Evolutionary systems therapy

Domain V · Systemic, relational, group & community · Simone Cheli · 2023 · Florence, Italy

What it is

EST is an individual psychotherapy aimed at "specific target mechanisms" rather than at diagnostic labels. It integrates four sources: evolutionary psychopathology, compassion-focused therapy, metacognitively oriented psychotherapy, and attachment theory. The ESTP version groups personality…

Format

• Format (published). Individual, talk-based psychotherapy, delivered by a single psychologist-psychotherapist. No family, couple or carer sessions are described. 24 weekly sessions of 50–60 minutes ("maximum of 1 hour") over 6 months, followed by an assessment one month after treatment ends.
• EST-S: adults (18+) with schizotypal personality disorder diagnosed on the SCID-5-AMPD. Exclusions were current psychotherapy or psychopharmacological treatment, schizophrenia-spectrum or other psychotic disorders, bipolar disorder, intellectual disability and neurological disease. The comparison…

Who practises it, and how they are trained or regulated

• Phases. Neither the EST-S trial protocol nor the ESTP registry record gives any phases. A manual-level phase structure may be in Cheli's chapters, which are not reproduced here. The working structure below is the writer's. It fits the published format, components and measurement points, but it is not the EST manual.
• Training, licensing and fidelity. No certification body, licensing requirement, published manual or fidelity scale for EST is known. The EST-S protocol describes no therapist training, supervision or fidelity checks. Sites were chosen for "expertise in treating personality disorders", and adherence was tracked only through session completion (target: no more than 10% of sessions skipped). The ESTP pilot checks…
• Version followed: Evolutionary Systems Therapy (EST) as developed by Simone Cheli and colleagues at Tages Onlus (Tages Charity Center for Psychology and Health, Florence). It is an individual talk therapy, and the only therapy known to be published under this exact name (see the scope note below). There are two published forms. The original is EST for Schizotypy (EST-S), tested in a pilot RCT (Cheli et al., 2023,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Rising scores or a crisis as the ending approaches; treat this as attachment material, not failure.
• Disengagement, and parents expecting reports. It is working if the young person attends and brings their own episodes.
• Fatalism ("it's in my genes") or intellectualising. It is working if self-blame eases and curiosity about the pattern grows.
• Mixed presentations; record secondary features rather than forcing a fit. It is working if the client adds to or corrects the formulation.
• Over-interpreting, which can feel intrusive to suspicious clients. It is working if ruptures repair faster and the client can talk about the relationship.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.