Approaches Schema Therapy

Schemas, coping styles and modes

A schema is a broad, enduring theme about yourself and your relationships. Young described eighteen early maladaptive schemas, which usually form in childhood or adolescence when a child's temperament meets experiences in which core emotional needs go unmet. A child who was often overlooked might grow up sensing that their feelings do not matter to others (emotional deprivation). Another schema, unrelenting standards, is a sense that nothing you do is ever enough. Young also described three coping styles. Someone who feels they are not good enough might surrender by accepting unfair criticism, avoid situations likely to bring up the feeling, or overcompensate by working long hours to prove themselves. Each style made sense when it developed, and in adult life it can keep the pattern going.

Modes describe the emotional state a person is in at a given moment and how they are coping with it. Child modes hold feelings such as hurt or loneliness that seem younger than the person's age, critic modes are quick to find fault, and coping modes protect, for example by switching feelings off. The Healthy Adult mode notices these states and responds with care and good judgement, and much of the therapy aims to strengthen it.

What sessions involve

Therapy begins with a careful assessment of your current difficulties, history and goals, sometimes including the Young Schema Questionnaire. From this, you and your psychologist develop a formulation (an account of which schemas and modes are most active, where they came from and what keeps them going) and agree a treatment plan. Later sessions add experiential work. In imagery rescripting, a memory linked to a familiar feeling is reworked in imagination, often with the psychologist stepping in, so that a younger self receives the care or protection that was missing. In chair work, you speak from the inner critic in one chair and from the Healthy Adult in another, which can make the critic easier to recognise and answer.

The therapy relationship plays an active part. Young used the term limited reparenting for the way a psychologist, within professional boundaries, offers some of the care and consistency a person missed earlier in life. For someone who grew up feeling unseen, this might mean the psychologist noticing and naming their feelings, then helping them learn to do this for themselves.

What the research shows

The strongest evidence comes from studies with people experiencing personality difficulties, including borderline personality disorder. In a well-known Dutch trial published in 2006, people with borderline personality disorder received up to three years of either Schema Therapy or another established psychotherapy. Both groups improved, with results favouring Schema Therapy. Later studies have tested group formats and other personality difficulties, and research is continuing.

Research on depression is more recent. A Christchurch trial published in 2013 offered 100 adults with depression a year of either Schema Therapy or CBT, and both groups improved by a broadly similar amount.

Who it tends to suit

Schema Therapy is often considered when difficulties have lasted a long time or keep returning, and for people curious about how early experiences connect with how they feel now. Because it explores the past and can bring up strong emotion, it usually suits people with some stability in daily life who can attend regular sessions over many months. For someone in crisis, or who wants practical coping skills first, CBT or DBT skills may be a better starting point, with schema ideas added later.