Loes van Donzel
Loes van Donzel is a clinical psychologist/psychotherapist at PersonaCura, Center of clinical excellence for Personality Disorders and developmental disorders in Older Adults, at mental health care institution GGz Breburg, the Netherlands. She is also a PhD student at Tranzo, the scientific center for care and wellbeing of the Tilburg School of Social and Behavioral Science of Tilburg University, the Netherlands. She is a senior member of the Dutch Schema Therapy Association
Working with positive schemas in schema therapy with older adults: effects and experiences
Early adaptive schemas, or positive schemas, have received increasing attention in recent years as an adjunct to regular schema therapy. Older adults in particular may benefit from incorporating positive schemas into schema therapy (Videler et al., 2020). Often, older adults with personality disorders have functioned better earlier in life because their positive schemas were validated by their social roles. We investigated whether older adults with cluster C personality disorders would benefit from an adapted form of schema therapy that included interventions to reactivate positive schemas. Through quantitative (multiple baseline case series design) and qualitative research, nine older persons (age > 60 years) with cluster C personality disorder were treated with modified schema therapy, with weekly sessions for one year. Two participants dropped out at the end of the treatment phase. Treatment was preceded by a baseline phase, which was randomly assigned to last 4 to 8 weeks, and was followed by a six-month follow-up phase. After follow-up, participants were interviewed about their experiences with this modified schema therapy, and therapists were interviewed in a focus group. Data from all participants in this study are not yet available but will be collected and analysed in the coming months. Preliminary results indicate a decrease in EMS and an increase in EAS. Results of the qualitative study are also not yet available but will be available and discussed at the Schema Therapy Conference. Rather than focusing solely on reducing negative schemas for therapeutic change, it is believed that adding positive schemas is a complementary approach. Incorporating positive schemas into schema therapy may be an important way to revive positive core beliefs in older patients, strengthen the therapeutic relationship, and also facilitate the initiation of experiential schema therapy techniques.
van Donzel, L., Ouwens, M.A., van Alphen, S.P.J., Bouwmeester, S., & Videler, A.C. (2021). The effectiveness of adapted schema therapy for cluster C personality disorders in older adults: integrating positive schemas. Contemporary Clinical Trials Communications, 21, 100715.
Videler, A.C., van Royen, R.J.J., Legra, M.J.H., & Ouwens, M.A. (2020). Positive schemas in older adults: Clinical implications and research suggestions. Behavioural and Cognitive Psychotherapy, 48(4), 481–491.