Chapter 2 62 borderline personality problems. In their study [32], they describe the development of the training and their first experiences with it in treating patients and acknowledged the training as a prerequisite for further treatment of borderline personality disorder. Unfortunately, some time after their publication the training was discontinued, and the protocol is no longer available. Farrell and Shaw indicate they have incorporated ‘the essential elements’ of their training into their Group Schema Therapy [129]. As they described a part of their protocol in their 1994 paper this part has been translated and rewritten into Dutch, with permission of the authors, by Derks, Westerhof and Bohlmeijer for use in general mental health care. See: https://www.boompsychologie.nl/media/4/protocol_bij_transdiagnostische_factor en.pdf Noteworthy is the work of Gendlin [130] on the technique of ‘focusing’. Gendlin developed a body-oriented treatment in which the patient is directed to and work with the feelings felt within the body – the ‘felt sense’. In patients with limited emotional awareness, these feelings are vague at first and even go by unnoticed. In the process of focusing, ‘a curious kind of attention’ is used to reflect on the sensations experienced (often in the chest, stomach, or throat). During therapy sessions, a careful dialogue is gradually encouraged with that part of the body in which ‘something’ is felt. Techniques that are used for this are: acknowledging the feeling, questioning the feeling inquisitively and cautiously, being present with the feeling in a friendly way, tentatively naming the feeling [131]. The goal of the dialogue is to initiate a process of increasing body awareness as well as emotional awareness. Apart from these treatment programs dedicated specifically to alexithymia and emotional awareness, a number of psychotherapeutic treatment programs are available in which improving emotional perception is a part of the overall program. Most of these therapies concern psychotherapeutic treatment programs for personality disorders. In addition to the aforementioned Group Schema Therapy by Farrell and Shaw, these include, for example, Mentalization Based Treatment (MBT) [132], Dialectical Behavioral Therapy (DBT) [133], the Systems Training for Emotional Predictability and Problem Solving for Borderline Personality Disorder (STEPPS) [134], (regular) Schema-focused therapy (SFT) [135], Mindfulness [136]; and BodyOriented Mentalization-Based Therapy for patients with somatic symptom disorders [121, 137-139]. Within these treatments, specific attention is paid to teaching patients to observe, reflect upon, and verbalize their (emotional) experiences. Both the dedicated psychological treatments for alexithymia and broader treatment programs have proven to be effective in increasing the level of emotional awareness
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