What is Schema Therapy?
What is schema therapy?
Schema therapy is an integrative form of psychotherapy developed by Jeffrey Young. The therapy focuses on persistent patterns in thinking, feeling, and behaving, often caused by unfulfilled basic emotional needs in childhood.
Schema therapy is based on three pillars:
1. The language of modes, schemas, and basic needs
Schema therapy works with the idea that every person has fundamental emotional needs. If these are not sufficiently met in childhood, negative beliefs (schemas) can develop, such as “I am not important” or “others cannot be trusted.”
When such schemas are activated, moods arise—called modes—that determine behavior and feelings in that moment.
There are four types of modes:
- Child modes: Emotional pain from the past comes to the surface.
- Coping modes: Survival strategies to avoid feeling pain (such as avoidance or pleasing).
- Critical modes: Internal critical voices that arise from negative childhood experiences.
- Healthy Adult: The side that provides self-care, sets boundaries, and makes healthy choices.
Therapy focuses on strengthening this Healthy Adult and restoring contact with suppressed feelings and needs.
2. The therapeutic relationship: limited reparenting
Schema therapy uses a warm, engaged therapeutic relationship. The therapist acts as a ‘healthy parent’ within professional boundaries and offers the client new experiences that can help heal old pain. This is also known as limited reparenting. The therapist personally addresses the client’s unmet needs, for example by offering protection or support in imagination exercises.
3. Integration of cognitive, behavioral, and emotion-focused techniques
Schema therapy combines insights from different forms of therapy. The emotion-focused techniques in particular make the therapy powerful. These include, for example:
- Imagery rescripting: meaningful memories are relived and positively adjusted.
- Chairwork: internal conflicts are made clear and experienced.
These techniques help clients not only to understand what drives them, but also to feel what they have missed and still need.
Treatment goals
The treatment aims to:
- Recognize and fulfill the needs of the Child;
- Reduce the Critical Sides (inner voice that judges, rejects, or demands);
- Make coping strategies such as avoidance or inversion less necessary;
- Strengthen the Healthy Adult so that the client can take charge of dealing with emotions, relationships, and choices.
Phases of therapy
The treatment has a clear structure consisting of three phases:
1. Initial phase
Focus on getting acquainted with the model, understanding schemas and modes, and gaining initial emotional experiences with techniques such as imagination and chair work.
2. Middle phase
The client actively learns to try out new behaviors, strengthen the Healthy Adult, and take more control of their daily life. The therapist provides support in this process as a coach.
3. Final phase
The client independently applies the insights they have learned in their daily life, makes important choices, and takes sustainable steps toward recovery. The therapist provides support from the sidelines.
Effectiveness of schema therapy
Schema therapy has proven itself over the past decades as a powerful and effective form of treatment, particularly for personality disorders. Research shows that schema therapy in an individual setting is particularly effective in the treatment of borderline personality disorder (Giesen-Bloo et al., 2006; Nadort et al., 2009). Strong results have also been found for this target group in group settings (Arntz et al., 2023).
In addition, research shows that schema therapy is effective for clients with cluster C personality disorders (Bamelis et al., 2014) and depressive disorders (Renner et al., 2016). Furthermore, there are promising indications that schema therapy can also be used for therapy-resistant anxiety and obsessive-compulsive disorders (Woelk et al., submitted) and eating disorders (Simpson et al., 2010).