The Therapy scheme approach has its roots in the concepts of “unsatisfied primary need” and “early maladative scheme” (SMP).
The dissatisfied primary needs and the early maladative schemes They are considered as originated by experiences of neglect or traumatic. They are held responsible for the symptoms and suffering presented by patients.
The concept of fash
With the evolution of the model, the therapeutic focus has moved more from the early maladative patterns to the concept of “Fash“Or“Scheme mode“.
Mode is defined as a system that includes emotions, physical sensations, cognitions and active behaviors at a specific moment. It is activated following an activating event and can concern several patterns.
In literature, different authors propose different models of conceptualization that include a different number of fashions. However, the reference macrocastreors tend to be four. We have the fash:
- Parent
- Child
- coping
- Healthy adult (AS)
Healthy adult mode
Mode AS is connected to functional aspects of the patient. Some of these include:
- the development of personal skills
- the possibility of dedicating itself to personal interests
- the ability to develop and maintain functional intimate relationships
- the aptitude to balance the interest in one’s needs and those of others and the time dedicated to the activities of duty and pleasure
- the ability to take responsibility and fulfill duties
Generally in Therapy scheme thetherapeutic goal It does not only concern the reduction of symptoms, but the implementation of the well -being and quality of the patient’s general life. That is, the construction of a lifestyle in which its needs can be adequately satisfied.
This objective becomes prosecutable by enhancing (or building and strengthening), the AS through any available strategy. During the therapy, frequency and intensity of activation of this mode should in fact increase.
The functions of “healthy adult” mode
THE’Healthy adult represents the functional part of the self. When this mode is active, the patient is aware of the present moment, in contact with his own cognitions and emotions (even if painful) and is connected to others.
THE’healthy adult It allows adequate emotional regulation, the adoption of cognitions and behaviors necessary to adequately perform duties and adult functions and allows the patient to respond to difficulties flexiblely. For example, by fulfilling one’s responsibilities and being at the same time in contact with their own needs and taking care of it.
Mode AS allows the adoption of behaviors oriented towards emotional satisfaction, through emotional opening, connection, intimacy and spontaneity. Suitable forwards to the hiring of conduct oriented towards self -care and one’s health.
Interpersonal relationships
The healthy adult allows you to exercise a functionally attitude compassionate and empathetic towards oneself and others and to hire in functional relationships, based on a safe attachment.
When this mode is active, the person considers himself, his relationships and the various areas of life in a confident and safe, but at the same time realistic way. Identifies for themselves, others, life situations and the future Realistic expectations.
Therefore, it allows you to exercise a functional self-director. In fact, considering adequately the personal resources of the individual, the healthy adult allows an adequate perception also of the sense of self-effectiveness and personal competence, having the person in an advantageous attitude to the pursuit of performance and successful objectives.
Commitments and responsibilities
Again, when the Mode as is active, the person is able to maintain the commitments made and take responsibility for himself and for others. To impose healthy limits and exercise an adaptive self -control.
The AS, in fact, allows you to perform adequate adult functions related to responsibilities (e.g. work, financial obligations, children’s care, pets, self -care …) and at the same time to achieve pleasant adult activities (e.g. hobbies, rest, wellness and pleasure activities …).
The healthy adult is in contact with emotions and needs And it is the mode that allows you to exercise metacognitive awareness and supplementary function. In fact, it allows the person to be aware of the different methods active at a certain moment, also allowing you to act and question them. For example, by voluntarily interrupting the dysfunctional ones, in order to adopt behaviors consistent with the satisfaction of one’s needs, in compliance with others.
The indicators of the activation of the Mode AS
In light of what is described, some indicators which in the course of therapy can lead to considering the activation of healthy adult mode include that the patient:
- identify, valid and express their emotions;
- put in place new functional behavioral schemes, to replace the old dysfunctional;
- Consider thoughts as internal events, separated and different from the objective reality of things;
- identify the activating events and thoughts below the painful emotions and behaviors and question them;
- Choose and engage in activities that concern a functional adult lifestyle, with reference to all areas of life;
- It opens and compares with others in reference to one’s thoughts, their emotions and moments of difficulty;
- ask for help and support adaptively.
Therapeutic work on healthy adult mode
Given the importance of this mode for the well -being of the person, within this theoretical reference matrix, work on it is fundamental in therapy.
Since the beginning of the therapeutic path, the clinician is oriented to the search for contact with the patient’s healthy adult. One of the first challenges for the therapist concerns precisely paying attention to not confusing the AS with fashions of dysfunctional coping.
Once identified and established one Connection with the patient’s asthe therapist will constantly appeal to it regularly and recursively, especially in critical situations (for example, when we need to stem aggressive or straight aggressive behaviors).
If at the beginning of the course this fashions were too weak it will be modeled directly by the therapist or other reference figures (e.g. relatives, educators, other support figures).
The use of the relationship
The functional use of the therapeutic relationship It is important in order to strengthen the Mode as.
First of all, it should be considered that the therapist will act as a model of Inner healthy adult For the patient and it is important that the clinician is aware of this aspect throughout the path and uses it in a therapeutic way.
In addition, the clinician immediately undertakes to relate as often as possible to the patient’s AS and solicit him. This solicitation can take place, for example, recursively referring to the shared conceptualization model. That is, by soliciting the patient’s skills to reflect on his mental states, strengthening their metacognitive skills.
Also, another relevant aspect concerns the construction of anshared assumption of liabilityfor which the therapist will try as often as possible to work in a collaborative way (for example, discussing with the patient what exercises to adopt according to the purposes) and explaining the collaborative nature of the work.
Finally, the adoption of Socratic dialogue also urges the activation of the Mode as.
Cognitive-behavioral strategies
In addition to what is described, similarly to work with other fashions, the work on the AS is also based on the adoption of different cognitive, behavioral and emotional therapeutic strategies.
Cognitive work will aim to develop adequate cognitions and will make use of the adoption of specific strategies such as monitoring diaries, flash-cardpros and cons lists, cognitive revaluation strategies.
Behavioral interventions will include the implementation of training of assertiveness or social skills, role-playing, Relaxation exercises, targeted exhibitions.
The interventions focused on emotions will be based on exercises of Imagory And at work with the chairs, oriented to develop cognitive, emotional and adaptive behavioral responses.
Even when emotional exercises have the work on other fashions as direct target, the Mode of the AS is generally always included in each implemented intervention. In addition, specific images of image -oriented to the strengthening of the AS can be adopted, which are generally related to problematic situations that the patient will face in the future.
It is also useful to consider that the third wave cognitive-behavioral therapies offer different strategies functional to the enhancement of the AS.
The techniques relating to the compassionate self deriving from the Compassion Focused Therapy, or the strategies oriented to the increase in psychological flexibility, the reduction of the comprehensive invitation and to the pursuit of the values deriving from the‘Acceptance and Commitment Therapy.
Bibliography
- ARNTZ, A. & Jacob, J. (2001). SortChematherapie in Der Praxis. Beltz (trad. It.: Therapy scheme in action. Theory and practice. Sassari: Institute of Cognitive Editore Sciences, 2013).
- ARNTZ, A., & Van Genderen, H. (2009). Therapy for borderline personality disorder scheme. John Wiley & Sons Ltd. (trad. It.: La la Therapy scheme for borderline personality disorder. Milan: Raffaello Cortina Editore, 2011).
- Novello C. (2022). Online course “Strengthen the healthy adult in the approach of the Therapy scheme.”
- Rodiger, E., Stevens, Ba, & Brockman, R. (2018). Contextual Therapy scheme: an supplementary approach to Personality Disorders, Emotional Dysreguration and Interpersonal Functioning. Oakland: Context Press (Trad. It.: Contextual Therapy scheme. An integrated third generation approach for the treatment of personality disorders. Trento: Edizioni Centro Studi Erickson, 2021).
- Young, Je, Klosko, Js & Weishaar, Me (2003). Therapy scheme: A Practitioner’s Guide. New York: Guilford Press. (Trad. It.: Therapy scheme. Cognitive-behavioral therapy for personality disorders. Trento: Edizioni Centro Studi Erickson, 2018).
