Scheme Therapy: Characteristics, Operation And Phases
In the clinic there are many cases in which addressing the patient’s problem from a single perspective is ineffective. Human reality is very complex, and so are its psychological problems, which pose a challenge if they are worked on from a single point of view.
Schema therapy is a therapeutic proposal that was born as an integrative approach of various currents and psychological tools in order to improve the quality of the patient taking an eclectic vision of the therapeutic process and how to manage it.
This therapy, proposed by Dr. Young, has been especially useful for personality disorders, but it seems to be valid for many other mental disorders, and below we will discover what they are and what tools it uses.
A fact that every clinical psychologist knows is that clinical practice is not as simple as one might expect. The causes behind the patient’s psychological discomfort and dysfunction can be several: the patient’s own personality, his or her relapse rate, and even the disorder itself.
An example of this is personality disorders (borderline, histrionic, schizotypal…) which are a real challenge for any psychotherapist. For these cases, integrative approaches are most appropriate, such as schema therapy..
Schema-focused therapy is the result of a great effort to coherently integrate several therapeutic strategies, coming from different psychological currents focused on the treatment of various psychological problems, especially personality disorders.
Its creator is Jeffrey E. Young, who brought together cognitive, behavioral, constructivist, psychodynamic and experiential models, and placing special emphasis on the individual’s childhood. This therapy is considered to be very effective for chronic psychological disorders or when they do not respond to other therapies.
The main premise of this therapy is to consider that there are some behavioral and emotional patterns that have their origins in the first years of life, which condition the way the individual acts and thinks. Schema therapy is very useful to face several of the most difficult problems to treat in therapy, especially getting the patient’s inner world out, isolating an interpersonal conflict that may be significant in their life, disinterest in therapy and the attitude uncooperative that some patients show.
This therapeutic option prioritizes creating a strong patient-therapist bondwhich will help the professional to make the patient confront his own contradictions through sessions in which what he experienced in his childhood and what impact it has on his current life is addressed.
It is a somewhat long therapy, lasting at least one year in which the therapist must show a non-directive attitude, promoting the patient’s assessment and discovery of what happens to him, happened to him or could happen to him.
Key ideas and proposals of this psychological therapy
Mainly, there are two fundamental concepts of this therapy. The first has directly to do with what gives its name to this therapeutic approach, the schemas, while the second has to do with the way in which people maintain or overcome these schemas.
Specific, Young coined the term “early dysfunctional schemas.”an idea we delve into below.
Early dysfunctional scheme
Early dysfunctional schemas are stable themes that develop throughout our lives and that are often perceived as true. Because of this, they have a high resistance to any type of logical argument that seeks to unseat them and, in addition, they perpetuate themselves through the person’s daily habits and their usual way of thinking.
Schemas have a powerful capacity to condition emotional life, so if their content is negative they can significantly harm the mental health of those who present them. According to the model, these schemes are the result of some type of dissatisfaction of some childhood needassociated with the following aspects:
The origin of the deficiencies would be found in the familyalthough it does not necessarily have to come only from her.
Young identified up to 18 schemes of a negative and pathological nature. Frustration of basic needs, abuse, and identification with dysfunctional parental patterns They would be behind his appearance. Briefly mentioning them, they are:
Outline operations
From the schema therapy model It is assumed that the patient has one or more of these schemes, which will lead him to carry out a series of behaviors and thoughts. aimed at perpetuating or overcoming them. The pathological perpetuation of these patterns would be carried out through four main mechanisms:
1. Cognitive distortions
They are interpretations of reality that are not objective at all.. As they are totally biased interpretations of reality, the behaviors associated with them are not adaptive.
You may be interested: “The 8 types of cognitive distortions”
2. Vital patterns
The vital patterns associated with dysfunctional schemas are unconscious choices of decisions that maintain the situation or do not facilitate options for change and self-improvement.
3. Avoidance
Avoidance is carried out in the form of flight or escape from life experiences seen as uncomfortablealthough they may be a real opportunity for transformation for the better.
4. Overcompensation
Overcompensation consists of the imposition of very rigid patterns of thought and action aimed at showing the opposite of what is known to be a lack.
The objective of treatment is to mobilize all available resources to ensure that the patient can adopt and carry out the second strategy, that is, overcome the harmful schemes of his mind. For this, a varied selection of therapeutic procedures is offered.
The patient’s improvement is achieved through overcoming their dysfunctional schemas.. To do this, a process is carried out aimed at questioning and debating schemes, in order to get rid of their influence and reduce or nullify their effects.
This is the main objective of therapy and, to achieve it, it attempts to promote potentially pleasant and beneficial memories, behaviors, emotions and sensations, a task for which the author selected a varied set of different strategies from practically all the psychological currents that we will see. next.
Related article: “Rationalization: what it is and how it influences our thinking”
For which patients is Schema-Focused Therapy useful?
Schema-Focused Therapy Is Especially Helpful for all those patients who have a disorder located on Axis I of the DSM-V. Among these clinical conditions we would find:
Jeffrey Young himself noted that schema-focused therapy is beneficial for all those people who cannot easily talk about their emotions, thoughts or feelings. This approach is useful for those cases in which patients suffer from some type of blockage or refusal to express their internal world. Patients with existential crises or even with low motivation for the therapy itself also benefit.
Phases of this therapy
The therapeutic process within schema therapy It is divided into three phases.
1. Evaluation and psychoeducation
The first stage of therapy focuses on establishing and stimulating the quality of the therapeutic relationship and investigating past experiences with the intention of identify the schemes that have conditioned the subject’s life and know how they have compromised their life so far.
It is necessary for the patient to review their own history, something that is not easy, but fortunately there is also a part of reading materials and completing questionnaires with which psychological variables of interest are explored, such as attachment style or regulation. emotional.
It is at this point that the objectives of the program are set and the therapist chooses the most appropriate tools to address the specific case.
2. Phase of therapeutic change
In the change phase, therapeutic procedures begin to be applied to treat the case. The administration format is individual, but If circumstances so demand, sessions can be scheduled with the family or even with the couple.. The main techniques used in this phase are:
The goal of the cognitive techniques used in schema therapy is review the evidence for and against that the person has to maintain or eliminate a certain belief.
The mental health professional asks the patient open questions that are not intended to persuade him or her, but rather to contrast the patient’s hypotheses, which is called guided discovery.
Strategies such as counterarguments or the use of cards with the rational ideas that have been derived from this debate process. These cards are especially useful since the patient can carry them with them to read when necessary.
Related article: “Cognitive schemes: how is our thinking organized?”
2.2. Experiential techniques
Experiential techniques aim to deal with the scheme from the emotional and existential. To do this, they use a series of strategies such as, for example, imagination (evoking experiences from the past through the guidance of the therapist), the role play (patient and therapist play important roles in the patient’s life) or the empty chair.
This last technique is of special importance. The empty chair consists of placing two unoccupied seats, one in front of the other, with which the patient will represent a conversation between him and a significant person in his life, such as a father, a brother, an uncle… The idea is that he goes interpreting the two roles alternately, sitting in one seat as himself and in the other as the other person, having a conversation related to the topic to be addressed in therapy.
23. Behavioral techniques
Behavioral techniques have the objective of identify situations in which the individual may behave in a dysfunctional and maladaptive way for himself and othersmeditating on what changes should be made to respect such behavior and environment.
They also seek to strengthen useful strategies for solving important problems for the patient, thus increasing their sense of self-efficacy.
You may be interested: “Cognitive-Behavioral Therapy: what is it and what principles is it based on?”
3. Completion of therapy
The duration of a schema therapy program can be highly variable, although As a general rule, it lasts longer than other similar proposals..
The detection and modification of all maladaptive schemes and behaviors is pursued, and therapeutic success is considered to be achieved when the patient manages to live a life with greater emotional autonomy.
Often, once the process has been completed, it is also A series of follow-up sessions are scheduled to assess the maintenance of improvements in the patient’s life..
