Schema Therapy

What is schema therapy?

Schema therapy is a type of psychological talking therapy. It was originally developed to help people with long-term and complex psychological difficulties, who did not respond to other types of therapy. Schema therapy is perhaps most commonly used to help people with personality disorders such as borderline personality disorder.

More recently, schema therapy has been applied to a range of different mental health challenges and has been used in individual, couples and group therapy settings.

The aim of schema therapy is to help you become more aware of the unhelpful patterns of thinking and behaving that contribute to mental health difficulties, and learn how they developed. It can help you to identify your emotional needs and learn how to meet them through self-care and supportive relationships.

What schema therapy can help with

Schema therapy was initially used to help with symptoms of borderline personality disorder. Since then, it has been used with varying degrees of success to treat other mental health challenges, including:

Effectiveness of schema therapy work

Research shows that schema therapy is an effective treatment approach. Reviews of the research have found that schema therapy helps to reduce maladaptive (unhelpful) schemas and improve symptoms of personality disorders. (1,2)

Researchers have suggested that a decision to use schema therapy with other mental health challenges should be assessed on a case-by-case basis, as firm conclusions can not yet be made about its effectiveness (1). It shows promise for the treatment of PTSD, substance misuse, eating disorders, anxiety and depression, although more research is needed (2,3)

How schema therapy works

Schema therapy integrates elements from other therapy types, such as cognitive behavior therapy (CBT), interpersonal therapy and psychodynamic therapy to help people who’ve struggled with longer-term mental health challenges.

Schema therapists help people to change what they call early maladaptive schemas (EMS). These are negative beliefs we have about ourselves, others and the world that affect our daily experience and reactions.

An EMS is thought to develop from difficult experiences in childhood - like neglect, hostility, or another form of abuse, for example. They can be based on a combination of:

  • Memories
  • Emotions
  • Thoughts
  • Body sensations

We are thought to develop a coping style to deal with these difficult experiences, like fighting back or being avoidant, for example. These coping styles can be problematic, yet often remain with us as ways of coping in adulthood.

We are thought to encounter challenges when something in the present triggers one of these unhelpful EMS and coping styles.

Schema therapists focus on these EMS. They help you identify how they developed and how they contribute to and maintain your current difficulties. They then work with you, using a variety of techniques, to change your EMS and decrease unhelpful coping styles.

They help you to identify your emotional needs, and find ways to meet unmet needs. The aim is to help you to develop new, healthy schemas and ways of coping.

Frequency and length of schema therapy

The frequency of schema therapy sessions depends on individual circumstances. Typically, sessions are more frequent at the beginning of therapy - often on a regular weekly basis for the first six months. Towards the end of therapy, sessions tend to become less frequent. You may have regular monthly sessions for another six months or longer, for example.

Schema therapy can be a lengthy process. This is partially due to the longer-term and complex nature of difficulties that schema therapy is used to treat. You and your therapist will decide together when the appropriate time is to end therapy.

What happens in a typical schema therapy session

The content of each schema therapy sessions will vary depending on your point of progress in therapy.  

That said, therapy usually starts with the development of a trusting therapeutic relationship. Your therapist works with you to understand the challenges that bring you to therapy.

Together, you’ll work on identifying your underlying EMS and unhelpful coping strategies.

The therapist helps you change your beliefs on a deep level. They aim to create emotional experiences that can ‘correct’ or alter some of the unhelpful things you learned from your difficult early life experiences. Some examples of the strategies used to help achieve this include:

  • Limited reparenting: This is an interpersonal strategy, where the therapist helps to correct a difficult early life experience by meeting an unmet need of yours.
  • Chair-work: An experiential strategy where you speak to an empty chair as though you were speaking to a particular person, or re-enacting a scene from the past.
  • Roleplay: Another experiential strategy. For example, you might act out an imaginary dialogue with a caregiver who did not meet your needs as a child.
  • Imagery: Using your senses to explore a painful scene from the past where, for example, a need was unmet. You change aspects of the historical scene by asking for your needs to be met.
  • Challenging core beliefs: Like the strategies used in cognitive behavior therapy (CBT), this involves reasoning with the accuracy of your thoughts, examining the evidence for and against them, and building more helpful thought patterns.

What to look for in a therapist for schema therapy

The best-fitting type of therapist for you will depend on individual factors, symptoms, your location and finances. When looking for a schema therapist, it can be helpful to consider the following factors:

Current license

Look for a mental health professional with a current license. This ensures that your therapist has completed the appropriate level of education to practice. When browsing through therapists on Zencare, you can rest assured that our therapists have already been vetted.

Specialized training in schema therapy

Look for a therapist who has completed specialized training in schema therapy. The International Society of Schema Therapy provides accredited training that therapists can complete for certification.

Take a look at therapists’ biographies; this is often where they note their experience and specializations.

Potential for a strong relationship

Prioritize the potential for developing a strong working relationship between you and the therapist. This trusting relationship, called the “therapeutic alliance” can have a significant impact on the effect of therapy.

Finding the right therapist to develop a trusting relationship is particularly important in schema therapy. This is particularly so for those who have had difficult experiences during childhood that makes it hard for them to trust others.

Talk in advance

The best way to gauge how you might feel about your prospective therapist is to ask for a preliminary phone call. Most therapists will be happy to do so. This gives you the opportunity to ask about your therapist’s:

  • Schema therapy training
  • Experience with working with people with similar concerns to you
  • What therapy with them will be like
  • Schema therapy is usually longer-term, so be sure to discuss your therapist’s participation in insurance plans and cost of therapy

It’s a good idea to speak to a few different therapists before making your mind up.

References and sources