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Deliberate Practice

  • Fortifying the Schema Therapist’s Healthy Adult Mode Through Self-Practice, Deliberate Practice and Therapist Improv

    This pre-conference 6-hour workshop combines Self-Practice/ Self-Reflection and Schema Therapy Deliberate Practice exercises, along with improvisational drama exercises to strengthen our inner therapist skills and our good parent voice. The workshop’s goals include increased self-awareness of modes and needs, the ability to access our Healthy Adult Mode when triggered in sessions, the development of a flexible and highly attuned Good Parent, and the construction of self-care plans to use outside of sessions. The workshop will support therapists in building ST intervention mastery as well as their authentic personal style. Deliberate practice exercises and improvisational (method acting) exercises will be employed to support the practice of accessing the “Good Parent voice” of the Healthy Adult Mode when working with clients’ child modes and a firm, confident and secure Healthy Adult Mode when limits for aggressive behavior are required. We will focus on interventions and practice that facilitate mastery of being a “real person” in the treatment room: present, attuned, and genuine, aware of our own schema and mode triggering, and expressing the internal advocate, “good parent” part of the Healthy Adult mode. We will explore the components of one’s HAM, including the role of support from mindful or spiritual beliefs, and examine how early maladaptive schemas influence the quality of these beliefs. We will introduce an expanded needs assessment to assist therapists in fortifying their HAM and building an effective self-care plan. The workshop’s experiential exercises and mindful self-reflection will culminate in a plan for further HAM development. The workshop will employ brief didactic PowerPoint and demonstration. The majority of the workshop time will be spent using experiential exercises with reflection and role-play practice with feedback.

  • Building Mastery in Group Schema Therapy: Applying Deliberate Practice to Core Interventions

    Rita Younan
    Joan Farrell
    Paul Kasyanik

    This in-conference workshop will present the application of the deliberate practice model to three of the most challenging interventions of group schema therapy (GST): maintaining a safe space, setting limits on disruptive overcompensating modes, and managing conflict, and provide attendees with opportunities to practice these skills using the format of the deliberate practice model. Deliberate Practice is a breakthrough approach in building mastery of clinical skills. GST presents therapists with additional challenges and complexity as the needs, schemas and modes of a group of patients must be simultaneously considered and safety and connection for all must be established and contained. One of the particular challenges of GST is management of the naturally occurring stages of a group’s process described by Yalom (2019). These can be summarized as: forming, storming, and norming. In contrast to the interpersonal process model of group therapy, which allows these stages to develop in an uncontrolled manner to increase emotion, in GST the therapists either facilitate or manage the stage to provide and maintain the safety and connection required to reach and heal the Vulnerable Child mode (VCM). In the treatment of personality disorder patients allowing anxiety or other distress to increase unchecked would trigger maladaptive coping modes to appear in some group members, often derailing or creating ruptures in the safety and connection of the group. The importance of managing the storming phase and group conflict is supported by a large randomized controlled trial of GST for borderline personality disorder. In the related qualitative study, patients reported that when aggression from other members was not firmly and confidently managed by the therapists, the ruptured connections and violation of safety of the group that occurred negatively affected their ability to do Vulnerable Child mode work and often led to premature dropout. We have observed as supervisors that setting limits is one of the more difficult skills for Schema therapists to learn and feel comfortable with. For this reason, we decided to apply the deliberate practice model to the skills of maintaining safety, limit setting, and managing conflict to allow participants to practice within the supportive structure of deliberate practice. The majority of the workshop time will be spent practicing in triads. Using the deliberate practice model, each participant will take a turn playing the role of a client, therapist, or supervisor. Three roleplay sessions will be conducted so that participants will have a turn in each role. The participant playing the therapist will form their response based upon the criteria of the micro skill. After this brief intervention, the client will give feedback followed by the supervisor role participant’s feedback about whether the criteria of the micro-skill were met and suggestions about how to improve the response. The ideal therapist response will be read at this time and used for discussion. The therapist in the roleplay will then have a second chance to respond to the repeated client’s statement using the feedback and discussion.

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