Schema-Focused Therapy: What It Is and How It Works

The experiences that we reap throughout our lives shape the way in which we relate to ourselves and to others.

We could say that the past conditions the future, and that we will only be able to aspire to new horizons when we decide to retrace part of the path we have traveled.

Schema-focused therapy, with respect to which this article will deal, is sensitive to such reality and proposes an integrative method to approach it. Knowing it is enriching, as it provides an interesting perspective on the how and why of human suffering.

• Related article: "Types of psychological therapies"

Schema-focused therapy

Schema-focused therapy is the effort to coherently integrate a broad group of therapeutic strategies aimed at treating those who suffer from a disorder of the personality. It was formulated by Jeffrey Young, and combines both cognitive and behavioral, experiential, psychodynamic and constructivist models; endowing each of them with a specific purpose in the context of a theoretical framework that emphasizes the evolutionary dawn of the individual: his childhood.

It conceives the existence of patterns of behavior and emotion that have their roots in the first years of life, and that determine the way we act and think. In this sense, he is sensitive to the greatest difficulties that the therapist may encounter when he treats a person with these types of problems; in particular the difficulty to access what is displayed inside, the impediments to isolate a interpersonal conflict of the other daily frictions, the motivational deficit and the disdainful or not attitude collaborator.

It is for this reason that prioritizes above all a solid rapport, which allows the confrontation of the patients' narrative (underlining its contradictions) through sessions with a substantial affective charge and that deal with what was experienced throughout childhood or its impact today. Generally, this therapy is extended for periods of time longer than usual; and it requires a non-directive attitude that promotes the appreciation and discovery of what happens, happened or could happen in the life of the person.

Below we will delve into all the fundamental concepts that are specific to this interesting form of treatment.

• You may be interested: "Cognitive schemas: how is our thinking organized?"

Basic concepts

There are two basic concepts for schema-focused therapy. It is key to know what exactly is a "scheme" for the author of the proposal, and also to understand what people do in order to maintain or transcend them. Specifically, he coined them as "early dysfunctional schemas", and on them this section will be built.

1. Early dysfunctional scheme

The early dysfunctional schemes are the axis on which the entire intervention revolves, and the raw material with which one works during the sessions. These are stable "themes" that develop throughout our lives, which are very often perceived as if they were true "a priori" (resistant to all the logical arsenal that tries to refute them) and that also they perpetuate themselves through the habits that guide daily life.

It can be observed that such themes have the ability to condition the emotional life of those who display them, exerting a harmful effect on their ability to adapt to day-to-day life. The thoughts and actions that are associated with such difficulties rush onto the scene of situations disparate social conditions, and represent the space in which temperament (biological predisposition) and environment.

Early dysfunctional schemas are the result of unmet needs in childhood, associated with a constellation of various issues: secure attachment (connection with bonding figures), autonomy (development of initiative to explore the environment without overflowing fear emerging), expressive freedom (ability to manifest individuality and will), symbolic play (establishment of positive ties with the peer group) and self-control (inhibition of impulses). Above all, the origin of such deficiencies would be detected in the family, although not only in it.

The author discriminated eighteen schemes of this nature. Frustration of needs, abuse and identification with parental patterns (vicarious learning) would be at its base. We go on to detail them.

1.1. Abandonment and instability

Feeling that you cannot 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 lives rocked in a constant lack of protection and uncertainty. In these cases, intense fear of abandonment may arise, real or imagined.

1.2. Distrust and abuse

Insecure attachment patterns, especially the disorganized one, would make up the habit of being suspicious of the intentions of others with respect to what is intended of oneself. This scheme implies a tendency both towards approximation and distancing, and it would be frequent in those who could have suffered situations of abuse on the part of their related figures. In any case, trusting would imply a feeling of deep nakedness and vulnerability.

1.3. Emotional loss

Intimate belief that even the most basic of needs cannot be met, so that Survival would require an attitude oriented solely to the self, to the detriment of the active search for support and understanding. It translates into a tendency to isolation and disinterest in social relationships. Self-reliance can lead to loneliness.

1.4. Imperfection and shame

This schematic describes an iron feeling of incompleteness, stemming from the constant invalidation of one's own will and identity. As a result, a tacit sense of shame and inadequacy would flourish, preventing the balanced development of intra and interpersonal relationships. In any case, you live in the constant concealment of a facet of your own identity that is considered totally inadmissible from your 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 scheme is also associated with alienation, that is, ignorance about everything that defines us as unique human beings and the acceptance of otherness as a synonym for property.

1.6. Dependence and incompetence

Feeling of zero self-efficacy, which comes to be expressed as ineptitude or inability to develop an autonomous life. In accordance with this scheme, an anxious search for the opinion of others would be articulated, as a guide in making decisions on matters considered personally relevant. The fear of being free is common in these cases.

1.7. Susceptibility to harm or disease

Apprehensive expectation that you are vulnerable to unforeseeable setbacks that may affect your own health or that of significant others. In general, it involves the feeling of serious imminent danger, for which the person believes they lack effective coping resources. It is because of that lives directing attention to everything that could represent some potential harm, with permanent insecurity.

1.8. Immature self or complication

Establishment of social relationships in which self-identity is sacrificed excessively, which is not perceived as a guarantor of individuality and only acquires its meaning when viewed from the prism of other people's glances. It is a kind of vagueness of the self, which is lived as undifferentiated and formless.

1.9. Failure

Belief that the mistakes and errors of the past will be inexorably repeated throughout life, without there being possible expiation of guilt or possibility of redemption. Everything that had been done incorrectly would be reproduced again, so that only the unfortunate memory of what has already been lived would serve as a guide for what is about to happen. Jealousy, for example, is associated with this scheme.

1.10. Law and grandeur

This scheme would imply an inflammation of the image of the self, which would occupy the top of the hierarchy relative to relevance or value. Thus, an attitude of tyranny would develop in interpersonal relationships and the prioritization of one's own needs over those of others.

1.11. Insufficient self-control

Difficulty controlling the impulse according to what is adaptive or appropriate in each of the situations interaction. Sometimes it would also be expressed in the difficulty in adjusting the behavior to the system of rights and duties that protect the people with whom one lives (incurring illegalities or antisocial acts).

1.12. Subjugation

Abandonment of the will as a result of the expectation that others wield hostile or violent attitudes towards one, folding to stay in the background for fear that the expression of individuality will degenerate into a conflict situation. It would be common in people subjected to excessively authoritarian or punitive upbringing.

1.13. Self-sacrifice

Emphasis on satisfying the needs of others to the detriment of their own, so that situations of deprivation are maintained at many levels as a result of hierarchical relationships ignoring any perspective of balance or reciprocity. Over time it can translate into an inner feeling of emptiness.

1.14. Approval seeking

Restricted search for the acquiescence and approval of othersTherefore, time is invested in exploring the expectations of the groups with which it interacts to define from them what will be the behavior to be carried out in the everyday scenario. In the process, the ability to decide autonomously and independently is diluted.

1.15. Pessimism

Construction of dark expectations about the future of events, in such a way that the worst-case scenario is restrictively anticipated provided there is a minimum degree of uncertainty. Pessimism can be experienced as a feeling of constant risk over which there is no control, which is why there is a tendency to worry and hopelessness.

1.16. Emotional inhibition

Excessive containment of affective life, so it is intended to support a perennial fiction about who we really are, in order to avoid criticism or feeling ashamed. Such a pattern complicates the mapping of relationships with which to obtain quality emotional support, with which the risk of problems in the psychological sphere would be reduced.

1.17. Hypercritical

Belief that one must conform to self-imposed norms, often extremely rigid. Any deviation from these, which are usually expressed in lapidary terms such as "should", would imply the appearance of self-righteous thoughts and behaviors or extreme cruelty towards oneself.

1.18. Sentence

Conviction that they exist a series of immutable laws whose compliance is mandatory and must be enforced by force. Anyone who decides not to take them should be subjected to severe punishments.

2. Schema operations

From this model, it is assumed that the patient lives with one or more of these schemes, and that they will carry out a series of behaviors and thoughts aimed at their perpetuation or healing. The goal of treatment is none other than to mobilize resources to adopt the second of these strategies, offering for him a varied selection of procedures in which we will delve further ahead.

The perpetuation of the schemes would be carried out through four specific mechanismsnamely: cognitive distortions (interpretation of reality that does not conform at all to objective parameters or facilitate adaptation to the environment), vital patterns (choice unconscious of decisions that maintain the situation or do not facilitate options for change), avoidance (flight or escape from life experiences that harbor an opportunity for authentic transformation) and overcompensation (imposition of very rigid patterns of thought and action aimed at artificially showing the opposite of what is known to be a lack).

Healing, for its part, describes a process aimed at questioning and debating schemas, to get rid of its influence and to transcend its effects. It involves living an authentic life, without the mediation of the harmful results that these exert for oneself or for others. It is the goal of therapy, and for this, potentially beneficial memories, behaviors, emotions and sensations must be promoted; task for which this author selects an eclectic set of strategies from almost all currents of Psychology. At this point we go deeper below.

Therapeutic process

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

1. Assessment and education

The first stage is aimed at stimulating the quality of the therapeutic relationship and inquiring about past experiences, in order to extract the schemes that emerge from the experiences of the subject and know the way in which they have compromised his life so far.

It involves a review of one's own history, but also the reading of materials and the completion of questionnaires with which to explore the variables of interest (attachment style or emotional regulation, to name a few examples). It is at this point where the objectives of the program are set and the tools to be used are chosen.

2. Change phase

In the phase of change, therapeutic procedures begin to be applied, displaying good theoretical coherence and creativity. The administration format is individual, but sessions with the family can be scheduled if circumstances dictate. Next we will describe what are the techniques commonly used in schema-focused therapy.

2.1. Cognitive techniques

The objective of the cognitive techniques used in schema-focused therapy is none other than to review the evidence for and against which has the person to maintain or discard a certain belief (which adheres to one of the schemes on which it was deepened previously).

The therapist makes use of collaborative empiricism and also guided discovery (open questions that are not intended to persuade, but rather to contrast the patient's hypotheses) and strategies such as arguments / counterarguments or the use of cards with the rational ideas that have been derived from the discussion process (which the patient takes with him to read when want).

2.2. Experiential techniques

The experiential strategies seek to deal with the scheme from an emotional and existential prism. To do this, they use a series of techniques, such as imagination (evoking past experiences through the guidance of the therapist), role play (patient and clinician play significant roles in the life of the first of them) or chair empty.

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

23. Behavioral techniques

Behavioral techniques are intended to identify situations in which the subject may behave in a way harmful to himself or others, considering what changes should be made regarding the behavior and / or the environment. Too They seek to strengthen specific coping strategies to solve the problems that plague themthereby increasing your sense of self-efficacy.

3. Termination

The duration of the program is variable, although it often lasts longer than other similar proposals. The detection and modification of all the schemes and maladaptive behaviors is pursued, considering that therapeutic success is achieved when a life can be lived with greater affective autonomy. Often completion of the process involves scheduling a series of follow-up sessions, with which the maintenance of improvements is valued.