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Bernstein, Arntz, & de Vos (2007). Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical Practice
Abstract
Until recently few empirically supported treatments for patients with personality disorders were available. Schema Focused Therapy (SFT) has recently shown efficacy in (non-forensic) outpatients with Borderline Personality Disorder, raising the question if it may also be effective in forensic PD patients. For the past two years, we have been collaborating with Dutch forensic hospitals to adapt the SFT approach to meet the challenges posed by this population. In this article, we present our forensic modification of the SFT theoretical model, and make recommendations for the implementation of SFT in forensic clinical practice.
Supplementary resource (1)
... Bates and Hester 41 (pp. [134][135] explain that 'ROs issued under Section 5 of the Protection from Harassment Act (PHA) 1997, are civil orders granted by a judge in criminal proceedings following a conviction (or acquittal) on a criminal charge. Thus, whilst the standard of evidence for issuing an RO is civil, they can only be made where a criminal charge has been brought. ...
... Bates and Hester 41 p. [134][135] explain that NMOs, issued under Part IV of the Family Law Act 1996, are applied for by the person subjected to stalking in civil proceedings (with or without Working with individuals who have engaged in stalking ...
... It seeks to identify and address maladaptive schemas, dysfunctional coping and schema 'modes' through understanding their origins and current 'presentation' 203 . A previous case study example 135 has outlined how schemas can logically explain the cognitive process that leads to stalking behaviours. Whilst a theoretical explanation of the development of stalking using a Schema Therapy framework has been discussed, there is currently no direct evidence of the effectiveness of Schema Therapy for addressing stalking behaviours 130 135 . ...
... z dzieckiem). Na kluczową rolę trybów w mechanizmie przestępczych zachowań zwrócił uwagę zespół Bernsteina [37]. W pracy terapeutycznej z pacjentami sądowymi badacze zaobserwowali podobne wzorce zachowań i opisali je w kategoriach "trybów przestępczych". ...
... W pracy terapeutycznej z pacjentami sądowymi badacze zaobserwowali podobne wzorce zachowań i opisali je w kategoriach "trybów przestępczych". W ten sposób uzupełnili listę podstawowych trybów schematów stworzonych przez Younga o tryby wiążące się z łamaniem prawa, z zachowaniami agresywnymi lub z przebiegłym działaniem mającym na celu oszukanie innych lub ich zastraszenie [37]. Przykładowo w trybie zn ęcan ia s ię i atak u sprawca wykorzystuje groźby, zastraszanie, agresję lub wymuszanie, aby zdobyć to, czego chce, stosuje odwet względem innych lub potwierdza swoją dominującą pozycję, odczuwa sadystyczną przyjemność wynikającą z atakowania innych. ...
... Przestępcze tryby zwiększają prawdopodobieństwo wystąpienia zachowań przestępczych i agresywnych, ponieważ często stanowią one nieadaptacyjne sposoby radzenia sobie z bolesnymi lub nieprzyjemnymi uczuciami [37]. ...
Poszukiwanie skutecznych metod leczenia sprawców jest niezbędne w kontekście obniżenia ryzyka popełnienia przez nich kolejnych przestępstw o charakterze seksualnym. W prezentowanym artykule została przedstawiona stworzona przez Jeffrey'a Young'a koncepcja Terapii schematów z omówieniem zasadności jej stosowania w leczeniu osób podejmujących problematyczne zachowania seksualne skierowane przeciwko wolności seksualnej. Zachowania takie są prawnie zabronione i wiążą się z popełnieniem przestępstw skodyfikowanych w rozdziale XXV kodeksu karnego (m.in. zgwałcenie, wykorzystanie bezradności, nadużycie stosunku zależności, czynność seksualna z małoletnim poniżej 15 lat). W artykule przedstawiono główne założenia terapii schematów. W odniesieniu do głównych założeń tego podejścia terapeutycznego został zaproponowany i omówiony teoretyczny model terapii schematów w kontekście przemocowych zachowań seksualnych. Następnie analizowano mechanizm powstawania i utrwalania się dewiacyjnych zachowań przestępczych w kontekście kluczowych konstruktów tego podejścia: wczesnych schematów dezadaptacyjnych oraz trybów schematów. Jako, że Terapia schematu ma udowodnioną skuteczność w leczeniu chronicznych osobowościowych aspektów zaburzeń, w ocenie autorek wydaje się być obiecującym nurtem dla tak trudnej populacji osób.
... In the next part, the participants were asked to identify the schema modes they could observe in the person they were dealing with in the situation they previously described by using the iModes (Bernstein 2014). The iModes (Bernstein, 2014) are cards illustrating schema modes through visual depictions and short descriptions of the modes at the backside of the card. ...
... In the next part, the participants were asked to identify the schema modes they could observe in the person they were dealing with in the situation they previously described by using the iModes (Bernstein 2014). The iModes (Bernstein, 2014) are cards illustrating schema modes through visual depictions and short descriptions of the modes at the backside of the card. The officers were given these cards and asked to carefully go through all of them and pick out the modes that they observed in the encountered persons. ...
... During the interview, the iModes (Bernstein 2014) were used to support the officers' description of the sequence of schema modes observed by them. Since the concept of schema modes is a new one within police contexts, the officers were naive to this system. ...
Working with extreme mood states is a regular challenge for law enforcement officers. In their encounters during police actions, they very often face manifestations of anger and aggression, as well as vulnerable states such as ones involving fear, helplessness, or humiliation. In this study, we investigated whether officers could reliably identify emotional states in the persons they encountered, using the Schema Therapy concept of “schema modes.” Although the mode concept has been extensively validated in the field of forensic mental health, this is its first application to police work. Twenty-seven police officers working for two different German police headquarters were asked to report about a recent operation involving a person showing intense emotional states. After receiving a short training in using the iModes , cards that facilitate working with modes, they retrospectively rated the presence and intensity of the schema modes of the persons whom they encountered. Two experts in Schema Therapy independently rated the same scenarios, using the Mode Observation Scale (MOS). Intraclass correlations showed moderate to excellent levels of agreement between the officers’ and experts’ mode-ratings. Modes involving anger (70%), aggression (70%), indirect hostility (44%), and arrogance/grandiosity (41%) were the most prevalent, while modes involving vulnerable emotions were less common. It can be concluded that police officers can reliably assess different modes in encountered persons, even without extensive training. This initial study suggests that the mode concept has applicability to police work and merits additional study for its potential for de-escalation and conflict management in police contexts.
... "Część Ciebie, która unika uczuć", "Część Ciebie, która jest nadmiernie czujna", "Część Ciebie, która stawia siebie ponad innymi ludźmi". U pacjentów z antyspołecznym zaburzeniem osobowości szczególnie ważne jest zauważanie trybu Wrażliwego dziecka, Impulsywnego dziecka, Rozwścieczonego dziecka oraz Zastraszania i ataku [16]. Techniki poznawcze mogą być wykorzystywane szczególnie na wczesnym etapie terapii. ...
... Źródło: opracowanie własne na podstawie [2,16] Typowe tryby u omawianej grupy pacjentów i praca z nimi W modelu terapii schematów i pracy z pacjentami z zaburzeniami osobowości (zwłaszcza z wiązki B) główna technika pracy opiera się na trybach (tabela 1). Ponieważ pacjenci z poważnymi zaburzeniami osobowości często bardzo szybko przełączają się między stanami emocjonalnymi, praca z trybami pomaga terapeucie monitorować i wprowadzać odpowiednie interwencje terapeutyczne podczas sesji terapeutycznej. ...
... Pacjent z antyspołecznym zaburzeniem osobowości może oscylować pomiędzy pozbawionym emocji odłączonym trybem Gniewnego obrońcy, kompulsywnymi wysiłkami w celu uspokojenia siebie poprzez używanie substancji psychoaktywnych lub inne uzależniające zachowanie w trybie Odłączonego samoukoiciela/autostymulatora, poczuciem bycia lepszym i wyjątkowym w trybie Samopowiększacza i ogromną wściekłością w odpowiedzi na narcystyczne urazy, niesprawiedliwość lub porzucenie w trybie Rozwścieczonego dziecka, próbami oszustwa i manipulacji w trybie Oszusta i manipulatora, próbami grożenia innym w trybie Zastraszania i ataku oraz bezwzględnymi aktami przemocy mającymi na celu wyeliminowanie zagrożenia, rywala lub napotkanej przeszkody w trybie Drapieżnika [16]. Zachowania kryminalne są wobec tego rozumiane w kategorii trybów i przełączania się pomiędzy trybami [5]. ...
schema therapy psychopathy forensic science Streszczenie Autorka przedstawia modyfikację terapii poznawczo-behawioralnej, jaką jest tzw. terapia schematów, opracowana w latach 90. XX w., i jej zastosowanie w leczeniu antyspołecznego zaburzenia osobo-wości w środowisku kryminalnym. Celem terapii schematów przeznaczonej dla pacjentów detencyj-nych ze strukturą osobowości antyspołecznej jest zredukowanie wczesnych nieprzystosowawczych schematów, które odpowiadają za psychologiczne czynniki ryzyka przestępczości i przemocy, oraz zbudowanie zdrowszych strategii radzenia sobie i poszerzanie czynników ochronnych. Skuteczność terapii schematów została częściowo potwierdzona empirycznie. W artykule krótko opisano cechy charakterystyczne pacjentów z antyspołecznym zaburzeniem osobowości. Przedstawiono możli-we interwencje terapeutyczne i korekcyjne, które mogą ograniczyć społeczne szkody kryminalne w omawianej grupie pacjentów. Podkreślono podstawowe założenia terapii schematów, jakimi są ograniczone korektywne rodzicielstwo i empatyczna konfrontacja. Opisano stosowane w trakcie terapii tryby schematów, proces budowania relacji terapeutycznej i zaufania, a także umiejętne wyznaczanie granic. Wskazano na różnice i pewne modyfikacje terapii schematów w tej grupie, przytoczono też konkretne techniki i narzędzia pracy, nakreślając przy tym pewne istotne kwestie i zalecenia oraz ograniczenia. Summary The author presents a modification of cognitive-behavioural therapy in the form of so-called schema therapy, developed in the 1990s, and its application in the treatment of antisocial personality disorder in criminal settings. The aim of schema therapy intended for detention patients with antisocial personality structure is to reduce early maladaptive schemas, which are responsible for psychological risk factors for crime and violence, as well as to build healthier coping strategies and extend protective factors. The effectiveness of schema therapy has been partially confirmed empirically. The article briefly describes the characteristics of patients with antisocial personality disorder. Possible therapeutic and corrective interventions that can reduce social criminal harm in this group of
... "Część Ciebie, która unika uczuć", "Część Ciebie, która jest nadmiernie czujna", "Część Ciebie, która stawia siebie ponad innymi ludźmi". U pacjentów z antyspołecznym zaburzeniem osobowości szczególnie ważne jest zauważanie trybu Wrażliwego dziecka, Impulsywnego dziecka, Rozwścieczonego dziecka oraz Zastraszania i ataku [16]. Techniki poznawcze mogą być wykorzystywane szczególnie na wczesnym etapie terapii. ...
... Źródło: opracowanie własne na podstawie [2,16] Typowe tryby u omawianej grupy pacjentów i praca z nimi W modelu terapii schematów i pracy z pacjentami z zaburzeniami osobowości (zwłaszcza z wiązki B) główna technika pracy opiera się na trybach (tabela 1). Ponieważ pacjenci z poważnymi zaburzeniami osobowości często bardzo szybko przełączają się między stanami emocjonalnymi, praca z trybami pomaga terapeucie monitorować i wprowadzać odpowiednie interwencje terapeutyczne podczas sesji terapeutycznej. ...
... Pacjent z antyspołecznym zaburzeniem osobowości może oscylować pomiędzy pozbawionym emocji odłączonym trybem Gniewnego obrońcy, kompulsywnymi wysiłkami w celu uspokojenia siebie poprzez używanie substancji psychoaktywnych lub inne uzależniające zachowanie w trybie Odłączonego samoukoiciela/autostymulatora, poczuciem bycia lepszym i wyjątkowym w trybie Samopowiększacza i ogromną wściekłością w odpowiedzi na narcystyczne urazy, niesprawiedliwość lub porzucenie w trybie Rozwścieczonego dziecka, próbami oszustwa i manipulacji w trybie Oszusta i manipulatora, próbami grożenia innym w trybie Zastraszania i ataku oraz bezwzględnymi aktami przemocy mającymi na celu wyeliminowanie zagrożenia, rywala lub napotkanej przeszkody w trybie Drapieżnika [16]. Zachowania kryminalne są wobec tego rozumiane w kategorii trybów i przełączania się pomiędzy trybami [5]. ...
... ST builds on the cognitive-behavioral approach developed by Beck et al. (1990), but places more emphasis on the processing of childhood origins of mental health problems, on experiential techniques, on the therapeutic alliance, and on maladaptive coping styles (Young et al., 2003). ST has already shown effectiveness for borderline PD (for a recent review, see Storebø et al., 2020), and Bernstein et al. (2007) designed an ST adaptation for use with forensic patients with severe PD. They stated explicitly that a high PCL-R score is not an exclusion criterion for treatment with ST (Bernstein et al., 2007). ...
... ST has already shown effectiveness for borderline PD (for a recent review, see Storebø et al., 2020), and Bernstein et al. (2007) designed an ST adaptation for use with forensic patients with severe PD. They stated explicitly that a high PCL-R score is not an exclusion criterion for treatment with ST (Bernstein et al., 2007). The forensic ST model hypothesizes that criminal and violent behavior can be explained by an unfolding sequence of maladaptive schema modes, or moment-to-moment states, that comprise emotions, cognitions, and behavior. ...
... Schema Mode Work is the preferred form of ST with more severe PDs (Young et al., 2003). Young defined 11 maladaptive schema modes, to which Bernstein et al. (2007) added 4 "forensic" modes: Angry Protector Mode, Predator Mode, Conning and Manipulative Mode, and Over-Controller Mode (Obsessive and Paranoid subtypes). Ideally, an individual also has a strong Healthy Adult Mode that is aware of the various maladaptive modes and can moderate and integrate them (Young et al., 2003). ...
Psychopathic offenders present a challenge to treatment providers. By definition, they experience limited distress that might motivate them for treatment. Because of their attitudes and behaviors, psychopathic offenders have been predominantly seen as unresponsive to treatment. In this chapter, we provide a review of existing empirical research on the treatment of psychopathy. We take a historical approach, starting with early treatment approaches and empirical studies into their effects, up until more recently developed interventions. Our review suggests that there is no empirical evidence to support the thesis that psychopathic offenders are generally unresponsive to treatment. In fact, several common “myths” that psychopathic patients are unable to form a working alliance with a therapist or that they cannot develop empathy, are refuted by recent evidence. We end our chapter with a set of “lessons learned” and “pointers to the future” concerning the treatment of psychopathy.KeywordsPsychopathyPsychopathic personality disorderTreatmentCognitive-behavioral therapyTherapeutic allianceDialectical behavior therapySchema therapyTherapeutic community
... Several treatments specifically target these deficits in offender populations, such as dialectical behavior therapy, emotion-focused therapy, and schema therapy. The latter specifically focuses on sequences of schema modes in the events leading up to and culminating in criminal behavior (Bernstein et al., 2007). Schema modes are emotional states that temporarily dominate a person's cognitions, emotions, and behavior at a given moment in time. ...
... First, in line with the literature, we expected no group differences in child modes prior to criminal and violent behavior. This hypothesis is also in line with schema therapy's forensic model (Bernstein et al., 2007;Keulen-de Vos et al., 2014). Detached self-soother was expected to be more prevalent prior to crimes than prior to incidents because drugs are expected to be less available in a forensic setting than in the outside world (Sonnweber et al., 2022) and because substantial drug and alcohol use seems to play a prominent role in the events leading up to criminal behavior (Keulen- de Vos et al., 2022). ...
This study explored emotional patterns in relation to the Offence Paralleling Behavior and the schema mode frameworks. The study retrospectively assesses schema modes in the events prior and during criminal and institutional violent behavior. It draws upon observer-ratings of schema modes by 42 male patients who received mandated clinical care in a forensic hospital in the Netherlands. Wilcoxon Signed Ranked tests showed no differences between events prior crimes and incidents with regard to schema modes that relate to universal childhood needs with the exception of impulsive child mode. States of intoxication were more prevalent prior and during the crimes than during the incidents. Furthermore, modes tended to be less activated during incidents, particularly low self-control, conning and manipulating, and self-aggrandizer modes. It is hoped that criminal justice institutions and their staff would benefit from being more aware of schema mode in order to prevent and deal with incidental violence.
... Several treatments specifically target these deficits in offender populations, such as dialectical behavior therapy, emotion-focused therapy, and schema therapy. The latter specifically focuses on sequences of schema modes in the events leading up to and culminating in criminal behavior (Bernstein et al., 2007). Schema modes are emotional states that temporarily dominate a person's cognitions, emotions, and behavior at a given moment in time. ...
... First, in line with the literature, we expected no group differences in child modes prior to criminal and violent behavior. This hypothesis is also in line with schema therapy's forensic model (Bernstein et al., 2007;Keulen-de Vos et al., 2014). Detached self-soother was expected to be more prevalent prior to crimes than prior to incidents because drugs are expected to be less available in a forensic setting than in the outside world (Sonnweber et al., 2022) and because substantial drug and alcohol use seems to play a prominent role in the events leading up to criminal behavior (Keulen- de Vos et al., 2022). ...
This study explored emotional patterns in relation to the Offence Paralleling Behavior and the schema mode frameworks. The study retrospectively assesses schema modes in the events prior and during criminal and institutional violent behavior. It draws upon observer-ratings of schema modes by 42 male patients who received mandated clinical care in a forensic hospital in the Netherlands. Wilcoxon Signed Ranked tests showed no differences between events prior crimes and incidents with regard to schema modes that relate to universal childhood needs with the exception of impulsive child mode. States of intoxication were more prevalent prior and during the crimes than during the incidents. Furthermore, modes tended to be less activated during incidents, particularly low self-control, conning and manipulating, and self-aggrandizer modes. It is hoped that criminal justice institutions and their staff would benefit from being more aware of schema mode in order to prevent and deal with incidental violence.
... Taken together, these modes may typically be involved in a broad range of aggressive features commonly seen in individuals with borderline personality disorder, antisocial personality disorder, paranoid personality disorder, and narcissistic personality disorder. In individuals with more dangerous and pronounced psychopathic features, modes such as "predator," "bully and attack," and "conning and manipulative" are more prominent (Bernstein et al. 2007;Keulen-de Vos et al. 2016). Accordingly, psychopathy is primarily conceptualized by cold and ruthless aggression (predator mode), aggression to proclaim dominance (bully and attack mode), and deceit and manipulation (conning and manipulative mode). ...
... Therefore, it is important to note that many such self-reports may be biased in a direction of "detached protector" mode, where respondents fail to fully report on their most vulnerable, shameful, and painful experiences. Thus, due to detachment from vulnerable feelings of the vulnerable child mode, including feelings of loneliness and sadness, signs of vulnerability are typically less pronounced in forensic populations (Bernstein et al. 2007). Therefore, the assessment phase may need to pay particular attention to developing a boundaried and limit-setting therapeutic alliance, where a sufficiently safe context can take form, thus allowing vulnerable emotions to emerge. ...
Research on schema therapy (ST) is presented linking aggression and violence to early maladaptive schemas and modes. The chapter introduces the applicability of schemas and forensic modes through a case presentation highlighting some of the issues that are vital to the early stages of engagement and assessment. The case is conceptualized through a mode map that helps facilitate patients’ understanding of the model and can become an important framework for the subsequent treatment. ST offers promising results working within forensic contexts or with clients with aggressive or violent behaviors; however, research is still scarce when looking specifically at violence.
... Existem produções internacionais que possuem como objetivo investigar a prevalência de EID's em populações específicas. Além disso, alguns estudos têm se dedicado à compreensão de diferentes contextos a partir dos EIDs, buscado-se assim, entender outros fenômenos que não estão necessariamente ligados a patologias (Fiuza & Godoy, 2021 (Bernstein et al., 2007). ...
... Frente às crescentes evidências empíricas da Terapia do Esquema (TE) e ao conceito modo de esquema em pacientes não-forenses,Bernstein et al. (2007) introduziram a TE no campo forense, expandindo o modelo de modo de esquema por uma definição e conceituação de estados particulares, comuns em indivíduos infratores com transtorno de personalidade, mas não em pacientes psiquiátricos não infratores com TP. Por exemplo, questões como a violência, a adicção e a manipulação são uma parte comum do estilo interpessoal de um criminoso, mas são relativamente incomuns em pacientes nãoinfratores com TP, como apontaKeulen-de Vos (2013).A Terapia dos Esquemas (TE) se distingue de outros tratamentos cognitivocomportamentais para pacientes forenses em vários aspectos. ...
Capítulo 5: Depressão no puerpério
... ST was adapted for the forensic population (Bernstein & Navot, 2023) and in 2007, researchers identified five typical hypercompensating schema modes in the forensic population: Self-Aggrandizer, Bully-and-Attack, Predator, Conning Manipulator, and Paranoid Overcontroller, whose descriptions are shown in Table 2 (Bernstein et al., 2007;Soygüt et al., 2023). "Forensic schema modes" increase the likelihood of offending and aggressive behaviors, as they typically represent maladaptive attempts to deal with painful and unwanted feelings (Oettingen & Rajtar-Zembaty, 2022). ...
The present study, a systematic review covering the analysis of publications in Portuguese and English from 2010 onwards, aims to survey empirical research using the Schema Mode Inventory (SMI) in cases of aggressive behavior. Using the acronym PICOS, the following question arises: What are the benefits (O), proven in empirical studies (S), of using the SMI (I) in work with adults with aggressive behavior (P)? The search was carried out in the databases PePSIC, Lilacs, PubMed, SciELO, PsycINFO, and SCOPUS, from which we selected nine articles. We noticed a low rate of publications, mainly in Brazil, and a greater focus on the correlation between schema modes and personality disorders, leaving a low number of publications on other topics. The results point to the possibility of using the SMI as a tool within a therapeutic process and as an assessment tool. The schema modes most related to aggressive behavior were the Impulsive Child, Angry Child, and Bully-andAttack. Due to the limitations found, mainly related to sample homogeneity and risk of bias in self-report instruments, further studies are necessary to elucidate the possibilities and benefits of using SMI in interventions with aggressive individuals.
... ST was adapted for the forensic population (Bernstein & Navot, 2023) and in 2007, researchers identified five typical hypercompensating schema modes in the forensic population: Self-Aggrandizer, Bully-and-Attack, Predator, Conning Manipulator, and Paranoid Overcontroller, whose descriptions are shown in Table 2 (Bernstein et al., 2007;Soygüt et al., 2023). "Forensic schema modes" increase the likelihood of offending and aggressive behaviors, as they typically represent maladaptive attempts to deal with painful and unwanted feelings (Oettingen & Rajtar-Zembaty, 2022). ...
... Mode descriptions are paraphrased from(1,5,25,26). ...
Background
Amongst “third-wave” cognitive behavioural therapies, schema therapy demonstrates encouraging efficacy across various mental health conditions. Within this field, clinical interest has begun to converge on the “schema-mode-model” – a conceptualization framework for affective, cognitive and behavioral states that guide individuals’ perceptions and behaviours at a given point in time. Schema mode expressions in patients with chronic tinnitus are as-yet unexamined.
Methods
The present study reports self-report data from N = 696 patients with chronic tinnitus who completed the Schema Mode- and Tinnitus Handicap Inventories alongside measures of perceived stress, anxiety and depression. The Schema Mode Inventory assesses so-called maladaptive “parent”, “child” and “coping” modes. Parent modes can be understood as self-states which are characterized by self-critical and hostile beliefs; child modes are characterized by biographically unmet emotional needs; and coping modes by inflexible attempts to regulate emotion and stabilize one’s sense of self. Descriptive, correlational and mediation analyses investigated schema mode expressions (1) in patients with chronic tinnitus, (2) as compared to published reference values from a healthy control sample, (3) in their relation to other psychological constructs, and (4) regarding their potential role in driving tinnitus-related distress.
Results
Patients reported mild-to-moderate levels of emotional distress. Compared to healthy controls, patients showed (1) high relative expressions of child-, detachment and compliant coping modes and (2) a conspicuously low relative expression of the ‘punitive parent’ mode. Correlational patterns suggested strong associations of (1) parent as well as angry child modes with perceived stress and anxiety, (2) the vulnerable child mode with all measured constructs and (3) emotional distress with - intrapersonally - emotional detachment as well as - interpersonally - alleged compliance. Mediation analyses demonstrated that tinnitus-related distress was driven by significant interactions between child and coping modes.
Conclusions
The study provides initial clinical evidence for the relevance and applicability of schema-mode based formulation and treatment planning in patients with chronic tinnitus.
... [11,12]. Other similar studies deal with aspects regarding the clinical picture of the maladaptive schemas of a decision maker that can explain the act of committing a crime [13][14][15]. ...
... The content of the care must also be equivalent to the care offered in other parts of psychiatry and all treatments must be based on current knowledge [5]. In forensic psychiatry, the challenge is to meet patients' emotional needs, set boundaries and connect, and be responsive and caring [6]. ...
The aim of this study was to describe the phenomenon of “fleeing the encounter when facing resistance” as experienced by carers working in forensic inpatient care. Qualitative analysis, namely reflective lifeworld research, was used to analyze data from open-ended questions with nine carers from a Swedish regional forensic clinic. The data revealed three meaning constituents that describe the phenomenon: shielding oneself from coming to harm or harming the other, finding one’s emotional balance or being exposed, and offering the patient emotional space and finding patience. The carers described their approaches in the encounters with the patients as alternating between primitive instincts and expectant empathy in order to gain control and deal with the interaction for their own part, for that of the patient, and for that of their colleagues. The phenomenon of fleeing the encounter when facing resistance was intertwined with carers’ self-perception as professional carers. Negative encounters with patients evoked feelings of shame and self-blame. A carer is a key person tasked with shaping the care relationship, which requires an attitude on the part of the carer that recognizes not only the patient’s lifeworld but also their own.
... [11,12]. Other similar studies deal with aspects regarding the clinical picture of the maladaptive schemas of a decision maker that can explain the act of committing a crime [13][14][15]. ...
This research aims to highlight the role and the importance of maladaptive cognitive schemas in the decision-making process of prisoners accused of murder, trying to outline the particularities of the criminal behavior profile. The sample consisted of 280 inmates charged with murder. The data were collected using the Young Cognitive Schema Questionnaire in the short form (YSQ-S3) and the Cognitive Assessment System (Analytic Reasoning; Decision-making capacity). The obtained results showed that cognitive schemes have a direct influence on the decision-making process in criminal behavior.
... [11,12]. Other similar studies deal with aspects regarding the clinical picture of the maladaptive schemas of a decision maker that can explain the act of committing a crime [13][14][15]. ...
This research aims to highlight the role and the importance of maladaptive cognitive schemas in the decision-making process of prisoners accused of murder, trying to outline the particularities of the criminal behavior profile. The sample consisted of 280 inmates charged with murder. The data were collected using the Young Cognitive Schema Questionnaire in the short form (YSQ-S3) and the Cognitive Assessment System (Analytic Reasoning; Decision-making capacity). The obtained results showed that cognitive schemes have a direct influence on the decision-making process in criminal behavior.
... Schema therapy (ST) was originally developed as an integrative approach to treat complex, recurrent psychological problems and is (cost-)effective for personality disorders (PDs) in both individuals (1)(2)(3)(4)(5) and group settings (2,(6)(7)(8)(9)(10). ST has been proposed and proven effective for both mood and anxiety disorders (11)(12)(13)(14). ...
Objectives
Evidence in favor of schema therapy's effectiveness in treating personality disorders is growing. One of the central and recently popular concepts of schema therapy is schema modes [i.e., temporary emotional–cognitive–behavioral states resulting from the activation of early maladaptive schemas (EMSs)]. A key aspect herein is self-reparenting, i.e., a healing relationship between the healthy adult (HA, i.e., compassionate and healthy emotional states, and functional dealing with reality) and the child modes (i.e., representation of fragile and hurt feelings and dysfunctional coping). Through an in-depth qualitative analysis, we aimed to better understand the components of the HA that enable self-reparenting.
Method
Purposive sampling procedures were used to recruit eligible participants (n = 10) with relatively strong HA modes, as determined by high scores on positive affect and satisfaction with life measures and low scores on EMSs and psychopathological symptom measures. Semi-structured 45- to 60-min face-to-face interviews were conducted individually, in which individuals were asked to help the child modes reflected in the pictures. Interviews were then analyzed using deductive thematic analysis in MaxQDA.
Results and discussion
The analysis revealed three superordinate themes comprising of a total of 10 group themes: (1) bonding between HA and the vulnerable child modes (“Bond”); (2) balancing expression and inhibition of adult and child mode emotions (“Balancing”); and (3) opposing demanding and critical voices and maladaptive coping styles (“Battle”). Furthermore, a strong HA mode seems to have a reciprocal relationship with the child modes: the HA gives nurturance and protection to the child modes, and the child modes boost up the HA with spontaneity and happiness. In conclusion, emotional stability and resilience may be highest when HA-child mode interaction happens bidirectionally; when the child modes get reparented by the HA, and the HA is informed by the child modes.
... Jeung-Maarse & Herpertz, 2020), wurden für die Behandlung von persönlichkeitsgestörten forensischen Patientinnen und Patienten angepasst. Hierzu zählen die forensische Adaptation der Dialektischbehavioralen Therapie (DBT; Linehan, 1993;Linehan et al., 2013), die DBT-F (Ivanoff & Marotta, 2018; für die deutsche Übersetzung siehe Oermann et al., 2008), eine weitere Adaption der DBT speziell für psychopathische Straftäter und Straftäterinnen, sowie die Schematherapie (ST; Young et al., 2003;Young, 1999; forensische Adaptation siehe Bernstein et al., 2007). Ebenfalls liegen vielversprechende Studienresultate für die Anwendung der Mentalisierungsbasierten Therapie (MBT; Bateman & Fonagy, 2008 ...
... Jeung-Maarse & Herpertz, 2020), wurden für die Behandlung von persönlichkeitsgestörten forensischen Patientinnen und Patienten angepasst. Hierzu zählen die forensische Adaptation der Dialektischbehavioralen Therapie (DBT; Linehan, 1993;Linehan et al., 2013), die DBT-F (Ivanoff & Marotta, 2018; für die deutsche Übersetzung siehe Oermann et al., 2008), eine weitere Adaption der DBT speziell für psychopathische Straftäter und Straftäterinnen, sowie die Schematherapie (ST; Young et al., 2003;Young, 1999; forensische Adaptation siehe Bernstein et al., 2007). Ebenfalls liegen vielversprechende Studienresultate für die Anwendung der Mentalisierungsbasierten Therapie (MBT; Bateman & Fonagy, 2008 ...
Behandlungskonzepte bei Menschen mit Psychopathie Zusammenfassung Die bereits in Harvey Cleckleys Psychopathie-Konzept verankerte Annahme, dass Psychopathie kaum behandelbar sei, wurde insbesondere durch die Ergebnisse der vielzitierten Oak-Ridge-Studie (Rice et al,, 1992) verfestigt und trug wesentlich zu einem allgemeinen therapeutischen Pessimismus bei. Tatsächlich sind Menschen mit psychopathischen Eigenschaften aufgrund interpersoneller und affektiver Defizite sowie aggressiver und antisozialer Verhaltensweisen eine schwierige Behandlungsklientel, die besondere Ansprüche an Behandlerinnen und Behandler sowie an den Behandlungskontext stellt. Es empfiehlt sich ein strukturiertes Vorgehen auf Grundlage des Risk-Need-Responsivity-Modells, mithilfe dessen im Sinne eines Zwei-Komponenten-Modells Rückfälligkeit verringert und gleichzeitig den interaktionellen Besonderheiten psychopathischer Straftäterinnen und Straftäter Rechnung getragen werden sollen. Darüber hinaus wurden bereits etablierte Behandlungsprogramme wie die dialektisch-behaviorale Therapie und die Schematherapie für die Behandlung von Persönlichkeitsstörungen und Psychopathie adaptiert. Schlüsselwörter (max. 5) Psychopathie; Therapie; PCL-R; DBT; MBT; Schematherapie
... While focusing in this article on pharmacotherapy, other interventions for this and related conditions should not be overlooked in designing an effective post-release rehabilitation and prevention of relapse/recidivism plan. Other treatment approaches which may be effective alone or in conjunction with pharmacotherapy include cognitive behavioral therapy (CBT is especially adaptable to the RNR model; Armelius and Andreassen, 2010;Gosse, 2013;Wong and Olver, 2015), dialectical behavioral therapy (DBT; Gallietta and Rosenfeld, 2012), and schema-focused therapy (SFT; Bernstein et al., 2007). The Reasoning and Rehabilitation (R&R) model has been used in both institutional and correctional settings (Ross et al., 1988) to reduce recidivism (Tong and Farrington, 2006). ...
Primary impulsive aggression (PIA) can be implicated as a common factor that results in an arrest, disciplinary, and restraint measures during confinement, and criminal recidivism after release. Evidence suggests that anti-impulsive aggression agents (AIAAs) can diminish or prevent impulsive aggression even when occurring with personality pathology such as borderline or antisocial personality disorder (ASPD), common conditions in offender populations. A previous review identified agents that have been subjected to controlled drug trials of sufficient quality, and subsequently, a decisional algorithm was developed for selecting an AIAA for individuals with IA. This selection process began with the five agents that showed efficacy in two or more quality studies from the earlier review. Today, 8 years after the quality review study, the present authors undertook this follow-up literature review. The aims of the present review were to survey the literature to identify and assess: (1) drug trials of comparable quality published since the 2013 review, including trials of the previously identified AIAAs as well as trials of agents not included in the earlier review; (2) severity of aggressive outbursts; (3) the materiality of risks or side-effects that are associated with individual AIAAs as well as antipsychotic agents commonly used to control clinical aggression; (4) efficacy of these agents in special populations (e.g., females); and (5) cost and convenience of each agent. Improved pharmacotherapy of PIA by addressing risks, side effects and practicality as well as the efficacy of AIAAs, should promote the rehabilitation and reintegration of some pathologically aggressive offenders back into the community.
... Si bien esta perspectiva otorgaría practicidad, es factible que la multiplicidad de opciones explicativas generase "fragmentación" teórica en un modelo clínico que se caracteriza por su poder integrativo y que continúa demostrando una alta efectividad terapéutica (Bernstein, Arntz, & Vos, 2007;Sempértegui, Karreman, Arntz, & Bekker, 2013). ...
La presente Tesis de Doctorado ha tenido tres objetivos centrales: (a) la adaptación lingüística y el estudio de calidad psicométrica de un instrumento para la evaluación de los Esquemas Desadaptativos Tempranos (EDTs) denominado Young Schema Questionnaire Short Form 3 (YSQ-S3; Young, 2005), en su versión al castellano “Cuestionario de Esquemas de Young Abreviado 3” (Cid, 2006) tanto en una muestra de adultos universitarios (N = 550) como en una muestra clínica (N = 157) de nacionalidad uruguaya; (b) el análisis de la variabilidad de los EDTs de acuerdo a distintas variables sociodemográficas, y (c) la descripción de la capacidad discriminativa del YSQ respecto a la psicopatología en términos de su gravedad y especificidad de los EDTs. El trabajo con la muestra universitaria permitió verificar que el YSQ-S3 presenta buenas propiedades psicométricas y comprobar el adecuado ajuste y parsimonia del modelo original de Young (2003) en muestras uruguayas. También se observó que los modelos de segundo orden sometidos a comparación obtuvieron índices de ajuste similares que el original (Young, 2003), acorde al debate existente sobre la cantidad de dominios que se deben considerar. Asimismo, se pudo hallar una apropiada consistencia interna, estabilidad temporal y validez externa de sus escalas. Algunas pruebas estadísticas se pudieron replicar en la muestra clínica obteniendo valores adecuados en términos de consistencia interna y ajuste factorial. En segundo lugar, se observaron los datos descriptivos de los EDTs característicos de ambas muestras. También se estudió la variación de los EDTs de acuerdo a diversas variables sociodemográficas observándose algunas asociaciones con la edad y algunas diferencias significativas en lo que refiere al sexo y el estado civil. Por último, el YSQ-S3 resultó ser un instrumento con evidencias de validez por grupos contrastados ya que logró discriminar sujetos con diferentes diagnósticos psicopatológicos en lo que refiere a: (a) diferenciar a los pacientes de quienes no lo eran, siendo los EDTs del Dominio 1 y 2 los de mayor poder discriminativo; (b) diferenciar a los pacientes con diagnósticos incluidos en el Eje II de los pacientes con trastornos del Eje I, siendo también más discriminativos los EDTs del Dominio 1 y 2; y (c) señalar perfiles cognitivos —determinados por los EDTs— asociados a la ansiedad (Vulnerabilidad al Daño, Abandono, Desconfianza y Pesimismo) y a la depresión (Defectuosidad, Fracaso, Vulnerabilidad al Daño, Pesimismo). El aporte de estos resultados fue cotejado con las investigaciones previas dando pie a ulteriores estudios que puedan continuar acrecentando el caudal de conocimientos acerca del Modelo de Esquemas en la región. Se espera que esta información resulte relevante para la planificación de baterías de evaluación clínica y el diseño de planes de tratamiento psicoterapéuticos, así como también para su uso en otros proyectos de investigación que profundicen sobre esta temática
... Si bien esta perspectiva otorgaría practicidad, es factible que la multiplicidad de opciones explicativas generase "fragmentación" teórica en un modelo clínico que se caracteriza por su poder integrativo y que continúa demostrando una alta efectividad terapéutica (Bernstein, Arntz, & Vos, 2007;Sempértegui, Karreman, Arntz, & Bekker, 2013). En este sentido, la paradoja se daría entre la parsimonia y practicidad, por un lado y la mejor representación de la realidad del paciente por otro. ...
Resumen: La presente Tesis de Doctorado ha tenido tres objetivos centrales: (a) la adaptación lingüística y el estudio de calidad psicométrica de un instrumento para la evaluación de los Esquemas Desadaptativos Tempranos (EDTs) denominado Young Schema Questionnaire Short Form 3 (YSQ-S3; Young, 2005), en su versión al castellano “Cuestionario de Esquemas de Young Abreviado 3” (Cid, 2006) tanto en una muestra de adultos universitarios (N = 550) como en una muestra clínica (N = 157) de nacionalidad uruguaya; (b) el análisis de la variabilidad de los EDTs de acuerdo a distintas variables sociodemográficas, y (c) la descripción de la capacidad discriminativa del YSQ respecto a la psicopatología en términos de su gravedad y especificidad de los EDTs. El trabajo con la muestra universitaria permitió verificar que el YSQ-S3 presenta buenas propiedades psicométricas y comprobar el adecuado ajuste y parsimonia del modelo original de Young (2003) en muestras uruguayas. También se observó que los modelos de segundo orden sometidos a comparación obtuvieron índices de ajuste similares que el original (Young, 2003), acorde al debate existente sobre la cantidad de dominios que se deben considerar. Asimismo, se pudo hallar una apropiada consistencia interna, estabilidad temporal y validez externa de sus escalas. Algunas pruebas estadísticas se pudieron replicar en la muestra clínica obteniendo valores adecuados en términos de consistencia interna y ajuste factorial. En segundo lugar, se observaron los datos descriptivos de los EDTs característicos de ambas muestras. También se estudió la variación de los EDTs de acuerdo a diversas variables sociodemográficas observándose algunas asociaciones con la edad y algunas diferencias significativas en lo que refiere al sexo y el estado civil. Por último, el YSQ-S3 resultó ser un instrumento con evidencias de validez por grupos contrastados ya que logró discriminar sujetos con diferentes diagnósticos psicopatológicos en lo que refiere a: (a) diferenciar a los pacientes de quienes no lo eran, siendo los EDTs del Dominio 1 y 2 los de mayor poder discriminativo; (b) diferenciar a los pacientes con diagnósticos incluidos en el Eje II de los pacientes con trastornos del Eje I, siendo también más discriminativos los EDTs del Dominio 1 y 2; y (c) señalar perfiles cognitivos —determinados por los EDTs— asociados a la ansiedad (Vulnerabilidad al Daño, Abandono, Desconfianza y Pesimismo) y a la depresión (Defectuosidad, Fracaso, Vulnerabilidad al Daño, Pesimismo). El aporte de estos resultados fue cotejado con las investigaciones previas dando pie a ulteriores estudios que puedan continuar acrecentando el caudal de conocimientos acerca del…
... Several trauma-focused treatment interventions for psychopathy have been developed: Dialectical Behavior Therapy for psychopathy [130] and Schema Therapy (ST) for forensic patients with personality disorders, including psychopathy [131]. Controlled effectiveness studies of these therapy models have not yet been published, but a single case study documented the process of individual ST in a Dutch forensic patient with psychopathic traits [132]. ...
Psychopathy is a personality disorder characterized by a mix of traits belonging to four facets: affective (e.g., callous/lack of empathy), interpersonal (e.g., grandiosity), behavioral instability (e.g., impulsivity, poor behavioral controls), and social deviance (e.g., juvenile delinquency, criminal versatility). Several scholars have argued that early childhood mal-treatment impacts the development of psychopathy, although views regarding its role in the four facets differ. We conducted a meta-analysis including 47 studies comprising a total of389 effect sizes and 12,737 participants, to investigate the association between psychopathy and four types of child maltreatment: physical abuse, emotional abuse, neglect, and sexual abuse. We found support for a moderate link between overall psychopathy and childhood physical abuse, emotional abuse, and neglect, as well as overall childhood mal-treatment. The link between psychopathy and childhood sexual abuse was small, but still statistically significant. These associations were stronger for the behavioral and antisocial facets than for the affective and interpersonal facets of psychopathy, but nearly all associations were statistically significant. Our findings are consistent with recently developed theories on the role of complex trauma in the development of severe personality disorders. Trauma-focused preventive and therapeutic interventions can provide further tests of the trauma-psychopathy hypothesis.
... Several trauma-focused treatment interventions for psychopathy have been developed: Dialectical Behavior Therapy for psychopathy [130] and Schema Therapy (ST) for forensic patients with personality disorders, including psychopathy [131]. Controlled effectiveness studies of these therapy models have not yet been published, but a single case study documented the process of individual ST in a Dutch forensic patient with psychopathic traits [132]. ...
Psychopathy is a personality disorder characterized by a mix of traits belonging to four facets: affective (e.g., callous/lack of empathy), interpersonal (e.g., grandiosity), behavioral instability (e.g., impulsivity, poor behavioral controls), and social deviance (e.g., juvenile delinquency, criminal versatility). Several scholars have argued that early childhood maltreatment impacts the development of psychopathy, although views regarding its role in the four facets differ. We conducted a meta-analysis including 47 studies comprising a total of 389 effect sizes and 12,737 participants, to investigate the association between psychopathy and four types of child maltreatment: physical abuse, emotional abuse, neglect, and sexual abuse. We found support for a moderate link between overall psychopathy and childhood physical abuse, emotional abuse, and neglect, as well as overall childhood maltreatment. The link between psychopathy and childhood sexual abuse was small, but still statistically significant. These associations were stronger for the behavioral and antisocial facets than for the affective and interpersonal facets of psychopathy, but nearly all associations were statistically significant. Our findings are consistent with recently developed theories on the role of complex trauma in the development of severe personality disorders. Trauma-focused preventive and therapeutic interventions can provide further tests of the trauma-psychopathy hypothesis.
... Schema therapy (Young et al., 2003) is an integrative therapy for personality disorders that has been shown to be effective in non-forensic patients with borderline disorder (Giesen-Bloo et al., 2006;Nadort et al., 2009) and Cluster C personality disorders, narcissistic, histrionic and paranoid personality disorders (Bamelis et al., 2014). The authors have adapted the schema therapy model for patients with forensic personality disorders (Bernstein et al., 2007), with the aim of motivating and involving patients, improving personality disorder symptoms and reducing risks and building strengths (i.e., protective factors) and ...
De federale overheid (FOD) Volksgezondheid heeft KeFor en CRDS de opdracht gegeven om onderzoek te doen naar de personen met een interneringsstatuut die moeilijkheden ondervinden om aangepaste zorg te vinden1 (vanaf hier hebben we het over ‘residuele geïnterneerden’) en formuleerde drie onderzoeksvragen:
1. Op welke manier verloopt de doorstroom van specifieke forensische projecten (gefinancierd door de FOD Volksgezondheid via een B4-overeenkomst, of via plaatsing) naar projecten die geen extra financiering ontvangen voor de zorg aan forensische patiënten.
2. Wat is het profiel van de geïnterneerden die moeilijkheden hebben om de juiste forensische zorg te ontvangen.
a. Beschrijf het diagnostisch, criminologisch, cognitief en sociaal-economisch profiel
b. Welke noden worden voor de personen in deze restcategorie niet vervuld? Welke veranderingen zijn er nodig om deze noden op te vullen? Welke aanpassingen zijn er nodig binnen het zorgtraject op gebied van samenwerkingen tussen partners (professionals, gebruikers en naasten)?
3. Breng de budgettaire impact in kaart van de oplossingen die zijn voortgekomen uit de eerste twee onderzoeksvragen. Geef ook budget neutrale voorstellen die gerelateerd zijn aan het verbeteren van samenwerkingen binnen een circuit of netwerk van zorg.
Deze vragen werden onderzocht aan de hand van een multimethodisch onderzoek: twee literatuurstudies, twee kwantitatieve studies en twee kwalitatieve studies. In het rapport worden de resultaten van de respectievelijke studies per hoofdstuk besproken. I
... According to schema therapy's crime theory (Bernstein et al., 2007;, the events leading up to and culminating in violent and criminal behavior can be explained by a sequence of schema modes. The events preceding this behavior are often initiated by painful emotional triggers (i.e., child modes), for example situation in which someone feels abandoned, lonely, or hurt. ...
The aim of this study was to examine the emotional states preceding and during sexual and violent offenses in a Dutch sample of male forensic inpatients. Moreover, the predictive impact of these emotional states on institutional violence in the first year of mandated care was examined using an incident scheme. Observer-ratings of emotional states by 103 male offenders and 97 sex offenders were examined using Mann-Whitney U tests. Using hierarchical multiple regression analyses, the predictive relationship between crime-related emotional states and incidents was examined. Sexual and violent crimes were equally preceded by painful emotions, primarily feelings of abandonment. During violent crimes, a state of bully and attack was dominant whereas sexual crimes were also characterized by self-aggrandizement and manipulation. These emotional states were not predictive for institutional violence. This study emphasizes the importance of emotional states in offending behavior and usefulness of schema therapy's crime theory.
... Another shared element is the compensatory function of anger/rage with respect to emotional states that involve feelings of vulnerability (Anderson & Bushman, 2002;Berkowitz, 1989;Bernstein et al., 2007;Keulen de Vos, Bernstein, & Arntz 2014;Keulen-de Vos et al., 2016;Ornstein, 1999). The vulnerability linked to shame (Lewis, 1993;Rogier et al., 2019) brings forth feeling of exclusion, humiliation, nurtured anger and violent, revengeful fantasies. ...
This paper starts from the claim that a shared understanding of anger, in both its normal and psychopathological dimensions, is missing and that there are various therapeutic paths that seem to be less effective than those related to other pathologies. A major limitation of anger research and of its treatments lies in the lack of precise clinical diagnoses to inform therapy. For this reason, the first aim of our work is to survey critical literature in order to find useful elements to differentiate anger, starting from the evidence of negative and positive outcomes of treatments. Such evidence will then be enhanced in our proposal of interpretation and intervention, within a dynamic framework and with particular reference to Orefice’s thought. The core focus is to explore the different functions that anger has for the patient and to investigate the elementary functioning of the self. Our reading of the phenomena related to anger will provide useful tools both for understanding the dynamics underlying anger and as a guide for clinical intervention.
... A reasonable goal for therapy can be structured around the patient's developing an awareness of the costs of using such an antagonistic/dissocial strategy (Harkness & McNulty, 2006;Livesley, 2003). If a reasonable alliance is established, there is some evidence of gains using MBT (Bateman & Fonagy, 2016), SFT (Bernstein et al., 2007), or transferencefocused therapy (Stern et al., 2017). ...
... Violence and deception are also more prominent in the forensic setting than in general mental health settings. Perhaps these overcompensatory modes develop under extreme childhood circumstances, in which the child is forced to survive (Bernstein et al., 2007;Jaffee et al., 2004). There were so many modes related to BPD, that a valuable mode model for BPD seems questionable. ...
The current study focused on examining the relationship between adverse childhood experiences (ACEs) and personality disorders in offenders with antisocial, borderline or narcissistic personality disorders. We tested whether emotional states mediate the relationship between ACEs and personality disorders in an offender sample. Self-ratings of adverse childhood experiences, emotional states and personality pathology by 102 male offenders with personality disorders were examined using hierarchical multiple regression analyses and mediation analyses. The findings show that personality disorders were characterized by certain emotional states. ACEs did not differentiate between personality disorders. Only the relationship between Physical Neglect and NPD showed a small negative direct effect and one small positive indirect effect, with healthy emotional states as mediator.
... This story reveals that Rüya used her anger as a way to keep away the men she saw as "dangerous" and who she thought would harm her. The main function of this mode for all sexually assaulted women was to keep men at a distance with displays of anger, or portraying themselves as a "wall of anger" (Bernstein et al., 2007;Lobbestael et al., 2007). Cansel:: I would like to stay away from it a little actually. ...
Sexual assault is one of the most challenging experiences to manage since it can have devastating effects on the individual's mental and physical health, and can cause many psychological problems, especially PTSD and depression. In this study, a psychotherapy process based on the schema therapy model was conducted with six women who were sexually assaulted in Turkey, and the psychotherapeutic change process was examined with both qualitative and quantitative methods. According to the descriptive results from Post Traumatic Stress Disorder Symptoms Scale‐Self‐Report (PSS‐SR), Beck Depression Inventory (BDI) and Symptom Check list‐90 (SCL‐90), the scores in the post‐test and follow‐up stages decreased compared to the pre‐test stage, and this decrease also had clinical significance for PSS‐SR both at post‐test (p < .05, .01 and .001 for each participant) and at follow‐up (p < .01 and .001 for each participant) stages. From the results of the narrative analysis, on the other hand, it was concluded that the psychotherapy process was completed in three stages (the introduction, the body, the conclusion); the participants conveyed the stories of some schema modes (the abused child, the punitive parent, the demanding parent, the angry‐protector, the avoidant and detached protector); and an important transitional stage was experienced (meeting the psychological needs, self‐awareness, self‐acceptance, self‐control and healthy boundaries, confrontation and normalisation) during the transformation of these stories into healthy adults. It is recommended that this discovered transitional stage is investigated in further schema therapy research. All findings are discussed in detail and a brief intervention protocol based on the schema therapy model is proposed.
This is the first book to analyze empirically supported treatments by using the newest criteria from the American Psychological Association's Society of Clinical Psychology, Division 12. Clinicians, scholars, and students all need to stay updated on the treatment research, and this book goes beyond providing updated treatment information by pointing readers to other useful treatment manuals and websites for continuing to stay up-to-date. The chapters, all written by prominent experts, highlight the best available evidence for specific disorders by breaking treatments down into credible components. With an emphasis on treatments for adults, chapters also share information about treatments for youth. Other variables that influence treatment are discussed, including assessment, comorbidity, demographics, and medication. Each chapter also corresponds with a chapter in the companion book, Pseudoscience in Therapy, presenting a full picture of the evidence base for common treatments.
p style="text-align: justify;">The article discusses the theoretical model of schema therapy and provides an overview of research on its adaptation for individuals with convictions and those who have committed criminal acts under the influence of a mental illness. The main focus of this article is on research into the diagnostic and therapeutic potential of approaches. Based on the findings of foreign studies, forensic schema therapy has been shown to be effective. Current research directions are proposed, and the possibilities and limitations of the approach are discussed when applied to a sample of Russian-speaking convicts and psychiatric patients. The analysis suggests that forensic schema therapy may be a promising adaptation of the classic theoretical model of schema therapy for individuals who have committed criminal acts under the influence of a mental illness and have been involuntarily hospitalized in a psychiatric hospital. Based on a meta-analysis of the available data, forensic schema therapy has been shown to significantly reduce the risk of criminal recidivism in these populations. The presented review of research in the field of forensic schema therapy in Russian is published for the first time.</p
Bu çalışmada, algılanan ebeveynlik biçimleri ve sınırda kişilik örüntüsü arasındaki ilişkide erken dönem uyum bozucu şema alanları ve duygu düzenleme güçlüğünün aracı rolünün incelenmesi amaçlanmıştır. Yapılan analiz sonuçlarına göre, koşullu/başarı odaklı ebeveynlik biçimindeki (anne ve baba) artışın kopukluk ve yüksek standartlar şema alanları ve duygu düzenleme güçlüğü aracılığıyla kişilerin sınırda kişilik belirti düzeylerini yordadığı görülmüştür. Ayrıca anneye ilişkin algılanan sömürücü/istismar edici ebeveynlik biçimindeki artışın hem doğrudan hem de kopukluk şema alanı aracılığıyla sınırda kişilik belirti düzeylerini yordadığı; babaya ilişkin algılanan sömürücü/istismar edici ebeveynlik biçimi için ise buna ek olarak duygu düzenleme güçlüğünün de aracı rol oynadığı görülmüştür. Anneye ilişkin algılanan aşırı koruyucu/evhamlı ebeveynlik biçiminin yüksek standartlar şema alanı ve duygu düzenleme güçlüğü aracılığıyla sınırda kişilik belirti düzeyi üzerinde yordayıcı bir rolü bulunduğu anlaşılmıştır. Bunun yanında babaya ilişkin algılanan değişime kapalı/duyguları bastıran ebeveynlik biçiminin hem doğrudan hem de kopukluk şema alanı ve duygu düzenleme güçlüğü aracılığıyla sınırda kişilik belirti düzeyi üzerinde yordayıcı bir rolü bulunduğu anlaşılmıştır. Son olarak babaya ilişkin algılanan aşırı izin veren/sınırsız ebeveynlik biçimindeki artışın kopukluk şema alanı ve duygu düzenleme güçlüğü aracılığıyla sınırda kişilik belirti düzeylerini yordadığı görülmüştür. Sınırda kişilik belirtilerinin etiyolojisinde özellikle fiziksel ve cinsel istismarın üzerinde durulmasına rağmen bu çalışmada erken dönem yaşantılar çeşitli ebeveynlik tutumları aracılığıyla daha kapsamlı bir bakış açısıyla ele alınarak sınırda kişilik belirtilerinin gelişmesinde etkili olan temel duygusal ihtiyaçların önemi vurgulanmıştır.
This chapter provides an overview of the literature on the treatment of psychopathy in adults. First, early treatment approaches are reviewed, with a particular focus on therapeutic communities. Next, studies examining the effectiveness of cognitive–behavioral therapy (CBT) for the treatment of psychopathy are summarized, including investigations of the Dangerous and Severe Personality Program and sex‐offender‐specific CBT interventions. Finally, research examining integrative approaches to the treatment of psychopathic personality traits in adults is reviewed, with an emphasis on dialectical behavior therapy and schema‐focused therapy. The chapter concludes with a brief critique of existing psychopathy research, highlighting the need for continued study in this area.
Research has shown a high prevalence of Cluster B personality disorders (e.g., borderline, narcissistic, and antisocial) in forensic populations, and the relationship between these traits and corresponding schema modes. Coping modes such as the Self-Soother, Detached Protector, and Self-Aggrandiser were relevant to these populations but could not fully explain a wider range of forensic risk behaviour seen in the forensic system among offenders. This led to an expansion of the schema therapy mode conceptualisation to include the following hypothesised modes commonly seen among offenders: Bully and Attack mode, Paranoid Overcontroller mode, Conning Manipulator mode, and Predator mode. The forensic schema therapy model described in this chapter provides a framework for understanding and ultimately treating forensic risk behaviour through the concept of schema modes which represent distinct ‘pathways to offending’, internal vulnerability risk factors for offending behaviour. Several treatment considerations are described for the application of schema therapy to the forensic context.
Purpose:
Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear.
Methods:
We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non-clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder.
Results:
Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders.
Conclusions:
The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders.
We aimed to explore the heterogeneity of schema therapy regarding (a) patient characteristics, (b) content, and (c) way of delivering schema therapy. A search was conducted of the electronic databases EMBASE, PsycINFO, Web of Science, MEDLINE, and COCHRANE up to June 15, 2022. Treatment studies were eligible if they (a) used schema therapy as (component of) the intervention examined, and (b) reported an outcome measure quantitatively. A total of 101 studies met the inclusion criteria, including randomized controlled trials (n = 30), non-randomized controlled trials (n = 8), pre-post designs (n = 22), cases series (n = 13), and case reports (n = 28), including 4006 patients. Good feasibility was consistently reported irrespective of format (group versus individual), setting (outpatient, day-treatment, inpatient), intensity of treatment, and the specific therapeutic components included. Schema therapy was applied to various (psychiatric) disorders. All studies presented promising results. Effectiveness of the different models of schema therapy as well as application beyond personality disorders should be examined more rigorously.
In dit hoofdstuk wordt de schematherapeutische behandeling van de 42-jarige tbs-patiënt Dave beschreven. Hij heeft ernstige Cluster B-persoonlijkheidsproblematiek en is veroordeeld voor een poging tot doodslag op zijn ex-vrouw. Aan de orde komen de specifieke kenmerken van de forensische setting en welke aanpassingen er in de schematherapie zijn gedaan. Dave is niet gemotiveerd voor behandeling en heeft sterke modi met veel wantrouwen. Door de levensgeschiedenis van Dave en de stappen in de schematherapie binnen het multidisciplinaire tbs-kader te beschrijven, wordt getracht een beeld te schetsen van het proces van dader (met overcompenserende modi op de voorgrond) naar slachtoffer (achterliggende kindmodi) en vervolgens naar Gezonde Volwassene. Aan het einde wordt teruggeblikt op de behandeling van Dave en wordt een aantal conclusies over forensische schematherapie getrokken.
The purpose of this paper will be to explore the treatment of psychopathy, personality disorders and sexual offending in order explain the rationale for a new group treatment intervention designed to target risk of sexual offending amongst high risk males with complex personality disorder. The paper will argue that as a result of early childhood and adolescent experiences, this client group may develop schemata which presents in treatment as therapy interfering and that this should be targeted within the group prior to exploring offending behaviour. The paper outlines each sequential aspect of the ‘Positive Pillars’ sex offender treatment group which attends to all of the principles of risk, need and responsivity in terms of ‘What Works’ when treating sexual offending and at the same time provides an integrative treatment that is evidence based for targeting therapy interfering behaviours.
Personality disorder affects more than 10% of the population but is widely ignored by health professionals as it is viewed as a term of stigma. The new classification of personality disorder in the ICD-11 shows that we are all on a spectrum of personality disturbance and that this can change over time. This important new book explains why all health professionals need to be aware of personality disorders in their clinical practice. Abnormal personality, at all levels of severity, should be taken into account when choosing treatment, when predicting outcomes, when anticipating relapse, and when explaining diagnosis. Authored by leading experts in this field, this book explains how the new classification of personality disorders in the ICD-11 helps to select treatment programmes, plan long-term management and avoid adverse consequences in the treatment of this patient group.
Zusammenfassung Das deutlich überarbeitete Persönlichkeitsstörungskonzept der ICD-11 eröffnet neue Perspektiven für die forensische Psychiatrie im Hinblick auf die Schuldfähigkeitsbegutachtung sowie die Therapieplanung und -prognose. Dabei übernehmen die allgemeinen Kriterien einer Persönlichkeitsstörung eine bedeutsamere Rolle in der Diagnostik. Außerdem erlaubt die Schweregradeinteilung im neuen dimensionalen Ansatz und die Bestimmung verschiedener, für die Funktionsbeeinträchtigungen besonders relevanter Persönlichkeitsdomänen eine nuancierte Beschreibung einer Persönlichkeitsstörung. Die differenzierte Diagnostik ermöglicht bei der Schuldfähigkeitsbegutachtung eine individuellere Abbildung von Defiziten, die einer exakteren Darstellung von Zusammenhängen zwischen psychosozialen Funktionsbeeinträchtigungen und Delikt zuträglich sein kann. Für die Behandlung von Persönlichkeitsstörungen gemäß der ICD-11-Aktualisierung werden Vorschläge aus der Psychotherapieforschung am Beispiel forensischer Adaptationen empirisch gestützter Therapieverfahren illustriert. Mithilfe eines Fallbeispiels werden die Konsequenzen des neuen Diagnosesystems im vorliegenden Artikel veranschaulicht. Abstract Personality disorders as per ICD-11: Implications for forensic psychiatric practice The substantive revision of the concept of personality disorder as published in ICD-11 creates new perspectives for forensic psychiatry as regards assessing criminal responsibility, as well as planning treatment and providing a legal prognosis thereon. The general criteria of a personality disorder take on a more important role in the diagnostic process. In addition, the measure of severity in the new dimensional approach allows a more nuanced description of personality disorders as does the specification of different personality domains with relevance to functional impairments. The more differentiated diagnosis facilitates a more individual mapping of deficits and resources when assessing criminal responsibility which can promote a more precise identification of linkages between impaired psychosocial functioning and a criminal offence. For the treatment of personality disorders as per the updated ICD-11, we outline preliminary proposals from psychotherapy research using the example of forensic adaptations of empirically supported therapy methods. The consequences of the new diagnostic system are illustrated on the basis of a clinical case.
Psychopathy is defined by a constellation of interpersonal, affective and behavioural characteristics that should, in principle, be strongly related to risk for recidivism and violence. We reviewed the literature on The Hare Psychopathy Checklist-Revised scales (PCL-R; Hare, 1980, 1991) and recidivism. We found that the PCL-R consistently was an important predictor across inmate samples and was consistently among the best predictors of recidivism. Average correlations between the PCL-R and recidivism, weighted by their degrees of freedom, were .27 for general recidivism, .27 for violent recidivism, and .23 for sexual recidivism. Relative risk statistics at one year indicated that psychopaths were approximately three times more likely to recidivate—or four times more likely to violently recidivate—than were non-psychopaths. The correlation between general recidivism and PCL-R Factor 2 (a measure of the social deviance facet of psychopathy) was stronger than the correlation between general recidivism and PCL-R Factor 1 (a measure of the interpersonal/affective facet of psychopathy). Both PCL-R factors contributed equally to the prediction of violent recidivism. The PCL-R routinely made a significant contribution towards predicting recidivism beyond that made by key demographic variables, criminal history, and personality disorder diagnoses. Across studies, PCL-R scores were as strongly associated with general recidivism, and were more strongly associated with violent recidivism, than were actuarial risk scales designed specifically to predict reoffending. Taken together, these findings indicate that the PCL-R should be considered a primary instrument for guiding clinical assessments of risk for criminal recidivism and dangerousness.
The Psychopathy Checklist (PCL/PCL-R) continues to receive recognition among clinicians and researchers for its ability to predict violent and nonviolent recidivism. This article reviews the psychometric properties and the clinical utility of the PCL-R and reports a meta-analysis of 18 studies that Investigate the relationship between the PCL/PCL-R and violent and nonviolent recidivism. We found that the PCL and the PCL-R had moderate to strong effect sizes and appear to be good predictors of violence and general recidivism. As a component of dangerousness assessments, psychologists may want to consider utilizing the PCL-R when making probability statements regarding placement decisions in institutions, parole and conditional release decisions, and community placement decisions for psychiatric patients. The generalizabilfty of the PCL beyond these groups, which have primarily consisted of Anglo-American samples, is still in question and requires further research.
Schematherapie is een door Jeffrey Young en medewerkers ontwikkelde benadering voor de ambulante, individuele behandeling
van patiënten met persoonlijkheidsstoornissen. In Psychotherapeutisch Centrum ‘De Viersprong’ wordt sinds 1997 gewerkt met
dit model, dat omgevormd is voor groepsbehandeling in een klinische setting. In het artikel wordt beschreven hoe deze vertaalslag
in de praktijk is verlopen en hoe de schematherapie gebruikt wordt in de psychotherapie, de sociotherapie en de non-verbale
therapieën. Ter illustratie van onze werkwijze wordt een casus gepresenteerd.
This study aimed to identify patient factors that predict early dropout from psychodynamic psychotherapy for borderline personality disorder (BPD). Thirty-six BPD patients began an open-ended course of twice per week psychodynamic psychotherapy that was defined in a treatment manual and supervised. Dropout rates were 31% and 36% at 3 and 6 months of therapy, respectively. Survival analysis techniques demonstrated that age and hostility ratings predicted early dropout, with continuers more likely to be older and expressing lower levels of hostility than dropouts. Many variables hypothesized to predict dropout failed to do so. Both the positive and negative findings are discussed relative to the literature.
The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.
Convergence of PDQ-R- and SIDP-R-derived personality disorder diagnoses was studied in a sample of 85 forensic psychiatric patients. For categorical diagnoses, the mean kappa was .34, but on a dimensional level convergence was somewhat higher. Paranoid, antisocial and borderline personality disorders had prevalence rates around 40%; the other personality disorders occurred with much lower frequency. The PDQ-R yielded more diagnoses, except for antisocial, histrionic, narcissistic, and sadistic personality disorder. Because the latter disorders are among the most prevalent in forensic settings, and because they have important risk and treatment implications, the PDQ-R is not suitable as a screening device in forensic populations. Semistructured interviews that make use of collateral information are recommended for diagnosing personality disorders in forensic subjects.
Within a Swedish longitudinal project, possible implications of childhood neglect and/or abuse on adult psychopathy checklist (PCL) scores and violent offending were studied.
The subjects were males (n=199), recruited from a socially high-risk neighborhood and grouped on an index variable of victimization, yielding high (n=110) and low victimization (n=89) groups. To highlight a possible comorbidity of all three problems in the same persons, a combined dimensional and categorical (configural frequency analysis, CFA) approach was applied.
The high victimization subjects exerted significantly more violence, as did subjects with high PCL scores. Furthermore, in the CFA two significant 'types' were found: one type indicating that 'high' victimization in childhood is closely linked to later 'extensive' violence and 'high' PCL scores at adult age in the same individuals; the other supporting a frequent co-occurring of 'low' victimization in childhood, 'none or minor' later indications of violence and 'low' adult PCL scores.
The results point to possible underlying mechanisms linked to all three problems characterizing the affected subjects.
We studied a large sample of male children from birth to adulthood to determine why some children who are maltreated grow
up to develop antisocial behavior, whereas others do not. A functional polymorphism in the gene encoding the neurotransmitter-metabolizing
enzyme monoamine oxidase A (MAOA) was found to moderate the effect of maltreatment. Maltreated children with a genotype conferring high levels of MAOA expression were less likely to develop antisocial problems. These findings may partly explain why not all victims of maltreatment
grow up to victimize others, and they provide epidemiological evidence that genotypes can moderate children's sensitivity
to environmental insults.
The aim of this study was to examine the rate of criminal recidivism among female homicide offenders evaluated by forensic psychiatrists, to compare this rate with that of other violent female offenders, and to analyze the explanatory variables of recidivism.
This was a retrospective study of all women (N=132) sent for forensic psychiatric examination after being convicted of homicide or attempted homicide in Finland during 1982-1992; subjects were followed up until mid-1999. Data were collected from the national crime register, the prisoner record, and Statistics Finland. The authors compared the rate of violent repeat offending in this group with that of other violent women and analyzed the explanatory variables of recidivism.
During the follow-up period, 23% of the study group committed a repeat offense, 15% of which were violent and 3% of which were homicides. Almost half of all repeat offenses occurred within the first 2 years after the index offense. There was no statistically significant difference in violent recidivism between the study group and other violent female offenders. Of those who committed repeat offenses, 81% were diagnosed with a personality disorder, and 10% were diagnosed with psychosis. Criminality prior to the index event, alcohol or drug dependency, and young age significantly raised the risk and rapidity of further offenses.
The risk of recidivism was high in this study group yet was similar to that of other violent female offenders. The risk was high very early after release. It seems that women and men who are violent and have personality disorders are comparable in their risk of recidivism.
Despite the rapidly growth of mental health attention focused on the phenomenon of stalking, no empirical research to date has attempted to assess the frequency of repeat offending or attempted to identify predictors of recidivism. A total of 148 stalking and harassment offenders who were court-ordered to undergo a mental health evaluation were followed for a period of 2.5-13 years in order to assess the frequency of repeat offenses and the variables that differentiated high versus low risk offenders. Recidivism data were obtained from a variety of sources, including criminal justice records, mental health records, and reports from probation officers and victims. A number of potential "predictor" variables were selected on the basis of the existing recidivism literature in other criminal justice populations. Frequency analysis were used to identify variables that significantly differentiated offenders who did and did not reoffened while survival analysis was used to analyze the impact of these covariates on time to reoffense. A total of 49% of the offenders reoffended during the follow-up period, 80% of whom reoffended during the first year. The strongest predictors of recidivism included the presence of a personality disorder, and in particular, a "Cluster B" personality disorder (i.e., antisocial, borderline, and/or narcissistic). In addition, those offenders with both a personality disorder and a history of substance abuse were significantly more likely to reoffened compared to either of these risk factors alone. Surprisingly, the presence of a delusional disorder (e.g., erotomania) was associated with a lower risk of reoffender. The findings are discussed in terms of the legal system and treatment implications.
Assessment and management of criminal offenders require valid methods to recognize personality psychopathology and other risk and protective factors for recidivism. We prospectively explored the association between dimensional and categorical measures of personality disorder (PD) measured with the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q, Ottosson et al., 1995) and registered reconvictions in adult offenders. One hundred and sixty-eight offenders consecutively referred for pre-sentencing forensic psychiatric evaluation in Sweden during 1995-1996 completed DIP-Q self-reports. The subjects received different types of sanctions and were followed for an average of 36 months after release from prison, discharge from a forensic psychiatric hospital, or onset of nondetaining sentences. Age-adjusted odds ratios revealed a 4.8 times higher risk for any recidivism and a 3.7 times higher risk for violent recidivism among subjects whose self-reports suggested a categorical diagnosis of antisocial PD as compared to offenders without antisocial PD. The remaining nine categorical DSM-IV PD diagnoses were not significantly related to recidivism. In dimensional analyses, each additional antisocial and schizoid PD symptom endorsed by participants at baseline increased the risk for violent reoffending. Our results suggest a relationship between self-reported behavioral instability and interpersonal dysfunction captured primarily by DSM-IV antisocial and schizoid PD constructs, and criminal re-offending also in a multi-problem sample of identified offenders.
Although psychopathy is frequently regarded as qualitatively distinct from other conditions, relatively little research has examined whether psychopaths represent a distinct class of individuals. Using a sample of 876 prison inmates and court-ordered substance abuse patients who were administered the Psychopathy Checklist-Revised (R. D. Hare, 2003), the authors examined the latent structure of psychopathy using several taxometric procedures developed by Meehl and colleagues (P. E. Meehl & L. J. Yonce, 1994; N. G. Waller & P. E. Meehl, 1998). The results across these procedures offer no compelling support for the contention that psychopathy is a taxonic construct and contradict previous reports that psychopathy is underpinned by a latent taxon. The authors discuss the theoretical, public policy, and practice-level implications of these findings.
Theorists have postulated that some variants of psychopathy result from childhood abuse and neglect. Dissociative symptoms are also thought to arise from abuse. To date, the conjoint associations among abuse, dissociation, and psychopathy have not been examined systematically. Some have hypothesized that abuse relates primarily to the affective symptoms of psychopathy, with dissociative experiences mediating this relationship. Others have suggested that abuse more directly affects the impulsive lifestyle features of psychopathy. The authors used structural equation modeling to examine these hypotheses in a sample of 615 male offenders who had completed a retrospective self-report measure of childhood abuse, the Dissociative Experiences Scale, and R. D. Hare's (2003) Psychopathy Checklist--Revised. Abuse exerted no direct or indirect effect on the core interpersonal and affective features of psychopathy but was directly related to the facet of psychopathy associated with an impulsive and irresponsible lifestyle. Implications for psychopathy subtypes are discussed.
Borderline personality disorder is a severe and chronic psychiatric condition, prevalent throughout health care settings. Only limited effects of current treatments have been documented.
To compare the effectiveness of schema-focused therapy (SFT) and psychodynamically based transference-focused psychotherapy (TFP) in patients with borderline personality disorder.
A multicenter, randomized, 2-group design.
Four general community mental health centers.
Eighty-eight patients with a Borderline Personality Disorder Severity Index, fourth version, score greater than a predetermined cutoff score.
Three years of either SFT or TFP with sessions twice a week.
Borderline Personality Disorder Severity Index, fourth version, score; quality of life; general psychopathologic dysfunction; and measures of SFT/TFP personality concepts. Patient assessments were made before randomization and then every 3 months for 3 years.
Data on 44 SFT patients and 42 TFP patients were available. The sociodemographic and clinical characteristics of the groups were similar at baseline. Survival analyses revealed a higher dropout risk for TFP patients than for SFT patients (P = .01). Using an intention-to-treat approach, statistically and clinically significant improvements were found for both treatments on all measures after 1-, 2-, and 3-year treatment periods. After 3 years of treatment, survival analyses demonstrated that significantly more SFT patients recovered (relative risk = 2.18; P = .04) or showed reliable clinical improvement (relative risk = 2.33; P = .009) on the Borderline Personality Disorder Severity Index, fourth version. Robust analysis of covariance (ANCOVA) showed that they also improved more in general psychopathologic dysfunction and measures of SFT/TFP personality concepts (P<.001). Finally, SFT patients showed greater increases in quality of life than TFP patients (robust ANCOVAs, P=.03 and P<.001).
Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.
The well-documented finding that child physical maltreatment predicts later antisocial behavior has at least 2 explanations: (a). Physical maltreatment causes antisocial behavior, and (b). genetic factors transmitted from parents to children influence the likelihood that parents will be abusive and that children will engage in antisocial behavior. The authors tested these hypotheses in the representative Environmental-Risk cohort of 1116 twin pairs and their families, who were assessed when the twins were 5 and 7 years old. Mothers reported on children's experience of physical maltreatment, and mothers and teachers reported on children's antisocial behavior. The findings support the hypothesis that physical maltreatment plays a causal role in the development of children's antisocial behavior and that preventing maltreatment can prevent its violent sequelae.
In this study, the prevalence of a broad range of Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) Axis I disorders (Composite International Disorder Interview) and all Axis II disorders (International Personality Disorder Examination) is determined with standardized, semistructured interviews of a group of 39 male forensic inpatients. Substance abuse (75.7%) and mood (51.3%) and anxiety (40.3%) disorders were the most prevalent Axis I disorders. Of Axis II disorders, 86.8% evinced a personality disorder most often from the B cluster. A high percentage of the participants received the diagnosis “personality disorder not otherwise specified” (42.1%). There was a high level of comorbidity of mood and anxiety disorders with personality (61%) and substance abuse (47%) disorders. Compared with the general population, the prevalence rates of the separate disorders found among these forensic participants are much higher. The results of this study emphasize the importance of the use of standardized diagnostic instruments and the assessment of a broad range of disorders.
This book discusses schema-focused therapy, an integrative approach . . . to treat characterological patients including borderline, narcissistic, avoidant, dependent, obsessive-compulsive, passive-aggressive, and histrionic personality disorders. . . . [This] model is [an] integration of cognitive behavior therapy with gestalt, object relations, and psychoanalytic approaches. It expands on conventional cognitive behavior therapy by placing more emphasis on the therapeutic relationship, affective experience, and the discussion of early life experiences. In addition to presenting the rationale, theory, and practical techniques of schema-focused therapy, this book includes an extended case example, and revised editions of the Schema Questionnaire, Client's Guide, and schema listings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Assessment of psychiatric signs and symptoms has undergone significant change and maturation over the past 3 decades. More specifically, the ability of clinicians and researchers to accurately diagnose psychiatric disorders and classify mental illness has significantly improved. Numerous structured diagnostic interviews have been developed for clinical, research, and training applications. Structured interviews have been devised to assist in diagnosis of all major Axis I (clinical) and all standard Axis II (personality) disorders. Most structured interviews are linked to DSM criteria and subsequently have been revamped to match refinements in the DSM classification system as it has evolved. This chapter reviews the prominent structured and semistructured interviews designed to enhance psychiatric diagnosis. For each instrument, the purpose, construction, psychometric properties, and clinical applications are discussed. In addition, general issues about the nature and development of structured interviews are examined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The interrelationships among early childhood victimisation, psychopathy and violence were examined in a sample of previously abused and neglected individuals (n = 652) and a matched control group (n = 489). Measures of psychopathy, assessed utilising Hare's Psychopathy Checklist (PCL-R), and violence (based on official arrest and self-report information) were included in a series of multivariate analyses. Victims of childhood abuse and/or neglect had significantly higher PCL-R scores than persons in a matched control group, despite controls for demographic characteristics and criminal history. PCL-R scores predicted official and self-reported violence. Childhood victimisation was a significant predictor of violence; however, when PCL-R scores were introduced, childhood victimisation was no longer significant. Findings demonstrate a clear connection between early childhood victimisation and psychopathy and suggest that the relationship between childhood victimisation and violence in some individuals may be mediated through psychopathy. A number of potential mechanisms are suggested to explain these linkages. Copyright © 1996 Whurr Publishers Ltd.
We review the theory, techniques, and development of a manual-guided individual psychotherapy for substance-dependent individuals diagnosed with personality disorders. Dual Focus Schema Therapy (DFST) integrates relapse prevention for substance dependence with targeted work on early maladaptive schemas (enduring negative beliefs about oneself, others, and events) and coping styles. The first 3 patients (one each from DSM-IV Axis-II Cluster A, B, and C) treated during the pilot testing phase of the manual are summarized to illustrate differences in psychopathology, personality and interpersonal functioning, early maladaptive schemas and coping styles, and treatment response.
Reliable patient re-conviction data after leaving high security hospitals are of public interest, but official statistics are without context and sometimes incomplete. Some patient sub-groups are rarely studied. Our study describes re-convictions for a complete national annual high security hospital discharge cohort. We hypothesized that: established community living would precede re-conviction and that more people with personality disorder would be re-convicted, with a higher rate, than people with other disorders, even allowing for community time. Cases were identified using the special hospitals' case register; follow-up data were from multiple records sources. Seventy-four patients (38 per cent) were convicted after discharge, 26 per cent of serious offences. All 10 multiple reoffenders (>9 offences) were men. Fourteen per cent of those re-convicted had offended during institutional residence. Median time to first community re-conviction was under two years. Logistic regression analysis confirmed that people with personality disorder were seven times more likely than people with mental illness to be convicted of a serious offence after discharge. Methodological procedures that maximize validity of findings are discussed.
We compared the childhood experiences of criminal psychopaths with those of criminal nonpsychopaths, to examine whether differences in either the type or intensity of adverse experience in childhood could be identified. One hundred and five prisoners, 50 psychopaths, and 55 nonpsychopaths were assessed with the Psychopathy Checklist-Revised (PCL-R) and Childhood Experience of Care and Abuse (CECA) semistructured interviews. Both assessment measures have been demonstrated to be reliable and valid instruments. File information from both adult and child services provided corroborative material. Factor analysis of the childhood experience variables revealed two distinct factors, familial and societal, both of which were highly correlated with adult psychopathy scores. These findings suggest that the experiences psychopaths have in childhood influence adult outcome.
- The present study examined the prevalence of DSM IV axis I disorders and DSM IV personality disorders among sexual offenders in Forensic State Hospitals in Germany.
- Current and lifetime prevalence rates of mental disorders were investigated based on clinical structured interviews among sexual offenders (n = 55). Additionally, subgroups were analyzed on the basis of diagnostic research criteria, with 30 sexual offenders classified as paraphiliacs and 25 sexual offenders as having an impulse control disorder (without paraphilia).
- Anxiety disorders, mood disorders, and substance use disorders were common among sexual offenders, as were cluster B and cluster C personality disorders. While social phobia was most common among paraphilic sexual offenders, major depression was most prevalent in impulse control disordered sexual offenders.
- The results replicate recent findings of high psychiatric morbidity in sexual offenders placed in forensic facilities. Furthermore, differential patterns of co-morbid mental disorders were found in paraphiliacs and impulse control disordered sexual offenders. With regard to an effective therapy and relapse prevention co-morbid mental disorders should be a greater focus in the assessment of subgroups of sexual offenders.
We aimed to evaluate critically the evidence behind the perceived inverse association between the degree of psychopathy as reflected by a high score on the Hare Psychopathy Checklist-Revised (PCL-R) and treatment response. A literature search with the key identifiers of PCL-R (or its derivatives) and treatment response produced 24 studies that were then systematically evaluated. This showed that only three studies were of an appropriate research design to answer the question and of these, none met our standard for an acceptable study. We conclude therefore that the commonly held belief of an inverse relationship between high-scores on the PCL-R and treatment response has not been established.
Individuals with early warning signs of life-long psychopathy, callous-unemotional traits (CU) and high levels of antisocial behaviour (AB) can be identified in childhood. We report here the first twin study of high levels of psychopathic tendencies in young children.
At the end of the first school year, teachers provided ratings of CU and AB for 3687 twin pairs from the Twins Early Development Study (TEDS). For the analyses of extreme CU, we selected same-sex twin pairs where at least one twin scored 1.3 or more standard deviations above the mean on the CU scale (612 probands, 459 twin pairs). For the analysis of extreme AB, we selected same-sex twin pairs where at least one twin scored 1.3 or more standard deviations above the mean on AB scale (444 probands, 364 twin pairs). Furthermore, the extreme AB sample was divided into those who were also extreme on CU (children with psychopathic tendencies; 234 probands, 187 twin pairs) and those who did not score in the extreme for CU (children without psychopathic tendencies; 210 probands, 177 twin pairs).
DeFries-Fulker extremes analysis indicated that exhibiting high levels of CU is under strong genetic influence. Furthermore, separating children with AB into those with high and low levels of CU showed striking results: AB in children with high levels of CU is under extremely strong genetic influence and no influence of shared environment, whereas AB in children with low levels of CU shows moderate genetic and shared environmental influence.
The remarkably high heritability for CU, and for AB children with CU, suggests that molecular genetic research on antisocial behaviour should focus on the CU core of psychopathy. Our findings also raise questions for public policy on interventions for antisocial behaviour.
In the current standard psychiatric nomenclature, the DSM-IV-TR (APA, 2000), mental disorders are divided into two groups: Clinical Disorders (CDs) and Personality Disorders (PDs), and CD and PD diagnoses are recorded on two separate axes (Axes I and II, respectively). This article considers evidence regarding putative bases for distinguishing between CDs and PDs, and finds that these constructs are more similar than distinct. Links between the domains may be better understood by focusing on how personality connects CDs and PDs. This perspective underlines the need to work toward a more unified model of personality, PDs, and CDs in research and in future editions of the DSM.
The effects of an intramural cognitive-behavioral treatment for forensic inpatients with personality disorders in a high-security hospital were examined. Treatment was aimed at modifying maladaptive coping and social skills, at enhancing social awareness, at reducing egoistic and oppositional behaviors, and at reducing psychological complaints. The patients, who all had committed serious crimes (violence, arson, sexual offences), participated voluntarily in the study. A total of 39 patients started the study, but during the course of the study, several patients dropped out because of several reasons. Patients as a group showed significant improvements over time on psychopathological symptoms, personality traits, and coping. A significant decrease of oppositional behaviors was reported by the staff. Though the patients improved well at the group level, only a minority of patients showed reliable change over time at the individual level. The meaning of the results in relation to treatment are discussed.
Psychopathy appears to be comprised of two broad dimensions: impulsivity/antisocial behavior and interpersonal detachment/callousness. This study examined the extent to which variance in these 2 psychopathy trait dimensions was associated with common or unique genetic, shared, and nonshared environmental factors in two independent samples of reared together 16-18-year-old male twins. One sample included 142 monozygotic (MZ) and 70 dizygotic (DZ) pairs; the other sample included 128 MZ and 58 DZ pairs. Boys completed the Minnesota Temperament Inventory (MTI), a 19-item measure that contains separate subscales: Antisocial and Detachment. Variance in the Antisocial and Detachment scales was associated with additive genetic factors and neither scale was associated with shared environmental factors. As expected, the bivariate biometric analysis suggested genetic influence on the covariance of the scales. The results are consistent with theoretical models of psychopathy that posit some independence in the etiology of the two major trait dimensions of psychopathy.
Assessment of early maladaptive schemas: on the validity of the Dutch young schema questionnaire
- M M Rijkeboer
Rijkeboer, M.M. (2005). Assessment of early maladaptive
schemas: on the validity of the Dutch young schema
questionnaire. Enschede/Amsterdam (the Netherlands):
Print Partners Ipskamp.
Schema Therapy: A Practitioner's Guide
- J E Young
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