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Individual Therapy

  • Schema Therapy for Children and Young Adults with Autism Spectrum Disorder (ASD)

    Christof Loose
    Claus Lechmann


    In previous treatment approaches for young people with autism spectrum disorder (ASD), the disorder-specific emotional needs, schemas, modes and coping strategies play no or a subordinate role. Schema therapy for this group of clients is relatively new, and therefore requires a more differentiated perpective and extension to the usual practice within Schema Therapy.


    In this Skills Class, typical schemas and modes in clients with ASD will be elaborated and a ASD-specific mode concept will be introduced. Typical hurdles within the ASD-specific treatment will be described, classified and solution paths will be discussed. For parents and other caregivers, schema therapy provides two starting points. On the one hand, the mode model offers a new framework for an understanding of ASD-specific problems including socio-emotional issues. On the other hand, the clients typical behavioural patterns can be better understood, classified, and, if necessary, modified in an appropriate, individual way. Finally, typical mode clashes between parental caregivers and ASD clients are discussed, completed by guidelines to support parents in strengthening their caring-and-guidance mode (Healthy Adult). This ASD-specific approach is highlighted by the dynamic interplay between warm and nurturing parenting on one side, and empathic confrontation on the other side.


    The schema therapeutic treatment of ASD clients requires a special consideration of the disorder-specific particular needs, accompanied by a mode- and schema-based treatment within CBT protocols that is supported by the system in which the client lives (e.g. family).

  • Focused schema therapy interventions for anxiety: A hands-on clinical training

    Offer Maurer
    Eshkol Rafaeli

    In a period of global crisis and unrest, the gap between the need for mental health treatments and their availability is wide and widening, leading to various efforts to create tailored, personalized solutions to help bridge this gap. But what should such personalization be based on? In recent decades, most research on treatment personalization has emphasized diagnostic categories and protocol-driven, diagnosis-specific care. In recent years, however, the limitations of this approach are increasingly recognized, along with the high prevalence of comorbidities, the utility of transdiagnostic work, and the use of unified protocols that are actually less personalized. Another approach that has gained momentum in recent years suggests that an effective way to improve treatment overall, and enable personalized care specifically, involves process-based therapy. In this approach, championed by Steven Hayes and Stefan Hofmann, leading figures in the second and third wave of CBT, the focus shifts from symptom-reduction to identifying and addressing the underlying processes whose disruption causes symptoms. While Hofmann and Hayes focus primarily on cognitive/behavioral processes of emotional regulation, process-based work can be expanded further to identify and address the array of processes underlying diverse emotional needs. To do so requires two things: (a) a clear lexicon of psychological needs, and (b) ideas for working with each of them. These and other topics will be the focus of this pre-conference. We will briefly review process-focused approaches in general, and then delve into a set of ideas and tools for process-focused work which brings schema therapy ideas into the realm of focused (and often brief and modular) interventions for anxiety and related disorders. We will provide an overview of this model, currently being researched jointly at Bar-Ilan University and UC Berkeley, and will devote the majority of the time to learning and practicing the therapeutic tools it provides.

  • Fine-tuning imagery rescripting: fostering and making use of the healthy adult mode

    Julie Krans
    Remco van der Wijngaart

    Imagery rescripting is nowadays regarded as an evidence-based technique for treating different disorders, such as PTSD, social anxiety disorder, and personality disorders (Morina et al., 2017, Kippe et al., 2023; Kroener et al., 2023). With imagery rescripting we aim to generate corrective emotional experiences in aversive memories/images in order to change negative encapsulated core beliefs. These corrective emotional experiences foster the Healthy Adult Mode, which is one of the main therapeutic goals in schema therapy. Conversely, the Healthy Adult Mode is also an important element that can be used to empower and fine-tune in imagery rescripting sessions. First, a powerful mental image of the Healthy Adult can be a helpful tool for when the patient is ready to start rescripting themselves. Second, in future oriented imagery, the Healthy Adult mode can be drawn upon to help prepare for schema activating events that may still occur, as future oriented imagery has been shown to motivate behavior as well (Libby et al., 2007). However, there are challenges for each use of the Healthy Adult mode in imagery rescripting and we will tackle them in this workshop. For example, it is not always easy to form a powerful mental representation of the Healthy Adult. Second, there are challenges when the patient starts rescripting themselves in which the Healthy Adult mode can play a role. Third, future oriented imagery at the end of treatment has its own specific challenges, as we assume that the client more and more ‘becomes’ a Healthy Adult overall. Should we ask the patient to keep an observer perspective, or should we ask the patient be the Healthy Adult? Should we focus on emotional experiences or behavioral change? Lastly, sometimes therapists themselves can get triggered during sessions too. Having an own empowering Healthy Adult image may benefit your clinical skills!

  • Enhancing Schema Therapy: Cultivating the Healthy Adult Mode

    Poul Perris

    At the core of Schema Therapy lies the concept of the Healthy Adult Mode, a critical element in fostering our client’s journey towards healing and self-discovery. As schema therapists, we not only aim to heal clients’ maladaptive schemas through the process of limited reparenting but also model for clients how to develop an extensive self-reflective capacity. This process of adaptive reparenting offers an emotional corrective experience within the therapeutic relationship, which in turn teaches clients to become aware of their thoughts, feelings and behaviors, guiding them towards the integration of their various modes and the healthy expressions of emotions, needs and wants.

    The Healthy Adult Mode is more than just a single, fixed state; it is a dynamic collection of interrelated sub-modes that characterize a mature individual’s adaptive responses to life’s situations. Recognizing this, the ISST’s Case Conceptualization Committee has undertaken a comprehensive revision of the Case Conceptualization form, to be released in 2023. This revised form includes a detailed evaluation of the Healthy Adult Mode, prompting therapists to appraise eight particular capacities:

    · Meta Awareness
    · Emotional Connectedness
    · Reality Orientation
    · A Coherent sense of Self (Identity)
    · Self-Assertiveness & Reciprocity
    · Agency & Responsibility
    · Caring Beyond Self
    · Hope & Meaning

    These capacities, while not an exhaustive list, have been identified for their clinical relevance and support within the broader psychological literature as key aspects of mature psychological functioning.

    The workshop is dedicated to a thorough exploration of each capacity. The presenter will offer detailed discussions and clinical examples to illuminate how each capacity can be cultivated and reinforced in therapy.

  • All you need is: Tough love to live your life fully in a healthy state.

    Jenny Broersen
    Michiel van Vreeswijk

    Sometimes you get stuck in schema therapy. Patients understand their schemas and modes and what they should do to change, but seem not to dare their life at the fullest. Patients who seem to undermine their progress in becoming more resilient. Almost clinging to maladaptive modes every time there is a chance to change. Trying to tackle all the different schemas and modes individually has not been successful and seem to lead to desperateness. When you are at this point in schema therapy it is time to change strategy. To throw overboard all the separate schemas and modes and focus solely on the Undermining mode (with all it different colours). In this workshop we demonstrate a form of chair technique in which the client and the patient surpass the Undermining mode and actively work on creating a working alliance between the Healthy adult and Vulnerable child of the patient using though love as a limited reparenting style.

  • Trauma map to enhance schema conceptualisation

    Christopher Lee


    According to schema theory, the key to schema change is to understand the origins of an early maladaptive schema and reprocess core memories where important developmental needs were not met. Similarly maladaptive modes are considered to have developed from adverse experiences. The presentation will focus on describing how schema theory and trauma information processing models can help clinicians identify the critical details of each of these core memories. Participants will then be shown how this model can be used to create a schema map, which is a visual representation of how these core experiences are linked and how they relate to a client’s symptoms. Schema maps were central in the formulation process of treating clients in the IREM and in the current IREM-freq studies. In these studies adults with PTSD from childhood were treated with either imagery rescripting IR or EMDR.


    Participants will watch a demonstration and then practise using the trauma map in the workshop using their own client experiences. In the original IREM study, 155 clients from 3 countries received either IR or EMDR. In this RCT people were treated for 12 1.5-hour sessions in 6-8 weeks. The average age of the participants was 38 and the average age of the main identified trauma was 8. 25% of partcipants reported experiencing over 1000 traumas


    In the IREM study, both treatments resulted in large and significant reduction in PTSD and other symptom measures. For example, 81% of participants no longer met criteria for PTSD one year after completing therapy.


    The schema map, which was designed to improve schema conceptualisation for various conditions, has a number of advantages as a formulation tool. These include that it is an associative based technique (therefore more emotional), it increases activation of memory network which promotes generalisation, it helps extract key components from each core memory, it provides psychological distance while doing a trauma history and it facilitates client insights on how experiences shaped beliefs, feelings and behaviours. In a study of clients with chronic difficulties, it was found to be well tolerated (only 7% treatment dropout) and the subsequent treatments were found to have very large effect sizes.

  • Real Pain or Mind Game? Unraveling Complex Somatic Disorders with Schema Therapy

    Marsha Blank
    Khrystina Zhyvaho

    Research shows early relational trauma raises the risk for somatic disorders like GI issues, autoimmune illnesses, skin conditions and chronic pain, This workshop explores schema therapy’s potential for treating such complex conditions.

    We will present a case study of a client whose IBS was alleviated using schema therapy interventions. Attendees will learn how schemas manifest physically and their commonly associated modes. Through lecture, experiential exercises and a detailed client illustration, participants will grasp how schemas and modes impact illness and pain.

    Skills covered include assessing somatic modes, chairwork, movement to access embodied emotions and rescripting to transform maladaptive body memories. Participants will gain concrete techniques for schema based treatment

  • Treating the Core of Compulsive Sexuality: Schema Therapy Solutions for Attachment-Based Hypersexuality

    Liz Lacy

    Hypersexual disorders are challenging conditions involving excessive, compulsive sexual thoughts, feelings, and behaviors that create significant personal distress and impair real intimacy. This experiential workshop will present an attachment-based developmental model for understanding and treating the root causes of hypersexuality using schema therapy. Through lecture, demonstrations, and interactive exercises, participants will learn how schema therapy works to transform maladaptive schemas and modes and meet unmet childhood attachment needs that drive hypersexual coping. Case examples will illustrate schema therapy strategies including limited reparenting, empathic confrontation, chairwork, and mode work to help heal early relational trauma. Participants will have opportunities to practice schema therapy techniques for addressing client attachment wounds and transforming engrained hypersexual modes. Attendees will be prepared to apply many effective interventions in this innovative attachment-focused model designed to heal the core psychological and emotional drivers of compulsive sexual behaviors.

  • What are the scripts we target in rescripting and how do they relate to schemas and modes?

    Schema therapists use imagery rescripting, to help clients to change their existing scripts. The concept of script has a long history outside psychology, in the theatre, and in information theory. Within academic psychology it was explored in the extensive work of Silvan Tomkins (1911-1991) and, in psychotherapy, in the work of Eric Berne (1910-1970) and those who further developed Transactional Analysis after his death. In this workshop we will examine what scripts are and how they relate to the foundational concepts in schema therapy: Early Maladaptive Schemas and Schema Modes. An understanding of scripts gives us insight into the personal meanings associated with schema modes. Once in place, scripts tend to run automatically with limited control from self-awareness. Uncovering script patterns, and understanding their nature and content, provides a foundation for working strategically towards helping clients change scripts that contribute to ways of experiencing and behaving that are limiting, harmful and self-defeating. All schema modes have scripts. Primary Child (Vulnerable, Angry) modes have, at their centre, a primary distressing emotional state such as sadness, abandonment, shame, anger. These have scripts that capture the meaning and action tendency of the primary emotion. Authentic Child modes have implicit action scripts for creativity and personal development. The scripts of Parent modes are messages directed at the child that were explicitly put into words or implicitly conveyed through the parent’s nonverbal behaviour. It is a standard practice for therapists to do a rescript to protect a Child from these kinds of harmful influences. However, this can have limited impact because the Parent messages, in turn, have their source in the scripts of the parent who sent them. These may themselves be complex coping scripts that incorporate family and cultural patterns that are intergenerational. To fully free the Child from the grip of the parent, these intergenerational scripts may need to be understood and addressed. Coping modes have scripts related to how they are set up to help individuals cope with adversity. Typically, these scripts were set up in childhood, often early childhood or even infancy. We work with these by helping clients see how they often emerged in a family context very different from the one in which the individual lives now, but they still run in the same way. This can help clients make a new decision from the Healthy Adult about how to cope differently in the present. The aim of this workshop is to show how a fuller understanding of the script of each mode provides us with a stronger toolkit for rescripting. This, helps to strengthen the Healthy Adult, which we can think of as a metascript, or set of metascripts, which equate with what has traditionally been called “wisdom.” This kind of script analysis will be illustrated with clinical examples, and participants will have the opportunity to do practical exercises in relation to themselves or their own cases using the perspectives being presented.

  • ST for addiction and personality disorders: stages, processes and techniques

    Klaartje van Hest
    Melissa van Rekom
    Suzanne Florissen
    Michiel Boog


    ST holds promise for the treatment of addiction and personality disorders. Based on research findings and clinical experience, the presenters founded a day treatment centre for addictions and personality disorders in Rotterdam, the Netherlands. In this centre, an integrated treatment is offered to patients suffering from various addictions and longstanding personality problems (personality disorders and other clinical disorders that are not responding to first-choice treatment). In the present workshop, the presenters will present some theoretical background on (the treatment of) this co-morbidity. Further, information will be shared on the treatment program, the different stages of the treatment and the processes that are involved. However, most of the available time will be spent on practicing techniques and interventions used in the integrated treatment. The workshop will be interactive, so participants can experience the different techniques themselves.

    Method: -short presentations -demo of combining Motivational Interviewing and mode work (including video) -happy child exercises with all participants -group demo: mode model -group demo with protective modes: ‘breaking the wall’

    Result/conclusions After this workshop, participants will have gained more insight regarding the integrated treatment of addictions and comorbid personality disorders. Further, they will have learned some specific (group) ST techniques addressing this comorbidity.

    Literature Ball, S. A., Maccarelli, L. M., LaPaglia, D. M., & Ostrowski, M. J. (2011). Randomized trial of dual-focused versus single-focused individual therapy for personality disorders and substance dependence. The Journal of nervous and mental disease, 199(5), 319. Boog, M., Dugonjic, H., Arntz, A., Goudriaan, A. E., Wetering, B. J. V., & Franken, I. H. (2022). Borderline personality disorder with versus without alcohol use disorder: Comparing impulsivity and schema modes. Journal of Personality Disorders, 36(1), 1-18. Boog, M., Van Hest, K. M., Drescher, T., Verschuur, M. J., & Franken, I. H. (2018). Schema modes and personality disorder symptoms in alcohol-dependent and cocaine-dependent patients. European Addiction Research, 24(5), 226-233. Van Den Bosch, L. M., & Verheul, R. (2007). Patients with addiction and personality disorder: Treatment outcomes and clinical implications. Current Opinion in Psychiatry, 20(1), 67-71.

  • Chairwork for patients with Obsessive Compulsive Personality Disorder Generating corrective emotional experiences when dealing with strong coping modes

    Hannie van Genderen
    Remco van der Wijngaart

    The essential goal in schema therapy is to validate unmet needs in our patients by creating corrective emotional experiences. Changes in Child modes and the Healthy Adult mode are the best predictors for therapy success (Yakin et al.,2020), and unmet needs are best felt when the client is in the Vulnerable Child mode. Therefore, in schema therapy the aim in every session is to connect with this emotional side of the client. Many clients, however, have developed coping modes that make it difficult for both the client and the therapist to connect to the Vulnerable Child mode or Healthy Adult of the patient. This is also strongly the case for patients with Obsessive Compulsive Personality Disorder (OCPD) who struggle with rigid and persistent Coping modes, especially the rational and intellectual Perfectionistic Overcontroller.

    Chairwork is considered an effective technique to help the therapist bypass coping modes and connect to the Vulnerable Child modes (Krans & van der Wijngaart, 2022). Yet, applying this technique effectively can be very challenging in the face of extremely rigid and persistent Coping modes. For example, patients with OCPD may find it extremely difficult not to speak from the Perfectionistic Overcontroller mode even when sitting on the chair of the Vulnerable Child. How can we help these patients to connect to their emotional sides? And even if you are successful, how do you create a corrective emotional experience when your patient sees these emotions as uncomfortable, distracting and unproductive? This workshop offers specific methods and techniques to create corrective emotional experiences with patients who have extreme difficulties in connecting to their emotional sides, which is so crucial for healthy change in schema therapy.

  • Association between Resilience and Positive and Negative Schemas using the Good Enough Parenting Model

    John Louis

    Families and society in general face enormous burdens arising from children with problematic behaviours. Fortunately, studies have shown the benefits of parenting interventions that are able to reduce such behaviour (Bonin et al., 2011; Herman et al., 2015;; O’Neill et al., 2013). Given these benefits, it is hugely advantageous to explore ways to educate parents and help them take balanced and holistic preventative measures. An evidenced based early intervention parenting program called “Good Enough Parenting” (GEP; Louis & Louis, 2020), which incorporates schema therapy principles, has been developed to equip parents with step by step guide on how to meet core emotional needs in children. The deprivation of core emotional needs is theorized in schema therapy to be associated with the development of rigid, active negative schemas. Conversely, meeting these needs are associated with the development of positive schemas. To-date, GEP is the only evidenced based parenting program (Louis et al., 2021; Louis & Louis, 2020) with a dual focus on both the positive and negative schemas plus core emotional needs. Positive schemas have been found to be associated with resilience both directly and indirectly (Chi et al., 2022) whereas negative schemas especially vulnerability and dependence have been found to be negatively associated with resilience (Faraji et al., 2022). The three psychometrically validated instruments developed by the presenter – The Young Positive Schema Questionnaire (Louis et al., 2018a), The Positive Parenting Schema Inventory (Louis et al., 2018b), and the latest version of the Young Parenting Inventory – R3 (Louis et al., 2022) measure positive schemas, and positive and negative parent-child interactions respectively; these will be discussed in full. This session will position clinicians and parents to better implement preventative measures, especially targeting early years in children as this has shown to provide the greatest benefits (Heckman, 2013).

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