DT-28-01-35.pdf 618.44 KB 641 downloads
Borderlinecliënten behandelen met schematherapie is leuk ...Samenvatting
Maakt schematherapie het behandelen van een cliënt met een borderlinepersoonlijkheidsstoornis echt leuker? Uit onderzoek (Giesen-Bloo et al., 2006) blijkt in ieder geval wel dat drie jaar intensieve schematherapie in 45% van de gevallen leidt tot volledig herstel en in nog eens 20% tot aanzienlijke verbetering. Na vier jaar is het percentage herstelde cliënten gestegen tot 52%. Dat geldt zowel voor lichtere gevallen als voor cliënten met ernstige symptomen. De therapie verreist een speciale hantering van de therapeutische relatie (limited reparenting) en een afwisseling van experiëntiële, cognitieve en gedragsmatige technieken. In dit artikel wordt schematherapie in het algemeen en de limited reparenting en de experiëntiële technieken in het bijzonder, toegelicht aan de hand van een casus. De vragen over de meest controversiële elementen in de therapie, zoals het modusmodel, limited reparenting en experiëntiële technieken worden in de discussie besproken. Geconcludeerd kan worden dat schematherapie niet alleen werkzaam is, maar gaandeweg de behandeling voor zowel cliënten als therapeuten ook steeds leuker wordt.
Summary
Does Schema Therapy really increase the fun of treating patients with a Borderline Personality Disorder? Research (Giesen-Bloo et al., 2006) has demonstrated that three years of Schema Therapy leads in 45% of the cases to recovery from the Borderline Personality Disorder, and in another 20% of the cases to significant improvement. After four years the proportion of recovered patients had increased to 52%. This held both for the more and the less severe patients.
The treatment requires a special way of dealing with the therapeutic relationship (limited reparenting) and a mixture of experiential-, cognitive- and behavioural techniques. This paper offers a general introduction to Schema Therapy and specifically elucidates limited reparenting and experiential techniques with the help of a case example. Issues related to the most controversial elements of Schema Therapy, such as the schema mode model, limited reparenting and the experiential techniques are reviewed in the discussion. It is concluded that Schema Therapy is not only effective, but also increases the fun of the treatment both for patients and therapists.
Referenties
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington DC: American Psychiatric Association.
Arntz, A. (2003). Borderline personality disorder. In: A.T. Beck, A. Freeman, & D.D. Davis. Cognitive Therapy of Personality Disorders (2nd. edition). New York: The Guilford Press.
Arntz, A. (2007). New insights from therapy Borderline trial. Delft: Paper presented at the 2nd congress of the International Society of Schema Therapy, 15-16 september 2007.
Arntz, A., Hoorn, M. van den, Cornelis, J., Verheul, R., Bosch, W. van den, & Bie, A. de (2003). Reliability and validity of the Borderline Personality Disorder Severity Index. Journal of Personality Disorders, 17(1), 45-59.
Arntz, A., Klokman, J., & Sieswerda, S. (2005). An experimental test of the schema mode model of borderline personality disorder. Journal of Behavior Therapy and Experimental Psychology, 36, 229-239.
Arntz, A., & Kuipers, H. (1998). Cognitieve gedragstherapie bij de borderline persoonlijkheidsstoornis. In: W. van Tilburg, W. van den Brink & A. Arntz (red.). Behandelingsstrategieën bij de borderline persoonlijkheidsstoornis, (pp. 42-64). Houten: Bohn Stafleu van Loghum.
Arntz, A., & Weertman A. (1999). Treatment of Childhood memories: theory and practice. Behaviour Research and Therapy 37, 715-740.
Asselt, A.D.I van, Dirksen, C.D., Arntz, A., Giesen-Bloo, J.H., Dyck, R. van, Spinhoven, Ph., Tilburg, W. van, Kremers, I.P., Nadort, M., & Severens, J.L. (2008). Outpatient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy versus transference-focused psychotherapy. British Journal of Psychiatry, accepted for publication.
Cicchetti, D., Toth, S.L., & Maughan, A. (2000). An ecological-transactional model of child maltreatment. In: A.J. Sameroff, M. Lewis, & S.M. Miller (eds.). Handbook of developmental psychopathology (second edition) (pp. 689-722). New York: Kluwer Academic/Plenum Publishers.
Cohen, P., Crawford, Th.N., Johnson, J.G., & Kasen, S. (2005). The children in the community study of developmental course of personality disorder. Journal of Personality Disorders, 19, 466-486.
Genderen, H. van, & Arntz, A. (2005). Schemagerichte cognitieve therapie bij borderline-persoonlijkheidsstoornis. Amsterdam: Uitgeverij Nieuwezijds.
Giesen-Bloo, J., Dyck, R. van, Spinhoven, Ph., Tilburg, W. van, Dirksen, C., Asselt, Th. van, Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy versus transference-focused therapy. Archives of General Psychiatry, 63, 649-658.
Giesen-Bloo, J., Wachters, L.M., Schouten, E., & Arntz, A. (ingediend voor publicatie). Assessment of borderline personality disorder with the Borderline Personality Disorder Severity Index-IV: psychometric evaluation and dimensional structure.
Holmes, E.A., Arntz, A., & Smucker M.R. (2007). Imagery rescripting in cognitive behaviour therapy: Images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38, 297-305.
Kellogg, S.H. (2004). Dialogical encounters: Contemporary perspectives on ‘chairwork’ in psychotherapy. Psychotherapy: Theory, Research, Practice & Training, 41, 310-320.
Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: The Guildford Press.
Linehan, M.M., Comtois, K.A., Murray, A.M., Brown, M.Z., Gallop, R.J., Heard, H.L., Korslund, K.E., Tutek, D.A., Reynolds, S.K., & Lindenboim, N. (2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63, 757-766.
Lobbestael, J., Arntz, A., & Sieswerda, S. (2005). Schema modes and childhood abuse in borderline and antisocial patients. Journal of Behavior Therapy and Experimental Psychology, 36, 240-253.
Lobbestael, J., Vreeswijk, M.F. van, & Arntz, A. An emperical test of mode conceptualisations in personality disorders. Aangeboden ter publicatie.
Lobbestael, J., Vreeswijk, M.F. van, & Arntz, A. (2007). Shedding light on schema modes: a clarification of the mode concept and its current research status. Netherlands Journal of Psychology, juni 2007, 76-85.
Nadort, M., & Giesen-Bloo, J., (2005). Pilot implementation study of SFT for borderline patients. Eindrapportage college voor Zorgverzekeraars.
Nadort, M., Dyck, R. van, Smit, J.H., Arntz, A., Spinhoven, Ph.,Wensing, M., Giesen-Bloo, J., & Asselt, T. van (2007). Implementation of out-patient schema-focused therapy for borderline personality disorder in general psychiatry. Ongoing study.
Nordahl, H.M., & Nysæter, T.E. (2005). Schema Therapy for Patients with Borderline Personality Disorder: A Single Case Series, Journal of Behavior Therapy and Experimental Psychiatry, 36(3), 254-264.
Rijkeboer, M.M. (2005). Assessment of early maladaptive schemas. On the validity of the Dutch Young Schema Questionnaire. Universiteit Utrecht: Academisch proefschrift.
Shiner, R.L. (2005). A developmental perspective on personality disorders: Lessons form research on normal personality development in childhood and adolescence. Journal of Personality Disorders, 19, 202-210.
Shiner, R.L., & Caspi, A. (2003). Personality differences in childhood and adolescence: Measurement, development, and consequences. Journal of Child Psychology and Psychiatry, 44, 2-32.
Smucker, M.R., & Niederee, J. (1995). Treating Incest-Related PTSD and Pathogenic Schemas Through Imaginal Exposure and Rescripting. Cognitive and Behavioral Practice 2, 63-93.
Spinhoven, P., Giesen-Bloo, J., Dyck, R. van, & Arntz, A. (2007). The Therapeutic Alliance in Schema-Focused Therapy and Transference-Focused Psychotherapy for Borderline Personality Disorder. Journal of Consulting and Clinical Psychology, 75(1), 104-115.
Yeomans, F., Clarkin, J.F., & Kernberg, O.F. (2002). A Primer for Transference Focused Psychotherapy for the Borderline Patient. Northvale NJ: Jason Aronson.
Young, J.E. (1990, 1994, 1999). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota, FL: Professional Resource Press.
Young, J.E., & Brown, G. (1994). Young Schema-Questionnaire (2nd. edition). In: J.E. Young, Cognitive therapy for personality disorders: A schema-focused approach, (Rev. edition, pp. 63-76). Sarasota, FL: Professional Resource Press.
Young, J.E., Klosko, J.S., & Weishaar, M.E. (2005). Schemagerichte therapie. Handboek voor therapeuten. Houten: Bohn Stafleu van Loghum.