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FRIDAY MORNING CASE PRESENTATION 2 (F1CP2): 10.45 AM - 12.15 PM

Schema Therapy DreamWork for Complex Trauma

by Samantha Flores Reynoso, and Maira Tiscornia Fortunato



General Overview

Background
Mexican female, 28 years old, moderate level of functioning. Psychologist. Catholic

Diagnoses: Posttraumatic stress disorder (due to complex trauma)
Generalized anxiety disorder
Panic disorder with agoraphobia
Avoidant Personality disorder

Current mayor problems
Problem 1: Dificulty establishing intimate relationships
Life pattern: Avoids intimate contact specially with men. Has had several “love” relationships in which she doesn´t allow the partner to get closet o her. Avoids sexual relationships. Is afraid of being abused.

Problem 2: Anxiety, low self eficacy related to self protection
Life pattern: Develops panic attacks when she feels in danger specially in relation to going out late, meeting people, getting to know others, being stupid, inferior and not knowing how to protect herself from others.

Problem 3: Subjugation
Life patterns: pleases others to avoid being abandoned, or abused. She offers herself to do things for other even when not being asked for. Impossible for her to say no.

Problem 4:
Sleeping problems, continuous nightmares related to being injured, abused, being in danger and not knowing how to protect herself and not having someone to care and protect her.

Developmental origins
Mother subjugated and extremelly critical, emotionally inhibited. Very catholic
Father aisolated from the family, gets in touch occasionally, overworks
7th out of 7 children. Being the youngest, one of her sisters was in charge of taking care of her.
Suffered ADHD since early life, didn´t receive treatment but was stigmatized.

Core childhood memories and images
Being sexually abused by one of her brothers who later became a priest
Being ignored by the mother who spent a lot of time in church
Being afraid of men and mother being critical of that
Mother forcing her to serve others as religion states
Being rejected and criticized at school. Feeling lonely and defective
Being kidnapped and held hostage by a man who raped her
Being robbed, by handgun
Mother blaming her for all the above
Sister who cared for her, died in a car accident

Unmet core needs
Being loved, cared for, protection, feeling accepted and valuable.
Secure attachment, freedom to express valid needs and emotions
Safety and protection

Most relevant schemas related to origins and coping styles
Emotional deprivation: wasn´t cared for, wasn´t protected, nobody emphatized with her emotions nor her needs. She surrenders by not allowing other to care for her. And over-compensates in her profession.
Defectiveness/shame: suffered bullying at school and at home. Was sexually abused by brother and held responsible for that. Surrenders to it every time someone talks about mistakes, she avoids being met, showing others who she is and overcompensates being a perfect psychologist
Mistrust/abuse: suffered bullying at school and at home. Was sexually abused by brother and held responsible for that. Has been kidnapped, raped and robbed.
Social isolation: Rejected by school peers, felt different to rest of the family for what had happened to her. She avoids by not letting others get closet o her, she surrenders by letting others abuse her.
Subjugation: she was forced to do so by the brother. Always saw mom being subjugated to others too to avoid problems and mother forced her to subjugate to almost everybody. Now she surrenders almost all of the time.
Unrelenting standards: she coped being the perfect daughter, the perfect sister, and the perfect student at school. Now she completely surrenders to it by being the perfect psychologist.
Punishment: She was punished by several members of the family and always held responsible for what had happened to her. She now thinks she deserves punishment for Little mistakes and has difficulty forgiving others even if she surrenders to them.

Current schema triggers:
Being close to men
Being rejected or criticized
Being told about religion, forgiveness and the church
Whenever someone needs something she thinks she can help with
Working with sexually abused clients

Relevant schema modes
Abandoned child
Uncared/unloved child child
Lonely child
Fearful child
Defective child
Demanding and punitive parent
Guilt inducing parent
Subjugating parent
Compliant surrender
Self agrandizer
Perfectionistic overcontroller
Avoidant protector

Possible temperamental factors
Anxious temperament
Introvert

Therapy relationship
Good

Treatment
Focuses on mode work and working with dreams to change the messages she got from all the trauma she has suffered. Dreamwork has being an emphasis of the work and has served to assess and modify cognitions, sensations, emotions and even behavior.

Discussant  1

Presenter: Chiara-Simenone DiFrancesco

Level of ISST Membership? (Full, Associates, Honorary, Supporter) Full Memeber

ISST Certification Level? (Standard, Advanced) Advanced

ISST Certification Area? (individuals, couples, group, children & adolescents, forensic, auxiliary) Individuals & Couples

Discussant 2 

Presenters: Astrid Ingham Brooke

Level of ISST Membership? (Full, Associates, Honorary, Supporter) Full Member

ISST Certification Level? (Standard, Advanced) Advanced

ISST Certification Area? (individuals, couples, group, children & adolescents, forensic, auxiliary) Individual


About the Presenters:

Samantha Flores Reynoso:

Samantha Flores is a physician specialized in neuropsychiatry. She has a Master´s Degree in Cognitive Behavioral Therapy and she is a certified advanced schema therapist who who took the certification course in the New Jersey Schema Therapy Institute. 

She currently runs a private practice in psychiatry and psychotherapy. She works with a variety of diagnoses of psychiatric  and neuropsychiatric patients through medication and psychotherapy. She has a special interest in patients who suffer functional neurologic disorders and patients with chronic mental illness as well as personality disorders. She also teaches psychopharmacology to psychology students at the Universidad Autonoma de Guadalajara.


Maira Tiscornia Fortunato:

coming soon


       


Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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