Reparenting is a form of psychotherapy in which the therapist actively assumes the role of a new or surrogate parental figure for the client, in order to treat psychological disturbances caused by defective, even abusive, parenting. The underlying assumption is that all mental illness results principally from such parenting, even including schizophrenia and bipolar disorder.
In the late 1960s, Jacqui Lee Schiff developed a form of therapy based on transactional analysis theory. She would dub this form of therapy as total regression reparenting. Schiff and her followers claimed success with curing clients with schizophrenia using reparenting, which resulted in the expansion of its practice. The promising findings of reparenting by Schiff led other therapists to develop their own application and forms of re-parenting. The other most notable forms of reparenting that later came include time-limited, spot, and self-re-parenting. Some people consider reparenting to be one of the many forms of New Age psychotherapy. [1] [2]
Deriving from transactional analysis theory, reparenting seeks to treat problems associated with defective parenting. The theory of reparenting states that psychological problems due to defective parenting can be overcome by reforming the parent ego state of the client. This is achieved by regressing the client to a state of mind that is vulnerable to new experiences, called the child ego state in transactional analysis theory. Once the client is in the child ego state, the therapist adopts the role of the client's parent and attempts to correctly reparent the client. The nature of reparenting by the therapist should be more positive and influence the client into developing a healthier parent ego state, which ultimately negates the psychological problems the client may have experienced before reparenting therapy. [3] [4]
Due to the wide varying forms of reparenting, each therapist may adopt different methods when treating clients. However, the mechanism that underlie the theory of reparenting is generally agreed upon. Typically, reparenting starts with the regression of the client to the child ego state. The therapist accomplishes this by partaking in child-rearing acts such as bottle feeding, lap pillows, and other techniques wherein the client consciously adopts physical positions and behaviors of a small child. These actions will also gain the client's trust in the therapist as his or her new parent. Once the ideal level of closeness is achieved, the therapist can finally proceed to providing the messages that reform the client's negative way of thinking by lecturing, entering discussions, or other forms of communication appropriate in a parent-child relationship. [3] [5]
Developed by Jaqui Lee Schiff, this form of reparenting was the first form of therapy built upon transactional analysis theory. Typically, the patient lives with the therapist for up to several years at an institution. During this time, the patient is totally immersed in the reliving of his or her childhood. The therapist provides all the care and nurturing with the goal of totally reforming the client's parent ego state. Total regression reparenting is famously associated with the Cathexis Institution, which was founded by Jaqui Lee Schiff. [1]
Thomas Wilson developed time-limited regression reparenting for the purpose of treating patients with schizophrenia. But unlike Schiff's therapy, the patient is only required to attend five two-hour sessions with the therapist instead of living with the therapist. Nurturing is also more intensive and more structured than total regression reparenting. [1]
Spot reparenting was developed by Russell Osnes. In addition to also being less time intensive than Schiff's total regression reparenting, Osnes's form of reparenting focuses more on patients traumatized by specific experiences and incidents rather than by general disturbances in childhood. [1] [6]
Self-reparenting was developed by Muriel James. Unlike prior forms of reparenting, James's form of reparenting did not attempt to totally replace the parent ego state of the client. Instead, the therapy confirms the positive aspects already apparent in the client's ego. The client is also the primary agent in therapy instead of the therapist. [1] [7]
Developed by Del Casale, this form of reparenting, like Wilson's time-limited regression reparenting, focused primarily on treatment for schizophrenic patients. But unlike both Schiff and Wilson, Del Casale proposes that the therapist does not play the role of the parent for the client. Instead, Del Casale had the client's actual parents become an active participator in the therapy. Del Casale bases this model on the belief that some parts of the client's parent ego state is still healthy, and that defective parenting is not at the fault of the parents, but of the weak communication between the parent and child. [1]
Dr. David Kline practiced Schiff's total regression reparenting and was a staff member of the Cathexis Institute. Among his most noted clients was a young girl diagnosed with severe anorexia nervosa. Dr. Kline theorized that the patient's anorexia was due to her mother's strict expectations. Reparenting was then used to counteract the negative influence of the patient's mother's parenting style. According to the patient, the therapy was a success, and she now lives with more confidence in her image as suggested by her therapist's reparenting. [8]
Jaqui Lee Schiff conducted a study to attain biochemical evidence for reparenting's effectiveness on schizophrenics. Schiff based this study on the observation that individuals with schizophrenia tend to have low levels of tryptophan reuptake. In the study, 20 patients diagnosed with schizophrenia were divided into three groups: a group going through reparenting treatment at the Cathexis Institute, a group going through separate treatment at the Lafayette Institute, and a control group that did not receive reparenting treatment. The results show that the subjects going through reparenting treatment at the Cathexis and Lafayette Institute had a mean tryptophan reuptake of 3.32 and 3.75 respectively. The control group had a group mean of 2.13. The numbers show that subjects that received reparenting had significantly higher tryptophan reuptake at the end of the experiment. [9]
Lilian M. Wissink conducted a study to determine self-reparenting's effect on self-esteem. Human subjects were divided into two groups, a treatment group that consisted of 10 people, and a control group that consisted of 12 people. The sample group was made up of students and staff from a rural university, and only the treatment group went through self-reparenting treatment. The subjects were given questionnaires to measure their level of self-esteem before and after treatment. The result showed that subjects that received self-reparenting had significantly increased levels of self-esteem while the control group had decreased levels of self-esteem. [10]
Gloria Noriega conducted a study to analyze the effects of self-reparenting on female delinquents in jail, who were between the ages of eleven and eighteen. In the study, all of the subjects received exactly the same treatment to support the theory that the effects of self-reparenting can be directly replicated. According to the results, twenty seven of the twenty eight subjects expressed less aggression, fewer conflicts with parents, increased motivation to achieve goals, and increased self-esteem in comparison to how they were before treatment. The subject that didn't show change was a drug abuser and clinicians concluded that more specialized treatment was required. [11]
Although reparenting is widely practiced, there is no set system of terminology among practitioners. In addition, the definitions of commonly used terms differ in definition among practitioners. The vagueness produced by these two weaknesses present danger of miscommunication between the therapist and the patient during treatment. The patient may also not fully understand the information shared with them when contracting or terminating treatment. [12] [13]
The nature of reparenting often requires the therapist to develop a close relationship with the client. There is no protocol to provide the boundary as to what the therapist can or cannot do. Often, it is up to the therapist to determine the plan of action to take when faced with a dilemma during treatment. [13] [14]
There is no way to objectively determine the success in completely replacing the client's parent ego state after reparenting therapy. The therapist can only rely on the client's subjective statement, which may conflict with the therapist's account of the results. [12] This conflict leads to questioning whether the therapy actually succeeded in reforming the Parent ego state.
This problem is especially true for total regression reparenting. Clients in therapy are totally immersed in an environment that promotes regression into the child ego state. However, during this time at which the client may spend months or years, the client is left at the mercy of the therapist and the institution. [12]
Although some studies have been done to test the efficacy of reparenting, the amount of statistically powerful studies available are few. Few studies try to confirm the mechanism or isolate moderating variables of reparenting. [12] [13]
Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.
Psychoanalysis is a theory and field of research developed by Sigmund Freud. It describes the human mind as an apparatus that emerged along the path of evolution and consists mainly of three functionally interlocking instances: a set of innate needs, a consciousness to satisfy them by ruling the muscular apparatus, and a memory for storing experiences that arises during this. Furthermore the theory includes insights into the effects of traumatic education and a technique for bringing repressed content back into the consciousness, in particular the diagnostic interpretation of dreams. Overall, psychoanalysis is a method for the examination and treatment of mental disorders.
Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.
Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's ability to fulfill their daily routines and roles. OTs have training in the physical, psychological, and social aspects of human functioning deriving from an education grounded in anatomical and physiological concepts, and psychological perspectives. They enable individuals across the lifespan by optimizing their abilities to perform activities that are meaningful to them ("occupations"). Human occupations include activities of daily living, work/vocation, play, education, leisure, rest and sleep, and social participation.
Transactional analysis is a psychoanalytic theory and method of therapy wherein social interactions are analyzed to determine the ego state of the communicator as a basis for understanding behavior. In transactional analysis, the communicator is taught to alter the ego state as a way to solve emotional problems. The method deviates from Freudian psychoanalysis, which focuses on increasing awareness of the contents of subconsciously held ideas. Eric Berne developed the concept and paradigm of transactional analysis in the late 1950s.
Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.
Gestalt therapy is a form of psychotherapy that emphasizes personal responsibility and focuses on the individual's experience in the present moment, the therapist–client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments people make as a result of their overall situation. It was developed by Fritz Perls, Laura Perls and Paul Goodman in the 1940s and 1950s, and was first described in the 1951 book Gestalt Therapy.
Otto Friedmann Kernberg is an Austrian-born American psychoanalyst and professor of psychiatry at Weill Cornell Medicine. He is most widely known for his psychoanalytic theories on borderline personality organization and narcissistic pathology. In addition, his work has been central in integrating postwar ego psychology with Kleinian and other object relations perspectives. His integrative writings were central to the development of modern object relations, a school within modern psychoanalysis.
Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.
Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.
William Ronald Dodds Fairbairn FRSE was a Scottish psychiatrist, psychoanalyst and a central figure in the development of the Object Relations Theory of psychoanalysis. He was generally known and referred to as "W. Ronald D. Fairbairn".
Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cognitive therapy is based on the cognitive model, which states that thoughts, feelings and behavior are all connected, and that individuals can move toward overcoming difficulties and meeting their goals by identifying and changing unhelpful or inaccurate thinking, problematic behavior, and distressing emotional responses. This involves the individual working with the therapist to develop skills for testing and changing beliefs, identifying distorted thinking, relating to others in different ways, and changing behaviors. A cognitive case conceptualization is developed by the cognitive therapist as a guide to understand the individual's internal reality, select appropriate interventions and identify areas of distress.
Child psychotherapy, or mental health interventions for children refers to the psychological treatment of various mental disorders diagnosed in children and adolescents. The therapeutic techniques developed for younger age ranges specialize in prioritizing the relationship between the child and the therapist. The goal of maintaining positive therapist-client relationships is typically achieved using therapeutic conversations and can take place with the client alone, or through engagement with family members.
Splitting, also called binary thinking, black-and-white thinking, all-or-nothing thinking, or thinking in extremes, is the failure in a person's thinking to bring together the dichotomy of both perceived positive and negative qualities of something into a cohesive, realistic whole. It is a common defense mechanism, wherein the individual tends to think in extremes. This kind of dichotomous interpretation is contrasted by an acknowledgement of certain nuances known as "shades of gray". Splitting can include different contexts, as individuals who use this defense mechanism may "split" representations of their own mind, of their own personality, and of others. Splitting is observed in Cluster B personality disorders such as borderline personality disorder and narcissistic personality disorder, as well as schizophrenia and depression. In dissociative identity disorder, the term splitting is used to refer to a split in personality alters.
Interpersonal psychotherapy (IPT) is a brief, attachment-focused psychotherapy that centers on resolving interpersonal problems and achieving symptomatic recovery. IPT is an empirically supported treatment (EST) that follows a highly structured and time-limited approach. Interpersonal therapy is intended to be completed within 12–16 weeks. IPT is based on the principle that relationships and life events impact mood and vice versa. The treatment was developed by Gerald Klerman and Myrna Weissman in order to treat major depression in the 1970s and has since been adapted for other mental disorders. IPT is an empirically validated intervention for depressive disorders and is more effective when used in combination with psychiatric medications.
The developmental needs meeting strategy (DNMS) is a psychotherapy approach developed by Shirley Jean Schmidt. It is designed to treat adults with psychological trauma wounds and with attachment wounds. The DNMS is an ego state therapy based on the assumption that the degree to which developmental needs were not adequately met is the degree to which a client may be stuck in childhood. This model aims to identify ego states that are stuck in the past and help them get unstuck by remediating those unmet developmental needs. The processing starts with the DNMS therapist guiding a patient to mobilize three internal Resource ego states: a Nurturing Adult Self, a Protective Adult Self, and a Spiritual Core Self. The therapist then guides these three Resources to gently help wounded child ego states get unstuck from the past by meeting their unmet developmental needs, helping them process through painful emotions, and by establishing an emotional bond. The relationship wounded child parts have with these Resources is considered the primary agent for change.
Schema therapy was developed by Jeffrey E. Young for use in the treatment of personality disorders and other chronic conditions such as long-term depression, anxiety, and eating disorders.
Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop mental health treatment before they have received an adequate number of sessions. In the United States, the prevalence of patient dropout is estimated to be between 40–60% over the course of treatment however, the overwhelming majority of patients will drop after two sessions. An exhaustive meta-analysis of 146 studies in Western countries showed that the mean dropout rate is 34.8% with a wide range of 10.3% to 81.0%. The studies from the US (n = 85) had a dropout rate of 37.9% (range: 33.0% to 43.0%).
Co-therapy or conjoint therapy is a kind of psychotherapy conducted with more than one therapist present. This kind of therapy is especially applied during couple therapy. Carl Whitaker and Virginia Satir are credited as the founders of co-therapy. Co-therapy dates back to the early twentieth century in Vienna, where psychoanalytic practices were first taking place. It was originally named "multiple therapy" by Alfred Alder, and later introduced separately as "co-therapy" in the 1940s. Co-therapy began with two therapists of differing abilities, one essentially learning from the other, and providing the opportunity to hear feedback on their work.