Schema Therapy

what is schema therapy?

Schema therapy is an approach for people who are experiencing long-standing emotional difficulties, such as struggling to manage emotions or experiencing relationship difficulties. Eating disorders or body image issues can often be used as a way of trying to manage these difficulties, by numbing the emotions or giving a sense of control or success in a different area of life. In these cases, just trying to get rid of the eating disorder/body image issue is often ineffective, and can even lead to the underlying problems worsening. Instead, schema therapy is designed to identify unhelpful patterns that may have developed in childhood and to find more helpful ways to cope with these.

Whilst schema therapy is based upon cognitive behaviour therapy (CBT), it focusses much more on early childhood experiences, integrating ideas from attachment theory, object relations theory and Gestalt psychology. The relationship between you and the therapist is seen as a key driving force in therapy.

Schema, coping styles and modes

Schemas (sometimes called “early maladaptive schemas”) are extremely stable, self-defeating themes or patterns that develop during childhood or adolescence and that we repeat throughout our lives. They consist of beliefs, feelings and memories about the self, others and the environment, which we accept without question. It is thought that schemas develop when childhood needs are not met.

When a person holds a negative schema about themselves, they then develop certain coping styles. These are strategies that have been developed to help the person cope with the schema and the distress that comes with them, and often seem useful at first (particualrly in childhood). However, the quickly become less helpful, often serving to maintain or worsen the problem.

Modes are emotional states that we all use from time to time. They can sometimes lie dormant for a long time, being activated by certain triggers. Sometimes people will stay in a more dominant state or mode for a period of time, whilst others may find then flip between modes much more quickly.

The boxes below explain these in more depth, including examples of the types of schema, coping styles or modes you may experience.

what does schema therapy involve

Schema therapy aims to show you how to get your emotional needs met in a healthy way.

Early sessions are used to identify core schema and draw links between these, your life history and your current problems. This will include completing questionnaires. Unhelpful coping styles are identified, and you will be encouraged to stop using them in order to get back in touch with the underlying feelings.

Subsequent sessions focus on finding different ways of managing these emotions, and developing different ways of relating to yourself and others. Techniques include traditional cognitive behavioural therapy techniques (such as thought challenging or behavioural experiments) and more experiential techniques such as imagery, letter writing and chair work. The experiential techniques help you access unmet emotional needs in the session, allowing you to experience having your needs met and validated by your therapist. This can both heal old wounds and strengthen the internal “healthy adult” so that you are more able to cope in the future. This process is sometimes referred to as ‘limited re-parenting’.

For more complex difficulties, schema mode therapy may be more helpful, enabling therapeutic work to be transdiagnostic rather than focused on specific symptoms.

Schema therapy tends to be longer in duration than CBT (it can be 18 months in duration or longer), but the number of sessions needed will depend on the difficulties experienced and the goals set.