Schema Therapy

Schema therapy (also known as schema-focused therapy) is a type of talk therapy that aims to help you change unhealthy patterns of thinking and behavior. These patterns are deeply ingrained and affect how you interact with others.

To better understand this therapy, it helps to know what a schema is. In psychology, a schema is a long-lasting outlook or assumption that you have about yourself, others or the world. Negative schemas tend to develop from negative experiences. If they’re based in childhood, they’re also called maladaptive early schemas.

Some maladaptive schemas include:

• “I’m a failure.”
• “People are out to get me.”
• “I must manage others’ feelings before my own.”
• “Bad things will happen that I can’t prevent.”
• “I am entitled to special rights.”
• “I am not worthy of others’ love.”

These core beliefs lead to unhealthy coping responses throughout your life. For example, you may have excessive avoidance, dependence or self-sacrifice. Or you may overcompensate.

Psychologists most commonly use schema therapy to treat personality disorders, especially borderline personality disorder. Research is ongoing, but it may also help treat other mental health conditions, like eating disorders, depression and panic disorders.

What happens during this treatment?

The goal of schema therapy is to understand and meet your core emotional needs. In most cases, these are needs that weren’t met in childhood. You’ll learn to detect and manage your automatic thought patterns, emotions and impulses. This can help prevent extreme thoughts and behaviors.

You’ll work very closely with a licensed clinical therapist who specializes in schema therapy. A close therapist-client relationship is key to this treatment. So, it’s important that you feel comfortable with your therapist and trust them.

In general, schema therapy involves deep self-reflection. Your therapist will help you understand how your views may not match reality, offer advice and suggest new behaviors.

You’ll learn how to:

• Identify your schemas and coping styles.
• Heal negative schemas with reparenting, both via your therapist and strategies outside of the sessions.
• Cope with emotions and relationships in healthy ways.

Schema therapy combines techniques of:

• Cognitive behavioral therapy (CBT), like understanding and addressing unhelpful thinking and behavioral patterns
• Gestalt therapy, like how to address thoughts and emotions in the moment
• Psychoanalysis, like gaining self-awareness of hidden thoughts and emotions
• Imagery rescripting, which involves reframing negative memories
• Chairwork, which involves having conversations with aspects of yourself, like a maladaptive schema or coping style

How long will I need this treatment?

Schema therapy is typically a long-term treatment. Most people with personality disorders require at least a year of this therapy. But it could take longer.

You may have sessions once or twice a week or every other week. It may be one-on-one with your therapist or in a group setting. Speak with your therapist about what to expect.

Benefits and risks

Schema therapy is a newer type of therapy. So, it isn’t as well studied as other forms of talk therapy, like CBT. But several studies on the use of schema therapy in the treatment of borderline personality disorder (BPD) specifically found that it:

• Reduces symptom severity
• Supports daily functioning
• Increases quality of life

Also, people with BPD are more likely to continue schema therapy treatment compared to other types of talk therapy.

You may experience intense emotional distress during schema therapy. This is because you may address previous trauma and other negative memories. It can be difficult, but it’s part of the process. Your therapist can help you through it.

Other potential cons of schema therapy include:

• How long it takes, which may also make it expensive
• An increased risk of becoming emotionally dependent on your therapist (compared to other types of therapy)

When should I call my healthcare provider?

It’s normal to feel uncomfortable during schema therapy. It can be painful to explore negative emotions and fears. If your symptoms get worse, contact your healthcare provider right away.

Get help immediately if you’re having suicidal thoughts. You can call the U.S. National Suicide Prevention Lifeline, now known as the 988 Suicide & Crisis Lifeline, 24/7.