5
(Contra)indications

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A fairly anxious young man with symptoms of melancholy has signed up for an initial assessment. The patient has withdrawn from school and spends most of his time sitting at home, playing video games or brooding in front of the TV. He had a history of dropping out of previous therapies before completion. The patient’s prominent schemas are Failure, Emotional Deprivation, and Social Isolation, and his most frequently active modes include Detached Protector, Vulnerable Child, and Demanding Parent. He truly wants to be helped and is ready to do the work, but fears he will end up dropping out again.

The patient agrees to follow eight sessions of the training Mindfulness and Schema Therapy, prior to starting therapy. This offers him the prospect of actually completing a therapy treatment program for a change. The relatively brief training period will also provide an introduction to Schema Therapy, enabling him to determine whether or not he is sufficiently motivated to continue therapy and to do the homework which would be required. It also presents him with an alternative to withdrawal and rumination, avoiding the ever-present distraction of video games and TV.

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Mindfulness training is increasingly used in clinical settings with a variety of patient demographics, however, effectiveness studies lag behind. So far, there are no scientifically supported criteria for indications and contraindications. In this protocol, criteria are based on insights from the authors’ clinical experience, and the guidelines for psychotherapy and psychological treatment in general.

Indication criteria are:

• openness to becoming aware of habitual patterns (schemas/modes);
• recurring Axis I disorders involving apparent personality disorder/ problems;
• persistent rumination;
• difficulties regulating emotion;
• impulsivity, and a preparedness to examine and change it;
• recurring difficulties in social interaction;
• openness to Schema Therapy, albeit with uncertainty regarding long-term Schema Therapy treatment;
• openness to Schema Therapy, albeit with limited insight into schemas and modes (e.g. as indicated by unexpectedly low scores on questionnaires).

Contraindications include:

• overly severe Axis I disorders, where patients are unable to adequately concentrate on exercises, or where exercises appear overly taxing from the very start (e.g. in cases of severe substance abuse disorder);
• severe learning disability;
• unpreparedness to invest time in mindfulness exercises;
• unpreparedness to plan predetermined actions for crisis situations;
• socioeconomic living circumstances requiring immediate attention (e.g. pending eviction, overwhelming financial debt, legal actions);
• lack of support for participation in the training in patient’s social network;
• lack of proficiency in the spoken language.

Specific contraindications for group-based mindfulness training are:

• lack of empathic capacity;
• hearing deficiencies.