Toxic masculinity has increasingly been discussed as a significant psychosocial factor affecting men's mental health, particularly in relation to depression, self-stigma, and low rates of help-seeking. In clinical practice, however, the concept remains ambiguous and may be applied in a reductive or pathologizing manner. This article aims to provide a clinically sensitive understanding of toxic masculinity within the framework of schema therapy. The aim of this article is to explore the relationship between toxic masculinity, early maladaptive schemas, and depressive symptomatology in men, and to demonstrate how schema therapy can facilitate long-term change without pathologizing male identity. This paper is a narrative review complemented by systematized clinical experience of schema therapists. Four composite heuristic vignettes are presented. These vignettes do not represent individual patients but are composite cases reflecting common clinical patterns. Each vignette includes schema-therapeutic conceptualization, a discussion of transgenerational transmission of masculine norms, and examples of therapeutic interventions. Toxic masculinity is clinically expressed through specific early maladaptive schemas (e.g., emotional deprivation, unrelenting standards, emotional inhibition) and protective schema modes (Detached Protector, Overcontroller, Punitive/Demanding Critic). Depression in men often manifests through masked, externalizing, or somatic forms. Schema therapeutic interventions-including limited reparenting, imagery rescripting, chairwork, therapeutic letters, and transgenerational re-scripting-enable gradual access to unmet emotional needs and the strengthening of the Healthy Adult mode. Toxic masculinity is conceptualized as a learned and modifiable pattern embedded in early maladaptive schemas and schema modes rather than as a stable personality trait. Schema therapy provides an integrative clinical framework that links gendered social norms with early maladaptive schemas and schema modes, and offers clinically applicable strategies for promoting sustainable change without pathologizing male identity.
This article introduces a structured method for communication skills training within group schema therapy (GST) specifically tailored for individuals with borderline personality disorder (BPD). Patients with BPD often face relational difficulties due to intense emotional responses and maladaptive schema modes, thus creating a need for targeted communication training to promote healthier interpersonal relationships. This training approach was developed based on interviews with six experienced schema therapists specialising in GST for BPD. The therapists shared practical insights, case examples, and strategies, which were synthesized into a structured communication skills training method. The main methods are chairwork, core emotional needs clarification, role-playing, and role reversal to increase self-understanding, empathy, and constructive problem-solving. The communication training in GST concentrated on recognising and articulating patients' core emotional needs while understanding the needs of others. The therapists recognized four main blocks to skill change: low self-esteem, fear of criticism, social and communication style variances, and undeveloped assertive skills. Methods used to address these tasks include strengthening self-assurance, forming a caring and kind setting, and teaching modes identification exercises to manage emotional answers. Patients described substantial progress in relational self-confidence, empathy, and flexibility in conflict resolution. The GST communication training offers BPD patients essential tools for understanding and expressing interpersonal needs. The group format improves learning through shared experiences and real-time These observations indicate that GST-based communication training can address BPD-related interpersonal problems and may support longer-term improvements in relational functioning and life satisfaction.
This article examines the development of the Kind (Good) Parent mode in schema therapy and supervision. A narrative review of literature on schema modes, Healthy Adult functioning, self-compassion, and experiential methods is integrated with therapists' and supervisors' clinical experience. We define the Kind Parent mode, distinguish it from related modes, and describe how it manifests in self-communication and communication with others. We outline cognitive, behavioral, experiential, imagery based, and supervisory methods, including guided discovery, cognitive restructuring, role playing, chairwork, and imagery rescripting, that can strengthen this mode in patients and supervisees. Because kindness toward oneself is often difficult for both patients and therapists, explicitly cultivating the Kind Parent mode may support self-love, emotional regulation, and relationships, while complementing existing work with the Healthy Adult mode.
The psychiatrization of borderline personality disorder (BPD) has expanded beyond clinical contexts into identity formation, interpersonal regulation, and digital self-presentation. For individuals with BPD-whose psychopathology centrally involves identity diffusion-the diagnostic label may function not only as an explanatory framework but also as a stabilizing, defensive, or performative identity resource, particularly within online environments. This article aims to examine how individuals with BPD integrate psychiatric diagnosis into their self-concept, to identify the psychological and relational functions of diagnostic identity in offline and digital contexts, and to explore clinical implications for psychotherapy, with a focus on schema therapy. A narrative review of international literature on psychiatrization, identity diffusion, stigma, and digital self-presentation in BPD was conducted and integrated with four analytically constructed clinical case vignettes. The vignettes are composite, theory-driven models derived from extensive clinical experience and are used to illustrate recurring patterns rather than individual patient trajectories. The analysis is grounded primarily in schema therapy, complemented by psychodynamic and mentalization-based perspectives. Across the reviewed literature and case material, psychiatrization in BPD emerged as a dynamic and context-dependent process. Four prototypical patterns were identified: (1) diagnosis as a public or performative identity, (2) diagnosis as a protective shield against guilt and responsibility, (3) diagnosis as an idealized marker of sensitivity and moral value, and (4) diagnosis as a community-based identity providing belonging. While diagnostic identification often provides relief, coherence, and a shared language for emotional experience, rigid identification may constrain agency, reinforce maladaptive relational strategies, and become amplified by digital environments that reward emotional intensity and visibility. This article introduces a clinically grounded typology of psychiatrization in BPD, linking diagnostic identity to specific relational and regulatory functions across offline and digital contexts Conclusions: Psychiatric diagnosis in BPD functions as a double-edged tool: it may support understanding and self-compassion, yet also risk becoming an identity substitute that limits psychological growth. Effective psychotherapy should therefore address not only symptoms but also the meaning and function of the diagnosis within the patient's identity system. Identity-focused work, strengthening of mentalization and emotion regulation, and reflective engagement with social media use are central clinical tasks. Further qualitative and longitudinal research is needed to examine how relationships to diagnosis evolve over the course of psychotherapy and across sociocultural contexts.
Elastin-like polypeptides (ELPs) are self-assembling recombinant biopolymers that can be precisely engineered to display functional targeting ligands. In this study, we developed ELP-based nanoparticles (NPs) displaying the variable domain of the heavy chain of heavy-chain-only antibodies (VHHs) targeting the SARS-CoV-2 spike protein. By tuning VHH selection, multivalency, and surface display density, we created targeted ELP NPs capable of blocking entry of spike-protein-presenting virus-like particles (VLPs) and live viruses, with subnanomolar IC50 values, significantly outperforming the monovalent VHH equivalents. Notably, optimizing multivalency and VHH density unlocked broad virus-neutralizing potency against multiple variants, including Omicron variants resistant against the monovalent VHH equivalents. Confocal imaging further revealed that VHH-ELP NPs formed aggregates with VLPs, enhancing uptake by M1 macrophages, suggesting potential for eliciting vaccinal effects. Overall, this work highlights the versatility of ELP NPs as a tunable antiviral platform and provides design principles for next-generation nanotherapeutics against evolving viral threats.
Background and Objectives: The autonomic nervous system (ANS) orchestrates adaptation to stress; however, its reactivity is influenced by demographic, anthropometric, and psychosocial factors. While arterial stiffness and central adiposity are established cardiovascular risk markers, less is known about how maladaptive coping strategies, cumulative life stress, and quality of life influence short-term autonomic regulation. This study examined the age- and sex-specific associations between anthropometry, maladaptive coping, life stress, quality of life, and ANS adaptation in adults. Materials and Methods: In this cross-sectional study, 122 healthy adults aged 21-78 years underwent a standardized lay-stand-lay (LSL) protocol with pulse wave analysis. Hemodynamic outcomes included pulse wave velocity (PWVao), augmentation indices (AIxA and AIxB), and aortic blood pressures (SBPao and PPao). Anthropometric measures comprised BMI, waist and hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Psychosocial assessments included the Young Hypercompensation Inventory (maladaptive coping), Holmes-Rahe Life Events Inventory (life stress), and EQ-5D-3L (quality of life). Associations were analyzed using mixed-effects models adjusted for covariates, with false discovery rate correction. Results: Age was the strongest determinant of autonomic reactivity: older adults showed greater recovery of augmentation indices and central pressures after orthostatic challenge. Sex differences were evident, with women displaying consistently higher augmentation indices and men showing greater PWV responses. Central adiposity (WHR, WHtR, and waist circumference) predicted blunted augmentation index reactivity, while hip circumference was protective. BMI-defined obesity showed weaker associations. Maladaptive coping, life stress burden, and quality of life were not significantly associated with ANS indices after correction for multiple comparisons. Conclusions: ANS adaptation to postural stress is largely determined by age, sex, and visceral adiposity, whereas psychosocial measures showed limited influence in this healthy adult sample. These findings highlight the demographic and anthropometric determinants of cardiovascular adaptability, suggesting that psychosocial influences may primarily act through long-term behavioral and neuroendocrine pathways.
Borderline personality disorder (BPD) is associated with significant difficulties in emotional regulation and a higher prevalence of nightmares, which increase emotional instability and decrease quality of life. Dreams represent valuable therapeutic material that can reveal internal conflicts and support self-awareness. This article explores dreamwork in group schema therapy (GST) aimed at the early maladaptive schemas (EMS) and modes. The ultimate goal of these approaches is to support the Healthy Adult mode in processing the emotional needs of patients with BPD. TThe article presents the theoretical foundations and therapeutic techniques, including imagery, dream rescripting, chairwork, and amplification of dream images. Case vignettes illustrate how dreamwork can help recognise and process a patient's internal conflicts and thus aid the therapy process. Dreamwork in GST helps patients better understand their emotional needs and schemas. The increased awareness helps to modify dysfunctional behaviour and improve emotional stability. The group therapy format allows patients to share their experiences and receive support from others, which increases the feeling of belonging and security. Dreamwork in GST creates a safe space for processing internal conflicts related to EMS and connections with real possibilities in the patient's life. Dreamwork also brings challenges, such as the risk of slipping into intellectualisation or being overwhelmed by strong emotions and unable to resolve impactful dreams. Dedicated courses and research are needed to warrant effective implementation and elaboration of these methods. Dreamwork in GST might be an effective tool for promoting self-awareness, processing emotional conflicts, and strengthening the Healthy Adult and Kind Parent modes.
The article examines the concept and methods of positive schema therapy. It is based on the theory of schema therapy and adaptive schemas, which enrich the perspectives of positive psychology, positive CBT and strengths-based CBT. Based on case vignettes, show practical methods associated with this approach. A literature review was conducted on adaptive schemas, their measurement using the Young Positive Schema Questionnaire (YPSQ) and therapeutic interventions supporting the development of the Healthy Adult and Kind Parent modes. In addition, special attention was paid to integrating schema therapy methods within therapeutic interventions of positive psychology and CBT based on resources. Selected case studies of various psychological problems and disorders are presented as examples of therapeutic work using positive schema therapy methods. Positive schema therapy has been shown in additional studies to be an effective tool for increasing emotional resilience, coping with stressful situations, and improving emotional regulation and the overall quality of life. Adaptive schemas such as self-compassion, social belonging, and emotional openness significantly support the development of the Healthy Adult mode. Positive schema therapy is an innovative approach in psychotherapeutic practice, expanding clinical methods of schema therapy work. Despite limited empirical support, it has the potential to develop further, introducing new procedures to strengthen the positive aspects of client´s experiences and behaviour when dealing with psychological problems.
This study examines the influence of childhood adversities, dissociation, and self-stigma on autonomic nervous system function and treatment outcomes in hospitalised patients with borderline personality disorder (BPD). Seventy-five BPD inpatients underwent a six-week intensive psychotherapy treatment program. Changes in psychopathology and autonomic nervous system function were monitored. (heart rate variability, LF/HF ratio). The study confirmed a positive impact of the treatment program on reducing BPD symptomatology, anxiety, and depressive symptoms. Findings indicate that the initial dissociation level does not correlate with changes in symptomatology. In contrast, changes in dissociation during treatment are associated with reductions in anxiety and depressive symptoms. Regarding HRV, our data show that although there were no significant changes in HRV during treatment, higher baseline LF/HF values correlated with smaller changes in symptom severity, which could indicate a possible link between autonomic nervous dysregulation and the stability of BPD symptoms. Our findings emphasise the importance of monitoring physiological and psychological factors in BPD treatment, highlighting potential predictors of therapeutic response.
Power dynamics are fundamental to therapeutic and supervisory relationships in psychotherapy. In cognitive-behavioural therapy (CBT) and schema therapy (ST), the therapist's power management can help the patient make positive changes. On the other hand, the abuse of power can undermine the patient's autonomy and worsen therapeutic outcomes. Understanding these dynamics is essential for effective and ethical practice. This article aims to explore how power and powerlessness manifest themselves in the practice of cognitive behavioural therapy (CBT) and schema therapy (ST), analyse their impact on therapeutic and supervisory processes, identify the risk of abuse of power, and suggest strategies to support patient and supervisee autonomy. The text provides a theoretical and practical analysis of the manifestations of power in therapy and supervision, illustrated with case vignettes to explain important processes. The discussion includes a comparison of CBT and ST, focusing on their respective approaches to power dynamics. Ethical principles, supervision practices, and cultural and institutional influences are also examined. Effective use of power in therapy and supervision increases trust, cooperation, and autonomy for both client and supervisee. In CBT therapy and supervision, collaboration with an appropriate power distribution between therapist and patient or supervisor and supervisee promotes patient or supervisee engagement. Still, excessive directiveness can sometimes threaten the relationship. In ST, where limited reparenting is the main vehicle for the therapeutic and supervisory relationship, therapeutic and supervisory leadership requires increased sensitivity by the therapist or supervisor to avoid reinforcing maladaptive modes. Supervisory approaches that rely on collaborative approaches are more supportive of professional growth than those dominated by hierarchical power structures. Reflection on power dynamics is vital in cognitive-behavioural and schema therapy for maintaining ethical and effective therapeutic and supervisory relationships. Strategies that help maintain a balance of power include adherence to ethical principles, self-reflection, and regular supervision. Future research should focus on developing innovative methods to capture solutions to power distribution issues in therapy and supervision.
Schema therapy is an integrative approach to treat patients with personality disorders and other complex psychological problems. Group schema therapy has been developed to enhance the effectiveness and efficiency of schema therapy by providing a supportive and stimulating environment for change. This article introduces the River of Life Method, a novel technique for facilitating group schema therapy, based on the metaphor of a river of life. The method helps patients to identify and modify their maladaptive schemas and modes in a nurturing process in the group. The article describes the theoretical background, the practical steps, and the clinical applications of the method. It also presents the patients' experience with the method, based on their feedback and self-reports. The results showed that the method was well received by both patients and therapists, and that it had positive effects on schema modes, psychological distress, and coping with adversities and hope for the future.
Bacitracin is an antimicrobial used in the feed or water of poultry in the U.S. for the prevention, treatment, and control of clostridial diseases such as necrotic enteritis. Concern has been raised that bacitracin can select for antimicrobial-resistant bacteria that can be transmitted to humans and subsequently cause disease that is more difficult to treat because of the resistance. The objective of the present study was to perform a quantitative risk assessment (QRA) to estimate the potential risk in the U.S. of human infection with antimicrobial-resistant Enterococcus faecalis and E. faecium derived from chicken and turkey products as a result of bacitracin usage in U.S. poultry. The modeling approach estimated the annual number of healthcare-associated enterococcal infections in the U.S. that would be resistant to antimicrobial therapy and that would be derived from poultry sources because of bacitracin use in poultry. Parameter estimates were developed to be "maximum risk" to overestimate the risk to humans. While approximately 60% of E. faecalis and E. faecium derived from poultry were predicted to possess bacitracin resistance based on the presence of the bcrABDR gene locus, very few human-derived isolates possessed this trait. Furthermore, no vancomycin or linezolid-resistant strains of E. faecalis or E. faecium were detected in poultry sources between the years 2002 and 2019. The model estimated the number of antimicrobial-resistant E. faecalis and E. faecium cases per year that might resist therapy due to bacitracin use in poultry as 0.86 and 0.14, respectively, which translates to an annual risk estimate for E. faecalis of less than 1 in 350 million and for E. faecium of less than 1 in 2 billion for members of the U.S. population. Even with the use of risk-maximizing assumptions, the results indicate that there is a high probability that the use of bacitracin according to label instructions in U.S. poultry presents a negligible risk to human health.
This article emphasizes the critical role of self-care in the professional lives of cognitive behavioural therapy (CBT) therapists and supervisors. It delves into the importance of self-care, elucidating its significance in maintaining therapists' mental health and effectiveness. The article presents a range of practical strategies that promote self-care, providing therapists and supervisors with specific steps to incorporate self-care into their daily routines. Moreover, the article explores common challenges and barriers to self-care, such as a lack of time, feelings of guilt associated with prioritizing one's needs, and a lack of available resources for self-care. The article aims to deepen our understanding of the complexities of practising self-care by shedding light on possible obstacles. In addition, the article includes case vignettes that demonstrate tangible examples of the positive impact of self-care on therapists' mental health and effectiveness. The overarching goal of this article is to encourage ongoing discussion and research on self-care. It advocates a greater emphasis on self-care in CBT and CBT supervision (CBTS), intending to promote the health and well-being of those who dedicate their lives to caring for others. The insights and strategies presented in this article serve as a resource for therapists and supervisors striving to achieve a balanced lifestyle while effectively catering to the needs of their clients.
The paper describes the characteristics of relationship obsessive-compulsive disorder (R-OCD), including the types of obsessions and compulsions, the common triggers and the impact on psychological well-being and relationship functioning. It also offers basic cognitive-behavioural strategies to help patients change their attitudes towards obsessive thoughts and reduce compulsive behaviours. This article is a narrative review of the literature and case studies on R-OCD. To search for relevant sources, we used PubMed, PsycINFO and Web of Science databases with the keywords "relationship obsessive compulsive disorder", "R-OCD", "relationship OCD" and "partner-focused OCD". We included only studies published in English from January 1990 to June 2023. The paper provides examples of how basic cognitive-behavioural strategies help individuals with R-OCD. People with R-OCD experience intrusive thoughts about whether they have the right feelings for their partner, whether their partner loves them, whether the relationship is suitable or whether their partner has flaws. These thoughts trigger the urge to perform various rituals to alleviate anxiety, such as repeated checking, reassurance or comparison. However, this behaviour leads to disruption of the relationship and long-term maintenance of the anxiety. Examples of basic cognitive-behavioural strategies can be applied in clinical practice to help individuals change their attitudes towards relational obsessive thoughts and reduce compulsive behaviours.
The parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process. This article aims to familiarize the reader with parallel processes in cognitive-behavioural therapy (CBT) and schema therapy supervision and discuss how to manage this phenomenon in supervision. This article is a narrative review with illustrations of supervision interviews in which the parallel process unfolds. The text provides an overview of theoretical constructions and empirical studies related to the parallel process. We searched PubMed, PsycINFO, Web of Science, and Google Scholar for relevant resources using the keywords "parallel process," "cognitive behavioural therapy," "schema therapy," "transference," and "countertransference." Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance CBT and schema therapy training, practice, and supervision.
The purpose of supervision is to ensure that clients' needs are met and to monitor the effectiveness of therapeutic interventions and the therapeutic relationship. Cognitive behavioural therapy (CBT) supervision is the systematic cooperation of the supervisee with the supervisor, which aims at increasing the therapists' competencies when working with specific clients. The advantage of supervision is the possibility to shape and develop the therapist's practical skills through specific techniques. This paper aims to review currently available CBT supervision strategies that boost the development of therapists' skills and provide possible examples. Various techniques are discussed, including behavioural, cognitive, imagery and psychodrama methods that facilitate supervisors in enhancing therapists' skills. In addition, complementary approaches are discussed, such as role-playing, modelling, chaining, or imitation to present at a particular moment of the therapy, increase the insight into the client's perspective or the treatment itself, and search for an alternative approach to improve the therapeutic outcomes for the client. Overall, the article describes the supervisor's need to have a flexible variety of skills and know which learning methods might be most effective for boosting the supervisee's skill level and needs with a particular client.
This article describes using imagery approaches during group schema therapy (GST). Imagery approaches are an important tool for identifying and changing maladaptive schema modes and early maladaptive schemas. It summarises the theoretical background of the group imagery method and practical case vignettes. The text describes methods for using imagery in therapeutic groups, building a safe place, imagery rescribing painful experiences, and dialogue between schema modes. It also stresses challenging matters, like problems with imagery, difficulties trusting another person, and resistance to change. Using imagery in GST is a powerful approach to increase patient results during the therapy.
Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic. This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements - the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire - Short Form, the Clinical Global Impression - Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses. Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability. Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.
This article focuses on utilizing therapeutic letters within group schema therapy-an innovative therapeutic approach that integrates elements from various therapeutic disciplines. The primary aim is to explore how therapeutic letters can enhance the therapeutic process and support the treatment of patients. To achieve this objective, we conducted a narrative literature review centred on schema therapy and using therapeutic letters as a therapeutic strategy. We systematically searched databases (PubMed, PsycINFO, and Google Scholar) using the keywords "schema therapy," "therapy letters," "group," "therapeutic strategies," and "adult psychotherapy." Additionally, we gathered clinical insights from schema therapists through interviews to gain a practical perspective. Group schema therapy primarily targets identifying and modifying early maladaptive schemas and maladaptive schema modes that originate during childhood and persist into adulthood. Within this context, therapeutic letters are an effective tool, allowing individuals to process intense emotions stemming from their formative years. Individuals complete these letters as homework assignments and then, divided into small groups, read them aloud while receiving emotional support and encouragement from their peers. This process enables individuals to explore their thoughts and feelings, potentially reframe their life narratives, seek forgiveness, and ultimately progress. Various types of therapeutic letters are discussed, including the "uncensored letter", "letter from the other shore", "letter to an adult child", "business card", and "letter from the future". The article provides an in-depth overview of the techniques and exercises employed in group schema work when using letters. It also addresses potential challenges, such as difficulties with visualization, resistance to change, and trust issues. Therapeutic letters emerge as a valuable tool in group schema therapy, enhancing the therapeutic process and supporting individual treatment. However, further research is necessary to comprehend and fully maximize their potential.
Ethics is an inherent part of psychotherapy that protects the interests and rights of all parties engaged in the therapeutic relationship. This article focuses on ethical issues and dilemmas that may arise when using schema therapy. We created a narrative review by searching the databases PubMed, Web of Science, and Scopus with the keywords "psychotherapy", "schema therapy", "therapeutic relationship", "ethics", "ethical questions", and "ethical dilemmas". In addition, we focused on the clinical experience of therapists, training instructors, and supervisors. Ethical psychotherapy requires adherence to ethical codes and standards. Among the most important ethical principles are confidentiality, informed consent, boundaries of the therapeutic relationship, and dual relationships. Understanding transference, countertransference, and one's modes and schemas is essential to ethical reflection in schema therapy. The article presents examples of ethical dilemmas in schema therapy and suggests possible solutions. At the same time, we point out the need for further research in this field. Similarly to other psychotherapeutic approaches, one of the schema therapist's core competencies is following the profession's ethical principles and productively finding solutions to the occasional ethical dilemmas. Ethics is a prominent part of all psychotherapeutic sessions. Still, it becomes even more central when working with challenging issues such as personality disorders that schema therapy routinely treats. More research on the topic is needed.