Is schema therapy something for me?
When I suggest schema therapy, clients often look a little confused. Some think they've misheard me, and a few have questioned my pronunciation. So here it is, in a nutshell.
I'm a big supporter of this way of working. Schema therapy is often described as a third-wave CBT approach. It was developed by Jeffrey Young for people whose difficulties didn't shift with standard cognitive therapy, and it brings together CBT, attachment theory, gestalt and psychodynamic ideas. Most importantly, it works with feelings as much as with thoughts. I believe almost everyone can benefit from it.
What is a schema?
A schema is a belief and a feeling at the same time. Say you carry a defectiveness schema. The thought that comes with it is "I am inadequate", and the feeling is shame. It doesn't feel like an opinion about yourself. It feels like the truth.
Schemas form in childhood when core emotional needs go unmet: the need for safe attachment, for autonomy, for being free to express what you feel and need, for play, and for realistic limits. Jeffrey Young described 18 of these early maladaptive schemas, among them abandonment, mistrust, emotional deprivation, defectiveness, failure, subjugation and unrelenting standards. Most of us have a handful that get triggered again and again, usually in our closest relationships.
In therapy we also look at modes, the state you're in at a given moment. When a schema is triggered you might find yourself in a Vulnerable Child mode, flooded with old feelings, or in a coping mode: giving in, shutting down or fighting back. Or you hear a harsh critic voice. The aim of the work is to grow your Healthy Adult, the part of you that can notice all of this and look after what you actually need. I've written more about the child and coping modes in Why talking about the trauma isn't enough.
If you'd like a quick taste, this short animation, What is Schema Therapy?, explains the idea nicely. I'm not affiliated with it.
Who is schema therapy for?
Schema therapy was originally developed for personality disorders and more severe clinical difficulties, and that's how the video presents it too. Its strongest research base is still with borderline personality disorder. But I truly believe it helps anyone who wants to break long-standing patterns, especially in relationships, and give themselves the best chance to thrive and live up to their full potential.
In my practice I use it mostly with adults carrying complex trauma and emotional neglect: people who understand their patterns very well and still feel stuck in them.
What do schema therapy sessions look like?
I'm often asked what schema therapy really looks like in practice and what to expect. I offer it online and in person, in a clear three-stage model, so you always know where you are.
- Stage 1: Your story
- We take a thorough history, which means talking about your childhood, and you fill in the standard schema questionnaire as a self-assessment. This takes around five clinical hours, plus about an hour of questionnaires at home. The goal is a one-page case conceptualisation: a map of your schemas, your critic voices and the ways you've learned to cope.
- Stage 2: Schema awareness
- We try the map out in real life. With everyday examples, you learn to spot your trigger points and what happens next, and we refine the map where it doesn't fit. Clients are often surprised by how much one sheet of paper can explain, and by how repetitive most of our reactions to triggers are. This stage usually takes three to five clinical hours.
- Stage 3: Growing the healthy part of you
- This is where we break the pattern, and you learn to give yourself what you really need instead of falling back into old coping modes. We use experiential techniques such as chair work, imagery rescripting and EMDR. In all of them we work with emotions, not just thoughts. It's the most complex stage, and clients usually find it the hardest, but they also tell me, almost without exception, that it's the part that helped them most.
How many sessions of schema therapy do I need?
The third stage varies the most, usually between 10 and 30 sessions, depending on how complex your history is. Added up, most people need somewhere around 20 to 40 sessions. With complex trauma or patterns that go very deep it can take longer, and that's normal.
Sessions are usually weekly at the start. Later, when you're practising more on your own, they can be spaced out.
Finding a schema therapist
Many therapists say they use schema therapy, so it's worth asking two things. Are they certified by the International Society of Schema Therapy (ISST)? And do they actually work experientially, with chair work and imagery, rather than only talking about schemas? The change happens in the experiential part.
I'm an accredited Advanced Schema Therapist, and I also supervise other therapists working towards their own certification. Ready for a change? Book a free call below and we'll see whether schema therapy is right for you.
