Schema therapy explained

When your past experiences, old traumas, and negative self-beliefs continue to influence the present, life can feel more difficult than it needs to be. Left unaddressed, these patterns and stuck points can affect your wellbeing and keep you stuck in cycles of frustration and pain. 

Schema therapy takes a closer look at those patterns and offers a way to change them. In this article, you’ll find a clear explanation of schema therapy and how it may fit your situation or the needs of someone you love.

What is schema therapy?

Schema therapy is a psychotherapy developed by psychologist Jeffrey Young. It’s designed to address long-standing emotional and psychological difficulties, making it somehow similar or related to cognitive-behavioral therapy (CBT) and Internal Family Systems (IFS) therapy. 

CBT focuses on changing unhelpful thoughts and behaviours in the present, while schema therapy goes deeper and addresses the core patterns and unmet needs that began in childhood. And compared to IFS therapy, which works with different “parts” of the self, schema therapy places more emphasis on schemas and modes, which are recurring themes and emotional states that shape how we see ourselves and others.

Over the years, schema therapy has been used to treat personality disorders, although different studies have shown its potential to help with other mental health conditions too.

Core principles of schema therapy

At its core, schema therapy focuses on what are known as “schemas,” which are our belief systems. These often begin in childhood as we learn from the people and environments around us. As adults, they act as building blocks for how we understand ourselves and others, and the situations we regularly face.

In psychology, some schemas are helpful while others can become problematic. These are known as maladaptive schemas. They usually form as a result of childhood emotional neglect, when a child’s basic needs for safety, love, or clear boundaries weren’t consistently met. They can turn into long-standing beliefs and behaviours that negatively shape relationships, attachment styles, and self-esteem. In schema therapy, the focus is on identifying and changing these maladaptive schemas.

Schema therapy also looks at what are called “schema modes.” These are our moment-to-moment emotional states and coping responses when maladaptive schemas are triggered. Understanding both maladaptive schemas and schema modes helps make sense of why we react the way we do, and it provides a clearer path toward change.

Understanding common early maladaptive schemas

A key part of schema therapy is recognising what are called early maladaptive schemas, or EMS. These are the patterns of thought and behaviour that often begin in childhood and continue into adulthood.

In schema therapy, there are 18 identified early maladaptive schemas. To make them easier to understand, they’re grouped into five broad schema domains:

• Disconnection and rejection - includes schemas like emotional deprivation, abandonment, mistrust, social isolation, and feelings of defectiveness or shame.

• Impaired autonomy and performance - covers schemas such as failure, dependence, vulnerability to harm, and enmeshment.

• Impaired limits - includes entitlement and insufficient self-control.

• Other-directedness - relates to putting others’ needs above your own, with schemas like subjugation, self-sacrifice, and approval-seeking.

• Over-vigilance and inhibition - includes schemas like emotional inhibition, unrelenting standards, negativity, and punitiveness.

Not everyone will relate to all of these schemas, but many people will recognise themselves in at least a few. 

Understanding schema modes

Schema therapy also works with what are called schema modes. Directly linked to early maladaptive schemas, a schema mode is a momentary state of mind that becomes active often when a difficult memory or situation triggers old patterns. 

For example, someone who grew up feeling abandoned might go on a full vulnerable child mode when someone cancels plans, experiencing intense sadness and fear even if the situation is minor. These reactions are often seen in people with an anxious-avoidant attachment style. Over time, they can become recurring patterns that affect relationships and day-to-day life.

Psychologist Jeffrey Young recognised 14 schema modes, which are grouped into four categories:

• Child modes - these represent emotional states connected to your unmet needs in childhood. These can include the vulnerable child mode mentioned earlier, as well as angry child or impulsive or undisciplined child mode.

• Coping modes - they involve unhelpful strategies people use to avoid or manage distress. For example, shutting down emotionally when they’re in their detached protector mode, or overcompensating when in overcompensator mode.

• Parent modes - they are the so-called critical or demanding inner voices, such as the punitive parent mode, which judges and shames, or the demanding parent mode, which pressures you to meet unrealistically high standards.

• Healthy adult mode - this reflects the balanced state that supports wellbeing and helps manage the other modes.

Some schema modes are adaptive, like the healthy adult and happy child, while others are maladaptive and contribute to ongoing difficulties. 

Who can benefit from schema therapy?

Schema therapy is known to be effective for people with personality disorders. But apart from that, experts have also explored schema therapy in a range of other conditions.

Case studies and treatment reports suggest it may help deal with substance use, eating disorders, post-traumatic stress disorder, grief, and obsessive-compulsive disorder. There’s growing evidence that it could support people experiencing anxiety and depression as well.

That said, the current research base is limited, and more studies are needed to fully understand how effective schema therapy is in the long term. For now, experts generally see it as a promising approach, though not yet 100% proven for every situation.

How does schema therapy work?

A schema therapy session is considered a longer-term therapy approach. It often requires at least 10 to 15 sessions, and each session can take several hours. The actual time frame can be longer for more severe medical conditions. 

The process may differ between therapists, but usually, it includes case conceptualisation and mode mapping to have an accurate understanding of you and your problems. A case conceptualisation is basically a clear outline of how your schemas and coping styles connect to the issues you’re facing. Then, they’ll often put together a mode map, which shows the main emotional states and patterns that come up for you in everyday life. 

From there, they’ll help you build the healthier parts of you. Therapists often have different strategies, depending on what fits you best. Some will use experiential methods, like chair dialogues where you explore different sides of yourself. Some will also use guided imagery, so you can safely revisit past experiences of trauma or grief and resolve them. 

Another popular strategy therapists usually use is limited reparenting. Here, they offer a supportive relationship to help meet needs that weren’t fulfilled earlier in your life, and somehow help you heal your early childhood trauma.

Taking the first step with schema therapy

Schema therapy provides a deeper understanding of the patterns that shape your thoughts, emotions, and relationships. By identifying and working through early maladaptive schemas and the modes they activate, this approach helps build healthier ways of relating to yourself and others. 

If you think that this therapy is right for you, Talked can help you connect with therapists trained in schema therapy.

Even better, you have access to free and unlimited 15-minute consultations here on Talked, so you can speak with as many therapists as you like until you find the one who feels like the best fit for you.