Schema Informed Formulation in Probation: The merits and challenges of

trauma informed thinking

Dr Felicity Nichols

Clinical Psychologist

Lincolnshire Offender Personality Disorder Pathway

Overview

• The Pathway and the probation context

• Schema Theory

• The Approved Premise– our input

– its reception

• The Challenges

• The Merits

• Reflections

Early Identification

Workforce Development

Sentence/Pathway Planning

Offender Management

Approved Premise

• 100% Screening

• KUF Awareness Training

• Bespoke Mandatory Training

• 3 Tiered Formulation System

• Ongoing case consultation

• Cases held within the team

• Formulation work

• Case consultation

• Enabling Environments

The PD Pathway

Probation Context

Austerity

Transforming Rehabilitation

E3

PD Pathway

Integrative Model

Early Maladaptive

Schemas

Schema Modes

• Developed by Dr Jeffrey Young

• Draws upon CBT, Gestalt, Psychodynamic, Interpersonal, Attachment

• Increasing evidence base

• Define thoughts and behaviours

• Develop throughout childhood

• Significantly dysfunctional

• Enduring Personality Traits

• Dominate an individuals presentation in the moment

• Individuals ‘flip’ between modes

• Maladaptive way to protect self

Schema Theoretical Underpinning

Core Childhood

Needs

Capital ‘T’ Trauma

Lower case ‘t’ trauma

Early Maladaptive

Schema

Persistent Pattern

Memories, Feelings & Thoughts

Bodily Sensations &

Physical Reactions

Dysfunctional and Unhelpful

Template of Self, World &

Other

Early Maladaptive Schema

Secure Attachments

to Others

Independence, Competence

& Sense of Self

Realistic Limits & Self

Control

Spontaneity & Play

Freedom to Express Valid

Needs and Emotions

Toxic Frustration of Needs

Victimization and Trauma

Too Much of a Good Thing

Selective Identification and Internalization with Others

Schema Informed Working

Behavioural strategies (including

offending) understood as mechanism for meeting unmet

needs from childhood

Uses the relationship as primary vehicle for

change

Emphasis on impact of childhood experience

The Set Up

• The House on the Hill

• The ‘Cast’ of Characters

• Trauma at the Hostel

• A ‘PIPE dream’

Naming the Elephant (Amongst other things…)

• Resident ‘Mode formulation’

• Consultation/ Supervision

• Supporting Work Towards EE

• Reflective Practice

• Intervention

• Tea!

Vulnerable Little BenFeel sad

Feel unloved

Feel uncared for

Feel scared that people will leave or hurt me

Angry Child

BenNo one will look out for

me

I’m going to do what I

want

It's not fair

Detached Protector

Ben“It’s fine” / “I’m fine”

Drug use to ‘cut off and cope’

Push things to one side

Bully-Attack BenLash out

Attack others to keep them close

Compliant

Surrender BenGives in to the will of others

Agrees with / does what others

think

Healthy Adult Ben“I want to be a good Dad”

Stopping self doing things sometimes

because I know it won’t help

“I’m responsible for my own actions

and for changing them”

Critical Parent“I should be better”

“I keep getting it wrong”

“I’m just like my Dad”

Likely Schemas

Abandonment / Rejection

Mistrust / Abuse

Defectiveness / Shame

Dependence / Incompetence

Insufficient self-controlCan’t tolerate this so switches to either...

When this no longer works or the situation

cannot be controlled switches to...

WHAT TO DO:

•Provide a consistent response/ message

•Recognise that sometimes it feels easier to do

what you think others want but that this is

frustrating

•Ask about alternative options to respond to the

situation

•Say “I wonder if you are trying to do what you

think I want you to do rather than what you want

because you are worried about what I might do”

WHAT TO DO:

•Be clear and succinct in providing information

•Be consistent

•Recognise that it seems frustrating, tough, things feel a

bit overwhelming...

•Reassure that you are there to listen

WHAT TO DO:•Don’t provide lots of

information•Say “this is really hard for

you”•Recognise that he is trying not

to think about things•Discuss alternative coping

strategies

WHAT TO DO:

•Hold the

boundaries

where possible

•Recognise how

angry/frustrated

he feels

WHAT TO DO:

•Reassure that you are there

trying to help

•Recognise that it may feel like he

is alone / uncared for

•Provide rationale for the decision

/ situation

You may feel verbally attacked or

intimidated, angry, or anxious.

Paranoid Over-

Controller BenControlling in relationships

Invites others to behave in the

way he expects them to

Impression management

You may start to think about other

things, lose your trail of thought, or

feel tired/ start yawning

If you don’t feel

threatened

The Plan...Referral to mental health team

Access the gym

Warning signs for staff – lots of time on my

own – ask me if I want to talk

Naming the Elephant (Amongst other things…)

• Resident ‘Mode formulation’

• Consultation/ Supervision

• Supporting Work Towards EE

• Reflective Practice

• Intervention

• Tea!

“It’s not ok to make people cry”

Stop making me think!

• “Pink and Fluffy”

• “Our job is Public Protection”

• “I can’t do that – they might go out and hurt someone and it will be my fault”

Help me think more!

• “This makes so much sense”

• “It really works”

• “It’s great having you on hand to help”

• “We need to work together”

So who is the client?!

Behavioural strategies understood as

mechanism for meeting unmet needs

Uses the relationship as primary vehicle for

change

Emphasis on impact of previous

experiences

Staff / System Formulation

‘Angry Child Mode’It’s not fair

We aren’t being listened to

It’s not our responsibility / job

It’s not all just about the residents

‘Vulnerable Child Mode’

Not listened to

Undervalued

‘Dumped on’

Unsupported

Unsafe

Punitive ParentThe pull to rubbish and blame self/

others

Detached Protector ModeNon-engagement

Avoid leaving the office

Interactions through the ‘hatch’

Not communicating or recording information

Early ExperiencesHighly anxious

Incidents in the hostel

Rumours and hearsay

No Supervision

Shift patterns

Upheaval and change – uncertainty about jobs

Paranoid Over-Controller

ModeConvinced it is all going to go wrong

Looking out for threat and wrong-doing

Consistent e-mailing/ phone calls if someone

‘needs to be recalled’

Healthy Adult

Pockets / moments of positive

engagement and thought

Likely Schemas

Emotional Deprivation

Mistrust / Abuse

Punitiveness

Challenges

• A state of ‘unprecedented change’ – flux

• Lack of safety & management

• Not dealing with history and trauma in the staff team

• ‘Lacks victim empathy’

• Austerity

• I’m not a Psychologist

• Scapegoating

Merits

• Offers a non-stigmatising frame to begin to grapple with painful and “brutalising” material

• Meeting the need vs dependence

• Shifts in thinking

• Shifts in practice

• Pockets of thought

• Impact for residents

Ardino (2014)

“Recovery cannot occur in isolation. It can take place only within the context of relationships characterised by belief

in persuasion rather than coercion, ideas rather than force, and mutuality rather then authoritarian control –precisely the beliefs that were shattered by the original

attachment relationships”

“A profound cultural shift in which clients and their behaviours are viewed differently, staff respond

differently…an understanding of clients and their symptoms in the context of their life experiences and

history”

Reflections• Can we ever really deliver trauma

informed care without considering the ‘brutalising’ impact of the work on staff?

• Do we have permission to do this work?

• How often do we play into the ‘false dichotomy’?

• If the first step in trauma work is stabilization how can we effectively support staff teams in ever-changing climates?

• Is there a false dichotomy perpetuated by ‘the system’?

• How do we stay mindful of the impact on ourselves?

Containing the Container

• Bion – Container Contained

• Stokoe – Healthy Team

• Karpman – Drama Triangle

• Bloom – Sanctuary Model

• Searles – Parallel Processes

• Maslow – Hierarchy of Need

Questions