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Reinventing the Therapeutic Relationship in Supervision

by Zsolt Unoka

We aim to introduce a supervision technique that targets problematic interaction sequences in the therapeutic relationship. The aim of the workshop is to help supervisees gain a better understanding of the complex interaction patterns between their and their patients’ schema modes, by the group dramatizing and acting out the modes. Participants acting out the interaction sequences of the therapist's and the patient's child, critical parent, and coping modes will share reflections which will contribute to the supervisee’s comprehension of the processes that characterize the regulation of the therapeutic relationship. They will also gain new insights by actively participating in the schema mode role play technique.

Teaching Methods:

We start with a short theoretical summary of the schema mode theory. As often limited reparenting is impaired by the therapist having received unhelpful messages from professional/institutional "figures" we have extended on the mode theory and included the critical supervisor role (as part of the critical parent mode). We will also focus on the healthy adult therapist mode and give examples of the typical schema mode interaction sequences between patient and therapist. After the powerpoint presentation, we will present our schema mode drama supervision model by doing a role-play demonstration with the group's participation. The aim of the role -play is to help supervisees with the following: Mode awareness: identifying different modes and sequences of their own and their patient's mode flips and the interaction between these modes. Group members will dramatize and act out the supervisee's and therapist's modes. The supervisee -whose "internal world" is acted out - will be observing the group work. This - rather than actively participating - will improve her mode awareness and self-reflection capacity.
Mode managements: the supervisor and other members of the supervision group share their experiences and ideas about the roles they acted. This will help the supervisee understand her patient's core needs and reach the patient's child modes. It will also be very helpful in rearranging the therapist's maladaptive coping modes and strengthening the healthy adult therapist mode, replacing internalized punitive messages with Good parent /supervisor, etc. messages and empathizing with their own child modes and core needs. Behavior pattern breaking: Finally, the group will create and act out a new patient-therapist mode interaction sequence where the Healthy adult therapist behaves more adaptively than in the original situation.

This method will allow participants to gain new insight into the interaction of the moment-to-moment mode-flips in the therapeutic relationship. The dramatization of the interaction process helps participants restructure the rapidly changing therapeutic relationship if needed and to understand needs, copings, internalized parental/professional/institutional others that may block effective therapeutic work. The advantage of the group format is that group members have a chance to contribute by sharing what they experienced when in a mode role. In addition, the group setting also allows participants to gain more schema mode awareness, self-reflection, and practice schema mode management. Based on previous feedback, we can say that the group schema mode drama supervision helps the therapist develop a very accurate representation of patient-therapist schema mode interaction. It also makes it possible for therapists to be simultaneously aware of their own and their patient's needs, child modes, coping, and critical modes.

Learning Objectives:

To identify intrapersonal and interpersonal obstacles of limited reparenting.

To gain new insight into the interaction of the moment-to-moment mode-flips in the therapeutic relationship.

To develop the mode awareness of both the patient's and the therapist's modes.

To practice schema mode drama techniques.

To reflect on the relationship difficulties in schema therapy

Workshop Intended For:


Relevant Background Readings on Topic:

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press. Chapter 6. The therapy relationship Joan M. Farrell, Ida A. Shaw (2018). Experiencing Schema Therapy from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Self-Practice/Self-Reflection Guides for Psychotherapists) Workbook Edition. The Guilford Press.

About the Presenter:

Zsolt Unoka

Zsolt Unoka, M.D., Ph.D., psychiatrist, psychoanalyst, CBT and schema therapist, an associate professor, the head of the Psychotherapy ward, and deputy director at the Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.

He is providing inpatient group cognitive/schema therapy for over ten years. He is an Advanced Level ISST Certified Trainer/Supervisor in individual ST. He recently started to provide an inpatient, group schema therapy program at Semmelweis University. He is the Educational Director of the Hungarian Association of Cognitive, Behavior and Schema Therapy. He has published several research articles, book chapters, on Schema Therapy and Borderline Personality Disorder.

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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