- Watch a "Sneak Peak" of the symposium in an interview with Joan Farrell. Click: PREVIEW -

SUMMARY:

Over the last few years session limits for psychotherapy in public and private insurance mental health care have decreased. In Australia only 10 individual and 10 group sessions per year are government funded independent of diagnosis. Even in the Netherlands, where psychotherapy sessions were once unlimited, cuts and co-pays have been instituted. This situation has existed in the US for over 20 years with the spread of managed care. This symposium addresses the development and testing of time-limited schema therapy treatment programs combining group with a limited number of individual sessions to meet these limits. Schema therapy is generally seen as a long-term treatment, not considered an option with limits of 20-30 groups or 10-12 individual sessions. It has been questioned whether it is even safe to include the essential experiential work of ST in brief treatment. However, we have growing evidence that using the mode model and the power of Group ST shorter treatment can be safely and effectively implemented. This symposium brings together schema therapists from the US, Australia and the Netherlands working with time-limited ST treatment who will present the protocols they are testing and preliminary results for a variety of disorders including BPD, AvPD, mixed PD and Complex trauma in inpatient and outpatient setting. Farrell and Shaw will present a “foundation” group ST program of 20-30 sessions for trans-diagnostic use, review results from the RCT of 30 GST sessions for BPD and give highlights of studies being conducted worldwide. Younan and May will present the four-week GST program for complex trauma being tested in Australia with pilot results. Skewes and van Vreeswijk will present the protocol and pilot results for mixed PD. Jeff Young will be the discussant.

Chairpersons: Joan Farrell, Jeff Young 

1. A Relatively Brief Trans-diagnostic “Foundation Treatment Program of Schema Therapy” using the Mode Model and combinations of Group and individual sessions by Joan Farrell

This presentation describes a trans-diagnostic treatment protocol for “relatively brief” Schema Therapy (ST) using the mode model and its current use in research and clinical settings. This “Foundation ST” treatment program consists of 20-42 group and 6-12 individual sessions. It includes all essential elements of ST – limited reparenting and cognitive, experiential and behavioral mode work and is consistent with the ST model of Young (Young, Klosko, Weishaar, 2003). The protocol divides mode treatment into three components: Mode Awareness, Mode Management and Experiential Mode Work (Farrell, Shaw, Reiss, 2014). It balances the structure of a protocol or manual with the caveat of ST that the modes and needs present in clients are addressed. Handouts of sample sessions will be provided. The protocol’s use in different lengths for various diagnoses and settings will be described. Preliminary results from the studies implementing versions of the “Foundation ST” protocol internationally will be highlighted. A lengthened version serves as the protocol for the international multi-site trial of group schema therapy (GST), which is underway (Weitzler, Farrell, et al., 2015). An earlier version was the protocol tested in the randomized controlled trial evaluating 30 weekly sessions of GST for Borderline Personality Disorder (Farrell, Shaw & Webber, 2009), which demonstrated significant reductions in BPD and global psychiatric symptoms and improved global functioning compared to TAU. This trial was funded by the NIMH, which controls the majority of funding in the USA, only if we agreed to cut from 50 sessions to 30. We developed the “Foundation ST” program presented here to meet the limitations of treatment delivery and research funding in the USA and now in much of the world.

2. Group schema therapy for adults with complex trauma: A pilot study of a four-week inpatient program by Rita Younan

Introduction: Complex trauma results from exposure to prolonged and repeated trauma including childhood sexual abuse and domestic violence. The condition is characterised by emotion regulation difficulties, disturbances in relational capacities, alterations in attention and consciousness, negative belief systems, and somatic distress. The mode model is able to describe and explain these symptoms and their etiology in a userfriendly manner for patients, which facilitates engagement and retention.

Method: Adults aged between 18 and 70 with complex trauma participated in a four week group schema therapy inpatient program in a private psychiatric hospital. Participants completed 54 hours (36 ninety minute sessions) of group schema therapy adapted from Farrell and Shaw’s (2012) group schema therapy approach. The program involved participants learning to understand their symptoms using schema mode terms, learning emotion regulation and distress tolerance strategies and experiencing the limited reparenting and limited re-family effect of the group. Measures of psychiatric and trauma symptoms were collected before and after the intervention and a subset of participants completed semi-structured interviews at the end of the program.

Results: Preliminary results will be presented including changes in outcome measures over the course of the program. Findings indicate that the program shows promise in reducing the symptoms associated with developmental trauma. In addition, the process of implementing this program in an inpatient private hospital setting will be discussed.
Conclusion: Schema Therapy shows promise as an effective, relatively brief treatment for individuals with complex trauma in an inpatient setting.

Additional presenter: Tamara May.

3. A Pilot Study of Short Term Group Schema Therapy for Mixed Personality Disorder by Sally Skewes

Short-term group schema therapy provides an effective and practical solution to the increasing demands for increased accessibility to schema therapy through mental health care systems across the world. We explored the feasibility, acceptability, and preliminary effectiveness of short-term group schema therapy in a sample of eight participants with mixed personality disorders (with a predominant diagnosis of avoidant personality disorder) and high levels of co-morbidity. Treatment consists of 20 sessions, which included cognitive, behavioral and experiential strategies. Specific schema mode focused techniques were chosen for a diagnostically mixed group of personality disorder clients. To gain an understanding of participants' qualitative experience of participating in group schema therapy, a focus group was conducted at the end of treatment. The focus group provided participants with an opportunity to discuss their needs and experiences associated with participating in the schema therapy group. This presentation will share results from this qualitative interview and discuss implications for future groups and larger trials being run in this growing field.

Additional speakers: Michiel van Vreeswijk, Rachel Samson.