Re:Critiques of Schema Therapy

Thank you for your response. I was taking those critiques way too personally. I am a "true believer" type clinician but have also tried to do some research on my work and beliefs but have run into roadblocks.

For example, I wrote up a schema-focused program for offenders who were abused as children. Since the program is not strictly offense-based, it is difficult to look at recidivism as a criteria for change. I asked about personality measures that might assess pre and post changes and couldn't find any that might be sensitive enough to assess program effectiveness. Also, I find the group members very poor at self-report measures. I tried a schema flexibility measure by Charles Elliot but didn't get too far. I should try again, I know. But we are trying to do some outcome study of our 30 session cognitive based program and have run into resource and money problems so that's been in the work for 3 years now.

It's true that there is not a lot of empirical basis for schema basis versus usual cognitive therapy for personality disorders. However, there was a study by Woody et al who found that cognitive-behavioral therapy only worked with antisocials when they were also depressed. This does suggest that antisocials do need to have some negative affect in order to give them motivation to use the cognitive-behavioral techniques. So my assertion that it helps offenders to get in touch with their emotional pain might be correct. In addition, Flemming and Pretzer in "Cognitive Behavioral approaches to Personality disorders" gives many examples of limited effectiveness of standard cognitive behavioral treatment for subjects diagnosed with personality disorders so there is evidence for a need for something more.

Thinking about it, I believe that Thornton has found some research on the efficacy of schema work with sex offenders. I'll try to find it and share it with you. Then there is Layden, Newman, Freeman and Morse who state, p.8 that "It is at the level of schemas that the most meaningful work is done with BPD patients in cognitive therapy. And they cite Beck for that observation!

I guess the best reason that schema therapy (especially the schema processes as proposed by Young) seems so helpful is that the conceptual basis makes a lot of sense and is very utilitarian to me as a clinician. For example, the conceptualization of Layden, Newman, Freeman and Morse is very interesting but not very handy when you have to work with a lot of mixed personality disordered clients in a group setting.

Just some thoughts. My main point is that I had assumed the use of schema therapy which Beck, Freeman et al. in 1990 discusses and the Layden et al. book also uses. Given the use of schemas, Young's approach is more useful and makes more sense with mixed personality disordered clients than the others I have read- just a silly clinician's view.

Replies:

Re:Critiques of Schema Therapy, by Paul Salkovskis, 01/04/02 Re:Critiques of Schema Therapy, by Linda Nauth, 01/05/02 Response to Critiques of Schema Therapy (Long), by Jeffrey Young, 01/06/02 Response to Jeff Young's comments, by Jim Pretzer, 01/06/02 Response to Jim Pretzer's Comments, by Jeff Young, 01/07/02 Re:Response to Jim Pretzer's Comments, by Jim Pretzer, 01/09/02 Not meant to offend, by Paul Salkovskis, 01/07/02 Re:Not meant to offend, by Jeff's Patient, 01/07/02 Please note that this is a forum for discussion by professionals, by Jim Pretzer, 01/08/02 Re:Please note that this is a forum for discussion by professionals, by Jeff's Patient, 01/09/02 Re: Re: Please note that this is a forum for discussion by professionals, by Jim Pretzer, 01/09/02 Re:a question, by Linda Nauth, 01/09/02 Re:Response to Critiques of Schema Therapy (Long), by philippe conrard, 12/14/02 Re:Request for Jeff Young, by Jim Pretzer, 12/14/02

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