The Schema Therapy (ST; Young, 1990; Young, Klosko, & Weishaar, 2003) was born and has been proposed as an effective and useful integrative model for the conceptualization and treatment of therapy resistant disorders, chronic and personality.
While having its roots in cognitive-behavioral therapy , the TS has integrated concepts of different theoretical matrices (for example psychoanalytic, gestaltic, transactional, attachment).
The approach is based on the concepts of ” primary unmet need ” and “Early Maladaptive Scheme” (PMS), which are considered the main culprits for the suffering presented by patients. They arise, for example, from experiences of neglect or trauma in childhood and adolescence.
The evolution of the model
Schema Therapy has evolved over time, focusing more on the concept of “ Schema Mode ” (Van Vreeswijk, Broersen, & Nadort, 2012) rather than SMP.
The Mode , or Schema Mode , concerns the set of Schemes and related operations (functional or dysfunctional) active in a person at a given moment.
Compared to cognitive-behavioral therapy, the focus is more oriented on the emotional level and on the exploration of the childhood and adolescent origins of the psychological difficulties presented by patients.
The core elements of Schema Therapy include the Mode- centered conceptualization model , a specific modality of therapeutic relationship (“ limited reparenting ”) and the intensive use of experiential techniques ( Imagery Rescripting and Chair Work ).
Research confirms Schema Therapy as one of the most effective treatment models for personality disorders .
The latest approach: Contextual Schema Therapy
Consistent with the integrative perspective that characterizes Schema Therapy, some authors have worked to further update the model, integrating it with the most recent evolutions of cognitive-behavioral therapy .
Thus, Contextual Schema Therapy (CST; Roediger, Stevens, & Brockman, 2018) was born: the frame of reference within which this model operates remains that provided by Young’s model.
Therapeutic strategies that derive from approaches different from cognitive-behavioral models continue to be used in an integrated manner. However, Schema Therapy is here revised in light of the recent contributions of the “third generation” of cognitive-behavioral therapy , in order to provide psychotherapists and their clients with an even more flexible and effective model.
The theoretical clinical assumptions of the model
The goal is to balance a “second generation” approach (based on changing the content of the schema) with a “third generation” one (changing the way people relate to their experiences).
Thus, for example, some basic principles of Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2012) are incorporated and integrated into the broadly emotional focus of Schema Therapy.
In CST, even more importance is given to work directly oriented to the Functional Adult Mode which, moreover, connects well to the concept of psychological flexibility (Hayes, Strosahl, & Wilson, 2012) and can be “enhanced” using ACT strategies.
The integration of techniques deriving for example from therapies based on Compassion , Mindfulness , and Acceptance, together with the therapeutic relationship, offers therapists valuable tools. In ST terms, it allows to face apparently impermeable modalities such as those typical, for example, of strong “avoidant and detached protectors”, of “overcompensating bullies” and of hopeless “submissive surrenders” who give up their needs.
The operational tools of Contextual Schema Therapy
Thus, additional tools are offered to clinicians useful in order to face and overcome the strong detachment presented by some patients. But also to manage the harmful internal dialogue deriving from persistent demanding and critical “parents” and to access the most vulnerable Fashions, protecting and taking care of them, while directly strengthening the “Healthy Adult” Mode.
The ultimate goal remains that of counteracting dysfunctional methods, in favor of healthier and more adaptive responses, consistent with one’s needs.
