Poul Perris, MD, Licensed Psychotherapist and Supervisor, is the Director of the Swedish Institute for CBT & Schema Therapy in Stockholm, Sweden. He is the Founding President of ISST (2008 – 2010), and served as President of the Swedish Association for Cognitive Behavioral Therapies (SABCT) from 2010 to 2016. Poul was originally trained by Dr. Jeffrey Young in Schema Therapy and is certified as an advanced level schema therapist, supervisor & trainer for individuals and couples. He specializes in the treatment of personality disorders, and on couples therapy for complex relational problems. Poul has published a handbook on Schema Therapy (in Swedish), and also co-authored several chapters in English textbooks on schema therapy. Poul has been teaching and supervising therapists internationally for over a decade.
Does the Healthy Adult Need a Guiding Spirit? – Navigating Emotional Storms.
In today’s fractious landscape, the role of the Healthy Adult takes on heightened significance. This keynote posits that Healthy Adult capacities must be underpinned by a set of guiding principles that not only meet core emotional needs but also honor the sacred balance between the individual and the collective. Deliberately echoing religious motifs, the “Democratic Trinity” model is introduced not in a religious sense but as a metaphor for principles to be revered and enacted in all our dealings. This spiritual dimension represents the soul of the Healthy Adult, offering a compass through the storms of emotional turmoil and conflict. The Democratic Trinity model elucidates the principles of universal equality and individual freedom under equal conditions. To bring these principles to life in actions, an individual must adopt a stance characterized by authentic presence and an emotionally integrated belief system that ignites a democratic impulse during interpersonal engagements and emotionally charged responses. This stance becomes the guiding spirit the informs the Healthy Adult mode, ensuring that democratic principles are deeply internalized, shaping not just a truly democratic society but also the individual’s own authentic way of being. The presentation will illuminate how schema theory transcends its therapeutic model to also conceptualize relational processes across all strata – from intrapsychic and interpersonal to group and societal levels. This holistic lens affords a multidimensional understanding of the ways individual and collective experiences intersect and inform each other.
Enhancing Schema Therapy: Cultivating the Healthy Adult Mode
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.
Conceptualizing and assessing the Healthy Adult within the context of schema therapy practice
Co-presented with David Edwards, George Lockwood, Tijana Mirovic
This panel discussion will focus on conceptual and practical aspects of the process of assessing a client’s healthy adult functioning in preparation for schema therapy. The Healthy Adult is best thought of as not a single mode, but a suite of healthy capacities or strengths that, when viewed together, characterize how a psychologically mature adult would think, feel and behave towards self and others. The ISST’s 2024 Case Conceptualization Form provides a framework for conceptualizing the Healthy Adult Mode with considerable breadth and depth, using eight broad categories.
David Edwards will discuss how these categories were arrived at. The nature of mature human functioning has always been of interest and concern within psychology and contributions will be reviewed from Alfred Adler’s community feeling, Carl Roger’s fully functioning person, Abraham Maslow’s self-actualizing personality, and those who have drawn on the traditional concept of wisdom as elaborated, for example, in the Berlin wisdom paradigm of Baltes, Linden and others. Within schema therapy, these perspectives are the foundation of Bernstein’s 16 qualities of the Healthy Adult portrayed in a set of illustrated iModes cards. More recently, the DSM-5 and ICD-11 diagnostic systems, in moving away from classifying personality disorders using a limited set of categories, have identified a range of dimensions of mature and healthy functioning which, taken together, offer a view of mature human functioning which is comprehensive, and evidence-based, and does justice to the complexity of human personality.
The eight categories for evaluating the Healthy Adult in the latest ISST case conceptualization form offer an attempt to synthesize these capacities into a manageable form for assessment of the Healthy Adult in clients along dimensions that are clinically relevant in that they directly impact case conceptualization and the effectiveness of therapy interventions.
On the basis of this, Poul Perris will describe a clinical tool for assessing these capacities: “My Healthy Adult Capacities in a specific Life Area/Relationship.” It is based on eight different statements relating to each of the eight categories from the case conceptualization form (64 in all). Based on a development process in which feedback was provided by clients and therapists, he will offer practical guidelines on how to implement this in clinical practice, both in the initial assessment process, and more generally, when conceptualizing the challenges presented by clients whose therapy does not proceed smoothly.
George Lockwood will draw on his experience in contributing to the development of the Positive Parenting Schema Inventory (PPSI) and the Young Positive Schema Questionnaire (YPSQ) and his clinical use of the PPSI, YPSQ and the International Personality Item Pool-NEO in the case conceptualization process to comment further on this discussion and to highlight the practical aspects of evaluating healthy adult functioning within the schema therapy process.
Tijana Mirovic will act as discussant, presenting her reaction to the material presented with a focus on the practical implications and challenges for trainers and supervisors.
Assessing partner responsiveness to disconnection and rejection: A new schema therapy-informed measure for couples research and practice.
In adulthood, romantic partners are considered to be a person’s primary attachment figure. Therefore, the relationship that one develops with a romantic partner in adulthood represents an important relational context within which schema-congruent and schema-incongruent experiences can occur. Of particular interest is the extent to which romantic partners can help to mitigate or attenuate an individual’s activation and perpetuation of early maladaptive schemas (EMSs) within the domain considered critical to secure attachment bonds – the disconnection and rejection domain (i.e., schemas of abandonment, mistrust abuse, emotional deprivation, social isolation, and defectiveness shame).
However, it remains unclear as to the relationship behaviours that romantic partners engage in that can attenuate the activation of their partner’s EMSs within the disconnection and rejection domain. Indeed, there exists no research that has specifically examined the types of behavioral responses rendered by partners that can address EMS activation. The reasons for this lack of research are varied, but a primary reason relates to issues around assessment. To date there is no measure that evaluates the specific partner behaviours that reflect responses that can soothe or mitigate activation of EMSs. This presentation addresses this gap by reporting on the development and psychometric evaluation of a novel self-report measure of partner behaviours that can help to mitigate or attenuate EMSs in the disconnection rejection domain.
. A large (N~800) general community sample of adults currently in a romantic relationship will complete an online survey. Participants are administered items comprising the partner behaviours measure as well as widely validated measures to examine the convergent and divergent validity of the new measure. These assessments include adult attachment styles, loneliness, partner conflict, partner support and responsiveness, partner relationship quality, sexual satisfaction, and items from the disconnection rejection domain of the YSQ-S3. Confirmatory Factor Analysis will be used to evaluate the structural validity of the newly developed measure. Correlation analyses will be used to evaluate the convergent and divergent validity of the measure.
Results and Conclusions
. It is anticipated that this study will provide a psychometrically sound new measure that can be used by clinicians and researchers to evaluate the extent to which a romantic partner engages in behaviour that can attenuate a variety of EMSs associated with the disconnection/rejection schema domain and thereby meet a person’s need to experience a stable, nurturing and secure romantic attachment.