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Beyond Empathy:  The Therapeutic Relationship in Forensic Schema Therapy

by David Bernstein, Truus Kersten & Bernardo van Doren


Most therapists are taught that empathy is the foundation of a therapeutic relationship.  But what if the patient is indifferent to, or rejects, our attempts to empathize with him?  This is frequently the case in working with forensic patients, where mistrust of therapists and the institutions where they work can be extreme.  In Forensic Schema Therapy, limited reparenting focuses on two seemingly opposite emotional needs: attachment and limit setting.  Warmth, availability, and empathy, while essential, are not enough.  They must be combined with firm, fair, and non-punitive limits to counter patients’ transgressive crossing of boundaries.  Moreover, to counter the patient’s mistrust, the therapy relationship must be grounded in authenticity.  Finally, we use a form of motivational interviewing which incorporates schema modes to overcome the many obstacles that patients place in the way of treatment.  The methods that we have developed appear to be effective for many forensic patients, as supported by our recent randomized clinical trial supporting the effectiveness of Forensic Schema Therapy.  Our approach to the therapy relationship can be applied to any patient, forensic or non-forensic, in which attachment difficulties, boundary violations, and motivational issues are central.

About the Presenters:

David Bernstein

Dr. David Bernstein is a Clinical Psychologist (PhD, New York University, 1990) and Associate Professor of Psychology at Maastricht University in the Netherlands, where he has served as Professor of Forensic Psychotherapy (endowed chair, 2010-2018), and Chair of the Section on Forensic Psychology(2010-2015). He is a former President of the Association for Research on Personality Disorders (2001-2005) and Vice-President of the International Society for the Study of Personality Disorders (2003-2007). He was also Vice-President of the International Society of Schema Therapy(2010-2012) and is an Advanced Level Schema Therapist and Schema Therapy Supervisor. He is the author or coauthor of more than 120publications on psychotherapy, personality disorders, forensic psychology, childhood trauma, and addictions. He is the coauthor of Schema Therapy: Distinctive Features with Eshkol Rafaeli and Jeffrey Young and the DVD series, Schema Therapy: Working with Modes, with Remco van der Wijngaart. He is also the author of the Childhood Trauma Questionnaire, a reliable and valid self-report questionnaire for child abuse and neglect, used worldwide. He is the creator of the iModes, a cartoon-based system for working with schema modes (www.i-Modes.com), and the founder of SafePath Solutions, a team-based program for adults and youth with personality disorders, aggression, and addiction (www.SafePath-Solutions.com). He was the Principal Investigator on a recently completed randomized clinical trial of Schema Therapy for forensic patients with personality disorders in the Netherlands.

Truus Kersten

Dr. Truus Kersten works as a Psychotherapist at De Rooyse Wissel Forensic Psychiatric Center in Venray in the Netherlands. She also works as a self-employed Supervisor and Trainer in CBT and ST. She is certified Supervisor and Trainer of the Dutch Schema Therapy Association and of the International Society of Schema Therapy (ISST). 

She is the leader of the Dutch Schema Therapy Training Program for therapists in Addiction and Forensic Care. She developed this training program together with David Bernstein.

She also gave international workshops on ST, especially on working with forensic modes and addiction. She did workshops in the UK, organized by Vartouhi Ohanian (Schema Therapy UK), in Australia, organized by Chris Hayes, and in Italy, organized by Melania Lugli.

She also specialized in implementing ST in (forensic) psychiatric clinics, in training and coaching psychiatric nurses on the wards. Furthermore she has developed an integrated treatment for patients with personality disorders and addiction, based on the Schema Mode model.

She participated as a Schema Therapist in the randomized clinical trial of Schema Therapy for forensic patients. Her special interest and expertise is in treating psychopathic and addicted patients with Schema Therapy.

She has written national and some international publications on the treatment of addictions and on treatment of PDs with ST. She is co-author, with David Bernstein, of the forthcoming book: Treating aggression, addiction, and Personality Disorders: A Schema-Focused approach to complex, Antisocial patients.

See also: https://www.akkerdistel.nl/english-version/

Bernardo van Doren

Experience Expert Bernardo van Doren is a former forensic patient who speaks to groups such as professionals, students, detainees, and youth.  He shares his experiences in Schema Therapy, his past and his recovery, including its challenges and successes.  He has been living in the community for ten years, working and living with his partner, and his daughter and stepdaughter.

Email: Bernardo_ExperienceExpert@hotmail.com

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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