"is avoidant personality disorder CHARACTERIZED by stability or instability? a study of mode fluctuation in the course of schema therapy sessions"
hot topic by ofer peled & eshkol rafaeli
APD is among the most prevalent personality disorders, but has received little empirical attention. This study characterize mode change patterns among APD clients in the course of ST. A newly-developed client mode rating scale was used to code every 5-minute segment of 60 ST sessions from 15 clients. The avoidant/detached mode was present in 3/4 of segments and was the most intense and fluctuating mode. Its great fluctuation implies that therapists can crack this coping mode and gain access to the clients' emotional needs. The over-compensator & compliant-surrenderer modes were less prominent (present only in 1/3 of segments); this implies that therapists can primarily focus on overcoming avoidance & detachment, implementing strategies for overcoming dependence or self-absorption less frequently. The vulnerable child mode was present in more than half of segments and was the second most intense and unstable mode. The presence of this mode provides a possible access point for corrective therapeutic experiences, but its instability may block the chances for healing emotional pain. The dysfunctional parent mode was present in less than 1/2 of segments, but was the third most intense and unstable mode. In contrast, the healthy adult mode, present in 1/3 of segments, was by far the most stable. It seems that APD clients were more prone to self-punitive criticism than to self-compassion. This study offers 4 innovations: (a) It documents the considerable instability of APD, using mean-square-successive-difference (MSSD) scores; (b) It offers rich data on the mode-based description of APD and its possible implications for intervention; (c) It demonstrates the utility of the mode concept as a lexicon for capturing personality states and their instability; and (d) It illustrates the use of in-session segment-by-segment ratings to assess client change within psychotherapy.
Eshkol Rafaeli, Bar Ilan University, Ramat Gan, Israel
©2019 International Society of Schema Therapy e.V.
International Society of Schema Therapy e.V. is a not-for-profit organization. Glossop-Ring 35, DE-61118 Bad Vilbel, Germany
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.