Which approaches (psychodynamic psychotherapy) can be effective in improving symptoms of Cluster C PDs?
Both confrontational and supportive approaches were effective
5 approaches to therapy with BPD
CBT, DBT, SFT, TFT and MBT
What is the aim in CBT?
Identify and modify core dysfunctional beliefs that automatically organize biased perceptions of self, others and the future.
Which types of patients is DBT used for?
Chronically suicidal and severely dysfunctional BPD patients.
What is at the core of BPD, according to Linehan?
Emotional dysregulation
What does emotional dysregulation stem from?
Biological vulnerability and an invalidating environment, which communicates to the person that their reactions aren’t adequate.
What principles is DBT based on?
Acceptance, mindfulness and dialectics.
What is the fundamental dialectic of DBT?
Between acceptance and change.
Differences between CBT and DBT
- CBT focuses only on change, DBT also focuses on acceptance
- DBT is directed at teaching new skills, CBT focuses on cognitive restructuring
What is the first phase of DBT and its 3 targets
Stabilizing the patient and achieving behavioral control
- patient needs to be alive and well
- productively collaborating on tasks of treatment
- and on issues that interfere with their effective functioning
How does DBT make intelligent use of contingencies and reinforcement?
Focus of therapist is in helping patient use the appropriate skills to manage current crisis, instead of directly managing the crisis itself.
(If the client executes these skills, and extra session can be scheduled to address the underlying issues)
What are schemata and why are they hard to change?
Broad, deep-seated beliefs and themes about the self and the world. Provide a sense of control and predictability and are part of a person’s sense of identity.
Where do schemata stem from?
From unsatisfied basic emotional needs during childhood.
What are the 5 core emotional needs?
- Development of a secure attachment to others
- Development of autonomy, competency and sense of identity
- Freedom to express valid emotions and needs
- Spontaneity and play
- Realistic limits and self-control
What are 4 types of early experience that foster the acquisition of schemata?
- Toxic frustration of needs (deprivation)
- Traumatization (mistrust/abuse)
- Overindulgence (entitlement and dependence)
- Selective internalization (subjugation)
3 types of coping behaviors when a schema is triggered
Overcompensation, avoidance and surrender
What is a mode in SFT?
The schemas and coping style operating at a given moment
What are the 5 modes in SFT?
The abandoned/abused child, angry and impulsive, detached protector, punitive parent and underdeveloped healthy adult
Which 3 phases does SFT follow?
- Bonding and emotional regulation phase
- Shema mode phase
- Development of autonomy phase
SFT uses 4 mechanisms of healing, which ones?
- Limited parenting
- Emotion-focused work through imagery and dialogues to produce positive change
- Cognitive restructuring and education
- Behavior pattern breaking
What is the aim of transference-focused therapy (TFT)?
Understand issues that originated in childhood, and learn to accept conflicting feelings in one person (both bad and good).
What’s the main assumption of TFT?
That important childhood conflicts will surface in the therapeutic relationships.
How is change achieved in TFT?
- Active therapist involvement
- Focus on here-and-now (transference and countertransference)
What is splitting?
Switching from all-good to all-bad images of self and others, which served as a defensive function in childhood
