The Wiley-Blackwell Handbook of Schema Therapy - Michiel van Vreeswijk - ebook

The Wiley-Blackwell Handbook of Schema Therapy ebook

Michiel van Vreeswijk

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The Wiley-Blackwell Handbook of Schema Therapy provides acomprehensive overview of developments in the theory, diagnosis,treatment, research, implementation, and management of schematherapy. * Presents a comprehensive overview of schema therapy -goes far beyond all previous books on the subject to covertheoretical, research and practical perspectives * Covers the latest developments, including work on mindfulnessand borderline personality disorder, as well as new applications ofschema therapy beyond personality disorders * Includes chapters by leaders in the field including WendyBehary and Arnoud Arntz, as well as a foreword by Jeffrey Young,the founder of schema therapy

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Table of Contents

Cover

Title page

Copyright page

List of Contributors

Foreword

Acknowledgments

Part I: An Introduction to Schema Therapy

1 Schema Therapy in Historical Perspective

Beyond Beck’s Cognitive Therapy

The Integration of Attachment, Interpersonal, and Object Relations Theories

The Integration of Experiential Techniques

Three Phases in the Development of Young’s Schema Therapy

Schema Therapy and Its Relationship to Other Schema-based Models

2 Theoretical Model

In Practice

Describing the Schemas

Coping Styles

Schema Modes

Mode Model in Borderline Personality Disorders

Current Situation and the Future

3 A New Look at Core Emotional Needs

Introduction

Needs, Temperament, and Parenting Styles

Needs, Temperament, Genes, and Molecular Biology

Core Emotional Needs and the Role of Mothers, Fathers, and Culture

The Evolution of Hominid Parenting and Needs

Empirically-based Comprehensive Models of Core Emotional Needs

The Empirical Status of Schema Therapy’s Current Model as it Relates to Needs

The Core Emotional Needs Model

CNM and Other Models of Core Emotional Needs

Summary

Acknowledgment

Part II: The Indication Process in Schema Therapy

1 The Case Formulation Process in Schema Therapy of Chronic Axis I Disorder (Affective/Anxiety Disorder)

Introduction

The Patient and the Treatment Context

The Case Formulation Process

Treatment Plan

Pitfalls and Tips

2 Schema Therapy for Narcissism – A Case Study

The Four Schema Modes of Patients with NPD

3 Assessment for Schema Therapy

Indicators for Schema Therapy

Alternatives to Schema Therapy

Approach

Pitfalls and Tips

The Future

4 The Use of Experiential Techniques for Diagnostics

In Practice

Approach

Pitfalls and Tips

The Future

5 Clinical Use of Schema Inventories

Introduction

Clinical Practice

Approach: Clinical Utility and Functions

Measuring Outcome

General Limitations on Clinical Use

Choosing a Schema Inventory to Use

Interpreting Schema Inventories

Pitfalls and Tips

The Future

6 Case Conceptualization in Schema Therapy

In Practice

Approach

Case Conceptualization Model for Schemas

The Schema Mode Model

Pitfalls and Tips

The Future

Part III: Schema Therapy Techniques

1 Schema Therapy for Eating Disorders

Introduction

Case Study – Nicki

Acknowledgements

2 Treating OCD with the Schema Mode Model

Introduction

Current Status

Approach

Pitfalls and Tips

The Future

3 Techniques within Schema Therapy

In Practice

Approach

Pitfalls and Tips

The Future

4 On Speaking One’s Mind: Using Chairwork Dialogues in Schema Therapy

Introduction

History and Background

External Dialogues

Internal Dialogues I

Internal Dialogues II

An Integrated Example

Pitfalls and Tips

The Future

Conclusion

5 Schema Therapy and the Role of Joy and Play

Introduction

Theory

Practice

Interventions

Play within the Therapeutic Relationship

Imagery as Play, Play in Imagery, and Playing as Dreaming

Play, Imagery, and Modes

Working with Play in a Group

Group Play Activities

Pitfalls and Tips

Summary

6 Schema Therapy, Mindfulness, and ACT – Differences and Points of Contact

Introduction

Current Status

Approach

Pitfalls and Tips

The Future

7 Why Are Mindfulness and Acceptance Central Elements for Therapeutic Change in Schema Therapy Too?

Introduction

Current Status: The So-Called Third Wave In Behavior Therapy

Looking Deeper into the Schema Mode Model

How Does the Healthy Adult Really Work?

Pitfalls and Tips

Conclusions and the Future

8 Mindfulness and ACT as Strategies to Enhance the Healthy Adult Mode

Introduction

Schemas and Memory

Levels of Intervention

Approach

Conclusion

9 Teaching Mindfulness Meditation within a Schema Therapy Framework

Introduction

Awareness

Choice and Intention

Relaxation

Letting Go

Here and Now Orientation

Non-Judgmental Acceptance

Values

Conclusion

10 Schema-Focused Mindfulness: an Eight-Session Protocol

In Practice

Approach

Pitfalls and Tips

11 The Impact of Measuring

In Practice

Approach

The Meaning and Interpretation of Outcome in Schema Therapy

Pitfalls and Tips

The Future

Part IV: Schema Therapy Settings and Patient Populations

1 Inpatient Schema Therapy for Patients with Borderline Personality Disorder – a Case Study

Background

Case Description: Patient Background and Presenting Problems

Schema Therapy Case Conceptualization and Course of Psychotherapeutic Treatment

After Inpatient Treatment

Summary

2 Individual Schema Therapy

In Practice

Approach

Pitfalls and Tips

The Future

3 Schema Therapy for Couples: Healing Partners in a Relationship

Introduction

Clashes and Healing: Mode Cycles in Couples

Application

Change

Tips and Pitfalls

The Future

4 Introduction to Group Schema Therapy

5 Group Schema Therapy for Borderline Personality Disorder Patients

Introduction

The Healing Power of the GST

Group Schema Therapy for BPD: the Beginning Stage

Limited Reparenting Broadened: Building a “Healthy Family”

Schema Mode Change

The Therapy Group Provides Opportunities for Identity Formation

Punitive or Demanding Parent work: Using the “Group Army”

Using Group Curative Factors to Build the Healthy Adult Mode

Challenges of Group Schema Therapy

The Future

6 Implementation of Schema Therapy in an Inpatient and Day Treatment Group Setting

In Practice

Approach

Treatment Strategies

Pitfalls and Tips

The Future

7 Schema Therapy in Groups: A Short-Term Schema CBT Protocol

In Practice

Approach

Pitfalls and Tips

The Future

8 Schema Therapy in a Psychodynamic Group

In Practice

Approach

The Structured Hour

Unstructured Hour

Pitfalls and Tips

The Future

9 Schema Therapy in Adolescents

In Practice

Approach

Pitfalls and Tips

The Future

10 Schema Therapy for Cluster C Personality Disorders

Introduction

Approach

Case Conceptualization

Treatment Approach

Pitfalls and Tips: Specific Issues with the Different Cluster C PDs

Acknowledgment

11 Schema Therapy in Personality Disorders and Addiction

In Practice

Approach

Pitfalls and Tips

The Future

12 Schema Therapy in Forensic Settings

Introduction

Clinical Practice

Approach

Pitfalls and Recommendations

The Future

Part V: The Therapist

1 Training for and Registrations of Schema Therapists

In Practice

Approach

Pitfalls and Tips

The Future

2 Training and Supervision in Schema Therapy

In Practice

Approach

Becoming an ISST Supervisor

Pitfalls and Tips

The Future

3 The Schema Mode Model in Personal Therapy

Introduction

In Practice

Approach

Pitfalls and Tips

The Future

4 Therapist Self-Care in the Context of Limited Reparenting

Definition of Self-Care: Therapist Burn-Out

Definition of Human Suffering

A ST Approach to Human Suffering and its Implications for Therapist Self-Care

General Demands of ST

Demands of Group ST

Therapist Self-Care in Practice

Pitfalls and Tips

Conclusion

Part VI: Research in Schema Therapy

1 Effectiveness Studies

Schema Therapy for Personality Disorders

Schema Therapy for Axis I Problems

Conclusion

Pitfalls and Tips

The Future

2 Experimental Studies of Schema Modes

In Practice

Approach

Comparison between Self-Report of Schema Modes and Reports Made by Others

The Influence of Emotional Inductions on Schema Modes

Pitfalls and Tips

The Future

3 Experimental Studies for Schemas

In Practice

Approach

Interpretations and Evaluations

Conclusion

Pitfalls and Tips

The Future

4 Validation of the Young Schema Questionnaire

In Practice

Approach

Pitfalls and Tips

The Future

5 Validation of the Schema Mode Inventory

In Practice

Approach

Sample Survey

Pitfalls and Tips

The Future

Part VII: Implementation and Public Relations in Schema Therapy

1 Implementation of Schema Therapy in General Mental Healthcare Institutes

Approach

In Practice

Outcomes

Pitfalls and Tips

The Future

2 Using ST Principles to Increase the Therapeutic Efficacy of the Forensic Care Team’s Interactions with Personality Disordered Clients

Introduction

In Practice

Approach

Pitfalls and Tips

Developing STPs

Summary

3 Implementation of Schema Therapy in de Rooyse Wissel Forensic Psychiatric Center

In Practice

Approach

Pitfalls and Tips

The Future

4 Cost-Effectiveness of Schema Therapy

Introduction

Practice

Approach

Pitfalls and Tips

The Future

5 Public Relations for Schema Therapy

In Practice

Approach

Pitfalls and Tips

The Future

6 Concluding Thoughts

Author Index

Subject Index – Schema Therapy

This edition first published 2012

© 2012 John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

The Wiley-Blackwell handbook of schema therapy : theory, research, and practice / edited by Michiel van Vreeswijk, Jenny Broersen, Marjon Nadort.

p. cm.

 Includes index.

 ISBN 978-0-470-97561-9 (cloth)

 ISBN 978-1-119-96282-3 (epdf)

 ISBN 978-1-118-33229-0 (epub)

 ISBN 978-1-118-33228-3 (mobi)

 1. Schema-focused–Handbooks, manuals, etc. I. Vreeswijk, Michiel van.II. Broersen, Jenny. III. Nadort, Marjon. IV. Title: Handbook of schema therapy.

 RC455.4.S36W55 2012

 616.89'1425–dc23

2011035197

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

List of Contributors

Helga Aalders is a Clinical Psychologist/Psychotherapist and works both at the Altrecht Outpatient Clinic, Utrecht and in private practice in Zeist, the Netherlands. She was trained in various fields (CBT/Schema Therapy/psychoanalytical and group dynamic therapy) and she is part of the Care Program Personality Disorders at the Altrecht outpatients’ clinic. She is also a teacher, supervisor, and coach within the P&A training institute.

Arnoud Arntz is a professor of Clinical Psychology and Experimental Psychopathology at Maastricht University, the Netherlands. He studies both fundamental psychological processes in and treatment of anxiety and personality disorders. He is also active as a therapist. Together with professor Marcel van den Hout he is editor of the Journal of Behavior Therapy and Experimental Psychiatry. Arnoud Arntz was and is project leader of various multicenter randomized controlled trials into the effectiveness and cost-effectiveness of Schema Therapy. Together with Hannie van Genderen he published a book describing a Schema Therapy protocol for borderline personality disorder published by Wiley. That protocol was the basis of the version of Schema Therapy which was successfully tested in Giesen-Bloo and colleagues’ study (2006), published in the Archives of General Psychiatry.

Thea van Asselt is a senior researcher at Maastricht University Medical Center, the Netherlands. She studied economics at Groningen State University, the Netherlands, and has been working as a health economist since 1998. Her PhD (awarded in 2008) was on the economic aspects of treatment, including Schema Therapy, for borderline personality disorders. Her cost-effectiveness research covers not only psychiatry, but other clinical areas as well, such as cardiovascular diseases and surgical infections.

Travis Atkinson LCSW is the Clinical Director of Advanced Cognitive Therapy of New York. He is a highly experienced, compassionate therapist working in Manhattan for many years, and is affiliated with the Cognitive Therapy Center of New York and the Schema Therapy Institute. Travis presented with Jeffrey Young, the founder of Schema Therapy, at the prestigious New England Educational Institute, training other couples therapists in the latest Schema Therapy techniques for couples therapy. He has completed advanced training with Susan Johnson, the founder of the top-rated Emotionally Focused Couples Therapy (EFT). He also has completed years of extensive training in couples therapy with the Gottman Institute, headed by the founder, John Gottman, and was awarded the distinguished title of Certified Gottman Therapist.

Lotte Bamelis is a PhD student at the Department of Clinical Psychological Science, Maastricht University, the Netherlands. Since 2006, she has been conducting a large, multi-center, randomized controlled trial on the clinical and cost-effectiveness of Schema Therapy for Cluster C, paranoid, histrionic, and narcissistic personality disorders. More than 300 patients are being treated in 12 mental health centers throughout the Netherlands.

Wendy Behary is with 25 years’ postgraduate training and advanced level certifications, the founder and director of The Cognitive Therapy Center of New Jersey and the New Jersey Institute for Schema Therapy. She has been treating clients, training professionals, and supervising psychotherapists for more than 20 years. Wendy is also on the faculty of the Cognitive Therapy Center and Schema Therapy Institute of New York, where she has trained and worked with Jeffrey Young since 1989. She is a founding fellow of the Academy of Cognitive Therapy (Aaron T. Beck). Wendy is also the President of the Executive Board of the International Society of Schema Therapy (ISST).

Wendy has co-authored several chapters and articles on Schema Therapy and cognitive therapy. She is the author of Disarming the Narcissist … Surviving and Thriving with the Self-Absorbed." Wendy has a specialty in treating narcissists and the people who live with and deal with them. She has lectured both nationally and internationally to professional and general audiences on the subject of narcissism and how to deal with difficult people. Her work with industry has included speaking engagements focused on interpersonal conflict resolution.

Wendy’s private practice is primarily devoted to treating narcissists, partners/people dealing with them, and couples experiencing relationship problems. She is also an expert in coaching individuals in interviewing, public speaking, and interpersonal skills enhancement.

David Bernstein is Professor of Forensic Psychotherapy (endowed chair) at Maastricht University and the de Rooyse Wissel forensic psychiatric center. He received his doctoral degree from New York University in 1990. He joined the faculty of Maastricht University in 2004, where he now serves as Chair of the Forensic Psychology Section in the Faculty of Psychology and Neuroscience. He is currently Vice-President of the International Society for Schema Therapy and is past President of the Association for Research on Personality Disorders. His research spans a wide range of areas, including forensic psychology, psychotherapy, personality disorders, childhood trauma, and addictions. He is an internationally acknowledged expert on Schema Therapy, an integrative psychotherapy for personality disorders. He is the author or co-author of more than 90 publications, including Schema Therapy: Distinctive Features and the forthcoming Treating Aggression, Addiction, and Personality Disorder: A Schema-Focused Approach to Complex, Antisocial Patients. His current research focuses on developing, testing, and implementing innovative forms of therapy for forensic patients with personality disorders.

Josephine Bloo was awarded a PhD for her thesis “Crossing Borders: theory, assessment and treatment in borderline personality disorder” at Maastricht University, in cooperation with the Leiden University and the VU Medical Center, Amsterdam in 2006. Her most important publications are on the subject of the efficacy of schema-focused therapy vs. transference-focused psychotherapy. Since 2008, she has worked as a therapist at LavOri BV, a department of the academic related RIAGG in Maastricht.

David Bricker is a psychologist in private practice in New York City. He received his PhD in psychology from the State University of New York at Albany. He is a member of the graduate faculty of the Ferkauf Graduate School of Yeshiva University. He is also an affiliate of the Schema Therapy Institute in New York and is a certified Schema Therapist. He splits his practice between individuals and couples and is also a certified Gottman Method Therapist. His main research interest has been the integration of various systems of psychotherapy.

Jenny Broersen is Mental Healthcare Psychologist and Psychotherapist. She is a Certified supervisor Supervisor Schema Therapist (ISST, Dutch register ST). In the last 15 years she has worked in outpatient and day treatment centers. She has a vast wealth of experience in the treatment of personality disorders working as site director of G-kracht Psychomedisch Centrum BV in Amsterdam, The Netherlands, together with her colleague Marjon Nadort. Jenny works in the Mental Healthcare Institute in GGZ Delfland in Delft (the Netherlands). She is co-author/editor of several schema books, chapters and articles and gives post doctorate courses in Schema Therapy and Cognitive Behavioral Therapy.

Pierre Cousineau is psychotherapist and supervisor in Montreal, Canada. He gives workshops to French-speaking psychotherapists in Quebec, Francophone European countries, and Morocco. He studied psychology in Montreal (Quebec) and in Waterloo (Ontario). He gained his PhD at the University of Waterloo in 1980. He wrote papers and was co-author of a textbook in the French language. He has a specific interest for the integration of mindfulness and ACT strategies into Schema Therapy.

Janie van Dijk works as a Clinical Psychologist/Psychotherapist in private practice and at Altrecht Cura, Utrecht, the Netherlands. She specializes in the treatment of personality problems, anxiety disorders, and couples therapy. She is a supervisor for Schema Therapy and couples therapy. She also teaches in both these specialist areas. Among other publications, she has written on the subject of trauma treatment for war victims.

David Edwards is a Professor at Rhodes University, South Africa. He was fortunate to be connected to the beginnings of Schema Therapy when, in 1984, he attended seminars with Jeffrey Young while training in cognitive therapy at the University of Pennsylvania. He has a long-standing interest in psychotherapy integration and has experience with expressive approaches to psychotherapy through drama, dance, sculpture, painting, and drawing, particularly within the humanistic and transpersonal traditions. He has promoted the role of case-study methodology in the development of applied clinical science and used case studies to provide a contextualized evidence base for the treatment of post-traumatic stress disorder in South Africa. His interest in historical perspectives on psychotherapy arose from reflection on his own experience and from writing an article and a book chapter on the history of imagery in psychotherapy.

Joan Farrell was awarded a PhD in Clinical Psychology in 1978. She is Program Director and founder of the Center for BPD Treatment and Research at Indiana University School of Medicine and has been a faculty member in psychiatry there for 25 years. She holds faculty appointments in the psychology departments of Purdue University and the University of Indianapolis. With Ida Shaw, she developed a group ST treatment for borderline personality disorder (BPD), which was tested in a successful randomized-controlled trial (RCT). Together, they developed an inpatient ST program and a dedicated unit for patients with severe BPD, which was awarded a Governor’s Showcase award. Farrell is co-PI with Arntz on a four-country, 14-site RCT of group ST for BPD. Her research focus is the evaluation of group ST and she consults in this area internationally. She is co-director of the Schema Therapy Institute Midwest–Indianapolis. Farrell is the co-author of Group Schema Therapy for BPD and has written book chapters and articles in research journals on BPD treatment. Farrell and Shaw give workshops and master classes internationally in the GST model they developed. She is an advanced-level Schema Therapist and Trainer certified by ISST.

Heather Fretwell is an Assistant Professor of Clinical Psychiatry at the Indiana University School of Medicine. She graduated magna cum laude with an Honors BS from Ball State University, and then earned her MD at the Indiana University School of Medicine in 2002, and completed her residency training in psychiatry there in 2006. She is the director of the IU Center for Borderline Personality Disorder Treatment and Research. Clinically, she directs the outpatient ST treatment program for borderline PD at Midtown Community Mental Health, the largest CMHC in Indiana, and supervises the psychiatry residency training site there. She is an associate of the Schema Therapy Institute Midwest. Her research interests are in the psychotherapeutic and pharmaceutical treatments of borderline personality disorder. She is a co-investigator on the multi-site international trial of group and individual ST with the co-PIs Arnoud Arntz and Joan Farrell. She has co-authored several articles on ST for various presentations and media and is a contributor to the Group Schema Therapy Treatment Manual (Wiley, 2012).

Maryke Geerdink is a forensic Psychologist working for De Waag Amsterdam, Centre for Outpatient Forensic Psychiatry, since 2003. She has many years of experience giving individual and group therapy to youths (12+) and adults with severe personality disorders. As a cognitive and behavioral therapist she specializes in relapse prevention with adult males with problematic sexual behavior and youths and adults with aggression and emotional regulation disorders. She is also a teacher, experienced in teaching post-graduate training for mental health professionals.

Hannie van Genderen is employed at the Mental Health Center, Maastricht and is a Clinical Psychologist and senior consultant on research. She was trained in Schema Therapy by Jeffrey Young in 1995. She closely collaborates with Arnoud Arntz at Maastricht University, with whom she wrote Schema Therapy for the Borderline Personality Disorder. She is a trainer and supervisor in Schema Therapy and cognitive behavioral therapy in the Netherlands. She is a member of the board of the International Society of Schema Therapy and the Dutch Schema Therapy Association. For both boards, she is the coordinator of Training and Certification.

Suzanne Haeyen is an Art Therapist and Master of Art Therapies, and is chairman for Art Therapy at Scelta, Expert Center for Personality Disorders, at GGNet, a mental healthcare institution in the Netherlands. She is the coordinator of content and lecturer of the Part Time Study Arts Therapy of HAN University. She has authored and co-authored several publications about art therapy and personality disorders, including Don’t Act Out but Live Through. She co-edited the Dutch Handbook for Art Therapy. In 2010, she carried out research focused on the effects of art therapy which resulted in her book The connecting quality of Art Therapy in 2011. Besides her specialization in borderline and Cluster B and C personality disorders, includes working with clients with traumas, eating disorders, and mood disorders, and with adolescents.

Asle Hoffart is Senior Researcher at the Research Institute, Modum Bad (a psychiatric hospital in Norway), Professor at the Department of Psychology, University of Oslo. He has written two books on social phobia and has published over 80 scientific articles in international journals, is a specialist in clinical psychology, and is an approved supervisor in cognitive therapy and Schema Therapy. His research interests are psychotherapy research, process and outcome in cognitive therapy, anxiety disorders including PTSD, the relationship between theories and clinical practice, and the philosophical basis of psychotherapy.

Geoff Hopping is a Consultant Psychotherapist in a prison unit for people with severe personality disorder who are at risk of harming others. He is qualified in psychoanalytic psychotherapy and is a Teaching and Supervising Transactional Analyst. He studied at the Metanoia Institute in London, where he works as a visiting lecturer. He previously worked for 20 years in private practice as a psychotherapist, trainer, and supervisor. His current interest is in relational group psychotherapy and the ways that this can have a reparative impact on destructive behaviors. He recently co-authored a chapter on group work, published in Relational Transactional Analysis: Theory and Practice.

Gitta Jacob is a Clinical Psychologist, Cognitive and Schema Therapist in the Department of Clinical Psychology and Psychotherapy, Freiburg, Germany. She is a founding board member of the International Society for Schema Therapy and was Chair of the Working Group on Borderline Personality Disorders at the Department of Psychiatry and Psychotherapy, University Hospital Freiburg. Her main research interests are borderline personality disorder and emotion-focused interventions. She is co-author of more than 40 publications in clinical psychology, psychotherapy, and borderline personality disorder.

Ellen de Jonge currently works as a psychologist for forensic outpatients at GGZ Noord-Holland Noord in the Netherlands. She studied clinical psychology at Utrecht University and received her MSc in 2006. Subsequently she did postgraduate research and treatment at FPC de Oostvaarderskliniek forensic psychiatric hospital to become a fully licensed psychologist. She is an associate member of the Dutch Association of Cognitive Behavioral Therapy.

Erik Jongman is a manager and therapist of adolescents (12–23 years old) with forensic and psychiatric problems. Most of these adolescents come from MPG (Multi Family Problems) families and have completed at least three treatments. He works mainly with family systems, and also uses individual treatments: EMDR, CBT, and Schema Therapy.

Daan Jonker works as a coach for the postdoctoral program of Clinical Psychology, Health Care Psychologist, and Psychotherapist. He is also coordinator of the Care Program Personality Problems at the GGZ Zoetermeer, Rivierduinen, the Netherlands). He has made a name for himself for his research into treatment of suicidal behavior, and has worked as a supervisor and trainer in family treatment, hypnosis, and schema-focused treatments for a long period. His work is particularly characterized by the integrative approach, partly as a result of his prior training in hypnosis, directive therapy, family therapy, psychoanalytical and group dynamic treatments, cognitive therapy, and Young’s Schema Therapy. In addition to his involvement in several professional associations in the Netherlands and Switzerland, he is a board member of the Dutch Register of Schema Therapy.

Philip Jonkers currently works as a psychologist-psychotherapist in private practice and in the Oostvaarderskliniek forensic psychiatry center, Almere, the Netherlands. In this clinic he participates in a multi-centre study initiated by David Bernstein, entitled: “Efficacy of Schema-Focused Therapy versus Treatment as Usual in Forensic Patients with Antisocial, Narcissistic, Borderline, or Paranoid Personality Disorder.” He has an MSc and studied psychology and family studies at the University of Amsterdam. He spent a year in Paris studying and working in a psychological institute, a school based on the ideas of Jacques Lacan. His postdoctoral studies in psychotherapy and sexuology were completed in Amsterdam at RINO, a regional institute for postdoctoral studies in psychotherapy. His specialisation is Schema Therapy, and Pesso-Boyden psychotherapy (a psychomotor system). He is a supervisor in Schema Therapy and cognitive behavioral psychotherapy.

Scott Kellogg is a Clinical Assistant Professor in the Department of Psychology at New York University; previously, he was on the faculties of The Rockefeller University, the Yale University School of Medicine, and the Program in Counseling and Clinical Psychology at Teachers College/Columbia University. Having trained in both Schema Therapy and Gestalt Therapy, he is currently a psychotherapist and a supervisor at the Schema Therapy Institute in New York City. Kellogg has created the Transformational Chairwork Training program and he is currently teaching this method of psychotherapeutic dialogue to practitioners in both the US and Europe.

Kellogg is the current and past President of the Division on Addictions of the New York State Psychological Association (2011, 2005, 2001), and a co-director of the Harm Reduction and Mental Health Project at New York University. He is also a leading advocate for gradualism, a vision of healing that seeks to utilize and integrate the best aspects of the harm reduction, scientific, and traditional treatment approaches. He has written on Schema Therapy, borderline personality disorder, and the integration of gestalt techniques in cognitive behavioral treatment. He has addressed such topics as addiction treatment, identity theory, trauma and violence, contingency management, harm reduction, and assessment.

Truus Kersten is a Psychotherapist at the de Rooyse Wissel Forensic Psychiatric Center, Venray. She also works as a self-employed consultant and trainer since gaining her PhD in 1998 on matching patients to addiction treatment. She specializes in projects that focus on developing, training, and implementing evidence-based treatments in addiction and forensic care. In the Rooyse Wissel, she is implementation leader in a project aimed at tailoring and teaching evidence-based addiction treatments and Schema Therapy in the treatment units. Participates as a Schema Therapist in the randomized clinical trial of Schema Therapy for forensic patients. She is a supervisor and trainer in Schema Therapy and also in cognitive behavior therapy. She trains psychologists and other professionals (e.g., nurses) in Schema Therapy and has developed manuals and protocols for implementing addiction treatment and Schema Therapy in a forensic setting. She has written national publications on the treatment of addictions and on treatment of personality disorders with Schema Therapy. In the study set up by David Bernstein and Elsa van den Broek she is currently writing a book on Schema Therapy for personality disorders, aggression, and addiction.

She is co-author of the fortcoming Treating Agression, Addiction, and Personality Disorder: A Schema-Focused approach to complex, Antisocial patients.

Marije Keulen-de Vos works as a researcher at the De Rooyse Wissel Forensic Psychiatric Center, Venray. She studied Health Sciences at Maastricht University. Her PhD research focuses on patterns and predictors in the treatment response of forensic patients with personality disorders. She is particularly interested in the effective aspects of Schema Therapy.

Pien van den Kieboom is a cognitive behavioral therapist and a supervisor at the Dutch association of CBT (VGCt). She is also a supervisor of the Dutch Register of Schema Therapy and the ISST, a trainer in mindfulness MBSR and MBCT, and a member of VMBN.

She works as a cognitive behavioral therapist, supervisor, learning therapist, and mindfulness trainer at the GGZ, Stichting Rivierduinen, GGZ Leiden en omstreken. She is affiliated to the RINO, Utrecht, as a Schema Therapy instructor, and she also offers supervision and personal therapy to people who would like to become a member of the Dutch association of CBT (VGCt), or subscribe to the Dutch Register of Schema Therapy.

Ellen Gross works as a resident in Psychiatry at the University Hospital, Department of Psychiatry and Psychotherapy, in Freiburg, Germany. She studied medicine in Heidelberg, Germany, where she received her doctor’s degree for research in Child and Adolescence Psychiatry. Her current research is concerned with psychotherapy of severe personality disorders, mainly borderline personality disorder, as well as psychotherapy of chronic obsessive-compulsive disorder. Much of her work is aimed at identifying the mechanisms of non-response to standard cognitive and behavioral techniques and developing new approaches. Ellen N. Gross is a certified schema therapist (ISST) since 2009 and supervisor in Schema Therapy since 2011. She is also well trained in dialectic behavioral therapy.

Miriam Labin is a Clinical Psychologist who currently works in private practice in Hertzelia, Israel. She gained her PsyD at Yeshiva University in 2006 and her BA as a psychology major at Bar-Ilan University, Israel. She recently worked at the Cognitive Behavioral Therapy unit for anxiety disorders at Geha Hospital, Israel. She is conducting lectures on the CBT for social anxiety for students and social workers in the Israeli Ministry of Defense and in Tel-Aviv University. Her clinical work focuses on people who suffer from anxiety disorders and depression while integrating CBT and Schema Therapy.

Jill Lobbestael is an assistant professor in the Department of Clinical Psychological Science, Maastricht University, the Netherlands. She was a postdoctoral fellow at Florida State University, Tallahassee, and at Harvard University, Cambridge, MA. She also coordinates the research track of the postdoctoral clinical psychology track at Rino Zuid. Her research interests are personality disorders – Cluster B disorders in particular – aggression, emotion regulation, trauma, Schema Therapy, and self-control. Recently, she received several grants for her work from the renewal impulse of the Dutch Research Organization, Brain and Cognition program, and the Niels Stensen organization.

George Lockwood is the Director of the Schema Therapy Institute Midwest, Kalamazoo, Michigan, US. He is a Founding Fellow of the Academy of Cognitive Therapy. He completed a postdoctoral fellowship in cognitive therapy under the supervision of Aaron T. Beck in 1982, and has training in psychoanalytic psychotherapy and object-relations approaches. He has Advanced International Certification in Schema Therapy, has written a number of articles on cognitive and Schema Therapy, and has maintained a private practice for the past 29 years.

Des McVey is a consultant nurse and psychotherapist with over 25 years’ experience of working within and developing forensic services across the full range of settings. He is a visiting lecturer at York University and regularly teaches on nursing and clinical psychology courses. Des has a particular interest in developing strategies that maintain treatment integrity and developing models of care for psychiatric nursing. He is co-editor of Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Problems and has co-authored several articles on using schema-focused principles to create a therapeutic milieu. Much of his clinical practice has been devoted to facilitating a strong role for psychiatric nurses in treatment and developing services that are embracing of psychological treatment principles.

Naomi Murphy is a consultant Clinical and Forensic Psychologist with over 15 years’ experience of working with clients presenting with complex psychopathology. Naomi has been instrumental in developing services for people with personality disorder in the community, secure services, and prisons. Naomi has a particular interest in the development of transdisciplinary teams and enabling non-psychologists to use psychological concepts to enhance their own role. She is co-editor of Treating Personality Disorder: Creating Robust Services for People with Complex Mental Health Problems and has co-authored several articles on using schema-focused principles to create a therapeutic milieu. Much of her clinical practice has been dedicated to enabling non-psychologists to use psychological principles to enhance their own role through the medium of schema-focused therapy.

Eelco Muste is a Clinical Psychologist and Psychotherapist. He works as a clinic director and team manager of the Department Schema Therapy at the De Viersprong psychotherapeutic center, a Dutch institute that specializes in the treatment of personality disorders. Following his psychology studies in Leiden, the Netherlands, he undertook postgraduate work in clinical psychology and psychotherapy, and he worked for different institutes, in several settings. Since 1996, he has worked at the de Viersprong psychotherapeutic center, where Schema Therapy was introduced in 1998. Since then, he has further specialized in Schema Therapy and he has initiated his own treatment program. Based on his clinical practice, he has written several articles and chapters on Schema Therapy and was the chief editor of the Handboek en Werkboek Klinische schematherapie. He runs several training programs and workshops and lectures in the field of Schema Therapy and is actively involved in the Register for Schema Therapists, both as a board member and as treasurer.

Marjon Nadort is a Mental Healthcare Psychologist and Psychotherapist. She is a Certified Cognitive Behavioral Therapist (VGCt) and Certified Supervisor Schema Therapist (ISST, Dutch register ST). She is site director of the private practice G-kracht Psychomedisch Centrum BV in Amsterdam, The Netherlands, together with her colleague Jenny Broersen. She also works at the Mental Health Institute GGZ in Geest - VU University Amsterdam.

She is also an Internationally Certified Schema Therapist and Supervisor. Having been trained by Jeffrey Young, she is one of the Dutch researchers/trainers on the successful randomized controlled trial of Schema Therapy for borderline personality disorder. In 2012 she will finalize her thesis on the implementation of Schema Therapy for Borderline Patients in regular mental healthcare in the Netherlands. She has given many presentations in Europe and America. She has also given workshops in the Netherlands, Oxford, Cambridge, Berlin and Australia. She is (co-) author/ editor of several schema books/chapters/articles.

Erwin Parfy works in private practice in Vienna, where he studied psychology and was certified to practice as a behavioral and cognitive-behavioral therapist. He gained his PhD for his investigations into concrete forms of psychotherapy integration between behavioral case conceptualization and the psychoanalytic concept of defense mechanisms, which were subsequently published by the university. Further books dealt with attachment theory and interaction in psychotherapy and with behavioral therapy and modern approaches in theory and practice. As a psychotherapist he worked for many years in a forensic hospital, specializing in personality disorders; as a teacher and supervisor he gave many workshops within different training programs. As board member and currently vice-president of the Austrian Society of Behavioral Therapy he continues to support the integration of all new treatment approaches (e.g., ST, DBT, ACT) in the behavioral tradition.

Poul Perris is the Director of the Swedish Institute for CBT and Schema Therapy and a licensed Psychotherapist with an advanced international certification in Schema Therapy, trained and supervised by Jeffrey Young. He is the Founding President of the International Society for Schema Therapy and the current President of the Swedish Association for Cognitive & Behavioral Therapies. He was trained in group ST by J. Farrell and I. Shaw and is a member of the protocol board in the international multisite study on group ST for patients with BPD. He offers international Schema Therapy workshops and supervision. He is part of a research group that focuses on the concepts of core emotional needs and limited reparenting.

Neele Reiss currently works as a Research Fellow at the University Medical Center, Department of Psychiatry and Psychotherapy in Mainz and as a Clinical Psychotherapist. She is a founding member of the Institute for Psychotherapy in Mainz, Germany and a member of the training faculty of the Schema Therapy Institute Midwest – Indianapolis Center. She is collaborating on the development of group ST and outcome studies to evaluate this model. She studied psychology in Marburg, Germany and State College, Pennsylvania. Her research focuses on intensive ST for patients with BPD in settings where a combination of group ST and individual Schema Therapy is applied. She also conducts research in ST-related psychological assessment. She has published in international journals and contributed chapters to books on Schema Therapy.

Marleen Rijkeboer is a Psychotherapist and Clinical Psychologist and is affiliated to the department Clinical and Health Psychology at Utrecht University as associate professor. In this position she heads the Academisch Angstcentrum Altrecht and is the chief trainer of postgraduate education for Clinical Psychologists. In addition, she works for the Ambulatorium, the psychotherapeutic center of the Department of Social Sciences, Utrecht University, as a practitioner. Marleen researches into and provides training on Schema Therapy, and is a board member of the ISST and the Dutch Register of Schema Therapy.

Eckhard Roediger is the Director of Schema Therapy Institute in Frankfurt, Germany and ISST secretary since its foundation in 2008. He studied medicine in Frankfurt and gained his MD in 1986. He is a Neurologist and Psychiatrist and went through a psychodynamic and cognitive-behavior therapy training. After running an addiction treatment clinic near Frankfurt for more than eight years he became director of a psychosomatic department of a clinic in Berlin. Since 2007 he is working in private practice, is training Schema Therapy in Germany, Switzerland, and Austria and published several books about Schema Therapy and self-help books.

Hilde de Saeger works as a Clinical Psychologist and Psychotherapist at the Psychotherapeutic Center De Viersprong in Halsteren, the Netherlands, a diagnostic and therapeutic center for clients with severe personality pathology. In addition, Hilde is researching the effects of therapeutic assessment at the University of Amsterdam. In 1992, Hilde graduated from the Catholic University Leuven, Belgium.

Agnes Scholing is Program Manager for Adult Treatments at De Waag, Ambulatory Forensic Mental Health Center. In addition, she is an associate professor at the University of Amsterdam, Department of Clinical Psychology. She is also a Clinical Psychologist/Psychotherapist and cognitive behavior therapist. In 1993, she gained her PhD at Groningen University on the assessment and treatment of social phobia. Following this, she worked at the University of Amsterdam, mainly on anxiety disorders in children and adolescents. In 2000, she started work at De Waag. Her current research is mainly on the assessment and treatment of domestic violence and substance use disorders, and on risk assessment.

Ida Shaw holds an MA in developmental psychology and has extensive training in experiential therapies. Her professional focus is training and supervision in ST and the group ST model that she developed with Farrell. Together, they developed an inpatient ST program and a dedicated unit for patients with severe BPD, which was awarded a Governor’s Showcase award. Shaw is the co-director of the Schema Therapy Institute Midwest-Indianapolis and an ISST certified advanced-level Schema Therapist and Trainer. She is co-author of Group Schema Therapy for BPD and has published book chapters and articles in research journals on BPD treatment. Shaw is the main clinical supervisor for the multi-site trial of GST underway in four countries and provides supervision and master classes in ST internationally.

Alex Sheffield is a Clinical Psychologist with a particular interest in Schema Therapy for eating disorders. Alex gained a BSc in Psychology and a Doctorate in Clinical Psychology from the University of Surrey, England. She worked in the field of adult eating disorders for a number of years before making the transition to working with adolescents. Alex currently works for The South London and Maudsley NHS Trust in an inpatient unit for adolescents with mental health problems. Most of Alex’s published work has focused on validating some of the schema inventories and using them to aid our understanding of the development of the eating disorders.

Simkje Sieswerda currently works as an assistant professor and licensed psychotherapist at Heidelberg University, Germany. She studied Psychology in Amsterdam and gained a PhD at Maastricht University in 2009. Her research seeks to understand specific underlying cognitive mechanisms in borderline personality disorder, using experimental studies. In particular, she is interested in the role of hypervigilance, extreme evaluations, negativistic evaluations, and emotion recognition in this disorder. She has published in Behaviour Research and Therapy, Journal of Behaviour Therapy and Experimental Psychiatry and Behavioural and Cognitive Psychotherapy.

Susan Simpson currently works at the University of South Australia as Clinic Director for the postgraduate clinical psychology programme. She trained as a clinical psychologist at Flinders University, Australia, and completed her clinical doctorate at the University of Newcastle upon Tyne, England. She practised as a Clinical Psychologist in the Scottish National Health Service (NHS) for 16 years, specializing in the treatment of complex eating disorders. Her research focuses on Schema Therapy for complex or chronic eating disorders and personality disorders. Her other research interest is the provision of clinical psychology services to remote and rural areas via videoconferencing.

Philip Spinhoven is Professor of Clinical Psychology and Dean of the Faculty of Social and Behavioral Sciences at Leiden University. His research focuses on how distant, recent, and current stressors interact with cognitive processes (e.g., attention, memory, thought, reasoning), behavioral processes (e.g., approach and avoidance), and biological processes (e.g., HPA axis) in anxiety disorders, mood disorders, somatoform disorders, and personality disorders. He has received several grants for his research and has supervised more than 30 PhD students since 1994. His publications total more than 350.

Nicola Stelzer currently works as a Psychologist in the Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Germany and as a Clinical Psychotherapist at the Freiburger Ausbildungsinstitut für Verhaltenstherapie, Germany. She studied psychology in Freiburg and Cologne. Her research focuses on intensive ST for patients with so far non-responding obsessive-compulsive disorder in an inpatient setting where a combination of individual schema therapy and exposure and response prevention is applied. Furthermore she participates in the professional training in Schema Therapy.

Lieda van de Vis is a Healthcare Psychologist and she has had several management roles in mental healthcare for 15 years. Until October 2010, she worked in the Forensic Psychiatric Hospital, de Rooyse Wissel, Venray and Maastricht, the Netherlands, as a Cluster Manager Treatment, Care and Daytime Programming, in which innovation and development were the main focus and was the project manager for several major development counselling programs, for example, projects of implementation of care and treatment of drug addicts and implementation of Schema Therapy, in cooperation with field experts. She currently works as a Content Manager of Clinical Care at the Dr. Leo Kannerhuis, a center for autism in Oosterbeek, the Netherlands.

Michiel van Vreeswijk is Clinical Psychologist and CEO of the private practice G-kracht Psychomedisch Centrum BV, The Netherlands. He is a Certified Cognitive Behavioral Therapist (VGCt) and Certified Supervisor Schema Therapist (ISST, Dutch register ST) and specializes in Schema Group Therapy. He is member of the board of the Dutch Schema Therapy register, study board member and protocol board member of the International RCT on group ST (Arntz and Farrell, 2010). He gives regular workshops and supervision in Schema (group) Therapy in the Netherlands and across Europe. He is (co-) author and editor of several schema books, chapters and articles.

Glenn Waller is a Consultant Clinical Psychologist with the Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust. He is also Visiting Professor of Psychology at the Institute of Psychiatry, King’s College London. He has published widely in the field of the psychology of the eating disorders, focusing particularly on cognitive-behavioral models and therapy. He has also published a number of papers about the clinical and psychometric properties of schema measures. He has served on the editorial boards of the International Journal of Eating Disorders and other journals.

Anoek Weertman is a Psychotherapist and currently works in private practice in psychotherapy, supervision, and education. She studied psychotherapy in Maastricht and during this period, she wrote her thesis on personality disorders under the supervision of Arnoud Arntz. Until recently, she worked at the Psychotherapeutic Center De Viersprong in Halsteren, the Netherlands, a diagnostic and therapeutic center for clients with severe personality pathology. During the last few years, she has mainly specialized in Schema Therapy for personality problems in adults and trauma treatment. She has been active within the Dutch Register of Schema Therapy for several years and is currently Chairman of this Register.

Foreword

I’m excited to have an opportunity to write the foreword for this outstanding handbook on Schema Therapy. This volume represents an important step in going well beyond the books that have already been published on the Schema Therapy approach.

Until now, readers have had access to textbooks on Schema Therapy that lay out basic schema theory and clinical strategies for treating personality disorders; self-help books written for the general public; and a detailed protocol for treating borderline personality disorder. But this is the first volume that extends the basic model beyond BPD and narcissism to a wide range of client populations and disorders, as well as addressing theoretical and research considerations that have not been discussed before in one book. This book represents the next logical step in the development of Schema Therapy: a state-of-the-art extension of the schema approach to new areas of theory, research, and clinical practice.

The three editors, all of whom are highly respected in the field, have done a remarkable job of enlisting the top schema therapists from around the world to contribute chapters across an extremely wide range of topics in their own areas of expertise. Each chapter is written from theoretical, research, and practical perspectives.

I want to mention how the book is organized, and mention some of the highlights, to give readers a sense of the breadth of topics covered. The first part provides an introduction to Schema Therapy that reviews its history and the basic schema conceptual model, along with a chapter by Lockwood and Perris that significantly extends the concept of core emotional needs that has only been touched upon in earlier books.

Part II focuses on diagnostic considerations. This includes chapters on the indications for utilizing ST, the relationship between chronic Axis I disorders and ST, experiential and questionnaire approaches to assessment, case conceptualization, and a case study on diagnosing narcissism from a schema perspective.

Parts III and IV will be of special interest to clinicians. These chapters include case studies and protocols that illustrate how Schema Therapy has been successfully applied to specific clinical groups, including important new techniques that have not been discussed previously. Two questions that I’m frequently asked at workshops are whether ST has been integrated with mindfulness techniques, and whether the approach has been applied to specific populations such as adolescents. There are several intriguing chapters on the integration of ST with mindfulness-based techniques and with ACT. Another chapter addresses the use of ST with an extremely difficult population – dual-diagnosis patients who suffer from both addiction problems and personality disorders. Other chapters focus on ST with eating disorders, OCD, gestalt “chair work,” “playful” techniques (such as puppets and games), adapting ST to adolescents, and working with Cluster C personality disorders. Another chapter is a valuable contribution by Travis Atkinson on the application of Schema Therapy to couples work, which integrates ST with both Gottman’s work and emotion-focused therapy.

I also want to highlight two important topics in this handbook that represent major expansions of Schema Therapy. The first is a series of excellent chapters on Schema Therapy in groups. I consider this one of the most promising advances in ST thus far, since the group format may allow clinicians and institutions to deliver schema treatment at a significantly lower cost, yet with equivalent or perhaps superior results, than individual approaches. Initial studies by Farrell, Shaw, Arntz, and others show great promise in terms of efficacy with BPD clients.

A second especially exciting new development is the application of ST to forensic patients, led by David Bernstein and his group in the Netherlands. Their preliminary work suggests that this adaptation of ST may prove to be a highly efficacious treatment for a population that is generally considered almost untreatable. Their chapter summarizes the protocol they have developed.

Part V deals with the training and supervision of Schema Therapists. This should be of particular interest to clinicians who are interested in becoming certified Schema Therapists themselves.

Part VI is written for readers interested in research on Schema Therapy. This is the first book I’m aware of that reviews the research across a wide range of ST topics, including: efficacy studies across several clinical disorders; experimental research on the schema and mode constructs; and validation studies of both the Young Schema Questionnaire and the Schema Mode Inventory.

The final part deals with an often neglected topic in psychotherapy handbooks: public policy considerations related to the implementation of ST in a variety of mental-health settings, including cost-effectiveness. These chapters will be of particular interest to mental health administrators and policy planners.

As the founder of Schema Therapy, it is difficult to express how gratifying it is for me to see how the field of Schema Therapy has expanded since its beginnings in the 1980s and 1990s. There is no better way for readers to grasp the extent of the new theoretical, research, and clinical work that has been done in recent years than to study the chapters in this handbook. This volume will provide clinicians, theoreticians, researchers, and mental health administrators with a roadmap for future directions in Schema Therapy. I believe that this handbook should be required reading for anyone interested in the field.

Congratulations to Michiel, Jenny, and Marjon for this outstanding contribution!

Jeffrey Young

Columbia University, Department of Psychiatry

Schema Therapy Institute of New York

Acknowledgments

Writing a book like this with dear friends like Jenny and Marjon has been one of the most wonderful journeys. The two of you have become more and more like sisters to me. Jenny, your inquiring and methodological way of working proved to be a strong backbone for me to rely on. Marjon, your enthusiasm for new ideas and your willpower have made it easy for me to come up with fresh ideas and to continue working.

I dedicate this book to my father, mother, and wife, Aglaia. Of my father (†1988), who died while still young, I hold fond memories of a warm, patient, loving, and nurturing man. You taught me to see nature and human beings in an open mind. You inspired me to go forward in science. You will always be with me. To my mother, you raised me with all your love and kindness, always being there when I needed you. A true, good-enough mother. Both of you are in my mind and heart when I work with my patients in their struggle with life. To Aglaia, from the start of our relationship you showed patience and interest in all the work I was doing. You have been an enormous support to me. I love you with all my heart and want to share my life with you.

Michiel van Vreeswijk, Utrecht, (The Netherlands) January 2012

Writing a book with Michiel and Marjon was an enormously enjoyable experience. In the past years both of you have become very good friends. I want to thank you for the collaboration and the warm friendship. I want to express my respect for my partner, Jeroen, in particular. I deeply appreciate your patience, love, safety, and humor; it helped me to prepare this book. In recent years I have had less time for my family and friends, so I look forward to seeing you more often.

I dedicate this book to my parents and sister, Inge. We have shared a lot. I am profoundly grateful that you are in my life. I dedicate this book to Anneke, who unfortunately died too young. She was like a mother and a good friend to me. She made me feel valued and inspired me to become a psychotherapist.

Jenny Broersen, Amsterdam, The Netherlands, January 2012

I would like to gratefully acknowledge the following people whose love, patience, guidance, and support carried me through the past years. I could not have co edited this book without you, Michiel and Jenny – both of you are such warm, loving people. You are the two people that made me believe that unconditional love and friendship really do exist. Thank you for your love, friendship, and support during all these years. I hope that there will be an infinite future for the three of us.

Mama, you have always supported and helped me with your love, doing all the housework and childcare of Fimme and Lorenzo. Without you I would not be the person I am today, and I could not have co edited this book and at the same time finished my thesis! I thank you for your love and practical help every day. Lorenzo and Fimme, my two beautiful sons, you are the lights of my life. Lorenzo, now 21 years old, you have become such a beautiful, strong young adult with such a warm, loving character: “your eyes, it’s a day’s work just looking into them” (Laurie Anderson). Fimme, my 16-year-old son, living with you makes me so happy, our daily life is pleasant and warm and full of excitement, sometimes a bit too much. But luckily, over the last year you have become stable and well balanced. “Your smiling eyes are just a mirror to the sun” (Red Hot Chili Peppers).

Papa (†1990), without your genes, your sense of humor, and your optimism, I probably would not have started this project. Thank you for being who you are.

To the rest of my family and friends, thank you for your support, patience, love, and warmth. I am so blessed to have the many fortunes of your love.

Marjon Nadort, Amsterdam, The Netherlands, January 2012

We would like to thank all the patients on whom our experience is based. Names and other details in case examples in this book have been changed to maintain patient confidentiality.

Michiel, Jenny and Marjon

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