Approaching Borderline Personality Patterns and Relationship Problems with Online Schema Therapy: A Case Study

Yıl 2023, Cilt: 10 Sayı: 1, 165 - 187, 31.01.2023

Nur Başer Baykal

https://doi.org/10.31682/ayna.1071857

Cited By: 1

Öz

Several situations, especially the coronavirus (COVID-19) pandemic, have obliged the implementation of online psychotherapy practices. Since such practices are becoming increasingly common, more research and case-based examples are necessary to understand their operations. This case study was presented as an example of a year-long online Schema Therapy practice. Approximately 40 sessions were held with the client who applied with relationship problems, depression, and anxiety symptoms. After evaluating the symptoms and life history, it was thought that it would be appropriate for the client to work with the Schema Therapy approach since the client had childhood traumas, problems with parents, and relationship challenges. In the study, detailed case presentation, formulation through the client's schemas and schema connections, the techniques, and the therapeutic relationship issues were analyzed. This case study provides valuable insights in terms of demonstrating the dynamics of the therapeutic alliance in online psychotherapy applications and the effectiveness of working with maladaptive schemas. In addition, the problems encountered in the online platform, the difficulties experienced while studying traumatic memories, and the limitations of the study were discussed in detail. 

Anahtar Kelimeler

Online psychotherapy, schema therapy, experiential techniques, relationship problems

Borderline Kişilik Örüntüsü ve İlişki Problemlerinin Şema Terapi ile Çevrimiçi Çalışılması: Bir Vaka Örneği

Öz

Koronavirüs (COVID-19) salgın süreci başta olmak üzere birçok durum, danışanları ve terapistleri çevrimiçi psikoterapi uygulamalarına yöneltmektedir. Günümüzde giderek yaygınlaşan çevrimiçi terapilerle ilgili çalışmalara ve örneklere daha fazla ihtiyaç duyulmaktadır. Bu vaka çalışması, yaklaşık bir yıl süren ve çevrimiçi gerçekleştirilen Şema Terapi uygulamasının bir örneği olarak sunulmaktadır. İlişki problemleri, depresyon ve kaygı belirtileri ile başvuru yapan danışan ile çevrimiçi ortamda 40 seans gerçekleştirilmiştir. Semptomlar ve yaşam öyküsü değerlendirildikten sonra, danışanın çocukluk dönemi travmalarının bulunması, ebeveynlerle ilgili sorunlarının ve ilişki problemlerinin yoğun olması nedeniyle, Şema Terapi yaklaşımıyla çalışmanın danışan için uygun olduğu düşünülmüştür. Çalışmada detaylı vaka sunumuna, danışanın şemaları ve şema bağlantıları üzerinden yapılan formulasyona, seansta belirlenen amaçlara ulaşmak için uygulanan tekniklere ve terapi ilişkisine yer verilmiştir. Bu vaka çalışması, çevrimiçi ortamda danışanın terapistle kurduğu terapötik ittifakı ve uyumsuz şemalarla çalışmanın etkinliğini göstermesi açısından oldukça önemlidir. Bununla beraber, çevrimiçi uygulamalarda karşılaşılan sorunlar, travmatik anıları çalışırken yaşanan güçlükler ve çalışmanın sınırlılıkları detaylıca ele alınmıştır.

Anahtar Kelimeler

çevrimiçi psikoterapi, şema terapi, yaşantısal teknikler, ilişki sorunları

Kaynakça

• Abbott, J. A. M., Klein, B. ve Ciechomski, L. (2008). Best practices in online therapy. Journal of Technology in Human Services, 26(2-4), 360-375. https://doi.org/10.1080/15228830802097257
• Akyunus, M. (2021). Görüntülü görüşme ile yabancı dilde semptom-odaklı bilişsel davranışçı psikoterapi uygulaması: bir olgu sunumu. AYNA Klinik Psikoloji Dergisi, 8(2), 295-311. https://doi.org/10.31682/ayna.765315
• Amerikan Psikiyatri Birliği (2014). Ruhsal bozuklukların tanısal ve sayımsal elkitabı (DSM 5) (E. Köroğlu, Çev.; 5. Basım). HYB yayıncılık.
• Andersson, G. (2016). Internet-delivered psychological treatments. Annual Review of Clinical Psychology, 12, 157-179. https://doi.org/10.1146/annurev-clinpsy-021815-093006
• Ar, Y. (2014). Büyüklenmecilik ya da incinebilirlik: Narsisistik kişilik örgütlenmesinin şema terapi yaklaşımı çerçevesinde ele alınması. AYNA Klinik Psikoloji Dergisi, 1(3), 29-43. https://doi.org/10.31682/ayna.470593
• Arntz A., Jacob G. A. ve Lee C. W. (2022). Effectiveness of Predominantly Group Schema Therapy and Combined Individual and Group Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial. JAMA Psychiatry, 79(4), 287–299. https://doi.org/10.1001/jamapsychiatry.2022.0010
• Bekes, V. ve Aafjes-van Doorn, K. (2020). Psychotherapists’ attitudes toward online therapy during the COVID-19 pandemic. Journal of Psychotherapy Integration, 30(2), 238. http://dx.doi.org/10.1037/int0000214
• Connolly, S. L., Miller, C. J., Lindsay, J. A. ve Bauer, M. S. (2020). A systematic review of providers’ attitudes toward telemental health via videoconferencing. Clinical Psychology: Science and Practice, 27(2), 1-19. https://doi.org/10.1111/cpsp.12311
• Earle, M. J. ve Freddolino, P. P. (2021). Meeting the practice challenges of COVID-19: MSW students’ perceptions of e-therapy and the therapeutic alliance. Clinical Social Work Journal, 50, 1-10. https://doi.org/10.1007/s10615-021-00801-3
• Fernandez, E., Woldgabreal, Y., Day, A., Pham, T., Gleich, B. ve Aboujaoude, E. (2021). Live psychotherapy by video versus in‐person: A meta‐analysis of efficacy and its relationship to types and targets of treatment. Clinical Psychology & Psychotherapy, 28(6), 1535-1549. https://doi.org/10.1002/cpp.2594
• Fisher, S., Guralnik, T., Fonagy, P. ve Zilcha-Mano, S. (2021). Let’s face it: video conferencing psychotherapy requires the extensive use of ostensive cues. Counselling Psychology Quarterly, 34(3-4), 508-524. https://doi.org/10.1080/09515070.2020.1777535
• Griffiths, F., Lindenmeyer, A., Powell, J., Lowe, P. ve Throgood, M. (2006). Why are health care interventions delivered over the Internet? A systematic review of the published literature. Journal of Medical Internet Research, 8(2), 498-514. https://doi.org/10.2196/jmir.8.2.e10
• Jacob, G., van Genderen, H. ve Seebauer, L. (2014). Mod terapisi: diğer yollardan gitmek; şema terapiyi temel alan bir kendine yardım kitabı (N. Azizerli ve M. Soykurt, Çev). Psikonet Yayınları. (2011)
• Kaiser, J., Hanschmidt, F. ve Kersting, A. (2021). The association between therapeutic alliance and outcome in internet-based psychological interventions: a meta-analysis. Computers in Human Behavior, 114, 106512-10623. https://doi.org/10.1016/j.chb.2020.106512
• Kar, S. K., Menon, V. ve Arafat, S. Y. (2020). Online group cognitive behavioral therapy for panic buying: Understanding the usefulness in COVID-19 context. Indian Journal of Psychiatry, 62(5), 607-609. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_610_20
• Karaca, B. K. ve Ateş, N. (2019). Yaygın kaygı bozukluğu ve öfke kontrol probleminde şema terapiyi kullanmak: Bir vaka üzerinden anlatım. Ayna Klinik Psikoloji Dergisi, 6(2), 169-182. https://doi.org/10.31682/ayna.438346
• Karaca, B. K. ve Gürsoy, M. (2019). Mükemmeliyetçiliği şema terapiyle ele almak: Bir vaka üzerinden anlatım. AYNA Klinik Psikoloji Dergisi, 6(3), 312-333. https://doi.org/10.31682/ayna.558846
• Khasho, D. A., Van Alphen, S. P. J., Heijnen-Kohl, S. M. J., Ouwens, M. A., Arntz, A. ve Videler, A. C. (2019). The effectiveness of individual schema therapy in older adults with borderline personality disorder: Protocol of a multiple-baseline study. Contemporary Clinical Trials Communications, 14, 100330-100335. https://doi.org/10.1016/j.conctc.2019.100330
• Kellogg, S. (2004). Dialogical Encounters: Contemporary Perspectives on" Chairwork" in Psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 41(3), 310-320. https://doi.org/10.1037/0033-3204.41.3.310
• Kellogg, S. H. ve Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62(4), 445-458. https://doi.org/10.1002/jclp.20240 Korkmaz, B. ve Şen, G. (2018). Psikoterapistlerin çevrimiçi yürütülen psikoterapilere yönelik algılarına ilişkin bir tematik analiz çalışması. Klinik Psikoloji Dergisi, 2(3), 140-152. https://doi.org/10.31828/kpd2602443829092018m000004
• Lobbestael, J., Arntz, A. ve Sieswerda, S. (2005). Schema modes and childhood abuse in borderline and antisocial personality disorders. Journal of Behavior Therapy and Experimental Psychiatry, 36, 240–253. https://doi.org/10.1016/j.jbtep.2005.05.006
• Lopez, A., Schwenk, S., Schneck, C. D., Griffin, R. J. ve Mishkind, M. C. (2019). Technology-based mental health treatment and the impact on the therapeutic alliance. Current Psychiatry Reports, 21(8), 1-7. https://doi.org/10.1007/s11920-019-1055-7
• Martin, R. ve Young, J. (2010). Schema therapy. İçinde K. S. Dobson (Ed.), Handbook of Cognitive Behavioral Therapies (ss. 317-346). Guilford Press.
• Norwood, C., Moghaddam, N. G., Malins, S. ve Sabin‐Farrell, R. (2018). Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta‐analysis. Clinical Psychology & Psychotherapy, 25(6), 797-808. https://doi.org/10.1002/cpp.2315
• Peeters, N., van Passel, B. ve Krans, J. (2021). The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda. British Journal of Clinical Psychology, 61, 1-19. https://doi.org/10.1111/bjc.12324
• Rafaeli, E., Bernstein, D. P. ve Young, J. (2010). Schema therapy: Distinctive features. (1. Basım). Routledge.
• Rigabert, A., Motrico, E., Moreno-Peral, P., Resurrección, D. M., Conejo-Cerón, S., Cuijpers, P., Martin Gomez, C., Del-Hoyo, Y. L. ve Bellón, J. Á. (2020). Effectiveness of online psychological and psychoeducational interventions to prevent depression: systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 82, 101931. https://doi.org/10.1016/j.cpr.2020.101931
• Roediger, E., Stevens, B. A. ve Brockman, R. (2018). Contextual schema therapy: An integrative approach to personality disorders, emotional dysregulation, and interpersonal functioning. (Illustrated Ed.). New Harbinger Publications.
• Simpson, S. ve Francesco, V. (2020). Technology as an invitation to intimacy and creativity in the therapy connection. Schema Therapy Bulletin, 17, 14–18. https://schematherapysociety.org/ Schema-Therapy-Bulletin
• Simpson, S. G. ve Reid, C. L. (2014). Therapeutic alliance in videoconferencing psychotherapy: A review. Australian Journal of Rural Health, 22(6), 280-299. https://doi.org/10.1111/ajr.12149
• Simpson, S., Richardson, L., Pietrabissa, G., Castelnuovo, G. ve Reid, C. (2021). Videotherapy and therapeutic alliance in the age of COVID‐19. Clinical Psychology & Psychotherapy, 28(2), 409-421. https://doi.org/10.1002/cpp.2521
• Simpson, S. G. ve Slowey, L. (2011). Video therapy for atypical eating disorder and obesity: A case study. Clinical Practice and Epidemiology Mental Health, 7(1), 38–43. https://doi.org/10.2174/1745017901107010038
• Suh, H., Sohn, H., Kim, T. ve Lee, D. G. (2019). A review and meta-analysis of perfectionism interventions: Comparing face-to-face with online modalities. Journal of Counseling Psychology, 66(4), 473-486. http://dx.doi.org/10.1037/cou0000355
• Tan, Y. M., Lee, C. W., Averbeck, L. E., Brand-de Wilde, O., Farrell, J., Fassbinder, E., Jacob, G. A., Martius, D., Wastiaux, S., Zarbock, G. ve Arntz, A. (2018). Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PloS One, 13(11), 1-20. https://doi.org/10.1371/journal.pone.0206039
• van Dijk, S. D. M., Bouman, R., Folmer, E. H., den Held, R. C., Warringa, J. E., Marijnissen, R. M. ve Voshaar, R. C. O. (2020). (Vi)-rushed into online group schema therapy based day-treatment for older adults by the COVID-19 outbreak in the Netherlands. The American journal of Geriatric Psychiatry, 28(9), 983-988. https://doi.org/10.1016/j.jagp.2020.05.028
• Weiner, L., Berna, F., Nourry, N., Severac, F., Vidailhet, P. ve Mengin, A. C. (2020). Efficacy of an online cognitive behavioral therapy program developed for healthcare workers during the COVID-19 pandemic: the REduction of STress (REST) study protocol for a randomized controlled trial. Trials, 21(1), 1-10. https://doi.org/10.1186/s13063-020-04772-7
• Wolf, A. W. (2011). Internet and video technology in psychotherapy supervision and training. Psychotherapy, 48(2), 179-181. https://doi.org/10.1037/a0023532
• Young, J. E., Klosko, J. S. ve Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. (1. Basım) Guilford Press.