The experiences we gain throughout our lives shape the way we relate to ourselves and to others.

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

Scheme-centred therapy , about which this article will be about, is sensitive to this 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.

Scheme-centred therapy

Scheme-centred therapy is the effort to coherently integrate a broad set of therapeutic strategies aimed at the treatment of those suffering from a personality disorder. It was formulated by Jeffrey Young , and brings together both cognitive and behavioral, experiential, psychodynamic and constructivist models; providing each of them with a specific purpose in the context of a theoretical framework that emphasizes the early development of the individual: his childhood.

It conceives the existence of patterns of behavior and emotion that are rooted in the first years of life, and that condition the way we act and think. In this sense, it is sensitive to the major difficulties that the therapist may encounter when treating a person with this type of problem; specifically, the difficulty in accessing what unfolds inside, the impediments to isolating an interpersonal conflict from other daily frictions, the motivational deficit and the disdainful or uncooperative attitude.

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 they lived through during their childhood or their impact on the present. Generally this therapy extends over longer periods of time than usual; and requires a non-directive attitude that promotes the assessment and discovery of what is happening, happened or could happen in the person’s life.

We will now go into detail on all the fundamental concepts that are characteristic of this interesting form of treatment.

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 people do in order to maintain or transcend them. Specifically, coined them as “early dysfunctional schemas” , and this section will be built on them.

1. Early dysfunctional schema

The early dysfunctional schemes are the axis around which the whole intervention revolves, and the raw material with which we work 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 the whole logical arsenal that tries to refute them) and which furthermore perpetuate themselves through the habits that guide everyday life .

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

Early dysfunctional patterns 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 overpowering fear), expressive freedom (capacity to manifest individuality and will), symbolic play (establishment of positive bonds with the peer group) and self-control (inhibition of impulses). Above all, the origin of such deficiencies would be detected in the family, but not only in it.

The author discriminated against eighteen such schemes. Frustration of needs, abuse and identification with parental patterns (vicarious learning) would be at the base. We will now go into detail.

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 one lives in a constant lack of protection and uncertainty . In these cases, intense fear of abandonment, real or imaginary, may arise.

1.2. Mistrust and abuse

The patterns of insecure attachment, especially the disorganized one, would form the habit of distrusting the intentions of others with respect to what is intended for oneself. This scheme implies a tendency to both approach and distance , and would be frequent in those who might have suffered situations of abuse by their bonding figures. In any case, trust would imply a feeling of deep nudity 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 actively seeking support and understanding. It translates into a tendency to isolation and disinterest in social relationships. Self-sufficiency can lead to loneliness .

1.4. Imperfection and shame

This scheme describes a strong feeling of incompleteness, coming from the constant invalidation of one’s 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, one lives in the constant concealment of a facet of one’s own identity that is considered totally inadmissible in one’s 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, the lack of knowledge about everything that defines us as unique human beings and the acceptance of otherness as a synonym of property.

1.6. Dependency and incompetence

Feeling of no self-efficacy, which comes to be expressed as ineptitude or inability to unfold an autonomous life. According to this scheme, an anxious search for the opinion of others would be articulated, as a guide in making decisions on matters considered as personally relevant. Fear of being free is common in these cases .

1.7. Susceptibility to damage or disease

An apprehensive expectation that one is vulnerable to unforeseeable setbacks that may condition one’s own health or that of significant others. In general, it implies the feeling of serious imminent danger, for which the person believes he or she lacks effective coping resources. For this reason , attention is focused on everything that could represent some potential damage , with permanent insecurity.

1.8. Self immature or complication

Establishment of social relations in which one sacrifices in excess one’s own identity , which does not come to be perceived as a guarantee of individuality and only acquires its meaning when it is contemplated from the prism of other people’s gazes. It is a kind of indefinition of the self, which is lived as undifferentiated and formless.

1.9. Failure

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

1.10. Law and grandiosity

This scheme would imply an inflammation of the image we have of the self, which would occupy the apex of the hierarchy relative to relevance or value . Thus, an attitude of tyranny would be developed in interpersonal relations and the prioritization of one’s own needs over those of others.

1.11. Insufficient self-control

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

1.12. Subjugation

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

1.13. Self-sacrifice

Emphasis on the satisfaction of other people’s needs to the detriment of one’s own, so that situations of deprivation are maintained at many levels as a result of the hierarchical structuring of relationships ignoring any perspective of balance or reciprocity. Over time this can translate into an inner sense of emptiness.

1.14. Search for approval

Restricted search for the acquiescence and approval of others , so time is invested in exploring the expectations of the groups with which one interacts to define from them what will be the behavior to be carried out in the everyday scenario. In the process, the capacity to decide in an autonomous and independent way is diluted.

1.15. Pessimism

Construction of gloomy expectations about the course of events, in such a way that the worst of the possible scenarios is restrictively foreseen as long as there is a minimum degree of uncertainty . Pessimism can be experienced as a sensation of constant risk over which there is no control, so there is a tendency to worry and despair.

1.16. Emotional inhibition

Excessive containment of the affective life, so that it is intended to sustain a perennial fiction about who we really are, in order to avoid criticism or embarrassment. Such a pattern complicates the drawing up of relationships with which to obtain quality emotional support , which would reduce the risk of problems in the psychological sphere.

1.17. Hypercritical

Belief that one must conform to self-imposed rules , often rigid in the extreme. Any deviation from these, which are often expressed in lapidary terms such as “should”, would imply the appearance of self-punitive thoughts and behaviour or extreme cruelty towards oneself.

1.18. Conviction

Conviction that there are a series of immutable laws whose fulfillment is obligatory and must be demanded by force . Any person who decides not to comply with them should be severely punished.

2. Schematic 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 behaviours and thoughts aimed at its 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 it a varied selection of procedures that we will delve into later.

The perpetuation of the schemes would be carried out through four specific mechanisms , namely cognitive distortions (interpretation of reality that does not adjust at all to objective parameters nor facilitates adaptation to the environment), life patterns (unconscious choice of decisions that maintain the situation or do not facilitate options for change), avoidance (flight or escape from life experiences that harbour 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, on the other hand, describes a process aimed at questioning and debating schemes , to free oneself from their influence and to transcend their effects. It involves living an authentic life, without the mediation of the harmful results that these exert on oneself or on others. It is the objective of therapy, and for this purpose memories, behaviours, emotions and potentially beneficial sensations must be promoted; a task for which this author selects an eclectic set of strategies from almost all currents of Psychology. We will now go into this point in more detail.

Therapeutic process

Three phases can be distinguished in schema-centred therapy. All of them have their own purpose, as well as techniques to be used.

1. Evaluation and education

The first stage is oriented to stimulate the quality of the therapeutic relationship and to investigate the past experiences, with the aim of extracting the schemes that arise from the subject’s experiences and to know the way in which they have committed their life up to this point.

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 cite some examples). It is at this point that the objectives of the program are set and the tools to be used are chosen.

2. Changeover 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 programmed with the family if the circumstances indicate it. Below we will describe the techniques commonly used in schema-centred therapy.

2.1. Cognitive techniques

The aim of the cognitive techniques used in schema-centred therapy is none other than to review the evidence for and against the person’s ability to maintain or discard a certain belief (which adheres to one of the schemes previously discussed).

The therapist makes use of collaborative empiricism and also guided discovery (open questions that do not aim to persuade, but to contrast the patient’s hypotheses) and strategies such as arguments/counter-arguments or the use of cards with the rational ideas that have been derived from the discussion process (which the patient takes with him/her to read them whenever he/she wishes).

2.2. Experiential techniques

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

For the latter, two unoccupied seats are placed in front of 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 reproducing a conversation.

2.3. Behavioural techniques

Behavioral techniques are intended to identify situations in which the subject may behave in a way that is harmful to himself or others, weighing what changes should be made to the behavior and/or environment. They also seek to strengthen concrete coping strategies to solve the problems that beset them , thus increasing their sense of self-efficacy.

3. Termination

The duration of the programme is variable, although it is often longer than other similar proposals. The aim is to detect and modify all of the schemes and the maladaptive behaviours, considering that therapeutic success is reached when a life with greater emotional autonomy can be lived. Often the completion of the process implies the programming of a series of follow-up sessions , with which the maintenance of the improvements is assessed.

Bibliographic references:

  • Taylor, C., Bee, P. and Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy, 90(3), 456-479.
  • May, Y., Lee, C., Averbeck, L.E., Brand-de Wilde, O., Farrell, J., Fassbinder, E. … Arntz, A. (2018). Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PLoS One, 13(11): e0206039.