Schema Therapy, pioneered by Jeffrey Young in the 1990s, is a talk therapy that combines elements of cognitive behavioural therapy, gestalt therapy, and attachment theory, among others. It was originally developed to support people with long-standing patterns, including those given a personality disorder diagnosis, particularly borderline personality disorder. The goal of schema therapy is to help people identify and understand their early maladaptive schemas, the model's term for patterns that formed to help us cope as children but now get in the way. Schemas often take shape when core emotional needs are not met in childhood. When they are triggered, they can set off ways of coping that end up hurting ourselves or getting in the way of other people's needs.
Schema Therapy was specifically designed for people who haven't found other therapies helpful, or whose difficulties have come back after earlier therapy.
In Schema therapy, the therapist and client work together to identify and understand the client's schemas, often with the help of a schema questionnaire. Sessions then use a combination of talk therapy, cognitive therapy, and behavioural techniques to change unhelpful ways of coping. Schema therapy aims to help people strengthen a healthy adult mode, where their emotional states and coping responses are more balanced and less likely to trigger the schema. Support for schema therapy, particularly for people with a borderline personality disorder diagnosis, includes a trial comparing schema-focused therapy with transference-focused psychotherapy.
The International Society of Schema Therapy recognises 18 schemas, divided into five schema domains. Schemas become a problem when they lead to unhelpful coping styles, such as surrendering to the schema, overcompensating, or avoiding it. Schema therapy includes techniques to heal schemas by reducing the intensity of the schema and the emotional memories that make it up. Different schemas and coping styles may call for different therapeutic techniques. Ultimately, schema therapy is about helping people meet their core emotional needs in a healthier way, without having to fall back on ways of coping that no longer help.
Schema therapy is often used to support people with:
In the context of Schema Therapy, the core needs of a child are fundamental emotional and psychological necessities that need to be met for healthy development and emotional wellbeing. These needs are central to understanding Schema Theory, as needs that went unmet, or only partly met, in childhood can lead to schemas forming. Schemas can carry on into adulthood and set off unhelpful coping styles that cause distress and make life harder.
When these needs are not met, children may develop schemas that later lead them to react strongly to hard things in life, in ways that end up hurting themselves or getting in the way of other people's needs. The goal of schema therapy is to help people understand these schemas and, through the therapy relationship, learn healthier ways of having their core emotional needs met. Over time this loosens the hold schemas have and makes room for more helpful ways of coping.
Schema domains are broad categories that group the 18 schemas. These domains provide a framework for understanding how unmet emotional needs in childhood can lead to schemas and unhelpful coping styles in adulthood. The five schema domains are:
This domain relates to the expectation that one's needs for security, safety, stability, nurturance, empathy, sharing of feelings, acceptance, and respect will not be met in a consistent or predictable manner. Schemas in this domain can lead to feelings of isolation, instability, and a lack of self-worth.
This domain reflects beliefs that you can't cope or manage on your own, which can lead to relying heavily on others, feeling vulnerable to harm or getting sick, and a sense of failure.
This domain involves difficulty setting internal limits, respecting others' boundaries, and thinking through the consequences of one's actions. It can show up as a sense of entitlement, or finding self-discipline and self-control hard.
This domain centres on a strong focus on the desires, feelings, and responses of others at the expense of one's own needs. This can lead to an unclear sense of self and relationships that feel one-sided.
This domain reflects a focus on suppressing one's feelings, impulses, and preferences to avoid making mistakes, maintain control, or meet high internalised standards of behaviour. This can result in finding it hard to be flexible, perfectionism, and missing out on positive experiences.
The goal of schema therapy is to help people identify their schemas within these domains and work towards healthier ways of meeting their core emotional needs. This involves using various techniques to change unhelpful coping styles, heal schemas, and ultimately live a more fulfilling and balanced life.
Schemas can lead to certain coping styles, which are strategies people use to try to protect themselves from the intense emotions they feel when their schemas are triggered. The three main coping styles are surrender, avoidance, and overcompensation. These made sense when they first formed and can bring short-term relief, but they tend to reinforce the schemas and lead to more distress over time.
This coping style involves giving in to the schema. Instead of challenging or trying to change the schema, people act in ways that keep it going. For example, someone with an abandonment schema might stay in relationships that hurt them, fearing that being alone is worse.
This coping style involves going to great lengths to avoid situations or stimuli that might trigger their schemas. This can take many forms, including physical avoidance, psychological avoidance, and numbing one's feelings. For example, someone with a mistrust/abuse schema might avoid intimate relationships altogether to prevent potential hurt.
This coping style involves acting in ways that are completely opposite to what their schemas would predict. They are, in effect, going overboard in their efforts to prevent the schema from being triggered. For example, a person with a defectiveness/shame schema might become very perfectionistic and set unrealistically high standards for themselves to avoid feelings of shame and worthlessness.
Schema modes are moment-to-moment emotional states and coping responses that we all experience. Many schema modes lead us to react strongly or act in ways that end up hurting ourselves or not meeting the needs of others. These modes are triggered by life situations that we perceive as threatening or challenging, particularly when they resemble situations from our past that were associated with unmet emotional needs.
Schema modes are categorised into four main types.
These reflect the emotional states and reactions that we experienced during childhood when our basic emotional needs were not met. They include the vulnerable child mode (feeling sad, lonely, or abandoned), the angry child mode (feeling angry, frustrated, or impatient), and the impulsive/undisciplined child mode (acting on impulses or desires without considering consequences).
These are ways of coping that we learned in childhood to survive difficult experiences, and that can get in the way later in life. They include surrender (giving in to the schema), avoidance (avoiding situations that trigger schemas), and overcompensation (behaving in ways that oppose the schema).
These reflect the internalised voices of critical or demanding parents. They can be punitive (punishing oneself for doing things wrong) or demanding (pressuring oneself to meet high standards).
This mode is the ultimate goal of schema therapy. It represents a state in which a person's emotional needs are being met in a balanced way, without having to fall back on old coping modes.
Schema therapy aims to help people strengthen their healthy adult mode to meet their core emotional needs and heal schemas by reducing the intensity of the schema and the emotional memories comprising the schema.
The goal of schema therapy is to help people meet their core emotional needs (listed above) that were not met in childhood.
The primary goal of Schema Therapy is to help people identify, challenge, and change their schemas and the coping styles that go with them, which often come from unmet core emotional needs in childhood. This form of therapy aims to reduce the distress and self-defeating patterns that come from these schemas and to build healthier ways of having emotional needs met.
A central objective of this therapy is to strengthen the 'Healthy Adult Mode'. This means helping the client develop skills and behaviours that allow them to get their needs met in healthier ways. This includes learning to set and maintain personal boundaries, assertively express and meet emotional needs, tolerate distress and frustration, and engage in self-care.
Another significant goal of schema therapy is to help people heal their 'Child Modes'. This involves identifying and accessing the vulnerable, angry or impulsive child modes, and providing the safety, acceptance, and nurturing that was lacking in their childhood.
In addition, schema therapy works to reduce the influence of 'Inner Critic (Parent) Modes', which are often internalised from critical or demanding parents and can lead to self-punishment or high self-expectations.
Schema therapy also aims to reduce reliance on unhelpful coping modes, which can involve surrender, avoidance, or overcompensation, and to build healthier ways of coping.
Schema therapy uses a variety of therapeutic techniques drawn from cognitive, behavioural, emotive, and interpersonal therapies. These techniques are used to identify, challenge, and change schemas and unhelpful coping styles, ultimately aiming to meet the client's core emotional needs in healthier ways.
These techniques aim to access and change the emotional memories associated with schemas. They can include imagery rescripting, where the client visualises a past distressing event and then imagines it with a more positive outcome, and chair work, where the client has a dialogue with different aspects of themselves (e.g., their vulnerable child mode and healthy adult mode) to elicit and process emotions.
These focus on the relationship between the client and the therapist, using it as a model for healthier relationships. Techniques may include limited reparenting, where the therapist provides the support, validation, and care that the client missed out on in their childhood, and empathic confrontation, where the therapist gently but assertively challenges the client's unhelpful behaviours and attitudes.
These involve helping the client identify and understand their schemas, and then challenge the beliefs and assumptions associated with them. This could involve cognitive restructuring, where the therapist helps the client challenge and change unhelpful thoughts and beliefs, and psychoeducation, where the therapist shares information about schemas and their impact.
These are used to help people change the behaviours associated with their schemas and coping styles. This could involve role-playing, in which the client and therapist act out scenarios to practise new behaviours, and behavioural experiments, where the client tests out new behaviours in real-life situations and then discusses the outcomes with the therapist.
These techniques are flexibly applied based on the client's needs and the schemas and coping styles at play, making schema therapy a highly individualised form of therapy.
While Schema Therapy has research support for people with personality disorder diagnoses and other long-standing difficulties, it does have several limitations:
Schema Therapy is typically a long-term therapy, taking several months to years. This may not be suitable or feasible for everyone, particularly those who cannot commit to regular, long-term therapy due to time constraints or financial limitations.
The process of revisiting and working through past traumas and emotional memories can be distressing and emotionally intense for some people. It works best when you feel ready, and your therapist will pace it with you.
While there is growing evidence supporting the effectiveness of schema therapy, particularly for people with a borderline personality disorder diagnosis, more research is needed on how well it works for other difficulties and groups of people.
Schema Therapy requires therapists to have specialised training and skills to effectively apply its techniques and strategies. Not all therapists may have these skills or be able to provide this type of therapy.
The limited reparenting component of schema therapy, where the therapist provides the nurturing, validation, and care that the client missed out on in childhood, may potentially lead to a dependence on the therapist. While this is managed within the model, it requires careful navigation by the therapist.
Schema Therapy may not be the right fit during psychosis, mania, or a crisis. A thorough assessment helps work out the most appropriate type of therapy for each person.
If you're considering schema therapy, the first step is to find a trained and experienced schema therapist. Once you've found a potential therapist, you should schedule an initial consultation to discuss your needs and ascertain whether schema therapy might be a good fit for you.
During the initial consultation, the therapist will likely conduct a thorough assessment. This includes understanding your current concerns, history, and the patterns you've noticed in your life. They may also use tools like the Young Schema Questionnaire, which is designed to identify your schemas.
Following the assessment, the therapist will provide you with feedback and discuss whether schema therapy is the best approach for you. If you both agree to proceed with schema therapy, you and your therapist will outline a therapy plan. This typically involves regular therapy sessions where you'll work on identifying and changing your schemas and coping styles.
Schema therapy is often a long-term commitment, and it's worth knowing it can take time. It can be emotionally intense, as it involves exploring past traumas and deep-seated patterns. With a qualified therapist, schema therapy can help many people make meaningful changes in their emotional wellbeing and relationships.
If at any point you feel that schema therapy is not working for you, it's important to talk about this with your therapist. They can adjust your therapy plan, try different techniques, or recommend other types of therapy that may suit you better. The key is to stay open and communicative with your therapist throughout the process.
The Psych Collective has a range of clear, easy-to-understand videos on YouTube explaining schema therapy. Below are two good videos to start with.
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