Makale Özeti: Schema-Focused Cognitive Therapy and the Case of Ms. S

Ms. S diagnosed with borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). The BPD diagnosis criteria:
1. Ms. S seeks any “quick, frantic attachment . . . to avoid being alone”
2. She is ambivalent about her mother, idealizing and devaluing her
3. She exhibits identity disturbance
4. Ms. S has affective instability
5. She has chronic feelings of emptiness
In terms of PTSD, Ms. S exhibits many of the characteristic symptoms:

1. She experienced early sexual abuse, with violent undercurrents, as a
child and continuing over a 15-year period.
2. She experiences recurrent, intrusive images, thoughts, flashbacks,
and nightmares related to the abuse.
3. Prior to treatment, she denied the abuse and tried to control the images. She also failed to recall important aspects of the abuse until
later in treatment.
4. The images interfere with her concentration and affect her ability to
function normally.

According to schema theory, BPD is characterized by four primary modes: the abandoned and abused child, the detached protector, the punitive parent, and the angry child modes. An individual may shift from one dysfunctional schema mode into another; as that shift occurs, different schemas. These shifts are referred to as “flipping” modes.

For each of the four schema modes, a set of specific treatment strategies has been developed. In Ms. S, the model anticipates that the limited re-parenting will be the most important component of treatment:
1. Imagery and dialogues, the therapist is as the healthy adult mode, then the patient plays the healthy adult in the image and carries on a dialogue with herself in each of the other modes.
2. Much later in treatment, Ms S. Studied imagery work with PTSD like as she learned how to deal with each of the four modes.
3. Cognitive techniques, the therapist examines evidence to test the validity of dysfunctional thoughts and coping strategies to deal with each mode.
4. Behavioral techniques, the therapist guides Ms. S in breaking self-defeating life patterns.
5. Emotional regulation skills: these skills are from dialectical behavior therapy, including mindfulness meditation, distress tolerance, and engaging in pleasurable activities.

Referans:
Young,J.,E., Schema-Focused Cognitive Therapy and the Case of Ms. S., New York

Makaleyi özetleyen: Kadriye Çelik