personality Disorder: A Step by Step Treatment Manual with Patie
Name: Group Schema Therapy for Borderline Personality Disorder: A Step by Step Treatment Manual with Patie
Author: claire j. creutzfeldt
Pages: 327
Year: 2012
Language: English
File Size: 1.86 MB
Downloads: 0
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P1: SFN/XYZ P2: ABC JWST150 fm JWST150 Farrell February 17, 2012 19:25 Printer Name: Yet to Come This edition first published 2012 2012 John Wiley & Sons Ltd Wiley Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley"s global Scientific, Technical and Medical business with Blackwell Publishing. Registered office:John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices:350 Main Street, Malden, MA 02148 5020, USA 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley blackwell. The right of Joan M. Farrell, Ida A. Shaw, Arnoud Arntz, Heather Fretwell, George Lockwood, Poul Perris, Neele Reiss, Hannie van Genderen, Michiel van Vreeswijk and Jeffrey Young to be identified as the authors of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging in Publication Data applied for. A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Set in 10.5/13pt Minion by Aptara Inc., New Delhi, India 1 2012


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P1: SFN/XYZ P2: ABC JWST150 Fwd JWST150 Farrell February 9, 2012 8:2 Printer Name: Yet to Come Foreword Iamverypleasedtohavebeeninvitedtowritetheforewordforthisground breaking treatment manual on Group Schema Therapy (GST). Since I first heard about the extremely positive results of the authors" randomizedcontrolledtrialofGSTforpatientswithBorderlinePersonality Disorder (BPD) in 2008, I have been very excited about the potential of the group model to make schema therapy (ST) more available and affordable for patients. Given the worsening climate for mental health reimbursement in this era of managed care in the United States and elsewhere in the world, GST has the potential to deliver the powerful treatment strategies of the schema approach in a more cost effective manner than has been possible with individual ST ... with equivalent or perhaps superior results. When I met Joan and Ida for the first time at the International Society for Schema Therapy Congress, I was surprised to learn that they had been developingtheirGSTapproachfor25years,andwasstruckbyhowmanyof thecorecomponentsinmyownworktheyhadindependentlydevelopedfor theirgroupapproach.GST feelsentirelyconsistentwithmyownindividual model,intermsoftheconceptualmodel,therapeuticalliance,andtreatment interventions. In the past, I had always been skeptical about the possibility of extending the intense therapy relationship I call Limited Reparenting ... which is so central to the effectiveness of ST ... to a group approach. I had always viewed group therapy as a watered down version of individual treatment, especially for patients with personality disorders. I was delighted to find that my preconceptions were entirely wrong. The GST approach Joan and Ida have developed is truly unique, exciting, and promising. GSTencouragesgroupmemberstobecomelikeahealthyfamilyinwhich they can reparent each other, under the watchful guidance of two highly


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P1: SFN/XYZ P2: ABC JWST150 Fwd JWST150 Farrell February 9, 2012 8:2 Printer Name: Yet to Come viiiForeword skilled therapist parents. The sense of belonging and acceptance provided by this group analogue to a loving family seems to catalyze both the limited reparenting and emotion focused components of ST. Furthermore, by using two co therapists for each group, GST has found a way to free up one therapist to move fluidly around the group, often working with one or two members at a time, creating novel experiential exercises to bring about change. At the same time, the second therapist serves as the "stable base" for the rest of the group, maintains an ongoing emotional connection with each member, monitors the reactions of all members, explains what is happening to educate them about what is taking place,andintervenestoshiftthedirectionofthegrouptofocusontheneeds of other group members. I am also impressed that GST goes well beyond traditional Cognitive BehaviorTherapy/DialecticalBehaviorTherapy(CBT/DBT)groupformat, in which members are taught skills in a seminar like setting; and non CBT groups,inwhichthetherapistdoesindividualworkwithonememberwhile the rest of the group primarily watches. In GST, the techniques used in individualST,suchasimagerychangeworkandmoderole plays,havebeen adaptedtoengageallofthemembersinuniqueexercisesthatmakeuseofthe power of group interaction and support. These group therapeutic factors, combined with the broad range of integrative techniques that are already part of ST, may account for the large treatment effects in the controlled outcome study I mentioned earlier, as well as in preliminary data from other ongoing studies of GST. This book is the first published treatment manual for GST, and succeeds in providing the most essential information clinicians will need to practice it. The authors describe a systematic approach to treating BPD patients in a group format, while retaining the flexibility that I have always valued so highly in developing individual ST. The treatment suggestions are specific andwell organized,withplentyofexamples,whileavoidingthetemptation to write a therapeutic "cookbook" for therapists to follow in a rote manner. Tobemorespecific,theauthorshavepreservedthecoreelementsofSTby developing"limitedreparenting"interventionstrategiesforeachmodethat arises in the group, seizing "experiential moments" to do emotion focused workthatbringsaboutchangeatadeeplevel.LikeindividualST,theirgroup model blends experiential, cognitive, Interpersonal, and behavioral work. This manual presents a step by step guide for GST with patients who have BPD. It includes a large selection of patient handouts, group exercises, and homework assignments all presented in downloadable form on the


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P1: SFN/XYZ P2: ABC JWST150 Fwd JWST150 Farrell February 9, 2012 8:2 Printer Name: Yet to Come Forewordix Wiley website for use with patients. The workbook material is arranged both by mode and by type of intervention, allowing therapists to choose the exercises and homework assignments that best match individual group members, and the therapist"s own personal style. The user friendly format of the book also provides sample therapist scripts, and numerous patient examples throughout. Theexperiencethatthetwoauthorshavegainedover30yearsoftraining therapists throughout the world, and leading GST groups with a broad range of clinical populations, is evident throughout the volume. The book is written at a level that should appeal to a very broad range of mental health professionals, including psychologists, social workers, psychiatrists, counselors, psychiatric nurses, as well as interns and residents. On a more personal level, I had the opportunity to experience GST first hand as a participant at an advanced training workshop that I invited Joan and Ida to teach for the senior schema therapists at our New York institute. I am even more excited about the potential of ST in a group after this experience, and would love to conduct a ST group like this myself once I have learned the necessary skills. Joan Farrell is an outstanding schema therapist who serves as the "stable base", emotional center, and "educator" for the group as a whole a role I can imagine myself learning to fill, given enough time and experience. What truly amazed me perhaps because her style is so different from mine and Joan"s was the remarkable group work of Ida Shaw. It is hard to convey the level of originality, creativity, and spontaneity she brings to thegroupexperience.Sheisabletoblendelementsofgestalt,psychodrama, role playing, and her own infectious style of play into an approach that perfectlyfitstheintensivedemandsofschemamodework,cajolingpatients to change in profound ways. The group exercises in this manual will allow schema therapists to try out some of her unique work. I see GST as one of the three most important advances since I began developing ST. It has served as a major impetus for international collabo ration to further the development and dissemination of ST, including pilot studies in the Netherlands and Germany, as well as an intensive version for inpatient or day hospital use. Iamespeciallyexcitedaboutthelarge scaleclinicaltrialthatisunderway at 14 sites in 5 different countries. Arnoud Arntz and Joan Farrell serve as the co principal investigators of the study, testing the efficacy and cost effectiveness of the GST model for BPD patients. This book includes the full treatment manual and patient materials used in the study.


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P1: SFN/XYZ P2: ABC JWST150 Fwd JWST150 Farrell February 9, 2012 8:2 Printer Name: Yet to Come xForeword Although this manual focuses on the treatment of patients with BPD, I believe that it also has great potential to be adapted for other patient populations, diagnoses, and treatment settings. Like individual ST, I expect the GST model (based on the principles outlined in this manual) to be effective for patients with other personality disorders (PDs), many Axis I disorders, and other chronic problems that have not responded to existing treatments. GST is already being explored as a potential treatment for pa tients with eating disorders, Avoidant PD, Dependent PD, Narcissistic PD, and Antisocial PD. I want to personally thank the many members of the international ST community who have helped Joan and Ida in the refinement of the GST modelandhandbook.Theseinclude:ArnoudArntz,HannievanGenderen, and Michiel van Vreeswijk from Holland; Poul Perris in Sweden; Heather Fretwell and George Lockwood in the US; and Neele Reiss from Germany. Theseindividualshavecontributedchapterstothisbookthatcoverpractical issues, such as combining individual and group ST; and more theoretical aspects, such as the chapter on needs and adaptive reparenting. The book also includes a meta analysis of the studies that have been conducted to evaluate the efficacy of ST for patients with BPD; along with a chapter on thefutureofthegroupmodel,whichIco authored. I highly recommend this outstanding manual to all mental health pro fessionals working with more complex, chronic, and hard to treat patient populations especially those who are looking for an evidence based, cost effective alternative to existing therapies. This book is essential reading for professionals interested in ST, BPD and other personality disorders, group therapy,andinnewapproachestoexpandingCBT.IcommendJoanandIda fortheirwillingnesstotakerisksindevelopingatrulycreativeandinspiring new approach to ST. JeffreyYoung, PhD Schema Therapy Institute of New York, Columbia University, Department of Psychiatry


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P1: SFN/XYZ P2: ABC JWST150 babout JWST150 Farrell February 9, 2012 8:9 Printer Name: Yet to Come About the Authors Joan Farrell, PhD, and Ida Shaw, MA, are the developers of the original Group Schema Therapy (GST) model and have specialized in the treatment of Borderline Personality Disorder (BPD) for 25 years. GST demonstrated its effectiveness in a randomized trial supported by a NIMH grant and was awarded the Governor"s Showcase Award in Mental Health, Indiana. They developedanintensiveinpatientprogramonaspecializedhospitalunit,which has promising pilot results. Currently they are the primary trainers and super visorsforafourteen site,five countrytrialofGSTandDr.Farrellisco PIwith Professor Arnoud Arntz. Dr. Farrell is the Research and Training Director of the Center for BPD Treatment & Research (CBPDT&R), Indiana University SchoolofMedicine MidtownCommunityMentalHealthCenter,adjunctpro fessor of Psychology, Indiana University Purdue University Indianapolis. She was a clinical professor in Psychiatry Indiana University School of Medicine for 25 years where she received the Outstanding Faculty Contribution Award fromtheclinicalpsychologyinternshipprogramandwashonoredbypsychiatry residencyclassesforherteachingandsupervisioninBPDtreatment.IdaShaw, MA, is an Advanced Level Schema Therapist/Trainer and program consultant for CBPDT&R. She contributes expertise in experiential therapy and develop mental psychology to GST. Together they direct the Schema Therapy Institute Midwest,IndianapolisandhavebeengivingtraininginSchemaTherapy(ST) and BPD treatment internationally for 20 years. They have published journal articles, a DVD series demonstrating GST and book chapters on BPD and GST and so far they have provided training to over 350 therapists from 12 countries in GST. They receive outstanding evaluations for their teaching and supervision, including the response that their enthusiasm and demonstrations inspire therapists to begin GST.


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