Schema Therapy for Borderline Personality Disorder. Hannie van Genderen
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СКАЧАТЬ see that you do not really know what you're talking about. You only pretend to be a good schema therapist.

      T:

      (he has a tendency to defend himself) I really think I know which side of you is this.

      P:

      O you are such a loser if you talk like that.

      T:

      I do not like it when you talk to me like that.

      P:

      (laughing) Now you are insulted huh? That is not very professional behavior.

       Response from a self‐aggrandizer:

      P:

      I am not angry at all. I am only irritated because you have planned your holiday at the wrong time. Exactly before my holidays. Can't you postpone your holiday?

      T:

      No, I'm not going to do that. Which side of you thinks I should adapt to you?

      P:

      Should I explain ST to you? I thought that limited reparenting was the core of your therapy. If you really think that I am important you would postpone your holiday.

       Response from punitive parent:

      P:

      I don't know which “side” of me this is. I only know that I must have been a complete idiot to trust you and that is one mistake I won't make again. It doesn't matter anyway; I'll never get better and I don't deserve to get better.

      T:

      I think I hear the voice of your punitive parent mode. Maybe that side says that you make a fool of yourself by having sad or angry feelings.

      P:

      That's not my punitive parent mode, but a fact. It is childish behavior when you only have 1 week holiday.

      In the beginning of the therapy, the subtle differences between the angry protector or bully and attack mode and the angry child can also be difficult to distinguish. The differences are primarily evident in the level of anger that is paired with the reaction (see the section “angry/impulsive child”), and in the intention underlying the anger. Whereas, with the angry protector, the intention is to keep others away to protect oneself for being abused, rejected, or abandoned, with the angry child the intention is to protest against maltreatment by others and to get recognition for one's (interpersonal) needs.

      These examples involve the protector expressing herself in an active manner. The completely opposite form in which the protector may express herself is by exhibiting tired or sleepy behavior. In this case the therapist must assess whether or not the patient is actually tired or whether she is in the protector mode.

      There is the risk that while in the protector mode, the patient may avoid therapy and not work on her problems with a serious chance of her stopping therapy all together. The patient can also have problems with dissociative symptoms, self‐injury, addiction to numbing substances (e.g., drugs or alcohol), or may attempt suicide. Because of this, it is important to identify when the protector mode is present and bypass it. This will give the patient an opportunity to work on her actual problems.

      How to recognize a detached protector mode during a session

      The patient is not making real contact with the therapist

      The patient doesn't show emotions, even if she talks about emotional experiences

      The patient is rationalizing

      The patient is angry or arrogant in a controlled way in order to keep you at a distance

      The patient talks a lot about nothing

      The patient is complaining about physical problems extensively

      The patient whines (seems to cry, but the therapist doesn't feel empathy)

      The patient is completely worn‐out without a clear cause

      The patient always wants to talk about actual problems and expects an immediate solution

      The tone of voice is flat

       The abandoned/abused child

      The abandoned/abused child is often referred to as “Little …” (= the name of the patient). In our examples, we refer to the patient as Nora. Therefore, when in this mode she becomes “Little Nora.”

      Little Nora is sad, desperate, inconsolable and often in complete panic (See ST step by step 5.01). When in this mode the patient's voice itself often changes to that of a child. Her thoughts and behavior become that of a four‐ to six‐year‐old. She feels alone in the world and is convinced that no one cares about her. The basic belief in this mode is that she can trust no one. Everyone will reject, abuse, or eventually abandon her. The world is a threatening, dangerous place that holds no future for her.

      Little Nora thinks in terms of black and white. She demands constant and immediate reassurance and solutions to her problems. She is incapable of helping herself. There is a great chance that during the first phase of the therapy, the therapist will face Little Nora mainly in situations of crisis. In the early stage of the therapeutic process, it is unlikely the patient will show her abandoned child side at other moments (for a sample dialogue, see Chapter 9, “Treatment Methods for the Abandoned and Abused Child”).

      Nora's feelings of desperation and the therapist's feelings of incompetence will only become greater if the therapist continues to advise practical solutions. Should she be referred on too quickly, Little Nora becomes even more desperate as she feels misunderstood, abandoned, and rejected.

      The therapist must allow Little Nora's presence in these sessions. He must be supportive of her, validate her feelings, offer a safe haven, encourage her to bond with him as a therapist, and address her past abuse. In short, he must offer her what she was most likely denied during her childhood.

      How to recognize the abandoned/abused child during a session

      The patient is overwhelmed by sad or anxious emotions

      The patient is helpless

      The СКАЧАТЬ