Scheme Therapy: characteristics, operation and phases

In the clinic, there are many cases in which addressing the patient's problems from a single perspective is not very effective. Human reality is very complex, and so are its psychological problems, which pose a challenge if they are worked from a single point of view.

Schema therapy is a therapeutic proposal that was born as an integrative approach of various streams and psychological tools in order to improve patient quality by taking an eclectic view of the therapeutic process and how to manage it.

This therapy, proposed by Dr. Young, has been especially helpful for personality disorders, but seems to apply to many other mental disorders, and below we will find out what they are and what tools uses.

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What is Scheme Therapy?

One fact known to every clinical psychologist is that clinical practice is not as simple as one might expect. The causes behind the psychological discomfort and dysfunction of the patient can be several: the patient's own personality, his relapse rate and even the disorder itself.

An example of this are the personality disorders (borderline, histrionic, schizotypal ...) that are a real challenge for any psychotherapist. For these cases, integrative approaches, such as schema therapy, are the most appropriate..

Schema-focused therapy is the result of a great effort to coherently integrate various therapeutic strategies, derived from different psychological currents focused on the treatment of various psychological problems, especially disorders of the personality.

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 in dealing with several of the most difficult problems to treat in therapy, especially in getting the inner world out of the room. patient, isolating an interpersonal conflict that may be significant in his life, the lack of interest in therapy and the uncooperative attitude shown by some patients.

This therapeutic option prioritizes creating a strong patient-therapist bond, which will serve the professional to get the patient to confront their own contradictions to through sessions that address what he experienced in his childhood and what impact it has on his current life.

It is a somewhat long therapy, with a duration of at least one year in which the therapist must show an attitude little directive, promoting the assessment and discovery of the patient of what happens, happened or could happen to him.

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Key ideas and proposals of this psychological therapy

Mainly, there are two fundamental concepts of this therapy. The first has to do directly with what gives its name to this therapeutic approach, the schemes, while the second has to do with the way in which people maintain or overcome these schemes.

Specific, Young coined the term "early dysfunctional schemas", an idea that we delve into below.

Early dysfunctional scheme

The early dysfunctional schemas are the stable themes that develop throughout our lives and are often perceived as true. Due to this, they have a high resistance to any type of logical argument that tries to unseat them and, furthermore, they perpetuate themselves through the person's everyday habits and habitual way of thinking.

Schemes have a powerful capacity to condition emotional life, so if their content is negative, they can significantly damage the mental health of the person presenting them. According to the model, these schematics are the result of some kind of dissatisfaction of some infantile need, associated with the following aspects:

• Insecure attachment: connection with bonding figures
• Autonomy: development of initiative to explore the environment without fear
• Expressive freedom: ability to express individuality and will
• Symbolic game: establishing positive ties with the peer group
• Self-control: impulse inhibition

The origin of the deficiencies would be in the family, although it does not necessarily have to come solely from her.

Young identified up to 18 patterns 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:

• Abandonment and instability
• Distrust and abuse
• Emotional loss
• Imperfection and shame
• Social isolation and alienation
• Dependence and incompetence
• Susceptibility to harm or disease
• Immature identity
• Failure
• Law and grandeur
• Insufficient self-control
• Subjugation (keeping your individuality in the background)
• Self-sacrifice
• Approval seeking
• Pessimism
• Emotional inhibition
• Hypercritical
• Sentence

• Related article: "The Attachment Theory and the bond between parents and children"

Schema 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. Being totally biased interpretations of reality, the behaviors associated with them are not adaptive.

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2. Vital patterns

The vital patterns associated with dysfunctional schemas are unconscious choices of decisions that maintain the situation or do not provide options for change and self-improvement.

3. Avoidance

Avoidance takes place in the form of flight or escape from life experiences seen as uncomfortable, despite the fact that 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 goal of treatment is to mobilize all available resources to ensure that the patient can adopt and carry out the second of the strategies, that is, to overcome the harmful schemes of its mind. For this, a wide selection of therapeutic procedures is offered.

The improvement of the patient is made through the overcoming of his dysfunctional schemes. For 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 the therapy and, to achieve it, it tries to promote memories, behaviors, emotions and potentially pleasant and beneficial sensations, task for which the author selected a varied set of different strategies from practically all the psychological currents that we will see continuation.

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For which patients is Scheme-Focused Therapy useful?

Schema-focused therapy is especially helpful for all those patients with a disorder located on Axis I of the DSM-V. Among these clinical conditions we would find:

• Anxiety disorders
• Mood disorders
• Dissociative disorders
• Personality disorders

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 some kind of blockage or refusal to express their internal world. Patients with existential crises or even low motivation for their own therapy 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 inquiring about past experiences with the intention of identify the schemes that have conditioned the life of the subject and know how they have compromised her life so far.

It is necessary for the patient to review her own history, something that is not easy, but fortunately there is also a part of reading materials and conducting 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. Therapeutic change phase

In the change phase, therapeutic procedures are applied to treat the case. The administration format is individual, but If circumstances require it, sessions can be scheduled with the family or even with the couple. The main techniques used in this phase are:

2.1. Cognitive techniques

The goal of the cognitive techniques used in schema therapy is to review the evidence for and against that the person has to preserve or eliminate a certain belief.

The mental health professional is asking open questions to the patient that are not intended to persuade him, but 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 discussion process. These cards are especially useful since the patient can take them with them to read them when necessary.

• Related article: "Cognitive schemas: how is our thinking organized?"

2.2. Experiential techniques

The experiential techniques try to deal with the schema from the emotional and existential. To do this, they use a series of strategies such as, for example, imagination (evoking past experiences through the guidance of the therapist), 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 is going to 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 plays 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 the therapy.

23. Behavioral techniques

Behavioral techniques aim to identify situations in which the individual may behave in a dysfunctional and maladaptive way for himself and others, meditating on what changes should be carried out in respect of such behavior and environment.

They also seek to strengthen useful strategies for solving important problems for the patient, thus increasing her sense of self-efficacy.

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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 patterns and behaviors is pursued, and considers that therapeutic success is achieved when the patient manages to live a life with greater autonomy affective.

Often, once the process is complete, equally a series of follow-up sessions are scheduled to assess the maintenance of improvements in the patient's life.