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Schema Therapy for Eating Disorders:The Importance of Therapeutic Relationship and Case Conceptualization

by Laura Beccia, and Marina Cirio


A frequent difficulty in dealing with eating disorders is the motivation to treatment and the creation of a good therapeutic relationship. The high comorbidity between eating disorders and personality disorders is well known and makes it clear that the dysfunctional behaviors are the symptomatic expression of a deeper disease. Appropriate treatment for such serious and disabling disorders should take into account the individual’s complexity, extending the aim of intervention from symptomatology to the patient’s personality functioning. Many authors in literature have shown that the presence of highly structured and rigid modes is strongly related to many difficulties during psychotherapeutic intervention. In fact many therapists focus exclusively on symptoms, such as the body weight or the eating habits, which in turn reinforce the dysfunctional coping responses that can worse the physical integrity of the patient.

Schema therapy (ST) is an effective approach, that involves specific interventions on schemas, modes, emotions, coping responses and behaviors. ST allows the patient to understand the different expressions of himself in an integrated personality model.
In this regard, ST allows the therapist-patient dyad to build together the case conceptualization, to understand how mode works, to identify which dysfunctional life events are related to the early maladaptive schemas and how the modes arise within the therapeutic setting. Therapeutic relationship (TR) is really the most important tool since the first session. TR helps the patients to experience a new kind of relationship, that enables to perceive and foster all the part of the self (mode work) even parts of themselves considered unworthy and unapproachable.

Empathic confrontation is a primary therapeutic technique with these patients because of their extremely structured coping modes. In this case therapist must pay extreme attention and awareness to build up a secure relationship that can lead the patient through imagery rescripting to change many aspects related to the inner life as well as the symptoms remission.

Target Audience:

Psychologist Psycotherapist

Learning Objectives:

The importance of therapeutic relationship in the treatment of eating disorders and how it allows the therapist to log into the dysfunctional modes of the patient.

It is well-known the Vulnerability to Harm schema is closely related to most of the anxiety disorders. This schema’s main characteristic is the cognition that something “bad” will happen at any time and the person will be helpless. These “bad” things can be related to medical, legal, economic and natural situations. Our research about the schema domains shows that the Vulnerability to Harm schema occurs in the same domain as Pessimism, Mistrust, Punitiveness, and Self-Sacrifice. These schemas are all related to high levels of anxiety. These findings suggest that anxious people are not only sensitive to being in a helpless situation; they are also sensitive about being responsible for a catastrophe. In light of these findings, we developed a "domain focused" procedure which targets the "guilt" side of anxiety, also. In this skill class the participants will learn domain-focused schema techniques specific to anxiety for the Vulnerability to Harm schema, Pessimism, Mistrust & Abuse; and also they will learn to manage the strong "Superego" side of the anxious people: Punitiveness and Self-Sacrifice schemas.

Level of Experience Required for Participants: 

Intermediate (Participants have had basic Schema Therapy training)

About the Presenter:

Laura Beccia:

She graduated in psychology in Padua University and specialized as a psychotherapist at Sandra Sassaroli & Cognitive Studies in Milan Cordinator of schema therapy center saronno She is Italian president of SIST (Italian Society of Schema Therapy) and trainer - supervisor ISST Referent ISC-Northern Italy She collaborates with several centers for the treatment of personality disorders and eating disorders.

Marina Cirio:

Marina Cirio Psychologist, cognitive behavioral and Schema Therapy psychotherapist. Supervisor and trainer in Schema Therapy for ISST and SIST (Società Italiana Schema Therapy). Coordinator of Genoa Schema Therapy Center. SIST executive committee member Co-founder of Mindful Interbeing Mirror Therapy She has collaborated with various therapeutic centers in the treatment of personality disorders in Italy

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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