Schema Centered Therapy: What It Is and How It Works

The experiences we gain throughout our lives shape how we relate to ourselves and to others.

We could say that the past conditions the future, and that we can only aspire to new horizons when we decide to undo part of the road traveled.

Schema-focused therapy, Concerning this article, is sensitive to this reality and proposes an integrative method to approach it. Getting to know him is rewarding because he offers an interesting perspective on the how and why of human suffering.

    Schema-focused therapy

    Schema-Centered Therapy is the coherent integration of a broad set of therapeutic strategies aimed at treating people with a personality disorder. It was formulated by Jeffrey Young, And unites cognitive and behavioral, experiential, psychodynamic and constructivist models; endow each of them with a concrete purpose within the framework of a theoretical framework which emphasizes the evolutionary dawns of the individual: his childhood.

    He conceives of the existence of patterns of behavior and emotion which submerge their roots in the first years of life, and which condition the way we act and think. In this sense, he is sensitive to the greatest difficulties that the therapist may encounter when treating a person with such problems; in particular the difficulty of accessing what is going on inside, the obstacles to isolating an interpersonal conflict from other daily frictions, the lack of motivation and the contemptuous or uncooperative attitude.

    It is for this reason that favors above all a solid relationship, which allows the confrontation of the patients’ story (Highlighting their contradictions) through emotionally charged sessions and focusing on what was experienced in childhood or its impact today This therapy usually extends over longer periods than usual; and requires an unmanageable attitude that promotes appreciation and discovery of what is happening, has happened or could be happening in the person’s life.

    Below we will delve into all the basic concepts typical of this interesting form of treatment.

      basic concepts

      There are two basic concepts for schema-centered therapy. Knowing what exactly a “pattern” is for the proponent is critical, and also understanding what people are doing to maintain or transcend them. More precisely, invented them as “early dysfunctional patterns”, And on them the current section will be built.

      1. Dysfunctional timetable

      The early dysfunctional patterns are the axis on which the whole intervention revolves and the raw material with which we work during the sessions. These are stable “problems” that develop throughout our life, which are often perceived as real “a priori” (resistant to all the logical arsenal that tries to refute) and also they are perpetuated through the habits that guide daily life.

      It can be seen that these subjects have the capacity to condition the emotional lives of those who hold them, exerting a detrimental effect on their ability to adapt to everyday life. The thoughts and actions associated with these difficulties rush to the stage of disparate social situations, and take up the space in which temperament (biological predisposition) and environment converge.

      The first models of dysfunction are the result of unmet needs in childhood, associated with a constellation of diverse subjects: Secure affection (connection with related characters), autonomy (development of initiative to explore the environment without overwhelming fear), freedom of expression (ability to express individuality and will), symbolic play (making connections positive with the peer group) and self-control (inhibition of impulses). Above all, the origin of such deficiencies would be detected in the family, but not only in her.

      The author has discriminated against eighteen regimes of this nature. Frustration of needs, mistreatment and identification with parents’ role models (vicarious learning) are believed to be at the root. Let’s go into details.

      1.1. Abandonment and instability

      Feeling that no one can count on anyone’s help, because at the time of greatest vulnerability (childhood) there was no possibility of accessing a figure capable of providing it. As a result, the environment is perceived as unpredictable and we live cradled in constant unprotectedness and uncertainty. In these cases, there may be an intense fear of abandonment, real or imagined.

      1.2. Mistrust and abuse

      Insecure patterns of affection, especially those that are disorganized, would be consistent with the habit of distrusting the intentions of others over what one hears by oneself. This scheme implies a tendency for both approach and distance, And it would be common among those who might have suffered situations of abuse from their tie figures. Either way, trusting would involve a feeling of nudity and deep vulnerability.

      1.3. emotional loss

      Intimate belief that even the most basic needs cannot be met, so survival would only require a self-directed attitude, to the detriment of the active search for support and understanding. This results in a tendency to isolation and disinterest in social relationships. Self-sufficiency can lead to loneliness.

      1.4. Imperfection and shame

      This diagram describes a fierce sense of incompleteness, arising from the constant invalidation of one’s own will and identity. As a result, a tacit feeling of shame and inadequacy would flourish, which would hamper the balanced development of intra and interpersonal relationships. In any case, one lives in the constant concealment of a facet of one’s own identity considered totally inadmissible in one’s own eyes.

      1.5. Social isolation and alienation

      Deliberate decision to maintain a position of isolation from others, On which a solitary existence is built and which is based on the fear of rejection. This pattern is also associated with alienation, that is, ignorance of everything that defines us as unique human beings and the acceptance of otherness as a synonym of property.

      1.6. Dependence and incompetence

      Feeling of lack of personal efficiency, which results in ineptitude or inability to develop an independent life. According to this scheme, an anxious search for the opinions of others would be articulated, as a guide to making decisions on matters considered to be personally relevant. Fear of being free is common in these cases.

      1.7. Susceptibility to damage or disease

      Apprehensive expectation that is vulnerable to the occurrence of unpredictable setbacks that can affect one’s own health or that of important people. This usually involves a feeling of imminent serious danger, for which the person feels they do not have effective coping resources. that’s why we live by drawing our attention to anything that could represent a potential harm, With permanent insecurity.

      1.8. Immature self or complication

      Establishment of social relationships in which his own identity is too much sacrificed, Which does not come to be perceived as guarantor of individuality and only acquires its meaning in the contemplative of the prism of the gaze of others. It is a kind of indefinite ego, which is experienced as undifferentiated and without form.

      1.9. failure

      Belief that the missteps and mistakes of the past will repeat themselves inexorably throughout life, Without any possible atonement for guilt or possibility of redemption. Anything that was done wrong would be reproduced again, so that only the unhappy memory of what you have already experienced can serve as a guide for what is to come. Jealousy, for example, is associated with this diagram.

      1.10. Law and grandeur

      This pattern would involve an inflammation of the image that one has of oneself, which he would occupy the top of the hierarchy when it comes to relevance or value. Thus, an attitude of tyranny in interpersonal relationships and prioritizing one’s own needs over those of others would develop.

      1.11. insufficient self-control

      Difficulty controlling dynamics based on what is adaptive or appropriate in each situation interaction. Sometimes this would also result in the difficulty of adapting the conduct to the system of rights and duties that protects the people with whom it coexists (incurring illegalities or antisocial acts).

      1.12. subjugation

      Abandonment of the will due to the expectation of others towards a hostile or violent attitude, lean to stay in the background lest the expression of individuality degenerate into a situation of conflict. This would be common among people subject to overly authoritarian or punitive parenting.

      1.13. Self-sacrifice

      Focus on meeting the needs of others to the detriment of their own, so that situations of deprivation are maintained at many levels due to the hierarchy of relationships ignoring any prospect of balance or reciprocity. Over time, time can translate into an inner feeling of emptiness.

      1.14. Find approval

      Restricted search for acquiescence and approval of othersSo this time is invested in exploring the expectations of the groups with which he interacts to define from them what will be the behavior to be performed in the daily scenario. In the process, the ability to decide autonomously and independently is diluted.

      1.15. pessimism

      Building gloomy expectations about the unfolding of events, so that the worst-case scenario is expected to be restrictive provided there is a minimum degree of uncertainty. Pessimism can be experienced as a feeling of constant risk over which there is a lack of control, so that there is a tendency towards worry and hopelessness.

      1.16. emotional inhibition

      Excessive stress on the emotional life, so that it aims to nurture a perennial fiction about who we really are, in order to avoid criticism or be ashamed. such a model makes it difficult to trace relationships with which to gain quality emotional support, Which would reduce the risk of problems in the psychological area.

      1.17. Hypercritical

      Belief in conforming to self-imposed standards, Often extremely rigid. Any deviation from these, which are usually expressed in concise terms such as “should”, would involve the emergence of self-punishing or extremely cruel thoughts and behavior towards oneself.

      1.18. conviction

      Conviction that they exist a series of immutable laws compliance is obligatory and must be demanded by force. Anyone who decides not to take them should be severely punished.

      2. Schema operations

      From this model, it is assumed that the patient coexists with one or more of these patterns, and that he will lead a series of behaviors and thoughts aimed at their perpetuation or healing. The goal of the treatment is none other than to mobilize resources to adopt the second of these strategies, by offering it a varied selection of procedures in which we will deepen later.

      The sustainability of the systems would be achieved by means of four concrete mechanismsNamely: cognitive distortions (interpretation of reality that does not correspond at all to the objective parameters or facilitates adaptation to the environment), vital patterns (unconscious choice of decisions that maintain the situation or do not facilitate the options for change), avoidance (flight or escape) of life experiences that harbor an opportunity for real transformation) and overcompensation (the imposition of very rigid thought and action patterns aimed at artificially showing the opposite of what the we know to be a deficiency).

      Healing, on the other hand, describes a process of questioning and debating models, Get rid of its influence and transcend its effects. It means living an authentic life, without the mediation of the harmful results that these have for oneself or for others. This is the goal of therapy, and for this, potentially beneficial memories, behaviors, emotions and sensations must be promoted; a task for which this author selects an eclectic set of strategies from among almost all the currents of psychology. At this point, we dig deeper below.

      therapeutic process

      There are three phases that can be distinguished in schema-centered therapy. All of them have their own purpose, as well as techniques to use.

      1. Assessment and education

      The first step aims to stimulate the quality of the therapeutic relationship and to investigate past experiences, in order to extract the patterns that emerge from the subject’s experiences and to know how he has compromised his life up to that time.

      This involves a review of the story itself, but also reading material and filling out questionnaires. to explore the variables of interest (affection style or emotional regulation, to name a few examples). It is at this stage that the objectives of the program are defined and the tools to be used are chosen.

      2. Change phase

      In the phase of change, therapeutic procedures begin to be applied, Demonstrate good theoretical consistency and creativity. The administrative format is individual, but sessions with the family can be scheduled if circumstances warrant. Next, we will describe some of the techniques commonly used in schema-centered therapy.

      2.1. Cognitive techniques

      The purpose of cognitive techniques used in schema-centered therapy is to examine the evidence for and against a person’s willingness to hold or exclude a particular belief (which adheres to any of the schemas explored earlier ).

      The therapist uses collaborative empiricism and also guided discovery (Open-ended questions that do not seek to persuade, but to contrast the patient’s assumptions) and strategies such as arguments / counter-arguments or the use of cards with rational ideas from the discussion process (which the patient brings with to read when you want).

      2.2. experiential techniques

      Experiential strategies seek to fight against the schema from an emotional and existential prism. To do this, they use a number of techniques, such as imagination (evoking past experiences through the advice of the therapist), role play (the patient and clinician play meaningful roles for the life of the first d ‘between them) or the empty chair.

      For the latter, there are two unoccupied seats, face to face. The patient has to sit alternately in the two, playing a different role on each occasion (his father in one of these spaces and himself in the other, for example) and playing a conversation.

      2.3. behavioral techniques

      Behavioral techniques aim to identify situations in which the subject may behave in a manner detrimental to himself or to others, by evaluating the changes to be made in relation to the behavior and / or the environment. too much they seek to strengthen concrete coping strategies to solve the problems that catch them, Thus increasing their sense of self-efficacy.

      3. Termination

      The duration of the program is variable, although it often runs longer than other similar proposals. The goal is to detect and modify all maladaptive patterns and behaviors, knowing that therapeutic success is achieved when one can live a life with more emotional autonomy. Often completing the process involves planning a series of follow-up sessions, With which the maintenance of improvements is valued.

      Bibliographical references:

      • Taylor, C., Bee, P. and Haddock, G. (2017). Does the treatment regimen change patterns and symptoms? A systematic review of mental health disorders. Psychology and psychotherapy, 90 (3), 456-479.
      • May, Y., Lee, C., Averbeck, LE, Brand-de Wilde, O., Farrell, J., Fassbinder, E. … Arntz, A. (2018). Treatment regimen for borderline personality disorder: a qualitative study of patient perceptions. PLoS One, 13 (11): e0206039.

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