Katy W. Martin-Fernandez and Yossef S. Ben-Porath
Attempts at informal personality assessment can be traced back to our distant ancestors. As the field of Clinical Psychology emerged and developed over time, efforts were made to create reliable and valid measures of personality and psychopathology that could be used in a variety of contexts. There are many assessment instruments available for clinicians to use, with most utilizing either a projective or self-report format. Individual assessment instruments have specific administration, scoring, and interpretive guidelines to aid clinicians in making accurate decisions based on a test taker’s answers. These measures are continuously adapted to reflect the current conceptualization of personality and psychopathology and the latest technology. Additionally, measures are adapted and validated to be used in a variety of settings, with a variety of populations. Personality assessment continues to be a dynamic process that can be utilized to accurately and informatively represent the test taker and aid in clinical decision making and planning.
Schema therapy has evolved since the late 1980s as an efficacious and increasingly widely used psychotherapeutic treatment for personality disorders and many other complex disorders that correlate with underlying maladaptive schemas. Only recently, attention among clinical geropsychologists has been growing for the application of schema therapy in older adults. Schema therapy is very feasible for both therapists and older patients. Schema therapy is an integrative psychotherapy, which draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions. In this treatment model, early maladaptive schemas are considered core elements of persistent and pervasive psychopathology, including personality disorders. The goal of treatment is to decrease the impact of maladaptive schemas and to replace negative coping responses and maladaptive schema modes with more healthy alternatives so that patients succeed in getting their core emotional needs met. The emerging attention for schema therapy in older adults is in line with the increased attention for personality disorders in later life, and also with the maturing field of psychotherapy for older adults. The first scientific evidence for the feasibility and the effectiveness of schema therapy has recently been shown. Despite these developments, much work is still to be done. The question is whether schema theory, which was developed for adults in young and middle adulthood, equally applies to those in later life. Although the first tests of effectiveness of schema therapy in older adults are encouraging, age-specific adaptations of existing therapy protocols, both for individual and group schema therapy, are wanted. Furthermore, the research that has been conducted so far has focused on the young-old. Especially for the growing and highly complex group of oldest-old patients, the development of feasible and effective schema-based interventions is needed. Integrating age-specific moderators for change, such as wisdom enhancement, attitudes to aging, and integrating the action of positive schemas, deserves recommendation.