Schema Therapy for the Treatment of Personality Disorder in Later Life

Abstract

About 1 in 10 older persons suffer from a personality disorder, which lowers their quality of life and wellbeing and increases their medical consumption of both somatic and mental health care. Meta-analyses show that several types of psychotherapy targeting personality (cost-)effectively reduce psychological distress and improve maladaptive personality functioning in younger and middle-aged people with personality disorders compared to usual care. The paucity of randomized controlled trials on the effectiveness of psychotherapy for personality disorders in later life is an example of ageism in modern health care, denying the ever-increasing life expectancy and ageing society worldwide. This may partly be due to the historical claim of Sigmund Freud that psychotherapy is not suitable for people aged 50+ as they would no longer be educable (‘erziehbar’) anymore.Schema therapy is an integrative psychotherapy that was originally developed for the treatment of chronic psychiatric disorders but has primarily been applied to borderline personality disorder. In younger and middle-aged adults, evidence for the effectiveness of schema therapy is growing considerably. Nonetheless, none of the randomized controlled clinical trials have included older persons thus far. Case-series, however, have shown that schema therapy is feasible for older persons with personality disorders and is highly appreciated. Therefore, in this symposium we will first present an overview of the evidence for the effectiveness of schema therapy, highlighting the case-series conducted in older age groups, secondly the results of the first randomized controlled trial on the effectiveness of schema therapy in later life, and finally, the potential of taking positive schemas into account, including a feasibility study in an older population.