Schema Therapy
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Overview, ‘schema’ defined, treatments, research, main concepts, goals, of therapy, phases, techniques
Four sections follow:
Background Material that provides the context for the topic
Suggestions for Practice
References
Appendix 1: Schemas Grouped into Domains
Feedback welcome!
Background Material
Introduction
Schema therapy (also called "schema focused therapy") is an approach to treatment which combines cognitive-behavioural, attachment, Gestalt, object relations, interpersonal, and psychoanalytic therapies into one unified model. Schema therapy arose to assist people with entrenched self-defeating patterns/thoughts of behaviour (schemas), that are often triggered in adulthood by life events which appear similar to the traumatic experiences of childhood. Triggering results in a strong negative emotion, such as grief, shame, fear, or rage. Examples of schema beliefs include, ‘‘I’m not good enough’’, ‘‘People will leave me’’, ‘‘I’m a failure’’, and ‘‘Something bad will happen’’. These beliefs post serious obstacles for accomplishing people’s goals and getting their needs met. Schema therapy is designed to help people break these stubborn, negative patterns of thinking, feeling, and behaving by replacing them with healthier alternatives (MHA, 2018).
What are Schemas?
Schemas describe patterns of thinking and behavior that people use to interpret the world. Schemas allow people to take shortcuts in interpreting the vast amount of information that is available in the environment. Schemas are essentially built from memories of a person’s unique experiences. For example, a young child may develop a schema for a horse. When the child sees a cow, the child may initially refer to the cow as a horse because it has four legs, a tail and hair. Once the child is told the animal is a cow a new schema for a cow is created (a process referred to as accommodation). Likewise, if a child encounters a miniature horse, the child could identify it as a dog until the child is told it is a horse. This learning brings about a modification in the child’s schema for horses (referred to as assimilation). Through new experiences existing schemas are modified and new information is learned (Cherry, 2025).
The four main types of schemas people hold in their memory are:
Person schemas—information about a person’s appearance, behaviors, personality, and preferences.
Social schemas—how people behave in certain social situations.
Self-schemas—what one knows about one’s current self and holds as an idealized or future self.
Event schemas—how one should act, and what one should say in a particular situation (Cherry, 2025).
Schemas play a role in education and the learning process. For example:
People are more likely to pay attention to things that fit in with their current schemas.
People learn information more readily when it fits in with their existing schemas.
Schemas can often make it easier for people to learn because new information can be classified and categorized by comparing new experiences to existing schemas.
Schemas allow us to think quickly and assimilate new information automatically.
When learning new information that does not fit with existing schemas, people sometimes distort or alter the new information to make it fit with what they already know. This can exhibit as prejudice.
Schemas can be difficult to change with some people clinging to existing schemas even in the face of contradictory information (Cherry, 2025).
Main concepts
Schema theory is based on the idea that traditional cognitive-behavioural therapy, which deals with surface level automatic thoughts and emotions, does not adequately address the core beliefs—or schemas—of patients with chronic and complex mental health conditions such as personality disorders, eating disorders, chronic depression and anxiety disorders (Joshua et al., 2025). There are four main concepts that are central to schema therapy; these are Early Maladaptive Schemas, Coping Styles, Schema Domains and Schema Modes (Masley et al., 2011).
Early Maladaptive Schemas (EMS) are at the heart of model. Young (the person who initially devised schema therapy) and colleagues developed 20 core “themes”—called early maladaptive schemas—that are defined as self-defeating emotional and cognitive patterns that begin early in one’s development and repeat throughout life. EMS are comprised of memories, emotions, cognitions and bodily sensations regarding oneself and one’s relationship with others. They commonly develop in children who live within an environment which fails to meet their core emotional needs, or where they experience repeated episodes of abuse, neglect, hostility and criticism (Joshua et al., 2025; Maisley 2011).
A few examples of maladaptive schemas include:
Defectiveness / Shame: People who believe that they are fundamentally unlovable may sabotage their relationships because they are afraid of being abandoned.
Emotional Deprivation: People who believe that other people will not meet their needs may end up in relationships with people who are emotionally neglectful.
Social Isolation: People who hold a schema that they are separate or unaccepted in the world may isolate themselves from others.
Enmeshment: People who hold a schema that they cannot be happy or successful without the support of other people, often family members, may become overly dependent on their loved ones. They may lack a sense of direction, autonomy, and individuality (Salters-Pedneault, 2023).
EMS can be grouped into five domains: disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness, and over vigilance and inhibition. The domains or schemas are based on five core emotional needs which, it is believed, all human beings have:
Secure attachments to others (including safety, stability, nurturance, and acceptance)
Autonomy, competence, and sense of identity
Freedom to express valid needs and emotions
Spontaneity and play
Realistic limits and self-control (MHA, 2018)
MHA (2028) elaborates on the impact of each of the five domains:
Disconnection and rejection—clients with schemas in this domain (especially the first four schemas) are often the most damaged. With traumatic childhoods, they zoom into one self-destructive relationship after another, or else avoid relationships altogether.
Impaired autonomy and performance—Clients feel they lack the self-confidence to function independently, to forge own identity, to set personal goals and achieve them.
Impaired limits—Clients find it difficult to respect the rights of others, cooperate, keep commitments, or meet long-term goals. This can arise in overindulgent families where following rules was not required.
Other directedness—Clients seek to meet others’ needs to the detriment of their own to gain approval, maintain emotional connection and avoid problems.
Over vigilance and inhibition—Clients Clients strive to meet rigid, internalised rules about their own performance which cost them happiness, self-expression, relaxation, close relationships and even health
People use various coping styles to manage EMS. Coping styles can be viewed as normal attempts of a child to cope in a difficult or even toxic and traumatic environment. But they may become maladaptive over time if they perpetuate as EMS. There are three maladaptive schema coping styles: resignation/surrendering, avoidance, and inversion/overcompensation:
Resignation, or surrendering, represents a coping mechanism whereby an individual fully believes the EMS; the person may engage in behaviours that reinforce their existing beliefs.
Avoidance, on the other hand, is characterized by efforts to evade or circumvent EMS activation.
Inversion, or overcompensation, is defined by the application of mental strategies to believe that the opposite messages of the EMS are true, and act accordingly (Masley et al., 2011; Salters-Pedneault, 2023; van Donzel et al., 2026).
MHA (2018) elaborates at length on how these coping styles impact on people. They may help people avoid the schemas, but do not generally heal the schemas, and may perpetuate them
Schema modes are the most recent addition to schema therapy. They are the combinations of the activated schemas, coping responses, and emotions, being momentary reflections of the individual's emotional, cognitive, and behavioral state. They help both the patient and therapist understand the current state of the patient. Young identified 10 schema modes that can be separated into four categories: four child modes, three dysfunctional coping modes, two dysfunctional parent modes and the healthy adult mode. There are, in essence, three groups of modes—child, parent, and coping modes. In addition to dysfunctional schema modes, there are also functional or positive modes, that is the healthy adult mode and the happy child mode (Masley et al., 2011; van Donzel et al., 2026). MHA (2018) discusses schema modes in more detail.
Goals
The initial goals of schema-focused therapy are to identify the person’s dominant/relevant schemas and to link these schemas to past events and current symptoms. The ultimate goal of schema therapy is to help people adaptively meet their own core needs. It can involve identifying maladaptive coping styles, and healing unhelpful schemas and modes whilst developing healthier, more adaptive alternatives. For example, the therapist and client may conduct exercises focused on venting anger, breaking unhealthy patterns of behavior, and changing unhelpful ways of thinking. Therapists help the patient challenge their EMS and use the healthy adult or adolescent mode to cope with their beliefs. This can be a long process which requires the individual to confront and modify or fight schemas that may have previously served a protective and adaptive function (Joshua et al., 2025; Masley et al., 2011; Salters-Pedneault, 2023).
What Schema Therapy Treats
Schema therapy was originally developed to treat personality disorders and, in particular, is often used to treat borderline personality disorder. Schema therapy has also been used to treat eating disorders, anxiety, depression, complex trauma, relationship problems and other mental health concerns, especially those that appear unresponsive to other forms of treatment. Currently, schema therapy is primarily used to treat adults, though some researchers are exploring its potential for treating children and adolescents (Joshua et al., 2025; Mindful Psychology, 2025; Psychology Today, 2022).
Schema therapy phases
Schema therapy generally takes between 20 and 60 sessions, so is more time consuming than cognitive-behavioural therapy but can provide a higher reduction in symptom severity and relapse rates in certain patients compared to traditional cognitive therapy (Joshua et al., 2025). Schema therapy does not have a fixed session structure. The general direction of the work is the gradual weakening of the dysfunctional parts of the personality structure through the strengthening of the healthy adult part of the person. There is an assessment / education phase followed by a change phase.
In the course of the assessment, the therapist gives the client psychoeducation about the schema model. Clients gradually learn to recognise their maladaptive coping styles (surrender, avoidance, and overcompensation) and how these perpetuate their schemas. The assessment phase takes two to three months on average and is multi-faceted, including a life history interview, self-monitoring assignments, and imagery exercises which trigger the schemas emotionally, thereby helping clients make emotional links between current problems and related childhood experiences. By the completion of this phase, therapist and client have collaboratively developed a complete schema case conceptualisation and have agreed on a schema-focused treatment plan which includes cognitive, experiential, and behavioural strategies, as well as the healing elements of the therapist-client relationship.
Throughout the change phase, the therapist combines cognitive, experiential, behavioural, and interpersonal strategies in a flexible manner, depending on the week-to-week needs of the client; there is no rigid protocol or set of procedures that must be followed. As the change phase gathers momentum, the therapist focuses more fully on reinforcing cognitive and emotional changes in order to bolster the Healthy Adult mode (MHA, 2018).
Schema therapy techniques
In schema therapy the therapeutic relationship is seen as the foundation for these changes to occur. As EMS and modes arise when core needs are not met, schema therapists aim to identify and meet these previously unmet needs within the therapy relationship. This may then progress to mobilising other supportive relationships. By helping the individual identify missed experiences or unmet needs in early childhood and providing opportunities to address these within a therapeutic relationship, schema therapy serves as an antidote to the early damaging experiences that led to the formation of maladaptive schemas and modes. In schema therapy this is referred to as ‘limited reparenting’ where the therapist does what s/he can (within the ethical bounds of the therapeutic relationship) to meet the needs of the client. This is akin to the therapist adopting the roles parents must take up with their children, e.g. showing tenderness at times and firmness at other times. (MHA, 2018; Young et al., 2003 cited in Masley et al., 2011).
Three techniques are commonly used by therapists implementing schema therapy: cognitive techniques, experiential techniques and behavioural pattern breaking.
Cognitive techniques
As long as clients believe that their schemas are valid, they will be unable to change; the distorted views will continue to colour their world unfavourably. Thus, the collaborative task for therapist and client is to build a case against the schema. Clients learn to disprove the schema’s validity through such actions as listing all the evidence supporting and refuting the schema; therapist and client then jointly evaluate the evidence. The technique of keeping a diary helps garner the evidence while flash cards help in developing the Healthy Adult mode.
Diaries Schema therapy diaries are a form filled out in between sessions which provides a guide helping the client to organise his/her experience throughout the week when the schemas they have been learning about are triggered. They record the reactions to the schemas that have been triggered, including concerns, overreactions and healthy behaviours.
Flash cards These are statements written onto cards which the client refers to in-between sessions whenever schemas are triggered. Those developed jointly between therapist and client tend to be highly effective. Because the client comes to internalise the messages on the cards, the flash cards are very helpful in developing the Healthy Adult mode. Different cards are typically developed for different challenging situations and phases of treatment (MHA, 2018).
Experiential techniques
Schema therapy clients are likely to have deep anger and sadness about what happened to them as children. The cognitive techniques above are well complemented by experiential techniques which help clients fight the schema on an affective level. Therapists use imagery early in the therapy. They
Elicit upsetting childhood memories in the form of images of experiences with the client’s significant others;
Ask the client to carry on dialogues with the significant others;
Ask clients what they need from significant others and attempt to link these needs to the schemas;
Ask the client to identify which current-life situations have the same emotions as the early childhood images and thus clarify links between early memories and current EMS triggers.
Dialogue/chair work is also used with imagery. Dialogue/chair work involves clients moving between two chairs as the client dialogues between the parts of him/herself represented by the chairs. The client can also carry on dialogues between him/herself and imagined significant others in order to reach closure, or practice assertiveness (MHA, 2018).
Behavioural pattern breaking
By using all of the aforementioned techniques, schema therapists can help clients design behavioural homework assignments that aim to replace maladaptive coping responses with new, more adaptive patterns of behaviour. The client begins to make healthier choices, breaking old self-defeating life patterns. However, clients have to be willing to give up their maladaptive coping styles in order to change. This is the crux of the matter where much of the therapeutic work has to be done because a schema will usually fight for its survival and seek to perpetuate itself. For example,
Overcompensators may be too busy blaming others to be able to acknowledge their schemas and take responsibility for their problems.
Surrenderers may be unwilling to give up destructive relationships or set limits with others in order to have the freedom to follow the dictates of their own conscience.
Avoiders may cut off or squash down their emotions, reward themselves (with reduced pain) in the short-term, but prevent themselves accessing the long-term reward of schema healing through confronting the unpleasant memories (MHA, 2018).
Research
Schema therapy is a relatively new therapy and research to confirm its effectiveness is still being published. The following are the comments of a number of authors describing how they see the current state of research in the area.
A review of 12 studies (reduced from 835 available titles) by Taylor et al (2017) found:
Limited evidence for schema change with schema therapy in borderline personality disorder, with only three studies conducting correlational analyses.
Very limited good quality evidence of schema therapy and schema change being associated for eating disorders, agoraphobia, PTSD and chronic depression—further work needed.
Use of schema therapy for disorders other than borderline personality disorder should be based on service user/patient preference and clinical expertise.
MHA (2018), in response to the question, “Is there any evidence for the effectiveness of schema therapy?” suggest there is a small body of research on schema therapy beginning to appear. They point out that validating schema therapy is difficult because it is not a short-term therapy. The authors cite Dutch research where 86 people with borderline personality disorder were divided into two groups, with one group receiving schema therapy. 70% of the BPD group achieved clinically significant and relevant improvement across a number of areas while 29% of the transference-focused psychotherapy participants reached full recovery.
In 2023 Salters-Pedneault concluded that extensive research on schema therapy was still lacking. Likewise, a review of 101 studies by van Dijk et al. (2023), where schema therapy was applied to various psychiatric disorders with promising results, concluded that the effectiveness of the different models of schema therapy should be examined more rigorously.
The systematic review by Joshua et al., (2025) supported previous research on schema therapy, finding that it could be a promising treatment for young people with mental health disorders, “although the quality of some studies reduced the voracity of the evidence” (p. 7). In reviewing the evidence for schema theory effectiveness in adults the authors suggested that many studies show positive results for depression, anxiety, eating disorders, or post-traumatic stress disorder but many only used small samples or were case studies.
Recently van Donzel et al. (2026) pointed out schema therapy is one of the most effective therapies for people with personality disorders, when conducted in both individual and group formats. They also pointed out that schema therapy has also been found to be effective in treating other psychiatric disorders, such as depression, anxiety disorders and eating disorders.
Overall, it appears evaluating the effectiveness of schema therapy has been limited by the length and subjectivity of the therapy, making large studies difficult to conduct. However there appears to be increasing evidence of its effectiveness in treating a range of mental health disorders, especially when cognitive behavioural therapy is not a viable approach.
Training
Schema therapy training is available. For example:
Australia https://schematherapytraining.com/
South Africa https://stisa.org.za/
Suggestions for Practice
Based on the above information schema therapy:
Would be unsuitable for beginning social workers who are still mastering different practice approaches
Requires specific training prior to using the approach
Will require experience/qualifications in mental health social work (e.g. post-graduate degree, experience in clinical social work
May be a logical development for therapists to make after experiencing the shortcomings of cognitive-behavioural therapy
References
Cherry, K. (2025). What is a schema in psychology? How we use shortcuts to organise and interpret information. VeryWellMind. https://www.verywellmind.com/what-is-a-schema-2795873
Joshua, P. R., Lewis, V., Kelty, S. F., & Boer, D. P. (2025). Applications of schema therapy in young people: a systematic review. Cognitive Behaviour Therapy, 1–23. https://doi.org/10.1080/16506073.2025.2522375
Masley, S. A., Gillanders, D. T., Simpson, S. G., & Taylor, M. A. (2011). A systematic review of the evidence base for schema therapy. Cognitive Behaviour Therapy, 41(3), 185–202. https://doi.org/10.1080/16506073.2011.614274
MHA: Mental Health Academy. (2018). Schema-focused therapy: The basics. https://www.mentalhealthacademy.com.au/catalogue/courses/schema-focused-therapy-the-basics
Mindful Psychology. (2025). Schema Therapy. https://www.mindfulpsychology.com.au/therapy/schema-therapy/
Psychology Today (2022). Schema therapy. https://www.psychologytoday.com/au/therapy-types/schema-therapy
Salters-Pedneault, K. (2023). How schema-focused therapy works for BPD. https://www.verywellmind.com/schema-focused-therapy-425463
Taylor, C.D.J., Bee, P. and Haddock, G. (2017), Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy: Theory, Research and Practice, 90, 456-479. https://doi.org/10.1111/papt.12112
van Dijk, S. D. M., Veenstra, M. S., van den Brik, R. H. S., van Alphen, S. P. J., & Voshaar, R. C. O. (2023). A systematic review of the heterogeneity of schema therapy. Journal of Personality Disorders, 37(2). https://doi.org/10.1521/pedi.2023.37.2.262
van Donzel, L., Claassen, A.-M., Ouwens, M. A., Broersen, J., van Alphen, S. P. J., Louis, J. P., & Videler, A. C. (2026). Positive constructs in schema therapy: A scoping review. Journal of Clinical Psychology. Advance online publication (Wiley). https://doi.org/10.1002/jclp.70111
Young, J. E., Klosko, J. S., Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Publications.
Appendix 1
Schemas Grouped into Domains
Domain | Schema |
Disconnection and Rejection Abusive, traumatic childhoods; unstable family life; rejection and humiliation; feel different and lacking in some way; long periods of insecurity and inconsistent parenting. Clients with schemas in this domain (especially the first four schemas) are often the most damaged. With traumatic childhoods, they zoom into one self-destructive relationship after another, or else avoid relationships altogether. | Mistrust/Abuse Abandonment/Instability—perceived instability or unreliability of those available for support and connection Emotional deprivation of nurturance, empathy and/or protection Defectiveness/Shame—leading to feelings of inferiority and being unlovable Social Isolation/Alienation—due to feelings of being different from others |
Impaired autonomy and performance Often overprotected and controlled as children, or neglected and ignored, left alone with no interest shown in their lives; continually undermined and made to feel incompetent, or encouraged to be dependent on others. Clients feel they lack the self-confidence to function independently, to forge own identity, to set personal goals and achieve them. | Dependence/Incompetence—feel unable to handle everyday responsibilities without help Vulnerability to harm—exaggerated fear of catastrophe Enmeshment—excessive emotional involvement with one or more significant others Failure—believe they have always failed and are failing now |
Impaired limits Internal sense of control not developed; difficulty respecting the rights of others; families very un-boundaried; children did not have rules. Clients find it difficult to respect the rights of others, cooperate, keep commitments, or meet long-term goals. From overindulgent families where following rules was not required. | Entitlement—feels superior, not bound by normal rules of social interaction; over demanding, lacking empathy Insufficient Self-Control /Self-Discipline—poor self-control to enable goal achievement, poor regulation of impulses and emotions. |
Other-directedness Experienced conditional love; family overly concerned with appearances; parents focused on their own needs Clients seek to meet others’ needs to the detriment of their own to gain approval, maintain emotional connection and avoid problems. | Subjugation—excessive surrendering to others Self-sacrifice—look to constantly meet others’ needs at expense of own gratification Approval-Seeking/Recognition-Seeking—need others to think positively of them to develop their own positive self-esteem. |
Over-vigilance and Inhibition Experienced conditional love; family overly concerned with appearances; parents focused on their own needs Clients strive to meet rigid, internalised rules about their own performance which cost them happiness, self-expression, relaxation, close relationships and even health. | Negativity/Pessimism—focus on the negative and dismiss the positive Emotional inhibition—flat, constricted, withdrawn or cold personal presentation * Unrelenting standards/Hyper-criticalness—strive to meet personal high standards to avoid criticism, highly critical of self and others Punitiveness—believe people should be punished for mistakes; difficulty in forgiving mistakes in themselves and others * |
* The Emotional Inhibition schema is better conceptualised as two separate constructs which are a Fear of Losing Control and Emotional Constriction. Similarly, Punitiveness (Self) and Punitiveness (Other) are distinct constructs derived from the original Punitiveness schema (Joshua et al., 2025).