Schema Therapy

Schema Therapy: Understanding and Changing the Patterns That Keep You Stuck

Have you ever found yourself reacting to a situation in a way that seems much bigger than the situation itself? Perhaps logically you know that you are safe, but you still feel intensely anxious. Maybe you repeatedly find yourself in relationships where your needs aren’t being met, struggle with feelings of inadequacy or shame, or find yourself being extremely critical of yourself. Often this is because of patterns that developed much earlier in life.

Schema Therapy is an approach that helps us understand these deeper pattern, where they came from, how they continue to influence us today, and how we can begin to change them. Rather than simply focusing on the symptoms we are experiencing now, Schema Therapy explores the underlying emotional patterns, beliefs, relational patterns, and unmet needs that may be contributing to your difficulties.

What is Schema Therapy?

Schema Therapy was developed by an America psychologist Dr Jeffrey Young as an integrative therapy combining ideas and techniques from attachment theory, gestalt therapy, psychodynamic approaches, Cognitive Behavioural Therapy (CBT) and other therapeutic ideas such as object relations.

At the heart of Schema Therapy is the idea that our early experiences, attachment experiences, negative experiences and traumas, can shape the way we understand ourselves, other people, and the world around us. When our core emotional needs are not adequately met during childhood, we can develop what are known as Early Maladaptive Schemas, or schemas for short. Schemas are deeply rooted patterns or themes about ourselves, and our relationships with others. They can influence what we expect from people, how we interpret situations, how we respond emotionally, and the ways we behave when we feel threatened or vulnerable.

There are many schemas and different schemas develop for different peoples depending on which emotional or psychological needs went unmet in childhood. For example, someone who experienced criticism, rejection or conditional acceptance growing up may develop a schema around Defectiveness/Shame. They may carry a deep sense that “There is something  wrong with me.” Someone who experienced unreliable or unsafe relationships may develop a Mistrust/Abuse schema and find it difficult to trust others, even when people demonstrate that they are safe. Someone who learned that they had to be exceptionally successful, productive or perfect to feel worthy may develop an Unrelenting Standards schema. Someone who wasn’t emotionally nurtured or didn’t have a safe place to express and receive support around their emotions may develop an Emotional Deprivation Schema.

Schemas aren’t conscious choices. They often develop as a way of making sense of our experiences and protecting ourselves. They can be thought of as emotional or psychological templates or lenses through which we experience ourselves, other people and the world. Schemas can remain relatively quiet for periods of time and then become activated when something in our current life reminds us, consciously or unconsciously, of earlier experiences. This can help explain why a seemingly small event in the present can sometimes trigger a surprisingly strong emotional response.

What can Schema Therapy help with?

Schema Therapy can be particularly helpful when you notice longstanding patterns that seem difficult to change, even when you understand them intellectually. Schema therapy is an evidence-based therapy that can be applied to a broad range of psychological concerns. Schema Therapy may be useful when working with difficulties such as anxiety, depression, eating disorders, low self-esteem, relationship difficulties, trauma and complex trauma, persistent self-criticism, difficulties with emotional regulation, or longstanding interpersonal patterns.

It can be particularly valuable for people who feel as though they keep repeating the same patterns despite their best efforts to change them. You may understand intellectually that a particular relationship isn’t healthy, for example, but continue to find yourself drawn to similar relationships. You may know that being extremely self-critical isn’t helpful, yet find that the critical voice inside your head seems almost impossible to switch off. Schema Therapy can help explore what is driving these patterns and, importantly, what purpose they may have originally served.

Schema Therapy and Relationships

Schemas can have a significant influence on our relationships. They can affect the people we are drawn to, what we expect from others, how we respond to closeness and intimacy, and how we behave when we feel rejected, criticised or abandoned. For example, someone with an abandonment schema may become highly anxious when a partner is unavailable or needs space. Someone with a mistrust schema may find it difficult to believe that others have good intentions. Someone with a self-sacrifice schema may consistently prioritise everyone else’s needs while neglecting their own.

Over time, these patterns can become self-perpetuating. We may respond to situations based on what we have learned to expect rather than what is actually happening in the present. Schema Therapy can help you understand these relationship patterns and develop healthier ways of connecting with others while also learning to recognise and communicate your own emotional needs.

Schema Therapy, Self-esteem and Self-criticism

Many people who seek therapy struggle with a harsh internal critic. They may constantly feel that they are not good enough, compare themselves to others, feel ashamed of themselves or believe that they need to achieve more in order to be worthy. Schema Therapy can help identify the deeper beliefs and experiences underlying this self-criticism. Rather than simply trying to replace negative thoughts with positive ones, therapy explores where these beliefs came from, why they became so powerful and how they continue to influence you today. The goal is to develop a healthier and more compassionate relationship with yourself, while also reducing the influence of old patterns that may no longer serve you.

Schema Therapy and Trauma

Traumatic and adverse experiences can contribute to schemas such as mistrust/abuse, abandonment, defectiveness, emotional deprivation, or vulnerability to harm. For some people, the impact of trauma extends beyond the memory of what happened and influences the way they see themselves and their relationships. Schema Therapy can therefore help explore not only what happened, but also what you came to believe about yourself and feel towards yourself and others because of what happened. For example, someone who experienced rejection may come to believe that they are unlovable. Someone who experienced repeated criticism may develop a deep sense of defectiveness. Someone who experienced unpredictable or unsafe caregiving may learn that other people cannot be trusted. These beliefs can continue to influence adult relationships and emotional responses long after the original experiences have ended. Once that is understood, it opens up the possibility of healing and changing the behavioural patterns that were used to cope with those experiences that may no longer be serving you.

How does Schema Therapy work?

Schema Therapy involves developing an understanding of how your past experiences, emotional needs, schemas and current coping patterns interact. The process usually begins by developing a personalised understanding of your difficulties. Together, you may explore the situations that tend to trigger you, the emotions that arise, what you believe about yourself in those moments, what you expect from other people and how you respond when you feel vulnerable or threatened. This can help create a psychological map of your experiences and identify patterns that may previously have felt confusing or difficult to understand.

An important concept within Schema Therapy is the idea of schema modes. While schemas are longstanding patterns or themes, modes describe the different emotional states and coping responses that can become activated at different times.

For example, someone may experience a Vulnerable Child mode when they feel rejected or abandoned, an Angry Child mode when their needs have been ignored, or a Detached Protector mode when their emotions become overwhelming, or a Detached Self-Soother mode, to sooth distressing emotions. Other modes may involve a harsh internal critic, perfectionistic demands, impulsive coping, avoidance or overcompensation. Understanding modes can help create an important shift from asking, “What’s wrong with me?” to asking, “What is happening for me right now, and what does this part of me need?”

Understanding emotional needs

Another important component of Schema Therapy is understanding our fundamental emotional needs. These include needs for safety, secure attachment, autonomy, realistic limits, emotional expression, spontaneity and play. When important emotional needs aren’t consistently met, schemas may develop. Therapy therefore isn’t simply about getting rid of “bad” thoughts or behaviours. Instead, it involves understanding what you needed, what may have been missing and how those unmet needs continue to influence you today. This can be a powerful part of therapy because it allows us to approach our difficulties with curiosity and compassion rather than shame and judgement.

Experiential therapy

One of the strengths of Schema Therapy is that it isn’t purely about talking or thinking about your experiences. It also incorporates experiential techniques such as imagery rescripting and chair work, which can help people connect with the emotional experiences underlying their schemas. Rather than simply discussing an experience intellectually, these techniques can provide an opportunity to work with the emotions, beliefs and unmet needs associated with earlier experiences. The aim is to develop new emotional experiences and healthier ways of responding, rather than simply understanding the past.

Developing the Healthy Adult Mode

An important goal of Schema Therapy is strengthening what is often referred to as the Healthy Adult mode. The Healthy Adult is the part of us that can recognise and validate our emotions, protect vulnerable aspects of ourselves, establish healthy boundaries, respond appropriately to our needs and make balanced decisions. Developing this healthier internal voice can help us become less controlled by old schemas and coping patterns. The goal isn’t to eliminate difficult emotions or get rid of vulnerable parts of ourselves. Instead, it is about developing a stronger and healthier internal relationship with these different aspects of ourselves so that we have greater choice in how we respond.

Can Schema Therapy and EMDR work together?

Schema Therapy and EMDR (Eye Movement Desensitisation and Reprocessing) can complement one another when a person’s difficulties involve both longstanding patterns and distressing or traumatic experiences.

The two approaches look at psychological difficulties from somewhat different perspectives. Schema Therapy can help us understand the pattern, including the schemas, emotional needs, modes, coping responses and relationship patterns that have developed over time. EMDR, on the other hand, can be used to target relevant distressing memories and experiences when clinically appropriate. Traumatic experiences can sometimes remain emotionally “stuck”, meaning that although we know intellectually that something happened in the past, our body and nervous system can continue to respond as though the danger is still present. EMDR aims to help the brain reprocess these distressing experiences so that they become less emotionally overwhelming and are more appropriately integrated as memories of the past.

It is common for psychologists in Australia to be trained in both Schema Therapy and EMDR, and utilise and integrate the two approaches into a comprehensive and holistic approach. When thoughtfully integrated, Schema Therapy and EMDR can therefore address different but interconnected layers of the same problem. For example, imagine someone who carries a deeply held belief that “I am not good enough.” Schema Therapy may help identify this as part of a longstanding Defectiveness or Unrelenting Standards schema and explore how it developed. EMDR may then be used, where appropriate, to process specific experiences that contributed to or continue to reinforce this belief. Schema Therapy can also provide a framework for understanding the emotional and relational patterns that emerge in response to activation of this schema, while EMDR may help address specific memories carrying the emotional intensity associated with those patterns. Importantly, not everyone needs both approaches. Therapy should be individually formulated, with the treatment approach selected according to the person’s history, needs, goals and readiness.

Could Schema Therapy be helpful for you?

Schema Therapy may be worth exploring if you feel as though you keep repeating the same patterns, even though you understand them intellectually. It may be helpful if you are extremely hard on yourself, struggle with feelings of shame or inadequacy, have difficulty trusting others, experience intense reactions to rejection or criticism, find yourself repeating unhealthy relationship patterns or feel as though different parts of you are constantly pulling you in different directions. You don’t need to know what your schemas are before starting therapy. Identifying and understanding these patterns is part of the therapeutic process. People often find schema therapy helpful when standard approaches like Cognitive Behavioural Therapy (CBT) haven’t been effective. For some clients, Schema Therapy provides a framework for understanding longstanding emotional, behavioural and relationship patterns. For others, it can be integrated with approaches such as EMDR to work more directly with distressing memories and experiences.

If you are interested in pursuing schema therapy or EMDR, Sherry-Lee Smith is a Perth based psychologist who is an EMDR Consultant with extensive training and experience in schema therapy, who provides an individualised and holistic approach to therapy, drawing in schema therapy, EMDR and other evidence-based approaches.

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References

Arntz, A., & Jacob, G. ( 2013). Schema Therapy in Practice: An introductory guide to the schema mode approach. Wiley-Blackwell: UK.

Brockman, R. N., Simpson, S., Hayes, C., van der Wijngaart, R., Smout, M. ( 2023). Cambridge Guide to Schema Therapy. Cambridge University Press: UK.

Shapiro, F (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic principles, protocols and Procedures (3^rd Ed). Guilford Publications: New York.

Shapiro, F., & Laliotis, D (2011). EMDR and the Adaptive Information Processing Model: Integrative Treatment and Case Conceptualisation, Clinical Social Work Journal (39), 191-200.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A practitioner’s guide. Guilford Press: New York.