SCHEMA THERAPY
What is the Schema Therapy
The Psychiatrist Kiosterakis Georgios is a certified Therapist in Schema Therapy, an innovative method of the 3d wave of Cognitive Therapies, holding the Advanced Training Certification of the International Society of Schema Therapy – ISST, as it is described at the webpage of ISST (isstonline.com/greece).
The Schema Therapy is a composite therapy model of cognitive behavioral origin, at the contexts of the 3d wave of Cognitive Behavioral Therapies, which has been designed for the treatment of patients with chronic emotional difficulties and patients with Personality Disorders, where the classic Cognitive Behavioral Therapy encountered restrictions regarding its effective application and treatment.
It was developed by Jeffrey Young in the 1990s, having as initial basis the Cognitive Behavioral Therapy and incorporating elements from other approaches, such as the Attachment Theory, the Object Relations Theory, the Gestalt Theory and techniques that focus on emotions.
The Schema Therapy occurred as an attempt to deal with the restrictions that the classical cognitive behavioral therapy presented in the therapy of people with chronic characteriologic problems and personality disorders. These patients do not respond well to the traditional cognitive behavioral techniques. Often, they do not abide by the therapy, they are unwilling to follow its agenda, to perform their homework and to develop a relationship of cooperation and alliance with the therapist.
The Schema Therapy incorporates elements of the Attachment Theory and of the Object Relations Theory and understands in depth the difficulties of the patient, connecting the present time with childhood and early adolescence and subsequently with the development of the preservation mechanisms and the generalization of the problems in the various areas of their lives. In parallel, this understanding helps in the creation of an essential therapeutic relationship, which consists a basic working tool in Schema Therapy.
Furthermore, the integration of techniques of the Gestalt therapy and of techniques focused on emotions is particularly helpful in the access of emotional avoidance and overcompensation that consist major mechanisms of preservation and perpetuation of the patient’s problems.
The basic concepts of Schema Therapy are three. They are the concepts of the Schema, the maladaptive coping response strategies (Coping Styles) and of the Modes.
Schema Therapy is indicated for a variety of psychological issues, including personality disorders (e.g., borderline personality disorder), chronic depression, anxiety disorders, eating disorders, and treatment-resistant post-traumatic stress disorder (Giesen-Bloo et al., 2006; van Vreeswijk et al., 2014). The primary focus of Schema Therapy is on identifying and addressing maladaptive schemas or deeply ingrained patterns of thinking, feeling, and behaving that contribute to an individual’s psychological distress.
Empirical evidence supporting the effectiveness of Schema Therapy has been growing over the past decades. In a randomized controlled trial, Giesen-Bloo et al. (2006) found that Schema Therapy was significantly more effective than transference-focused psychotherapy in reducing borderline personality disorder symptoms. This study also demonstrated a lower dropout rate and a higher recovery rate for Schema Therapy. Another study by Nadort et al. (2009) found that Schema Therapy led to significant reductions in borderline personality disorder symptoms and improved global functioning.
Furthermore, research has demonstrated the efficacy of Schema Therapy in treating chronic depression (Bamelis et al., 2014), with results showing significant improvements in depressive symptoms compared to treatment-as-usual. Overall, the accumulating evidence supports the effectiveness of Schema Therapy for a range of psychological disorders and highlights its potential as a valuable therapeutic approach (van Vreeswijk et al., 2014).
Research on the effectiveness of Schema Therapy for personality disorders beyond borderline personality disorder (BPD) is limited, but some studies show promising results. Farrell et al. (2009) found that Schema Therapy, when applied in a group setting, led to improvements in symptoms of narcissistic personality disorder. Another study by Renner (2006) reported positive outcomes for avoidant personality disorder, examining the relationship between adult attachment, parental bonding, and treatment outcomes.
In a multicenter randomized controlled trial, Bamelis et al. (2014) observed significant improvements in various personality disorders, including avoidant, dependent, obsessive-compulsive, and histrionic personality disorders when treated with Schema Therapy compared to treatment-as-usual. This study highlighted the potential for Schema Therapy to be effective across a range of personality disorders and not just BPD.