Schema-centered therapy: what it is and how it works

he experiences that we are reaping throughout our lives forge the way in which we relate to ourselves and 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 traveled.

Schema-centered therapy , which this article will cover, is sensitive to that reality and proposes an integrative method to approach it. Knowing it is enriching, because it provides an interesting perspective on how and why human suffering.

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Schema-centered therapy

Schema-centered therapy constitutes the effort to consistently integrate a broad group of therapeutic strategies aimed at treating those suffering from a personality disorder. It was formulated by Jeffrey Young , and combines both cognitive and behavioral, experiential, psychodynamic and constructivist models; giving each of them 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 immerse their roots in the first years of life, and that condition the way we act and think. In this sense, it is sensitive to the greatest difficulties that the therapist may encounter when treating a person with these types of problems; specifically, the difficulty in accessing what is displayed inside, the impediments to isolate an interpersonal conflict from other daily frictions, the motivational deficit and the disdainful or non-collaborative attitude.

It is for this reason that it prioritizes above all a solid rapport, that allows the confrontation of the narrative of the patients (underlining their contradictions) through sessions with a substantial emotional load and that deal with what has been experienced throughout childhood or Its impact today. Generally this therapy extends for longer periods of time than usual; and it requires a little directive attitude that promotes the valuation and the discovery of what happens, happened or could happen in the person’s life.

Next we will deepen in all the fundamental concepts that are own of this interesting form of treatment.

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Basic concepts

There are two basic concepts for schema-centered therapy. It is key to know what exactly a “scheme” is for the author of the proposal, and also to understand what we do with the objective of maintaining or transcending them. Specifically, he coined them as “early dysfunctional schemes” , and on them the present section will be built.

1. Early dysfunctional scheme

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 being true “a priori” (resistant to the entire logical arsenal that attempts to refute them) and which also perpetuate themselves. through the habits that guide everyday life .

It can be seen that such issues have the ability to condition the emotional life of those who hold them, exerting a harmful effect on their ability to adapt to day to day. The thoughts and acts that are associated with such difficulties are precipitated in the scenario of disparate social situations, and assume the space in which the temperament (biological predisposition) and the environment converge.

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

The author discriminated against eighteen schemes of such nature. Frustration of needs, abuse and identification with parents’ patterns (vicarious learning) would be at its base. We will detail them.

1.1. Abandonment and instability

Feeling that you can’t 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 is lived rocked in a constant lack of protection and uncertainty . In these cases, intense fear of abandonment, real or imaginary, may arise.

1.2. Distrust and abuse

Patterns of insecure attachment, especially the disorganized, would conform to the custom of distrusting the intentions of others regarding what is intended of oneself. This scheme implies a tendency towards both the approximation and the distancing , and it would be frequent in those who could have suffered situations of abuse by their related figures. In any case, trusting would imply a feeling of deep nudity and vulnerability.

1.3. Emotional loss

Intimate belief that not even the most basic of needs can be satisfied, so that survival would require an attitude oriented only 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 relations. Self-sufficiency can lead to loneliness .

1.4. Imperfection and shame

This scheme describes a strong feeling of incompleteness, resulting from the constant invalidation of one’s will and identity . Because of this, a tacit sense of shame and inadequacy would flourish, which would impede the balanced development of intra and interpersonal relationships. In any case, one lives in the constant concealment of a facet of one’s identity that is considered totally inadmissible in one’s eyes.

1.5. Social isolation and alienation

Deliberate decision to maintain a position of isolation from others , upon which a solitary existence is built and based on 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 express itself as ineptitude or inability to display an autonomous life. Under this scheme, an anxious search for the opinion of others would be articulated, as a guide in the decision making on matters considered personally relevant. The fear of being free is common in these cases .

1.7. Susceptibility to damage or illness

Apprehensive expectation that it is vulnerable to the appearance of unforeseeable setbacks that may condition one’s own health or that of significant people. In general, it involves the sensation of serious imminent danger, for which the person believes he lacks effective coping resources. That is why you live by focusing attention on everything that could represent some potential harm , with permanent insecurity.

1.8. Immature self or complication

Establishment of social relationships in which their own identity is excessively sacrificed , which does not become perceived as guarantor of individuality and only acquires its meaning when viewed from the prism of the eyes of others. It is a kind of self-definition, which is lived as undifferentiated and informed.

1.9. Failure

Belief that the mistakes and mistakes of the past will be inexorably repeated during life , without the possible atonement of guilt or the possibility of redemption. Everything that had been done incorrectly would be reproduced again, so that only the vague memory of what was already lived would serve as a guide for what is 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 cusp of the hierarchy related 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 in controlling the impulse according to what is adaptive or appropriate in each of the interaction situations . Sometimes it would be expressed, also, in the difficulty for the adjustment of the behavior to the system of rights and duties that protects the people with whom they live (incurring illegalities or antisocial acts).

1.12. Subjugation

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

1.13. Self-sacrifice

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

1.14. Search for approval

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

1.15 Pessimism

Construction of gloomy expectations about the evolution of events, in such a way that the worst possible scenario is provided restrictively provided there is a minimum degree of uncertainty . Pessimism can be experienced as a feeling of constant risk over which control is lacking, so the tendency to worry and despair appears.

1.16. Emotional inhibition

Excessive containment of emotional life, so it is intended to support a perennial fiction about who we really are, in order to avoid criticism or feel shame. Such a pattern complicates the drawing 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 rigid in the extreme. Any deviation from these, which are usually expressed in lapidary terms such as “should”, would imply the emergence of thoughts and behaviors self-destructive or extreme cruelty to oneself.

1.18. Sentence

Conviction that there are a number of immutable laws whose compliance is mandatory and must be enforced by force . Any person who decides not to assume them should be subject to severe punishment.

2. Schema operations

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

The perpetuation of the schemes would be carried out through four specific mechanisms , namely: cognitive distortions (interpretation of reality that does not at all fit objective parameters or facilitate adaptation to the environment), vital patterns (unconscious choice of decisions that maintain the situation or do not facilitate options for change), avoidance (escape or escape from vital 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 It is a lack).

Healing, on the other hand, describes a process aimed at questioning and debating schemes , to get rid of its influence and to transcend its effects. It means living an authentic life, without the mediation of the harmful results that they exert for oneself or for others. It is the goal of therapy, and for this, memories, behaviors, emotions and potentially beneficial 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 delve 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 turn to.

1. Evaluation 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 subject’s experiences and to know how they have compromised their life so far.

It implies a review of the history itself, 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. Exchange phase

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

2.1. Cognitive techniques

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

The therapist makes use of collaborative empiricism and also guided discovery (open questions that are not intended to persuade, but 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 process of debate (which the patient takes with them to read them whenever they want).

2.2. Experiential techniques

Experiential strategies seek to deal with the scheme from an emotional and existential prism. For this they make use of a series of techniques, such as imagination (evoking experiences of the past through the guidance of the therapist), role play (patient and clinical interpret significant roles for the life of the first one) or the empty chair.

For the latter two vacant seats are located, facing each other . The patient has to sit alternately in both, 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 are intended to identify situations in which the subject may behave in a manner that is harmful to himself or others, by weighing what changes should be made regarding the behavior and / or the environment. They also seek to strengthen concrete coping strategies to solve the problems that hold them , thereby increasing their sense of self-efficacy.

3. Termination

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

 

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