About Schema Therapy
Schema Therapy is an integrative psychotherapy approach that combines elements from Cognitive Behavioral Therapy (CBT), attachment theory, Gestalt therapy, object relations theory, and psychoanalytic schools. Schema Therapy was developed by Jeffrey E. Young.
It is an approach designed to help individuals understand and heal long-standing schemas that originate in childhood. While initially developed to treat personality disorders, individuals dealing with unclear, chronic, and pervasive life problems, Schema Therapy has since been applied to a wide range of psychological issues, including anxiety, depression, trauma, relationship difficulties, etc.
Schema therapy places a stronger emphasis on exploring childhood and adolescence, as psychological issues are often rooted in these early life periods.
The core concepts of schema therapy include early maladaptive schemas, maladaptive coping styles, schema modes, and core universal emotional needs.
Early Maladaptive Schemas
Early maladaptive schemas are deeply ingrained self-defeating, core themes or patterns that shape how we perceive ourselves, our relationships, and the world. These schemas consist of memories, emotions, bodily sensations, and thoughts. They usually develop during early childhood and contribute to a person’s vulnerability to various psychological disorders.
Schemas develop in childhood from an interplay between the child's innate temperament, and the child's ongoing negative experiences with its environment. Because they begin early in life, schemas become familiar and thus comfortable. We distort our view of the events in our lives in order to maintain the validity of our schemas. Schemas may remain dormant until they are activated by situations relevant to that particular schema.
Schemas arise when basic emotional needs in childhood are unmet. These emotional needs include:
1. Secure attachment
2. Autonomy, competence and sense of identity
3. Freedom to express feelings, thoughts and needs
4. Spontaneity and play
5. Realistic limits and self-control
These needs are universal—we all have them.
Even though schemas often lead to suffering, people are unconsciously drawn to situations and individuals that "trigger" their schemas. This makes them difficult to change.
Schemas are viewed on a continuum. Not everyone has the same schemas at the same intensity. The stronger a schema, the more situations it will be activated by. Importantly, a schema doesn't have to be active all the time—it is triggered by specific situations.
There are 18 early maladaptive schemas, including: Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame, Social Isolation/Alienation, Dependence/Incompetence, Vulnerability to Harm or Illness, Enmeshment/Undeveloped Self, Failure, Entitlement/Grandiosity, Insufficient Self-Control, Subjugation, Self-Sacrifice, Approval-Seeking/Recognition-Seeking, Negativity/Pessimism, Emotional Inhibition, Unrelenting Standards/Hyper-Criticism, and Punitiveness.
These schemas are grouped into five domains: Disconnection and Rejection, Impaired Autonomy and Performance, Impaired Limits, Other-Directedness, and Over-vigilance and Inhibition.
Young identified 18 early maladaptive schemas, which can be categorized into five broad domains:
Disconnection and Rejection:
This theme relates to the belief that one's essential needs for security, stability, acceptance, empathy, and respect will be inconsistently met. Common family dynamics associated with this belief might include coldness, rejection, unpredictability, or even abuse.
1. Abandonment/Instability - Fear that loved ones will leave or be unreliable
A pervasive sense that close relationships are unreliable or unstable, leading to fears that emotional support or protection will not be maintained. This might stem from others being emotionally volatile, physically absent, or inclined to leave for someone perceived as better.
2. Mistrust/Abuse - Expectation of harm or betrayal from others
An expectation that others will cause harm, through actions like lying, manipulating, or taking advantage. This belief often involves the idea that such harm is intentional or results from severe negligence.
3. Emotional Deprivation - Feeling deprived of nurturance, empathy, or protection
The expectation that one's need for emotional care and support will not be adequately fulfilled.
4. Defectiveness/Shame - Belief of being fundamentally flawed or unlovable
The belief that one is flawed, unlovable, or fundamentally inferior. Individuals may feel hypersensitive to criticism, rejection, or judgment due to perceived internal or external flaws.
5. Social Isolation/Alienation - Feeling different from others and isolated
A feeling of being disconnected from others or fundamentally different from those around them, resulting in a sense of not belonging.
Impaired Autonomy and Performance:
This theme revolves around beliefs that hinder an individual’s ability to function independently or succeed. These individuals may have experienced overly controlling or undermining environments growing up.
6. Dependence/Incompetence - Feeling incapable of taking care of oneself
A belief that one cannot manage daily responsibilities without substantial help from others. This may manifest as feelings of helplessness.
7. Vulnerability to Harm or Illness - Fear of imminent catastrophe or illness
A heightened fear of impending disaster, such as medical crises, emotional breakdowns, or external dangers, and the belief that one will be powerless to prevent them.
8. Enmeshment/Undeveloped Self - Feeling overly close to others, leading to a lack of independence
Excessive emotional closeness with significant others, to the point where personal identity and independence are compromised. This might include feelings of being overly dependent on others for survival or happiness.
9. Failure - Belief that one will inevitably fail in achieving success
A deeply held belief that one is inadequate or destined to fail, particularly in comparison to peers. This often manifests as feelings of incompetence in areas such as education, career, or personal achievements.
Impaired Limits:
These beliefs involve a lack of internal regulation and difficulty balancing personal needs with long-term goals or responsibilities, often linked to permissive or overindulgent environments during childhood.
10. Entitlement/Grandiosity - Feeling superior and entitled to special treatment
A sense of superiority or entitlement to special privileges or rights, coupled with disregard for social norms or the needs of others. This may involve a focus on power, control, or domination without empathy.
11. Insufficient Self-Control/Self-Discipline - Difficulty controlling impulses and emotions
An ongoing struggle to exercise restraint or tolerate frustration in pursuit of goals, resulting in avoidance of discomfort or conflict and a lack of personal fulfillment.
Other-directedness:
This theme relates to an excessive focus on fulfilling the needs and expectations of others at the expense of one’s own desires, often in pursuit of approval or connection.
12. Subjugation - Prioritizing others’ needs over one’s own due to fear of punishment or abandonment
A tendency to surrender control to others, suppressing personal desires and emotions (especially anger) to avoid conflict or abandonment. This often leads to feelings of resentment or passive-aggressive behavior.
13. Self-Sacrifice - Excessive focus on others’ needs at the expense of one’s own
An excessive focus on meeting the needs of others, frequently at one’s own expense, often to avoid guilt or to maintain close relationships with those perceived as needy.
14. Approval-Seeking/Recognition-Seeking - Excessive focus on gaining approval or recognition from others
An overemphasis on gaining approval or recognition from others, leading to decisions that may feel inauthentic or unsatisfying in the long run.
Overvigilance and Inhibition:
This theme involves a strict focus on suppressing emotions or impulses, often driven by internalized rules and fear of failure or disapproval. It can result in a lack of joy, self-expression, or connection with others.
15. Negativity/Pessimism - Persistent focus on the negative aspects of life
A habitual focus on negative outcomes, with an exaggerated sense that things will go wrong, leading to chronic worry and an inability to fully enjoy positive aspects of life.
16. Emotional Inhibition - Suppressing emotional expression and spontaneity
A tendency to suppress spontaneous emotional reactions or avoid sharing feelings to prevent disapproval or losing control. This may include holding back positive emotions or failing to communicate vulnerabilities.
17. Unrelenting Standards/Hypercriticalness - Striving for perfectionism and imposing excessively high standards
An internal pressure to meet high standards, often to avoid criticism or feelings of inadequacy. This can lead to perfectionism, self-criticism, and difficulty relaxing or enjoying accomplishments.
18. Punitiveness - Belief that people should be harshly punished for mistakes
A belief that mistakes should be harshly punished, often accompanied by anger, intolerance, and difficulty forgiving oneself or others.
Maladaptive Coping Styles
To cope with these schemas, people develop maladaptive coping styles to avoid the overwhelming emotions that schemas tend to cause. While these coping mechanisms help individuals avoid the schema, they don’t heal it; rather, they reinforce it. As mentioned earlier, schemas are composed of memories, emotions, bodily sensations, and thoughts, but behaviors are not part of the schema. Behavior is part of the coping style, and the schema triggers that behavior.
People may develop different maladaptive coping styles at different stages of their lives or in different situations to deal with the same schemas.
The three types of maladaptive coping styles are surrendering to the schema, avoiding the schema, and overcompensating the schema.
Schema Modes
Modes are moment-to-moment emotional states that reflect how we react in various situations. In schema therapy, we differentiate between 10 basic schema modes, although their names can be adapted based on agreements with clients. The 10 modes are divided into four categories: Child Modes, Coping Modes, Dysfunctional Parent Modes, and the Healthy Adult Mode. The Child Modes include the Vulnerable Child, Angry Child, Impulsive Child, and Happy Child. The Coping Modes include the Overcompensator, Compliant Surrenderer, and Detached Protector. Dysfunctional Parent Modes include the Punitive Parent and Critical/Demanding Parent. Finally, the Healthy Adult is a stand-alone mode in the fourth category.
Healing Schemas
The primary goal of schema therapy is to heal schemas. Since schemas are made up of memories, emotions, bodily sensations, and thoughts, schema healing involves reducing the intensity of memories associated with schemas, as well as the strength of emotions, bodily sensations, maladaptive thoughts, and behaviors linked to them. With therapy, schemas are weakened, making them harder to trigger. Even when they are triggered, the emotional response is less intense, and the individual recovers more quickly.
Phases of Schema Therapy
Schema therapy has two phases: the Assessment and Education Phase, and the Change Phase. During the first phase, the therapist helps the client identify their schemas and understand how they developed in childhood or adolescence, linking them to current issues. In the change phase, the therapist applies cognitive, experiential, behavioral, and interpersonal strategies to help the client weaken the schema and replace maladaptive coping styles with healthier behaviors.
Cognitive, Experiential, and Behavioral Techniques
As long as an individual believes their schemas are valid, no change will occur. Therefore, cognitive techniques are used to help the individual evaluate the validity of their schemas, weighing the evidence for and against them. Experiential techniques include imagery exercises, chair work, and role-playing. Behavioral techniques involve practicing new, adaptive behaviors—first in sessions through imagery and role-play, and then in real-life situations.
Therapeutic Relationship
The therapeutic relationship is crucial in schema therapy. The client internalizes the therapist’s “Healthy Adult,” which helps combat schemas and leads to a more emotionally fulfilling life.
Two key aspects of the therapeutic relationship are empathetic confrontation and limited reparenting. Empathetic confrontation involves the therapist empathizing with the client while also challenging their schemas. The therapist acknowledges the reasons behind the schema and the difficulty in changing it, while simultaneously emphasizing the importance of change. Limited reparenting involves the therapist meeting the unmet emotional needs of the client in a way that respects therapeutic boundaries, fulfilling the role that the client’s parents may have failed to provide during childhood
Young, J. E., & Klosko, J. S. (1994). Reinventing Your Life: The Breakthrough Program to End Negative Behavior and Feel Great Again. Plume.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner's Guide. Guilford Press.
Mirović, T. (2015). Schema therapy, in Cognitive-behavioral therapies today (development and changes), Institute of Psychology, Faculty of Philosophy, University of Belgrade, 101-124.