AIMS:

Patients with Cluster C Personality Disorders - avoidant, dependent and obsessive-compulsive PD’s - are often hard to recognize in clinical practice. They  can come into treatment for different reasons and through different pathways. 

In General Mental Health Care settings they regularly start with treatments for their anxiety and/or mood disorders. Only if this treatment doesn’t have the desired effect, they are being offered a PD treatment. 

Other pathways for cluster C-patients to come into treatment are through seeking help for their substance abuse in Addiction Care settings or when they are convicted for a crime, like for instance arson or a sex offence, they end up in a Forensic Care setting.

The common characteristic of Cluster C-personality disorders is that anxiety plays a central role in some way. The dysfunctional coping modes are developed to avoid feeling anxiety and the associated feelings of vulnerability. Their most prominent coping modes are the Avoidant Protector, Detached Protector, Compliant Surrender, Perfectionistic Overcontroller and Self-Aggrandizer (Arntz, 2012). 

But: in Cluster C-patients also another mode can be active which is not always obvious in first instance: the Self-Soother or Self-Stimulator. 

This workshop focusses on this mode, especially on the ‘hidden addictions’ we see in Cluster C-patients. 

We will illustrate which self-soothing and self-stimulating coping behavior patients use in order not to feel emotions: not only substance addictions, but also ‘behavioral addictions’, like cleaning the house, working, jogging, gambling, gaming, surfing on the internet, multitasking on smart phones, sex-addiction and so on.

This workshop aims at learning:

1. how to recognize the Self-Soother/Self-Stimulator in Cluster-C-patients, 
2. how to conceptualize the addictive behavior in terms of the Mode Conceptualization,
3. how to work with this mode, step-by-step, with a blend of CBT and ST techniques; giving psycho-education and motivate the patient to stop with the self-soothing behavior, contingency management, imagery and chair techniques to fight the parent modes and negotiate with the healthy adult mode about the Self-Soother/Self-Stimulator.

So we focus on how to overcome the Self-Soother and to bring the Cluster C-patient in closer  contact with his basic core needs and emotions and to stimulate him to fulfill these needs in a healthier way, express his emotions and thus be more connected to others. From addiction to connection!

Summary

In this workshop we start with an introduction on the Self-Soother Mode in cluster C PD. We talk about the specific characteristics of this mode and also focus on the differences with other avoidant coping modes. We explain how it can be observed in and outside the therapy session. We also give a short introduction on the core elements of evidence based addiction treatment (CBT) and suitable ST techniques.

We will argue that the Self-Soother can be a hidden mode, illustrated by case examples of Cluster C-patients in different treatment settings, such as General Mental Health, Addiction and Forensic settings. We will present different Mode Conceptualizations.

The practical part of the workshop consists of: 

1. A demonstration of a mode dialogue with the Self-Soother; here we will  focus on the specific pittfalls with cluster C patients that make them tend to avoid behavior change.
2. A demonstration how to make a step by step plan, in mutual agreement, to beat the addictive behavior. 
3. A roleplay exercise in which participants learn to work with the Self-Soother in dyads.
4. A video of a chair technique with an avoidant patient with hidden addictions, showing how he overcomes his fear of expressing anger to one of his parents

Learning objectives

The workshop participant will learn:

1. To be more aware of, and to recognize more easily the Self-Soother in Cluster C-patients.

2. How to explore this mode, conceptualize it in terms of the Mode model, motivate the patient to  change the self-soothing behavior/addiction, how to hold through with contingency management and relapse prevention.

3. How to use experiential ST techniques to reach the Vulnerable Child, and to learn to fulfill own emotional needs instead of self-soothing.

Arntz, A. (2012). Schema Therapy for Cluster C personality disorders. In: Van Vreeswijk, M., Broersen, J. & Nadort, M. (eds). The Wiley-Blackwell Handbook of Schema Therapy. Theory, research, and practice. Malden: Wiley-Blackwell. Pag. 397-414.

Brief biography

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

She is the leader of the Dutch Schema Therapy Training Program for Psychologists working in Addiction and Forensic Care. She developed the training program together with David Bernstein, who’s also coteacher. She also gives international workshops on ST, especially on working with forensic modes and addiction. She gave workshops in the UK, organized by Vartouhi Ohanian, Schema Therapy UK, and in Australia, organized by Chris Hayes. 

She is 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 and Elsa van den Broek, of the forthcoming book, published by Guildford Publishers: Treating aggression, addiction, and Personality Disorders: A Schema-Focused approach to complex, Antisocial patients.

 
The workshop is intended for: Beginners and Advanced