Schema Therapy or even Schema Focused Therapy, conceived by Jeffrey Young and colleagues, is a theoretical model and an innovative psychotherapeutic approach.
This treatment integrates the extensively demonstrated Cognitive Behavioral Therapy techniques with elements derived from other therapeutic approaches such as Gestalt, Transactional Analysis, Attachment Theory and Hypnotherapy to provide a clear explanatory model and a treatment approach easily applicable. Schema Therapy is therefore proposed as a broad and focused approach, paying particular attention to the relationship with the patient.
This approach is particularly useful in the treatment of patients with complex difficulties such as Personality Disorders, especially in Borderline Personality Disorder and Narcissistic Personality Disorder, but also in all those cases of severe discomfort, particularly resistant to change (anxiety, chronic depression, substance use disorder, couple problems).
Features
Schema Therapy has its origins in the recognition of the existence of a series of universal emotional needs that every living being presents from birth.
These universal emotional needs include:
- the needs for security, stability, care and acceptance;
- the needs for autonomy, ability and a sense of identity;
- the need to be free to express one's needs and emotions;
- the need for spontaneity and play;
- the need for realistic limits that favor the emergence of self-control.
According to Schema Therapy, psychological well-being derives from the ability to satisfy one's needs in an adaptive way.
The development of children, in fact, revolves mainly around the satisfaction of their basic needs on the part of parents or caregivers.
The adequate satisfaction of these needs in childhood favors the development of healthy schemes that make the individual able, over the course of his life, to learn to satisfy these needs in a functional way that is functional to psychophysical well-being.
Schemas represent the glasses with which we code the reality, the relationships with the other, be it a family member or partner, a friend or an acquaintance. From this vision derives our relationship with the world, with ourselves, with the highs and with life.
Where the primary needs are not adequately met, instead, what are called "Early Maladaptive Schemes" (EMS) are formed.
An early maladaptive pattern is defined by Jeffrey Young as: “a general and pervasive theme or aspect: it includes memories, emotions and knowledge. It is related to oneself and one's relationships with others. It arises during childhood or adolescence and is processed throughout life ".
These patterns can be activated by particular situations that somehow recall the painful events of the past and can be revived repeatedly throughout life causing intense suffering and leading to dysfunctional behavior. These dysfunctional behaviors, the so-called coping styles (surrender, avoidance, hypercompensation), which each develops to face and / or avoid intense emotions, can themselves maintain or aggravate the problem.
Despite being a source of suffering, these maladaptive schemes are maintained by the person as they represent the known, the family member from whom one does not want to be detached. This is why we are attracted by situations that reinforce the schemes, making it difficult not only to change but also to recognize their dysfunctionality.
Schema Therapy is based on four fundamental concepts:
- the fundamental emotional needs;
- early maladaptive patterns (ie an organized pattern of thoughts and behaviors);
- coping styles (how a person reacts to the scheme: avoidance, surrender and hypercompensation);
- mode (ie ways of being that group together patterns and styles of coping).
How does Schema Therapy work?
Schema Therapy works, therefore, by virtue of its therapeutic objective: that is, to make the patient aware of the existence and functioning of these schemes, helping him to find more effective relationship strategies to satisfy his own needs.
A central role in the process of change is the therapeutic relationship, as it represents the first field where making the patient aware of his dysfunctional modalities, identifying and satisfying the needs of the patient, not caught in childhood, and allowing a secure attachment.
Schema Therapy works directly on emotions; during the session, certain particular conditions or patterns of relationship are recreated that lead the individual to relive a given situation.
The goal of therapy is to make the person understand that a certain maladaptive pattern, developed during childhood to react to a difficulty, is no longer adequate to his needs in adulthood. It also aims to help the patient satisfy fundamental emotional needs by replacing maladaptive coping styles with more functional ones and with adaptive behavioral models. With this psychotherapy, therefore, attempts are made to undermine the existing maladaptive patterns and to reinforce adult behaviors and emotional states that allow the person to satisfy his deepest needs.
In Schema Therapy, cognitive and behavioral techniques of standard behavioral cognitive therapy are used in an integrated way, which have shown a high efficacy for symptom reduction and change of basic beliefs, for example, identification and change of one's beliefs, reduction of perfectionism or self-criticism through disputing, analysis of pros and cons, techniques to increase social skills, increase of positive activities or relaxation techniques.
Also Schema Therapy works by goals and the therapist has an active role in helping the person to achieve his goals.
Emotion-focused techniques are experiential techniques that help the patient to recognize, express and modulate emotions, eg. chair techniques or imagination techniques.
All the techniques used in Schema Therapy have been subjected to numerous scientific verifications. The central healing factors are emotions-focused techniques and the therapeutic relationship itself.
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