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Enmeshment

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, referred to as ‘coping styles’. This Enmeshment information handout forms part of the Psychology Tools Schema series. It is designed to help clients and therapists to work more effectively with common early maladaptive schemas (EMS). 

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Introduction & Theoretical Background

A brief introduction to schema therapy

Schema therapy is an integrative therapy initially developed for treating complex, longstanding, and diffuse psychological difficulties. It combines cognitive behavioral, attachment, gestalt, object relationships, constructivist, psychoanalytic, and neurobiological approaches within a unifying conceptual model (Young, 1990, 1999; Young et al., 2003). Additional interventions have since been outlined, such as EMDR (Young et al., 2002), mindfulness (van Vreeswijk et al., 2014), and body-focused methods (Briedis & Startup, 2020). Schema therapy expands on CBT by emphasizing the developmental origins of psychological problems, incorporating relational and experiential interventions, and targeting the maladaptive coping styles that perpetuate these difficulties (Young et al., 2003). 

Early maladaptive schemas 

Schemas are enduring and foundational mental structures that play an essential role in cognitive processing, enabling humans to represent the complexities of the world (Rafaeli et al., 2016). By simplifying reality, they make the vast array of information we encounter manageable, so that we can take quick and automatic action. Schemas also act as shortcuts that help us reach conclusions without unnecessary processing. However, while these shortcuts are efficient, they can produce distorted interpretations of reality. Research confirms that schemas can be adaptive or maladaptive, and positive or negative, depending on their output (Young et al., 2003). Adaptive schemas are associated with positive functions and adaptive behavioral dispositions (Louis et al., 2018).  

In schema therapy, EMS are defined as negative, pervasive themes or patterns regarding oneself and one’s relationship with others that are dysfunctional and self-defeating. Structurally, EMS are believed to consist of thoughts, memories, emotions, bodily sensations, and the meanings ascribed to them (Van Genderen et al., 2012). Importantly, behavior is not a component of schemas, but a response to their activation. In other words, EMS activation results in schema-driven actions (Young et al., 2003).  

Interactions between a child’s temperament, parenting, sociocultural context, and significant life experiences (e.g., traumatic events) can give rise to unmet emotional needs, which form the basis of EMS. EMS are usually accurate representations of these early environments and lead to responses that help the child survive and adapt to these contexts (Farrell et al., 2014; Young et al., 2003). EMS become dysfunctional when they are indiscriminately and repeatedly applied to later life experiences.  

EMS are elaborated and strengthened throughout their lifespan, becoming the ‘filters’ through which individuals understand and make predictions about themselves, others, and the world (Young & Klosko, 1994). Accordingly, EMS developed in early life are superimposed on current events (even when not applicable), leading to dysfunctional patterns of thought, feeling, and behavior (Young et al., 2003). 

[EMS] become dysfunctional because … they render all new situations, even ones that are profoundly different from the toxic early experiences, similarly toxic (even when in reality they are not), and … lead the person to maintain particular types of [toxic] environments or relationships, even when they can exert influence or choice and create other kinds of experiences.

 Rafaeli et al., 2011.

Schema development

Core emotional needs

Satisfying core emotional needs during childhood leads to the development of healthy schemas, while unmet needs give rise to EMS. Young and colleagues (2003) originally outlined 5 core emotional needs based on Bowlby’s (1977) attachment theory and clinical observation (Bach et al., 2018). While they are believed to be universal, the strength of these needs can vary across individuals and potentially across cultures (e.g., Hahn & Oishi, 2006). They are: 

  1. Secure attachments (e.g., safety, protection, acceptance, stability, and belonging).
  2. Autonomy, competence, and sense of identity.
  3. Freedom to express needs and emotions.
  4. Spontaneity and play.
  5. Realistic limits and self-control.

Given that core needs initially relate to the child’s primary attachments, difficulties within the nuclear family are often the principal source of EMS (Rafaeli et al., 2011). Young acknowledged that attachment needs were of primary importance for the developing child, laying the foundation for the satisfaction of other needs (Brockman et al., 2023). However, as children mature, needs arising other arenas such as school and the wider community become important (e.g., stable friendships, peer group acceptance, etc.). While unmet needs in these later contexts can lead to EMS, schemas emerging in adolescence are usually less pervasive than those developed during childhood (Young et al., 2003). EMS can also develop in later life (such as in response to deeply disturbing events), although this is much less common (Louis et al., 2018). 

Other core needs have also been proposed, such as fairness, self-coherence (Arntz et al., 2021), novelty, self-comprehension (Flanagan, 2010), self-esteem (Loose et al., 2020), meaning (Meier, 2019), and connectedness to nature (O’Sheedy, 2021). However, these core needs have not yet been fully incorporated into the schema therapy model. Core needs are described in more detail in the Psychology Tools Unmet Emotional Needs information handout.

Early experiences

Interactions between a child’s early environment and innate temperament can frustrate their core emotional needs, leading to EMS development. Young and colleagues (2003) identify 4 childhood experiences that contribute to EMS:

  1. Toxic withholding. The child is given too little of what they need (e.g., insufficient attention, affection, protection, etc.).
  2. Toxic excess. The child is given too much of what they need (e.g., they are over-indulged, overprotected, granted excessive freedoms, etc.).
  3. Traumatization. The child is harmed, victimized, or humiliated (e.g., parental abuse, bullying, discrimination, etc.). 
  4. Selective internalization. The child internalizes maladaptive attitudes that are modeled by a caregiver or family member  (e.g., perfectionism, pessimism, etc.).   

Emotional temperament

Temperament refers to enduring differences in children’s behavioral style and reactivity (Zentner & Bates, 2008). It can contribute to EMS formation by influencing parenting styles (Eisenberg et al., 1999; Kiff et al., 2011; Pekdoğan & Mehmet, 2022). For example:

  • Irritable children tend to elicit punitive parenting, leading to increased anger.
  • Fearful children tend to elicit protective parenting, leading to increased anxiety. 
  • Impulsive children tend to elicit controlling parenting, increasing impulsivity. 

Moreover, children have a ‘differential susceptibility’ to their childhood environments and experiences (Belsky, 2013). For example, reactive children are more likely to flounder in response to poor parenting. This partly explains why some individuals develop EMS in the absence of severe trauma (Lockwood & Perris, 2012). 

Schema perpetuation

EMS are remarkably obstinate: they “fight for survival”. Young and colleagues (2003) suggest the durability of EMS partly stems the need for ‘cognitive consistency’: people strive to maintain a stable view of themselves and the world, even if it is inaccurate and distressing. Moreover, EMS are often central to an individual’s sense of self, making the idea of a schematic “paradigm shift” extremely threatening (Beck et al., 2004; Young & Klokso, 1994):

Although [the client’s] schematic structure may be unrewarding and lonely, change means that [they] are in new territory... They are being asked not just to change a single chain of behaviors, or reframe a simple perception, but rather to give up who they are and how they have defined themselves for many years, and across many contexts. 

Beck et al., 2004.

Several other factors account for why EMS persist and are strengthened over time.

  • Cognitive factors. EMS act as cognitive filters, distorting information and generating unhelpful thinking styles (Young et al., 2003). For example, schema-consistent information is exaggerated, while schema-inconsistent information is filtered out (i.e., magnification and minimization). Other cognitive distortions linked to EMS perpetuation include selective abstraction, overgeneralization, and labeling (Da Luz et al., 2017; Young, 1999). Research indicates schema activation not only generates negative automatic thoughts, but that these appraisals in turn reinforce EMS (Calvete et al., 2013).
  • Affective factors. Individuals often block painful emotions linked to their EMS. Consequently, EMS do not reach conscious awareness which prevents their disconfirmation (Young et al., 2003). Affect can also make schema-congruent perceptions feel true. Finally, schema maintenance processes and their centrality to the individual’s sense of self can engender hopelessness about change (Young, 1999).  
  • Behavioral factors. EMS lead to self-defeating behaviors, referred to as ‘coping responses’. For example, individuals might remain in toxic situations, provoke negative responses from others, or select partners that reinforce their EMS (Rafaeli et al., 2011).

Maladaptive coping styles

Coping styles refer to the characteristic ways individuals manage their EMS. Coping styles develop in childhood and operate outside of awareness, helping individuals adapt to their EMS, the intense affect accompanying them, and the environments in which they were formed (Rafaeli et al., 2011; Young et al., 2003). Much like EMS, factors that may influence the emergence of coping styles include temperament, modeling, conditioning, and culture (Loose et al., 2020; Nia & Sovani, 2014). While they are apparent in all individuals, coping styles tend to be more rigid, extreme, and ‘overlearned’ in clinical groups (Beck et al., 2004). Most importantly, coping styles play a central role in EMS perpetuation. 

Coping styles, in turn, give rise to idiographic ‘coping responses’ – the situation-specific manifestations of the client’s coping style. While coping styles are repetitious, coping responses are more variable and can take the form of behavioral, cognitive, or emotional reactions to EMS activation (Simeone-DiFrancesco et al., 2015).  

Young and colleagues (Young & Klosko, 1994; Young et al., 2003) identify three coping styles, recently reformulated by an international working group (Arntz et al., 2021). While most individuals use a mix of coping styles, some disorders are characterized by the predominance of one coping style (e.g., overcompensatory control in narcissistic personality disorder; Rafaeli et al., 2011):

  • ‘Surrender’ (Young et al., 2003) or ‘Resignation’ (Arntz et al., 2021). Corresponding to the evolutionary ‘freeze’ or ‘fawn’ response, the individual responds to their EMS by accepting its core message and behaving as if it were true. Consequently, they experience the pain of the EMS directly.
  • ‘Avoidance’ (Young et al., 2003) or ‘Escape’ (Young & Klosko, 1994). Corresponding to the evolutionary ‘flight’ response, the individual arranges their life such that their EMS is not triggered. The pain of their EMS is avoided or suppressed. Avoidant coping may be overt (e.g., escaping from schema activating situations or individuals) or covert (e.g., using substances or dissociation to dull schema-related distress). 
  • ‘Overcompensation’ (Young et al., 2003) or ‘Inversion’ (Arntz et al., 2021). Corresponding to the ‘fight’ response, the individual responds to schema activation by attacking, overcorrecting, or externalizing their EMS (Greenwald & Young, 1998). The pain of the EMS is masked with other thoughts, emotions, and actions (e.g., the individual replaces feelings of inferiority with superiority). 

Three additional coping styles (indolence, mockery, and gaucherie) have also been proposed (Askari, 2021). 

Young (1990) originally described 15 EMS, which were later increased to 18 schemas (Young et al., 2003). Additional schemas have since been proposed (e.g., Arntz et al., 2021; Brockman et al., 2023; Yalcin et al., 2023). The 18 EMS described by Young and colleagues (2003) were subsequently clustered into ‘schema domains’ which correspond to specific unmet emotional needs. Enmeshment (previously referred to as ‘enmeshment/undeveloped self’; Young et al., 2003) is grouped with EMS in the ‘impaired autonomy and performance’ domain (Bach et al., 2018). Schemas in this domain are characterized by difficulties separating from others (i.e., one’s family), functioning independently, and performing successfully. Associated unmet needs include independence, autonomy, parental attunement, and self-expression.

Enmeshment

The concept of enmeshment originates from Salvador Minuchin’s structural family therapy (Minuchin, 1974). Central to Minuchin’s seminal work with families was the role of ‘boundaries’ in systems: rules that organize family interactions, manage familial hierarchies, and balance individuality alongside connectedness. Michuchin identified three types of boundaries within the family system (Minuchin, 1974; Suppes, 2023):

  • Rigid boundaries. These are fixed, impermeable, and often poorly explained. Rigid boundaries do not support emotional connection and are associated with ‘disengaged families’ in which members simply ‘do their own thing’. 
  • Clear boundaries. These are explicit, understood, and can be altered in response to changing circumstances. Clear boundaries are associated with ‘connected families’ that balance emotional connectedness, separateness, and individual development. 
  • Diffuse boundaries. These are unclear boundaries, where roles are inconsistent and poorly defined. Diffuse boundaries are associated with ‘enmeshed families’ in which individuals are highly dependent and reactive, resulting in intrusion and volatility. Privacy and separateness are deprioritized or actively discouraged, while the needs of the family are prioritized above those of the individual. 

Crucially, Minuchin (1974) and subsequent research (e.g., Cerniglia et al., 2017) suggest that both extremes – highly enmeshed or rigid boundaries – result in individual or systemic difficulties:

In enmeshment, the family members are over involved with one another and overresponsive. Interpersonal boundaries are diffuse, with family members intruding on each other’s thoughts, feelings and communications. Subsystem boundaries are also diffuse, which results in a confusion of roles. The individual’s autonomy is severely restricted by the family system.

Minuchin, 1974.  

Similarly, schema therapy defines the enmeshment EMS in terms of blurred interpersonal boundaries, limited individuality, and a lack of autonomy. Individuals with this EMS are excessively involved in the life of one or more significant others (e.g., a parent, partner, or sibling), often at the expense of their individuation and distinctiveness (Young, 2014). Additionally, individuals with this EMS almost always have an undeveloped sense of self: having adopted the identity of the ‘enmeshed other’ and suppressed their natural inclinations, they feel empty, fraudulent, and directionless (Love, 1991; Young et al., 2003).   

Overinvolvement is central to enmeshment. Individuals with this EMS are extremely emotionally involved with the person with whom they are enmeshed, sometimes to the point of feeling fused or questioning of their existence (Young et al., 2003). ‘Magical thinking’ is also common, such as knowing what the other wants or needs without communicating. So intense is this involvement that clients often struggle to distinguish their thoughts and feelings from the enmeshed other. The client shares everything and expects the other to do the same. In this context, personal privacy is an unfamiliar (and sometimes threatening) idea which may seem tantamount to betrayal.  

Intrusion is another common feature of enmeshment. Some clients describe feeling smothered, overwhelmed, or overprotected by the other (Young, 2014). However, the idea of separating or setting boundaries is often highly guilt-inducing or anxiety-provoking. As a result, the client continues to surrender to the needs and wishes of the enmeshed other, further undermining their autonomy (Conway, 2019). 

Parentification is also associated with enmeshment. Individuals with this EMS might recall being enlisted by one parent against the other in reaching decisions, filling the vacuum of a deceased relative, or being a parent’s primary source of support (Minuchin & Fishman, 1981). As children, these individuals feel burdened by the weight of their enmeshed relationships and the pressure to suppress their needs (Love, 1991). As adults, they often continue to feel excessively obligated and responsible, fearing that either they or the enmeshed other will not survive without such intense involvement (Young, 2014).  Other individuals may have been forced to become a surrogate partner to a parent (what is sometimes referred to as ‘emotional incest’ or ‘covert incest’):

The boundary between caring love and incestuous love is crossed when the relationship with the child exists to meet the needs of the parent rather than those of the child. As the deterioration in the marriage progresses, the dependency on the child grows... Attempts at play, autonomy, and friendship render the child guilt-ridden and lonely, never able to feel okay about his or her needs. Over time, the child becomes preoccupied with the parent’s needs and feels protective and concerned.

Adams, 2011.

Young and colleagues (2003) note that enmeshment is almost always associated with an undeveloped self. Individuation is an important developmental process whereby children establish their individuality and separateness from significant others (Karpel, 1976). However, this process is compromized in families where boundaries are diffuse and members are excessively close: belonging within such an enmeshed system requires a yielding of autonomy (Minuchin, 1974). Consequently, enmeshed children often surrender their identities and adopt the interests and attitudes of attachment figures to maintain proximity, resulting in reduced self-identity and self-direction. Lacking a sense of personal identity or appropriate interpersonal boundaries, these individuals grow up feeling lost, inauthentic, and empty: “Who am I if not tied to the other person?”’ (Suppes, 2023).   

Therapists should note that individuals with this EMS sometimes view their enmeshment relationships positively, emphasizing how protected, ‘special’, or connected they feel to these individuals (Chan & Ma, 2008; Love, 1991). Consequently, they may struggle to identify distressing aspects or experiences associated with this schema.

These families look like the normal, all-American family. They are benign neighbours. They do not fight. They are very loyal and very protective – the ideal family.

Minuchin & Fishman, 1981.

In addition, therapists should be aware of the cultural dimensions of enmeshment. While many Western therapists consider enmeshment to be an unhealthy relationship style, it is normalized in other cultures (Lin, 2016). For instance, many Eastern cultures embrace collectivistic values and cultural practices that emphasize group (i.e., familial) harmony, emotional dependence, and connectedness over individual needs. Jin and Roopnarine also note that:

Relationships in Korean-heritage families are also steeped in indigenous cultural concepts such as Jung… wherein families are often viewed as having blurred physical and psychological boundaries.

Jin and Roopnarine, 2022

Furthermore, cross-cultural studies have challenged the view that enmeshment is universally detrimental. For instance, Chun and McDermid found that individuation was related to low self-esteem among Korean adolescents, while Jin and Roopnarine (2022) found that enmeshed family relationships benefitted South Korean immigrant children in the US. In addition, enmeshment has been associated with poorer psychological functioning in UK adolescents but not Italian individuals (Manzi et al., 2006). These findings suggest that extreme closeness in families steeped in cultural traditions relating to intimacy and cohesion do not always put children at risk. Accordingly, therapists need to be curious about the meaning and consequences of enmeshment for individuals from different cultural backgrounds. 

As with all EMS, enmeshment has multiple structural components. Individuals with this schema are prone to several cognitive distortions or ‘unhelpful thinking styles’ (Lorzangeneh & Issazadegan, 2022; Young & Klosko, 1994; Young et al., 2003), including:

  • Catastrophizing (e.g., “My family wouldn’t survive if we weren’t so close”).
  • Discounting the positives (e.g, “I don’t enjoy things unless my partner is involved”). 
  • Emotional reasoning (e.g., “It feels wrong to have secrets, so it must be wrong”). 
  • Fortune-telling (e.g., “My father wouldn’t manage if I lived away from him”).
  • Labeling (e.g., “Separating from my parents would make me bad”).
  • Mental filter (e.g., “There’s nothing to gain from setting boundaries with my family”).
  • Overgeneralization (e.g., “My behavior reflects my whole family”).
  • Personalization (e.g., “It’s my fault that my parents aren’t happier”).
  • “Should”s and imperatives (e.g., “I shouldn’t keep things from my partner”).

Emotions linked to enmeshment include:

  • Fear associated with individuation and reduced involvement in the life of the other.
  • Anxiety associated with being abandoned or replaced by the enmeshed other.
  • Overwhelm associated with smothering and intrusion. 
  • Guilt associated with separation and boundary-setting.
  • Loneliness associated with being unable to share experiences, needs, and interests. 
  • Confusion associated with appropriate boundaries (e.g., entitlement to privacy) and differentiating one’s emotions, opinions, and preferences from the other. 
  • Anger associated with betrayal and violation. 
  • Emptiness, hollowness, and fraudulence associated with a lack of identity and self-direction.

As a result, people with enmeshment may experience difficulties when it comes to:

  • Separating from significant others. 
  • Self-awareness and self-identity (e.g., personal needs, values, and preferences).
  • Identifying and regulating emotions.  
  • Assertively communicating their thoughts, feelings, needs, and preferences. 
  • Developing balanced relationships based on mutual respect and understanding.
  • Setting and maintaining healthy boundaries with others.
  • Acting independently (e.g., making decisions that are at odds with the significant other, moving away from home). 

As with most EMS, enmeshment often co-occurs with other schemas (Bacon & Conway, 2022; Love, 1991; Young et al., 2003). Associated EMS include:

  • Dependence/Incompetence. The client believes they would not survive without the support of the other (i.e., dependence/incompetence) and the other would not survive without their support (i.e., enmeshment), e.g., co-dependent relating.  
  • Emotional deprivation. Enmeshment and emotional deprivation arise from a lack of attunement and the parent’s failure to recognize the child’s emotional needs.
  • Mistrust/Abuse. Enmeshment and mistrust/abuse both originate from experiences of betrayal and violation. 
  • Self-sacrifice. The client feels excessively responsible for meeting the needs of the enmeshed other. 
  • Social isolation. Enmeshment precludes or obstructs relationships with others, such as the individual’s peer group.  
  • Subjugation. Parental dominance prevents the client from developing a separate sense of self; they must meet the needs of the enmeshed other to avoid rejection or abandonment. 
  • Unrelenting standards. The client believes that they must be extraordinary to continue to be idolized or enmeshed with the other. 

Enmeshment is associated with a range of difficulties, including addictions (Arpaci, 2023), body image problems (Abedi et al., 2018), bipolar disorder (Ak et al., 2011; Nilsson et al., 2015), burnout (Simpson et al., 2019), childhood trauma (Pilkington et al., 2021), dependent personality disorder (Nordahl et al., 2005), depression (Bishop et al., 2022), eating disorders (Nicol et al., 2020), psychosis (Sundag et al., 2016; Thimm & Chang, 2022), post-traumatic stress disorder (PTSD) (Price, 2007), and relationship problems (Janovsky et al., 2020).

Development origins

Enmeshment is associated with unmet emotional needs relating to autonomy and self-direction, attunement, self-understanding, safety, and healthy boundaries (Bacon & Conway, 2022; Lockwood & Perris, 2012). Formative experiences that might play a role in the development of this EMS may include:

  • Parentification (e.g., the child is assigned a developmentally inappropriate role, such as being a parent’s confidant or emotional support).
  • Childhood abuse (e.g., the child becomes ‘punchbag’ for the enmeshed parent, is sexualized by them, or experiences envious attacks from the estranged parent). 
  • Parents who are controlling, imposing, overly involved, and/or misattuned to the child’s needs.
  • Attempts to separate or individuate resulted in conflict, accusations of betrayal, or guilt induction. 
  • Restricted opportunities for individuation and self-directed exploration. 

Research confirms that specific developmental experiences are associated with enmeshment, including emotional and sexual abuse (May et al., 2022; Pilkington et al., 2021) and parenting that is overprotective and controlling (Bach et al., 2018; Bruysters & Pilkington, 2022; Sheffield et al., 2005).

Therapist Guidance

Many people struggle with enmeshment, and it sounds like it might be relevant to you too. Would you be willing to explore this schema more with me?

Clinicians might begin by providing psychoeducation about emeshment and EMS more generally:

  • Schemas are negative themes and patterns that start in your childhood and continue throughout your life. Some are very common.
  • Schemas get stronger as time passes, becoming the negative filters people use to understand and predict the world. You could think of them as dark sunglasses – they color and distort our experiences in unhelpful ways. 
  • Schemas operate ‘behind the scenes’: we’re not usually aware of them or when they are active. However, with practice, you can become more aware of them. It is a bit like a theatre – you can learn to bring your backstage schemas to the main stage. 
  • One of these is ‘enmeshment’: you are so involved in the life of another person (such as your parent(s) or best friend) that you don’t have a sense of who you are as a person. ‘Fusing’ with another person might leave you feeling empty, smothered, or worried that you won’t survive without them.  
  • Signs that you have an enmeshment schema include being extremely close to another person, feeling anxious or guilty if you spend time apart, or lacking a sense of your own identity. 
  • People develop schemas because some of their emotional needs were not met while they were growing up. As children, our schemas help us make sense of early experiences. If you have an enmeshment schema, you might have had limited opportunities to think or act independently as a child. For example, your parents might have been overinvolved and controlling, or imposed their preferences or opinions upon you. Some people with this schema were parentified as children (i.e., forced to act older than they were, such as being an emotional support for a parent).  
  • Schemas are painful, so people learn to cope with them in different ways. You might cope with enmeshment by sacrificing your identity and living life through the other person, avoiding relationships where there is a risk of becoming enmeshed, or trying to be the exact opposite an over-involved person in your life.

Standard treatment techniques for working with enmeshment are listed below. They include:

  • Self-monitoring (e.g., schema diaries). 
  • Cognitive interventions (e.g., historical review, decentring, flashcards).
  • Emotion-focused interventions (e.g., imagery rescripting, chairwork, letter-writing). 
  • Relational interventions (e.g., limited reparenting, empathic confrontation).
  • Behavioral interventions (e.g., experimentation, behavioral pattern-breaking).  

In light of the unmet needs associated with enmeshment, individuals with this EMS also require a specific ‘need-meeting’ style of interaction from the outset of therapy (Cutland Green & Balfour, 2020). This includes supporting and promoting the client’s independence, self-direction, and healthy boundaries, as well as their personal preferences, opinions, interests, and values (Lockwood & Perris, 2012).    

References And Further Reading

  • Abedi, A., Sepahvandi, M. A., & Mirderikvand, F. (2018). Investigating the role of early maladaptive schemas in body image disturbance. Journal of Advanced Pharmacy Education and Research, 8, 51-57.
  • Adams, K. M. (2011). Silently seduced: When parents make their children partners. Health Communications Inc. 
  • Alba, J., Calvete, E., Wante, L., Van Beveren, M. L., & Braet, C. (2018). Early maladaptive schemas as moderators of the association between bullying victimization and depressive symptoms in adolescents. Cognitive Therapy and Research, 42, 24-35. DOI: 10.1007/s10608-017-9874-5.
  • Ak, M., Lapsekili, N., Haciomeroglu, B., Sutcigil, L., & Turkcapar, H. (2012). Early maladaptive schemas in bipolar disorder. Psychology and Psychotherapy: Theory, Research and Practice, 85, 260-267. DOI: 10.1111/j.2044-8341.2011.02037.x.
  • Arntz, A., Rijkeboer, M., Chan, E., Fassbinder, E., Karaosmanoglu, A., Lee, C. W., & Panzeri, M. (2021). Towards a reformulated theory underlying schema therapy: Position paper of an international workgroup. Cognitive Therapy and Research, 45, 1007-1020. DOI: 10.1007/s10608-021-10209-5.
  • Arpaci, I. (2023). Predicting problematic smartphone use based on early maladaptive schemas by using machine learning classification algorithms. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 41, 634-643. DOI: 10.1007/s10942-022-00450-6
  • Askari, A. (2021). New concepts of schema therapy: The six coping styles. Amir Askari.
  • Bach, B., Lockwood, G., & Young, J. E. (2018). A new look at the schema therapy model: organization and role of early maladaptive schemas. Cognitive Behaviour Therapy, 47, 328-349. DOI: 10.1080/16506073.2017.1410566.
  • Bacon, I., & Conway, J. (2022). Co-dependency and enmeshment—a fusion of concepts. International Journal of Mental Health and Addiction, 1-10. DOI: 10.1007/s11469-022-00810-4.
  • Beck, A. T., Freeman, A., & Davis, D. D. (2004). Cognitive therapy of personality disorders. Guilford Press.
  • Belsky, J. (2013). Differential susceptibility to environmental influences. International Journal of Child Care and Education Policy, 7, 15-31. DOI: 10.1007/2288-6729-7-2-15.
  • Bishop, A., Younan, R., Low, J., & Pilkington, P. D. (2022). Early maladaptive schemas and depression in adulthood: A systematic review and meta‐analysis. Clinical Psychology and Psychotherapy, 29, 111-130. DOI: 10.1002/cpp.2630.
  • Bowlby, J. (1977). The making and breaking of affectional bonds: I. Aetiology and psychopathology in the light of attachment theory. British Journal of Psychiatry, 130, 201–210. DOI: 10.1192/bjp.130.3.201.
  • Briedis, J., & Startup, H. (2020). Somatic perspective in schema therapy: The role of the body in the awareness and transformation of modes and schemas. In G. Heath and H. Startup (Eds.), Creative methods in schema therapy: Advances and innovations in practice. Routledge, 60-75. 
  • Brockman, R. N., Simpson, S., Hayes, C., Wijingaart, R. V. D., & Smout, M. (2023). Cambridge guide to schema therapy. Cambridge University Press.
  • Bruysters, N. Y. F., & Pilkington, P. D. (2023). Overprotective parenting experiences and early maladaptive schemas in adolescence and adulthood: A systematic review and meta‐analysis. Clinical Psychology and Psychotherapy, 30, 10-23. DOI: 10.1002/cpp.2776.
  • Cerniglia, L., Cimino, S., Tafà, M., Marzilli, E., Ballarotto, G., & Bracaglia, F. (2017). Family profiles in eating disorders: family functioning and psychopathology. Psychology Research and Behavior Management, 10, 305-312.
  • Chan, Z. C., & Ma, J. L. (2006). A feminist family therapy research study: Giving a voice to a girl suffering from anorexia nervosa. Journal of Feminist Family Therapy, 17, 41-64. DOI: 10.1300/J086v17n02_03.
  • Chun, Y. J., & MacDermid, S. M. (1997). Perceptions of family differentiation, individuation, and self-esteem among Korean adolescents. Journal of Marriage and the Family, 59, 451-462. DOI: 10.2307/353482.
  • Conway, J. (2019, November 7). Treating enmeshment and the undeveloped self. https://schematherapysociety.org/news/8100663.
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