How Secure Nest enhances schema therapy outside the therapy room

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How Secure Nest can benefit individual therapy, group therapy, and clients on wait lists for therapy
By Sally Skewes & Michiel van Vreeswijk

By Sally Skewes & Michiel van Vreeswijk

Thank you so much to the clients who shared their experiences included below.

A version of this article was recently published in the March 2020 edition of The Schema Therapy Bulletin, an official publication of the International Society of Schema Therapy. We would highly encourage all schema therapists and others interested in schema therapy to support the amazing work they are doing by signing up as a member.

As the possible ways of using technology expand and grow, so too do our opportunities for enhancing the experience of schema therapy for both therapists and clients. The opportunity to collaborate in a shared safe place online can strengthen connection between sessions, enliven and intensify the therapy experience.

The outcomes of working with online schema therapy tools, such as Secure Nest, are presented in our article through three case examples. The case examples illustrate the therapeutic process of integrating Secure Nest into schema therapy for individual and group therapy settings.

Case Example 1: Blended individual schema therapy

The collaboration between client and therapist using Secure Nest to complement individual schema therapy. This case example is written from the perspective of the personal experience of the client.

Client presentation

Aurora’s presenting difficulties stemmed back to early disconnection in her family, where the following lessons were learnt:

  • Family dynamics consisted of alienation: “them vs her” being “set up” or “ganged up on” and feeling a lack of support from the family “team”
  • A lack of love, no recollection of being told “I love you” early in life
  • Intense humiliation and judgment
  • Feeling invisible in her family of origin

“Then of course came the laughter, mocking, humiliation, taunting if I wasn’t very good… which of course has fostered a level of self-consciousness that sadly should not exist.”

“Not having a parent emotionally present and feeling invisible generates strong feelings of deep sadness and also distress. It is a heavy, inconsolable sadness I feel towards having to accept that as a young child I was made to feel invisible.”

A long traumatic list of “perfect storm” events later in life reinforced the above messages.

“Abusive intimate relationships, and a reaction of blame from my family, as though I deserved it …never a reaction of protecting or defending or looking after me.”

Ultimately she realised that the pattern of emotional neglect was repeating in life.

“I am sad (and ashamed) to admit that being conditioned to not having my voice and needs respected, I have adapted to not share and thus do actually perpetuate being alone and invisible.”

Aurora did not want to be seen in a vulnerable state and naturally this occurred in therapy and in her work too.

Aurora worked in a highly competitive, stressful, profession and is someone who does not believe in quitting or failure, someone who knows how to suffer for achieving goals.

Secure Nest became a shared safe place to experience connection

To provide a corrective emotional experience for:

  • A lack of safety, feeling undeserving of any love, respect, or attention, feeling unworthy – no matter what, connected to intense feelings of shame and the lack of a sense of belonging

“Shame has left me on the sidelines of life, disconnected, feeling unworthy of belonging in a meaningful and respected way.”

Aurora needed a personalised approach to therapy that really “got” Aurora and stimulated her inherent creative expression and independence to develop self-confidence.

Secure Nest provided this personalised space beyond the therapy room
To provide a corrective emotional experience for:

  • Impaired autonomy
  • Being unable to develop her own qualities, own choices and to feel valuable

“My parents have been often absent when desperately needed but then frustratingly present to a detrimental extent when instead independence was required. My self-confidence has been often undermined by commentary that highlighted deficits and obstacles or fostered doubt in my abilities.”

How the narrative developed using Secure Nest over the therapy journey

My Journal, a tool within Secure Nest, became a shared safe place for authentic and transparent communication between client and therapist.

Importantly, journal entries could only be initiated by the client and therefore there was space for Aurora, which was required and was separate from the therapist’s agenda.

Aurora experienced connection in My Journal.

“You’re the first person who’s ever said to me that you just want to sit beside me so that I’m not alone. It’s a new experience.”

In an online space the disinhibition effect was evident, which encouraged Aurora to reach her Vulnerable Child, to establish more direct contact with her Vulnerable Child and the therapist, and to share in a way that would not be possible in person due to intense shame.

In session corrective emotional experiences were consolidated through encouraging reflection using the Homework tool within Secure Nest.

“First of all I feel like a burden, somewhat embarrassed or ashamed for taking up your time and for appearing needy (pathetic, weak)…not wanting to be seen in a vulnerable state…having to concede that I’m actually not ok to such an extent that I’d actually allow you into the safe place and to see me being vulnerable.

There is definitely an element of comfort felt by experiencing your presence. Whilst adult Aurora is rather reluctant to let anyone into the safe place because she’s learnt it’s safest when alone Little Aurora felt a great sense of relief because finally her distress was seen, heard and responded to.”

Self-confidence and autonomy were supported step by step.

“I have learnt that Little Aurora’s unique talents should have been celebrated and encouraged, and the fact that she was a shy and more anxious child should have attracted a much more thoughtful, caring, supportive approach from the entire family.”

Therapist reflection

George Lockwood (Lockwood, 2008*) describes how,

“Limited reparenting parallels healthy parenting, and involves the establishment of a secure attachment through the therapist, within the bounds of a professional relationship, doing what she can to meet these needs.

The therapist’s regulation of the client’s affect becomes internalised by the client and forms a healthy adult mode modelled on the therapist’s. This healthy adult mode becomes a strong foundation for the establishment of autonomy.”

In my experience, the use of Secure Nest enhances the key steps of limited reparenting:

  • Firstly, reaching the Vulnerable Child mode and providing reassurance
  • Next, strengthening the connection between therapist and client as Secure Nest itself can act as a transitional object between sessions. It serves as a link to the therapist, and
  • Inviting collaboration and promoting autonomy

*Lockwood, George, Posted on Dec 27, 2008 on Limited Reparenting.

Case Example 2: Three week self-education program, using Secure Nest on a waiting list

Anna was on a waiting list for schema therapy and her therapist suggested that the Secure Nest self-education program could provide an opportunity to become familiar with the key schema therapy concepts to prepare for their work together.

Anna was guided through the self-education program using the inbuilt prompts.

Anna’s process of working through the three week self-education program

Anna completed schema and mode assessments and was guided to listen to relevant schema mindfulness recordings.

Anna connected with her Vulnerable Child through imagery and was guided through a reflection exercise.

Anna was then guided to prepare her safe place.

Anna then creatively expressed her experience of schemas, modes and core childhood memories in Artful Sparks (an art tool within Secure Nest).

Anna became more aware of the childhood origins of her schemas and unmet needs.

Anna became aware of current triggers (linked to schemas) that relate to presenting problems by completing mode diaries.

Therapist reflection

As Anna’s therapist I felt so informed when we met for the first time as I had received updates on her journey through the self-education program.

I had the feeling of knowing Anna and being able to plan our time together in session effectively, including planning goals for change during the therapy process.

Overall, I had a lot of information about Anna’s personal experience of her modes.

As part of the self-education program Anna had been invited to connect with her Vulnerable Child – and even before commencing schema therapy Secure Nest had become a shared safe place.

Case Example 3: Blended Group Schema Therapy

Secure Nest also offers the opportunity for group members and the co-therapists to view each other’s progress and homework assignments as well as having a platform where group members can interact with each other in a safe digital group environment.

A group of 8 clients were introduced to a time-limited blended schema therapy group. The presence of emotional deprivation, self-sacrifice and abandonment schemas, and Demanding Parent, Detached Protector and Impulsive Child modes were strong in the group. To introduce how to work with blended schema therapy it was described that sharing in Secure Nest (in Group Notes) and sharing homework and progress was as important as it was to share in live group sessions. The co-therapists explained that group members do not have to respond to everybody every time they share although their schemas might say otherwise and that every group member has the personal responsibility to ask for support for their Vulnerable Child from a Healthy Adult perspective.

How the narrative developed using Secure Nest over the therapy journey

Group rules and group tasks were written on Secure Nest for every group member to read. Two of these group tasks were:

  1. As a group we work on creating a healthy balance between the Vulnerable Child, Happy Child and Healthy Adult. We do this by sharing our emotions and thoughts and listening respectfully to each other, and asking for what our fellow group members need from us.
  2. As a group we work within a safe mini-society where schemas and maladaptive modes can be triggered in interactions with each other and where we then try to learn from it together. We do this by acknowledging that we all have our own histories which play a part in the presence of trigger situations and which we can heal together by accepting that we want to learn from each other.

The group chose a picture which represented the schema therapy group for them, which was uploaded to Secure Nest. Group members wrote down their individual goals in Secure Nest. During the blended schema therapy group they became more aware of how the group could be of help to reach their goals, which they then wrote down in Secure Nest so each group member would be able to see it.

Weekly progress was measured (using Ratings) and homework assignments were uploaded by the group members. At the end of the blended schema therapy group in their evaluation, group members mentioned that after the first stage of getting to know Secure Nest and an initial hesitation to use new technology they really appreciated having this safe opportunity to have contact with each other on a shared schema therapy platform. It helped them to connect more with each other and to stimulate each other to keep up the good work or reduce avoidance.

Co-therapists reflection

In the beginning of the blended schema therapy group the group had to be actively stimulated to reflect on themselves and share the reflections not only in live group sessions but also within Secure Nest. For some group members, the Demanding Parent mode said that they always had to share the same amount of information and had to respond to each individual group member.

It was especially important for the group members to express to each other that they would not show the information which was put on Secure Nest to other people who were not part of the schema therapy group. When this was explicitly stated and the group was actively stimulated to use Secure Nest by the co-therapists there was a lot of activity.

Initial worries the co-therapists had in relation to how to mediate online communication between group members were revealed to be unnecessary. Group members were very respectful when they wrote to each other and sometimes the co-therapists even had to stimulate the group to also empathically confront each other online.

Summary

These case examples illustrate how Secure Nest can help to guide therapists and clients through the journey of schema therapy. Our article illustrates three journeys that are possible with the support and guidance of the blended individual and group protocols and the three week self-education program. Please create a free trial account to experience the opportunity to work in a new way with your clients.

SHARING IS CARING 😊

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Secure Nest provides personalised online therapy tools designed specifically for schema therapy. Read more here or register for your free trial.

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