Dr. David Bernstein is a Clinical Psychologist (PhD, New York University, 1990) and the Founder and CEO of SafePath Institute, devoted to training teams that work in challenging environments. He is the former “Professor of Forensic Psychotherapy” at Maastricht University in the Netherlands, and has served as Vice-President of International Society of Schema Therapy and President of the Association for Research on Personality Disorders. He is an internationally recognized expert on personality disorders, forensic psychology, childhood trauma, and psychotherapy, and has published more than 130 articles and book chapters, and several books. He has contributed many innovations to Schema Therapy, including Forensic Schema Therapy; SafePath, a team-based form of Schema Therapy; and the Bernstein iModes, image-based therapy tools. He is an active Schema Therapy supervisor and trainer.
When a ‘Moral Vacuum’ Enters the Therapy Room: Training our professional Healthy Adult to reflect rather than react
As humans, we are born with the capacity to feel ‘moral emotions’, such as shame, guilt, and remorse. They help us function in society, inhibit ourselves, and repair and maintain relationships. As Schema Therapists, we tend to look at pathological shame or inappropriate self-blame as part of the person’s Inner Critic modes, and have a large toolbox aimed at reducing those experiences. However, we are much less trained to deal with their ABSENCE. We refer to those moments – where an expected sense of genuine shame or guilt is lacking – as a ‘moral vacuum’ (Navot & Bernstein, 2023). The obvious example is when a patient is talking about somebody getting hurt, while not showing any signs of regret (e.g., common in Antisocial and Narcissistic personality disorders). However, other ‘moral vacuums’ can be much harder to detect. For example, when a patient becomes demanding or demeaning in a very subtle way, or when the patient is taking a very passive role in the therapy. In those moments, as human beings, our modes tend to jump in and fill the ‘moral void’ without our awareness. Therapists may quickly shift into blaming themselves for doing something wrong. Sometimes they may unconsciously join the client in blaming others, or feel highly judgmental, resentful, or reject the client. How can we train our healthy adults to identify and reflect on those moments? How can we increase our strengths in order not to fall in the trap of filling the ‘moral void’? In this presentation, we will provide tools for recognizing different kinds of ‘moral vacuums’ and connecting them to different modes. We will then explore ways to increase therapists’ healthy capacities and resilience so they can choose their interventions wisely in those moments.
Strengths Based Schema Therapy (SBST): A new, short-term therapy that rapidly mobilizes the Healthy Adult mode
Co-Presented with Erwin Bijlsma
Schema Therapy is remarkably effective for a broad range of personality disorders (PDs). However, it requires a substantial commitment of time, usually one to three years or more, depending on the severity of the case. In clinical practice, there are quite a few patients with less severe personality and behavior problems who could benefit from shorter-term forms of Schema Therapy. In this workshop, we introduce Strengths-Based Schema Therapy (SBST), a 12-session manualized therapy plus 4 optional booster sessions, that rapidly mobilizes patients’ Healthy Adult mode. It incorporates positive psychology, mindfulness, and experiential techniques to help patients become aware of their dysfunctional modes, and utilize their strengths to get their emotional needs met. The therapy is intended for patients with mild to moderate PDs or traits, along with mood, relationship, or adjustment problems. It was developed by Dr. David Bernstein and piloted with 15 patients at 4mb (“For mind and behavior”), an ambulant treatment center in the Netherlands directed by Mr. Erwin Bijlsma. In a pilot study of N = 3 patients with mild to moderate personality disorders, all three patients showed positive reliable change in early maladaptive schemas, modes, symptom distress, coping, and strengths. SBST uses the visual metaphor of a sailboat, the “Healthy Adult Boat,” based on a concept by Hugo Albert (Albert, 2018, Bernstein et al., 2021), to represent the Healthy Adult on its life’s voyage. The therapy consists of 4 phases: 1) assessment (“Where are you in your life’s voyage?”), 2) problem definition and analysis, and mindful awareness (“Setting your course, experiencing the voyage”), 3) Creating Healthy Adult messages for maladaptive modes (“Braving the stormy seas”), and 4) Building strengths to meet emotional needs (“Coming to Strengths Island”). We incorporate the iModes image-based therapy tools throughout the therapy. In this workshop, we will use case examples, demonstrations, and exercises to show how this strengths focused approach can rapidly mobilize patients to recognize unhealthy patterns, improve coping and symptoms, and get emotional needs met more adequately.
The Healthy Adult Mode; Key Similarities and Differences Between four empirical based models and their Clinical Implications
Co-Presented with George Lockwood, John Louis & Guygu Yakin
Four major research based approaches to the development of our understanding of the Healthy Adult Mode will be discussed with a focus on the key areas of overlap, differences, possibilities for integration, clinical implications and suggestions for further development. Each had distinctly different starting points. Yakin and Arntz have been exploring the interactions between healthy adults and child modes. Bernstein cast a broad to develop a model drawing on the work of Seligman, Bowlbly, Frankle, Ryan & Deci and the DSM-5 model of healthy functioning, among others. Louis and Lockwood started with 18 positive schemas hypothesized by Lockwood, Perris and Young as the adaptive counterpoints to the 18 early maladaptive schemas. Louis and Lockwood also developed a second model of the healthy adult mode in a nurturing context with their starting point being hypothesized counterpoints to the maladaptive parenting interactions operationalized in the Young Parenting Inventory. Tilling the soil of healthy adult functioning from such distinct yet compelling directions offers the promise of significantly advancing our understanding of this important and complex construct.
Yakin and Arntz’s work involved in-depth qualitative analysis of the interactions between child modes and healthy adults by conducting 45 to 60 minute semi-structured interviews. Three broad themes and 10 subthemes emerged. Bernstien’s personal strengths model consists of four domains and 16 primary factors and has an accompanying scale for clinical use. Louis and Lockwood’s model of healthy adult functioning consists of 14 positive schemas organized into 4 domains and Louis and Lockwood’s model of the healthy adult parent consists of 7 parenting schemas. Each of these two models have an accompanying scale for clinical use. All four of these models are in the midst of ongoing research and updates on recent findings will be provided.