Moderate EvidenceIntegrativeThird-wave CBT

Schema Therapy

Last evidence review: January 20266 printable resources

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Overview

Schema Therapy is an integrative psychological therapy developed by Jeffrey Young for people with long-standing emotional and relational difficulties that have not responded to standard CBT. It combines cognitive, behavioural, attachment, and experiential approaches to address deeply ingrained patterns known as Early Maladaptive Schemas (EMS).

Schemas are broad, pervasive themes or patterns regarding oneself and one’s relationships, developed during childhood and elaborated throughout life. They are self-defeating and are maintained through cognitive distortions, self-defeating life patterns, and maladaptive coping styles.

What this therapy focuses on

Schema Therapy helps identify unmet emotional needs from early life and how maladaptive schemas and coping modes developed in response. It aims to modify schemas, reduce maladaptive coping, and strengthen the “Healthy Adult” mode.

What sessions are usually like

Session length: 50–90 minutes

Frequency: Weekly or twice weekly

Time-limited or long-term depending on complexity

Experiential techniques (imagery, chair work) are common

Therapeutic relationship is used actively as a vehicle for change

Session profile

Duration: 50–90 minutes

Frequency: Weekly or twice weekly

Typical course: 1–3 years for personality disorders; shorter for focused presentations

Between sessions: Flashcards, schema diaries, imagery practice, mode monitoring

Common uses and suitability

What problems it is commonly used for

Personality disorders (especially BPD)Chronic depressionRecurrent relationship difficultiesTrauma-related difficultiesTreatment-resistant anxietyEating disorders (complex presentations)

Who this therapy may suit best

Individuals with long-standing patterns not responsive to brief therapy
Those open to experiential and emotional work
People with complex early histories
Those who recognise repeating life patterns

When it may need adapting or may not be suitable

Acute instability without containment
Limited capacity for emotional reflection
Where briefer interventions have not yet been tried

Where this therapy may not be enough

Schema Therapy is not indicated for acute symptom management. It is resource-intensive and requires specialist training. Brief therapy needs are better served by other modalities.

What happens in therapy

Schema Identification

Identifying your core patterns (schemas) using questionnaires and exploration of early experiences.

Schema Mode Work

Understanding the different “parts” of yourself that show up in different situations and learning to strengthen the healthy part.

Imagery Rescripting

Revisiting difficult memories in imagination to create a new, safer experience — changing the emotional impact without changing the facts.

Safety note: Requires careful assessment. Contraindicated in active dissociation without stabilisation. Therapist must be trained in managing abreaction.

Limited Reparenting

Your therapist provides a warm, boundaried relationship that offers some of the emotional support that was missing in early life.

Evidence Base

Guideline support

Emerging to moderate. Schema Therapy is included in some specialist pathways, particularly for BPD.

Strength of evidence

Moderate; strongest for borderline personality disorder. The Giesen-Bloo et al. (2006) RCT demonstrated Schema Therapy outperformed TFP for BPD. Several subsequent RCTs support its use for personality disorders and chronic depression.

Limitations

Evidence base is growing but still limited compared to CBT and DBT. Requires specialised training. Long-term nature increases cost considerations.