Blogs

UPDATE ON THE GROUP COMMITTEE'S WORK
A committee on Group Schema Therapy was established by the ISST Board of Directors in 2011. I was appointed as chair and over the year we grew to include: Jeff Young, Ida Shaw, George Lockwood, Poul Perris, Neele Reiss, Gerhard Zarbock, Christine Zens, Michiel van Vreeswijk, Eelco Muste, Kerry Beckley, Heather Fretwell, Friederike Vogel, Marco Nill with Hannie van Genderen and Arnoud Arntz as our advisers. We worked this year on a number of group related issues. We formulated recommendations for the ISST Board of Directors regarding a certification in Group ST. Neele led the work on identifying critical components and core interventions of the GST model for BPD. Michiel led the attempt to identify the models of Group ST being used and their stage of development. Gerhard is leading the work on developing the Group STRS we need for research and to institute certification. Our report will go to the board in January and will be posted on the website. We hope to have a meeting of schema therapists interested in Group ST at the ISST congress to further identify the group work being done and to facilitate research and training collaborations.

UPDATE ON THE GST MODEL
I know that I enjoy reading about what other schema therapists around the world are doing as it helps me feel connected to our community. This blog post is intended to fill people in on the development of GST (the abbreviation we are using for the model of group we developed for BPD) and opportunities for collaboration and training with this model. We hope that it is accepted in that spirit and that others working with Group ST will add their information.

This has been an active year for those of us working with the GST model The year began for Ida and I in January with a 2 day workshop at the Schema Therapy Institute NYC, which included Jeff and Wendy as participants along with many of the senior schema therapists connected with the NY and NJ institutes. We are grateful for Jeff’s support and the opportunity to begin the year at the institute where ST began. Needless to say, it was a very interesting and thought provoking workshop and the beginning of discussion about adapting the GST model for other patient populations and settings. A short paper we wrote with Jeff comparing individual ST and GST was also discussed. Poul Perris and Neele Reiss joined us for the training and discussions.

In February we took GST to Australia. Chris Lee was our host for a 3 day workshop in Sydney and 4 days in Perth. The Perth training included the multi-site GST for BPD trial therapists. This is the five country, 14 site trial led by Arnoud and Joan that was planned at the 2008 ISST Conference in Coimbra. There are two sites in Perth. In Sydney we had the pleasure of having a number of experienced group therapists participating. We will be back in November 2012 for a 2 day Introductory Workshop in Brisbane and a 3 day Workshop II in Sydney.

The next few months we worked furiously to finish the manuscript of Group Schema Therapy for Borderline Personality Disorder: A Step by Step treatment Manual and Patient Workbook so that it would be published in time for the ISST Congress. With the help of George Lockwood, Heather Fretwell and Neele Reiss, who read our many “unrelenting standards” driven rewrites, we made the deadline! The treatment manual by Wiley comes out in April 2012. Michiel van Vreeswijk, Jenny Broersen and Marjon Nadort also completed their edited volume Wiley- Blackwell Handbook of Schema Therapy, which has a number of chapters describing approaches to using ST in groups, including our GST model. There is a case study by Neele Reiss, Gitta Jacob and Joan of a BPD patient treated in the Intensive individual plus GST approach used in the Department of Psychiatry and Psychotherapy, University Medical Center Mainz. The Schema Therapy Handbook will also be out by Spring and is already on Amazon.de for pre-publication ordering.

In June we were back in Maastricht for a 3 day workshop and a special 2 day workshop for Creative therapists. It was the second workshop for the Creative therapists and a very productive opportunity for us to again see how specialists in the various experiential therapies work with modes. We took away new ideas for group work. We also held a day-long supervision for therapists participating in the multi-site study. These supervision days occur throughout the year at different locations as they are part of the training plan of the multi-site BPD trial. We think that supervising therapists in a group when group is the subject makes an important training contribution.

In August we gave a one day workshop Klinik für Psychiatrie und Psychotherapie, Lubeck (and saw where marzipan is made!) A landmark event in GST took place at IVAH in Hamburg where we made a DVD set: Group Schema Therapy: An Innovative Approach to Treating Patients with Personality Disorders in Groups (demonstrated with BPD). Gerhard Zarbock was the producer and driving force behind the project with Vivian Rahn and Christine Zens. We had a professional director in Nana Novosad and her crew, which included a make-up artist who put scars and tattoos on our “BPD patient”actors”. Ida and I would not have been able to make the DVD without IVAH’s help and our schema therapist friends who played patients: Gerhard, Christine and Vivian joined by Eva Fassbinder, Niclas Wedemeyer, Friederike Vogel, Brigitte Haaf and Poul Perris. I am happy to announce that the 7 hour DVD set will be available in January. Inquiries can be made to schemadvd@aol.com. Wendy sent the flyer describing the set to the listserv also. The DVD includes a 90 minute typical BPD group session, clips of the core interventions of GST and an interview with Ida and I by Vivian. We hope that it will be helpful for schema therapists interested in how GST works. It was great fun making it with our friends and we really appreciate all the hard work that went into this project and the funds from IVAH that were crucial to the idea being realized. We gave a 2 day Introductory GST workshop at IVAH and a supervision for the multi-site therapists. We will be back at IVAH for a one day Introduction to GST (March 13) and a 3 Day Workshop II (March 14-16).

We had our first London workshop with Chris Hayes and Arnie Reed in September affiliated with their Schema Therapy Workshops. We will be back there soon for a one day Introduction (March 6) and a 3 day GST II workshop (March 7-9) for those who have attended workshop I. The first London workshop included therapists who travelled from Israel, Italy and Greece.

October saw us in Wil, Switzerland with Neele for a second workshop with Christoph Fuhrhans at Schematherapie Ostschweiz Cliena Littenheid. We consulted to his team as they are adapting GST to use with mixed PD groups and plan a pilot study on their inpatient unit. Since they have a certified DBT unit, their studies will allow us to compare the two group approaches directly – an important step in the ST research. We will be back at Clienia Littenheid September 5-9 2012 for an Advanced Workshop.

Another program adapting the GST approach to mixed PD is that of Eelco Muste at de Viersprong. We spent 4 days in October with Eelco and his therapy team – training and planning the integration of GST with the schema based group model Eelco and associates developed and have been using. We think that the combination of the mode and schema focus is important for broadening GST beyond BPD. We realized that when we tested GST on severe BPD patients we were also treating their numerous Axis I and Axis II symptoms. This suggests to us that GST is a good fit for some other PDs particularly those frequently comorbid with BPD and some axis I disorders like Eating disorders and PTSD, with some adaptation for level of emotional awareness. While in Halsteren we also gave a supervision day for the multi-site BPD trial.

Each visit added something to the original GST model for BPD. In NYC with Jeff we explored adapting GST to treat healthier patients. With Gerhard and Christine we further developed our thinking on trauma work in GST. With Chris and Arnie we had the opportunity again to work with therapists from forensic settings and look at the adaptations of GST that setting requires. With Christoph and Neele we explored GST applications for Cluster C and Eating disorder patients. With Eelco we did the same, and we were reminded of the role of schemas in group work and the need to make it more explicit in GST. With the creative therapists in Maastricht and de Viersprong, Ida was particularly happy to add some new experiential techniques to GST. We discussed the need to have psychotherapists and creative therapists in the same workshop, since they are likely to constitute the group therapist pair in most clinical settings. This pairing could solve the problem that we are hearing about as we travel - of sites not being able to have two psychotherapists in the same group. We were reminded of how ideal it can be to have a psychotherapist by training paired with a creative therapist. That is how Ida and I began 25 years ago – combining our different foundations and interventions to have a complete approach that like individual ST integrates experiential work with cognitive and behavioral change.

Schema Therapists who collaborate with us have also taken GST to additional meetings and countries. Heather Fretwell gave a presentation at the American Psychiatric Association meeting in Hawaii this year and with Neele Reiss gave a GST workshop at EABCT in Reykjavik, Iceland. Neele with Arnoud chaired a symposium on GST at that meeting. Neele has been busy presenting papers and giving workshops on GST with Friederike Vogel in Germany and Switzerland. Together with Marco Nill and Brigitte Haaf, they established IPSTI-Mainz and were certified as an ISST Training center. They are initiating their training program in 2012 and plan to have GST as one of their areas of specialty. Heather and Neele accomplished having a workshop on GST accepted for the American Psychiatric Association annual meeting in Philadelphia, 2012. Heather makes regular presentations in Indiana on GST and the BASE group program she directs at Midtown CMHC, which has an enrollment of 100 patients with BPD. She is adapting GST for patients with severe dissociative disorders with Ida and one of her psychiatric residents in training. A pilot of this program is about to begin and will hopefully be presented at the May congress.

Ida and I are happy to announce that this year we joined George Lockwood to become the Indianapolis Center of the Schema Therapy Institute Midwest (STIM) founded by George with STIM- Kalamazoo. We gave a one day workshop in May for the psychology department of Indiana University-Purdue University, Indianapolis IUPUI) and a summer course for clinical psychology graduate students at the University of Indianapolis. We were invited to do this university training because ST has been acknowledged as having a “moderate evidence base” by the American Psychological Association, Clinical psychology division. We will begin to provide training through the Indianapolis Center in June 14-16, 2012. We are joined also by Heather Fretwell and the Center for BPD Treatment & Research- Indiana University School of Medicine and Midtown Community Mental Health Center as partners in this training plan. Feel free to contact us at STIM-Indpls@sbcglobal.net or check our website for more information.

Our plan is to continue to provide GST training in the US and at key collaborating ST institutes in Europe and Australia, which are also committed to GST training and research. To this end, in collaboration with Neele, Gerhard, Christine, and Poul, we developed an organized curriculum for GST training and supervision. This curriculum is currently being offered in Hamburg at IVAH, London with Schema Therapy Workshops, Switzerland with Schematherapie Ostschweiz at the Cliena Littenheid and in Australia (Sydney & Brisbane) with Chris Lee. Plans are being made for 2012 workshops in Maastricht, Mainz at IPSTI-Mainz and in Stockholm at the Swedish Institute for CBT & Schema Therapy. We hope to be able to offer GST training twice a year at these institutes. The GST curriculum and training schedule are on our website http://www.BPD-home-BASE.org

We love the opportunity to interact with schema therapists all over the world and to continue learning and improving the GST model. The multi-site trial sites in the Netherlands and Germany are well underway and Australia has begun. In the US we are still fighting to secure funds, which feels like an uphill battle with the National Institute of Mental Health. As everywhere, funds for research and treatment are shrinking in the US. On a positive note, Ida has been greatly enjoying supervising the GST work of the multi-site therapists. We also offer skype supervision for therapists outside of the trial. A number of new collaborations for research and treatment manuals came out of our travels. In addition, with the Group ST Committee we have planned some interesting submissions on Group ST for the 2012 ISST Conference. We will submit proposals for symposia the new applications of our GST model and an overview of the various models of Group ST. Ida is organizing a symposium on Creative Therapy and GST. We are happy to have been invited to present a ½ day pre-congress workshop on Limited reparenting in GST on May 17th.

We welcome your comments on what we have written here and invite you to add information on other Group ST activities.

Happy Holidays to all of you and see you hopefully in New York!

Joan Farrell & Ida Shaw

Dear ISST members,

We have been delving into an interesting and controversial area of Schema Therapy theory. This has to do with whether we have empirical support for the existence of schema domains. Research on the YSQ has lead to clear and consistent support for 15 schemas being separate factors but inconsistent findings regarding what are called second order factors that would define domains. Answering this question would allow us to, for example, see if there is an underlying and meaningful structure to the array of 15 schemas, generate hypotheses about how schemas interact with one another, and relate these higher order constructs to similar constructs in other theories. If domains do not exist, this would be of relevance theoretically and clinically in that we would know that the schema therapy model is most clearly and accurately defined by the 15 schemas.

Our knowledge at this point is limited to research published in English journals. To get as clear a picture as possible of what we currently know about the YSQ in terms of first and second order factors we are interested in anyone who has knowledge of published studies on the YSQ involving an exploratory or a confirmatory factor analysis in foreign or less well-known journals and anyone who has knowledge of unpublished studies on this topic letting us know. You can respond directly to George at glockwood@chartermi.net.

I have listed the studies we are aware of below so you can check to see that we do not already have it.

We will be including a discussion of this topic in a forth coming chapter and can let you know what we find out.

Best wishes,

George, Poul and Jeff

Studies we have:

Baranoff J, Oei TPS, Cho SH et al. (2006) Factor structure and internal consistency of the Young schema questionnaire (short form) in Korean and Australian sample. J Affect Disord, 93: 133-140.

Cecero JJ, Nelson JD, Gillie JM (2004) Tools and tenets of schema therapy: Toward the construct validity of the early maladaptive schema questionnaire–research version (EMSQ-R). Clin Psychol & Psychother,

11: 344-357.

Chevallet KL, Mauchnad P, Cottraux JC et al. (2006). Factor analysis of the schema questionnaire-short form in a non-clinical sample. J Cognit Psychother: An International Quarterly, 20: 311-318.

Hoffart A, Sexton H, Hendley LM et al. (2006) The structure of maladaptive schemas: A confirmatory factor analysis and psychometric evaluation of derived scales. Cognit Ther Res, 29: 627-644

Lee CW, Taylor G, Dunn J (1999) Factor structure of schema questionnaire in a large clinical sample. Cognit Ther Res, 23: 441- 451.

Rijkeboer, M. M., & Bergh, H. van de (2006). Multiple group confirmatory factor of the Young

schema-questionnaire in a Dutch clinical versus non-clinical sample. Cognitive Therapy

and Research, 30, 263-278.

Saariaho, T., Saariaho, A., Karila, I., Joukamaa, M., The psychometric properties of the Finnish Young Schema Questionnaire in chronic pain patients and a non-clinical

Sample. J.Behav.Ther.&Exp.Psychiat.40(2009)158–168

Schmidt NB, Joiner TE, Joung JE et al. (1995) The schema questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas. Cognit Ther Res, 19: 295- 321.

Soygut, G., Karaosmanoglu, A.,Cakir, Z. (2009), Assessment of Early Maladapive Schemas: A Psychometric Study of the Turkish Young Schema Quesionnaire-Short Form-3. Turk Psikiyatri Dergisi, Vol XX, 1-10.

Thimm, J.C. (2010). Personality and early maladaptive schemas: A five-factor model perspective. Journal of Behavior Therapy and Experimental Psychiatry, 41, 373-380.

"No wind is the right wind if you don't know which direction you want to sail," is a popular paraphrasing of quotes offering the upside of setting goals. But which harbor is refuge from the storm? Here's a hint; it's not "out there."

Although it may seem otherwise, even irrefutable at times, clients are simply not all over the place. In a novel way, when we are successful in reading our client's map, familiarity breeds contempt. Not as in the Bible- finding fault with others, but in Mindfulness, finding the fault (in Mindfulness terms, the obstructions, in Budhist thought or metaphorically, the clouds) in the parts of our personality that creates our continuing suffering.

But how to understand the map that informs us accurately enough of the Schema(s) that the client is too familiar with, ego-syntonic beliefs in our language. Shakespeare, Hamlet, Act III, Scene I: "To be, or not to be: That is the question. Whether tis' nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles, and by opposing end them." Our clients do what brings order and consistency, not resolution, and not necessarily who they are, but what they have become, lost without the skills to read the map.

When our clients either do isolation, domination, or submission, existence is either past or future oriented. Mindfulness exists Now. Life lacks luster, the preciousness of each and every moment is lost, and rather than living happiness, clients look for happiness outside themselves. If only so-and-so was different; perhaps, if only I were different. All keys to the map.

Accurate map reading through Mindfulness leads us directly to our client's schemas in the best case scenario: our client's reaction and subsequent collaboration lets us know when are going in the right direction. Consistent, accurate, relentless reflection to our clients requires the skills of map reading. These skills can be learned regardless of our schemas- therapist and client alike. But, we do need someone to point the way out to us. Mindfulness, as is known is the West, is naive. We can be conscious every moment, like sailing nowhere, or worse, around in circles, without a goal. Can you read the Schemas in these maps?

Schema work, done right, shows us what's on the map. Mindfulness, done right, helps us recognize (or find) where we are on the map with our client, forming the collaboration that heals the longing. When therapist and client both know the map, no one feels lost.

So, how to read the client's map and show it (interpret) to your client? Awareness is lost when thought elaborates, the breeding ground for unhealthy Schemas. We think things and then believe they are true. In one sense, they are true as they once happened, because there was no other map available. However, in present tense, they are perceptions and elaborations of what might occur. The fantasy becomes reality because there is no other map. Corrective emotional experience opportunity in the here-and-now, if you know how to re-write the map.

Starting with a way to differentiate states of mind, and how to do so, is Map Orientation 101. When we "see" the elaboration, we see the resulting Schema. When we can point out the continuity of thought, along a readable key, its continuum from Mind observing (Awareness) to Mind reacting (Schemas) and everywhere inbetween, we begin the process of helping our clients differentiate their own States of Mind with a map that is both readable and knowable. We know the significant difference between awareness and elaboration.

This provides the limited reparenting metaphor of having a different map, one that provides consistency and Mindfulness, going beyond the naivety of trying to be conscious at all times. When you can simply look at the Map and it makes sense, security is instantaneous, direction is gained, and unhealthy Schemas are empty. Their lose their "grab" in Mindfulness terms. This gives clients choice. Then, we help them make the choice that is productive, feels good, is meaningful, and gives the greatest sense of personal satisfaction- knowing one's own mind and reasonably knowing the mind of another

Coming soon, Map Orientation 201....

warmly,

Rob Jaskiewicz

Incipient therapists spend many an hour on case formulation. Too often, a summary of the demographics and presenting problem is reapeated and presented as a case formulation. Utilizing the client's language as an integral part of the formulation- when repeated to the client, begins the therapeutic bond formation that constitues second order change. Second order change is an anomaly to most PD clients. Having to think the unthinkable in a personal world that is driven by failed attempts at recognition and regulation of emotional states of mind makes the relationship bond crucial to moving forward. It is this bond that can help begin recognition and regulation for any client, especially so to the PD client, enough to hear our plea; that the way to sucessfully integrate and resolve emotional states is to be fully present (please see Wendy's blog; she is presently having a discussion of the therapist's state of Mind relative to the client's state of Mind) in a new, previously unthinkable way.

Our (Schema) language is crucial because being developmentally informed- the reason why accurate case formulation is central to relentless interaction with the Detached Protector, et. al, it is imperative to have our language "good enough" that upon presentation, the rising of emotional states and evidence supporting our formulation comes forth from our client. Now we are on the same page.

Onward, I would like to open this discussion to language when introducing recognition and regulation to our PD clients to process feelings and generate empathy when they are trying to talk you out of doing so. Of course, BPD clients are ably apt at recognizing what they are feeling; far too much so. Regulating their emotions is another story. Vice versa for our NPD clients. We address the task at hand; of course you do not want to re-live and feel things that were once overwhelming painful, however....

In my own practice I try to address this dilemma with some form of the cognitive triad, pointing out the once necessary limitations of the client's negative experiences, thoughts, and subsequent negative interpretations and beliefs. When I am prompted by the frequent response of "I don't know," the creativity of developmentally informed opportunistic reparenting rises to the occasion. How to get the client to appreciate the unthinkable? (That) there is another way to use his/her feelings... for direction, guidance, and healing. How are others handling this often decisive interaction when we discuss the need for regulation and recognition of feelings, and create the dissonance between the part that doesn't want to recognize feelings and the part that knows that regulating feelngs appropriately is an integral part of treatment and becoming invested in his/her work?

Warmly,

Rob Jaskiewicz

I am pleased to announce the authorization by the ISST board of an official work group on developing Group Schema Therapy (GST).

The goals of the work group are:
1. To refine, and possibly expand, the GST model for a range of Axis II and I disorders. This would involve incorporating any others in the ISST working on group ST that have an evidence base
2. to develop adherence and competency scales for rating therapists conducting groups,
3. to explore and reach consensus within ISST about the best way to integrate GST certification into the current certification process.
4. if there is a consensus about GST certification, to identify the minimum criteria for training in GST and to explore how to integrate GST into existing training programs

The beginning ISST work group consists of those of us who have been working for the last two years on the treatment protocol for the collaborative multi-site BPD RCT now underway, and others who have expressed strong interest in GST. We have been discussing the group model and issues of training and certification with Jeff Young, so that we remain consistent with ST, and are very pleased that he has agreed to be part of the work group. We are also happy to have Arnoud Arntz as our research adviser and Hannie van Genderen as our adviser on training and certification issues.

ISST Work Group on Group Schema Therapy
USA: Joan Farrell, Chair
Ida Shaw
Jeff Young
Heather Fretwell
George Lockwood, board liaison
Sweden: Poul Perris
Germany: Neele Reiss
Marco Nil
Gerhard Zarbock
NL: Michiel van Vreeswijk
Hannie van Genderen, adviser on training & certification
Arnoud Arntz, research adviser
Switzerland: Christoph Fuhrhans

We welcome everyone's input on these issues. Questions and input can be directed to me at ijinindy@sbcglobal.net

Best wishes,
Joan

Joan Farrell, Ph.D.
ISST Certified Schema Therapist
Training Director, Center for BPD Treatment & Research, Indiana University School of Medicine and Midtown Mental Health Center
Asst. Professor of Clinical Psychology, IU School of Medicine
BASE Consulting Group, LLP
Indianapolis Center of the Institute for Schema Therapy Midwest

ESSENTIAL ELEMENTS IN SCHEMA THERAPY FOR COUPLES/MARRIAGES
Published by the ISST Couple/Marital Subcommittee
Drafted by Chiara DiFrancesco, Ph.D. Chairperson

a) There must be a significant focus on both individual ST for each partner as well as joint couple sessions. An individual schema therapy work up, with an individual attachment to the therapist is essential. This includes the standard inventories: YSQ-L3, YP1-1, SMI 1.1 & the Multimodal Life History Inventory, plus the therapist performing a detailed Conceptualization sheet for each partner and engagement in mode work.
b) There is a significant individual focus as well a joint focus, the method being individually applied by the therapist according to the circumstances.
c) There is full disclosure between partners.
d) We do not see the boundary issues which many current therapies have concerns about, as the roles of individual therapist and therapist for the couple relationship are clearly defined and consented to by both parties up-front.
e) Situations where there may be a conflict of interest are also clearly assessed and at least discussed with the clients also up front, and when these exceptions occur then schema therapy for the couple to heal the relationship is not pursued. There are other exceptions when schema therapy for the couple is pursued even with a conflict of interest regarding saving the relationship, however with the goals re-defined.
f) This combination of helping the relationship and persons is far more effective than having separate therapists for individual and couples, even when one partner starts later. We are much more adeptly able to evaluate the behaviors and modes of the partners and how they trigger each other.
g) Actually dealing with the client in a triggered mode happens readily in the individual/joint ST model both with partner and therapist. And we consider this an important essential element to the healing process. This can happen even with appropriate warnings of how a client might get triggered by the fact that the therapist is also the partner's therapist, and brings up excellent core material to actually work through in the therapy.
h) As the clients progress through ST for couples, we “up” the challenge and the triggers in the session, to help them strengthen their fight against their respective schemas, and resort to either vulnerable child or healthy adult modes as more effective coping techniques/tools.
i) In order to use this method in therapy, the schema therapist needs to be able to actually promote attachment with him or herself and the client, and fill some of the needs; otherwise the client will not be able to overcome the triggering situation. This happens best individually between client and therapist alone, but bears fruit in the joint sessions, which each partner feeling the understanding and connection with the schema therapist.
j) On the topic of dealing with couples where there are multiple affairs in the history, we reflected upon the components of not only Detached Self-Soother and Punitive Parent modes frequently involved, but also the Impulsive Child mode and activation of the Entitlement schema involving GREED with multiple extra-marital relationships. It is a failure to have a normal internalized "stop" mechanism which has components of both impulsivity and entitled greed.

I would be really keen to be involved in forming a blog to find ways of meeting the needs of disadvantaged and third-world populations.

This might involve looking specifically at how schema therapy can be applied in non-western populations and how it might fit within the particular ‘psychology’ of the disadvantaged cultural groups we are working with. Here in Australia, I hope that schema therapy could play a role in increasing our understanding of the emotional and spiritual impact of the trans-generational trauma associated with colonization, prolonged disadvantage and the forcible removal of children on the wellbeing of Aboriginal people. Although we may be working with different cultural groups and different types of trauma, I would really value the opportunity to exchange ideas with other schema therapists, to look at ways of developing relationships/rapport with people from disadvantaged cultural groups, learning to conduct therapy in less ‘clinical’ and more flexible ways that fit with the needs of the communities we are working with, and further developing schema therapy in ways that fit well within others’ cultural values and way of life. It might be interesting to think about how schema therapy can be applied at a community as well as an individual level, as it is often whole communities which have shared in the traumas of the past. I am wondering if there might also be scope for finding new ways of offering schema therapy to remote and rural disadvantaged populations, such as through the use of video conferencing and other forms of technology.

I would be delighted to hear from others who might also be working in this area and to learn from your experience!

Please open the attachements below in order to take a look at the minutes of the Berlin membership assembly, the new statutes (which are now confirmed by the lawyer) and the complete treasuers report. You have to click on the blue words above this textbody "Minutes, new Statues and Treasurer´s Report"
to get access to the attachments

I find the same challenge as Wendy did with anger when it comes to differentiating a client´s expressed sadness and grief.

The board want to initiate a discussion about ongoing issues in ST. Wendy startet with some thoughts about diffentiating expressions of anger among the patients.