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Adapting Schema Therapy for Personality Disorders in Older Adults

Schema therapy (ST) is an evidence-based treatment for personality disorders (PDs). The first research into ST with older adults in a short group format demonstrated its applicability for this population, although with lower efficacy than in younger age groups. This raises the question whether ST can be optimized for older adults. Therefore we conducted a mixed quantitative/qualitative case study of individual ST of a 65-year-old man with a cluster C PD to explore possible adaptations of ST for older adults. We assessed symptomatic distress, early maladaptive schemas, PD diagnosis, and the quality of the working alliance. The patient improved on these parameters and no longer met PD criteria. Five domains of adaptations emerged for possibly enhancing the outcome of ST for older adults: the ST language, the case conceptualization diagram, imagery rescripting, chairwork, and contextualizing to a life span perspective by incorporating wisdom enhancement and reinforcing positive schemas.