What Is Schema Therapy?

This accessible information handout describes the key principles of schema therapy.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Overview

Schema therapy is an evidence-based talking therapy used to address various psychological difficulties. Central to schema therapy is the idea that many difficulties stem from early maladaptive schemas (EMS), how individuals respond to them (their ‘coping styles’), and the transient self-states they produce (their ‘schema modes’). The What Is Schema Therapy? information handout is designed to introduce clients to this approach. It provides an overview of key concepts and therapeutic tasks, and examples of conditions where schema therapy has been shown to be effective.

Why Use This Resource?

This handout provides an accessible yet comprehensive explanation of schema therapy. Therapists can use to:

  • Introduce clients to key ideas in schema therapy.
  • Support treatment selection.
  • Reinforce clients’ understanding of schema therapy principles throughout treatment.
  • Communicate the rationale for core therapeutic tasks.

Key Benefits

Clear

Presents key schema therapy principles using client-friendly language and illustrations.

Informative

Explains what schema therapy involves and the problems it can help address.

Versatile

Suitable for a wide range of clients.

Engaging

Encourages collaboration and increased motivation for treatment.

Integrating it into your practice

01

Introduce

Start a conversation about the potential benefits of schema therapy.

02

Explore

Use the information handout to explore the key ideas in schema therapy.

03

Reflect

Help clients reflect on how schema therapy might be helpful to them.

04

Reinforce

Use the handout to consolidate client learning between sessions.

Theoretical Background & Therapist Guidance

Schema therapy is an integrative, evidence-based talking therapy used to treat various psychological difficulties (Bernstein et al., 2023; Joshua et al., 2023; Kopf-Beck et al., 2024; Peeters et al., 2022; Zhang et al., 2023). It has been successfully applied in individual, couple, and group settings.

Originally developed by Jeffrey Young in 1990s (Young et al., 2003), schema therapy was created to help individuals with complex, longstanding difficulties that did not respond well to traditional cognitive behavior therapy (CBT; Edwards & Arntz, 2012; McGinn & Young, 1996). Schema therapy combines CBT with elements from attachment, gestalt, object relationships, constructivist, psychoanalytic, and neurobiological approaches, forming a unified conceptual model. Over time, schema therapy has incorporated additional approaches, such as EMDR (Young et al., 2002), mindfulness (van Vreeswijk et al., 2014), and body-focused methods (Briedis & Startup, 2020).

Central to schema therapy is the idea that many difficulties arise from ‘early maladaptive schemas’ (EMS): enduring, negative themes or patterns in people’s thoughts and emotions about themselves and their relationships with others. EMS are thought to develop when core emotional needs are unmet in childhood, such as the need for connection, autonomy, and self-expression. When EMS are activated, people often respond in characteristic, self-defeating ways, referred to as ‘coping styles’. These behaviors, along with other factors such as cognitive distortions, reinforce and perpetuate EMS.

Another key concept in schema therapy is ‘schema modes’: EMS and coping styles that are active for an individual at a given moment. Unlike EMS, which are more stable and ‘trait-like’, modes are transient and ‘state-like’, usually triggered by situations that push an individual’s ‘emotional buttons’ (Martin & Young, 2010).

This What Is Schema Therapy? information handout is designed to introduce clients to schema therapy. It provides an overview of some its key concepts, therapeutic tasks, and conditions for which schema therapy has been shown to be effective.

What's inside

  • A clear and accessible information handout explaining schema therapy.
  • A comprehensive introduction to schema therapy written for therapists.
  • Guidance for using the resource with clients.
  • Key references and recommended further reading.
Get access to this resource

FAQs

A schema is an enduring, negative theme or pattern in a person's thoughts and emotions that relates to themselves and their relationships with other people.
Modes are moment-to-moment emotional states or coping responses that emerge when schemas are triggered. Examples include the ‘vulnerable child’ or ‘detached protector’.
While CBT focuses on current thoughts and behaviours, schema therapy targets the deeper belief structures underlying emotional and interpersonal problems. It uses more experiential techniques and put a greater emphasises on clients' developmental history and the therapeutic relationship.
Schema therapy includes cognitive restructuring, experiential techniques like imagery rescripting and chairwork, behavioural pattern breaking, and healing through the therapeutic relationship ('limited reparenting').

How This Resource Improves Clinical Outcomes

Using this resource can help clients:

  • Learn about schema therapy and what to expect from it.
  • Answer the questions they might about this therapy.
  • Make an informed decision about taking up schema therapy.
  • Feel confident and motivated about starting schema therapy.

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References And Further Reading

  • Andersson, G., & Cuijpers, P. (2009). ‘Psychological treatment’ as an umbrella term for evidence-based psychotherapies? Nordic Psychology, 6, 4-15. DOI: 10.1027/1901-2276.61.2.4.
  • Barber, J. P., & DeRubeis, R. J. (1989). On second thought: Where the action is in cognitive therapy for depression. Cognitive Therapy and Research, 13, 441-457. DOI: 10.1007/BF01173905.
  • Barlow, D. H. (2004). Psychological treatments. American Psychologist, 59, 869-878.
  • Barlow, D. H. (2006). Psychotherapy and psychological treatments: The future. Clinical Psychology: Science and Practice, 13, 216-220.
  • Beck, A. T. (1996). Beyond belief: A theory of modes, personality, and psychopathology. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy (pp.1-25). Guilford Press.
  • Bernstein, D. P., et al. (2023). Schema therapy for violent PD offenders: A randomized clinical trial. Psychological Medicine, 53, 88-102. DOI: 10.1017/S0033291721001161.
  • Briedis, J., & Startup, H. (2020). Somatic perspective in schema therapy. In G. Heath & H. Startup (Eds.), Creative methods in schema therapy (pp.60-75). Routledge.
  • Crits-Christoph, P., et al. (2010). Interpersonal accuracy and outcomes in therapy. Journal of Consulting and Clinical Psychology, 78, 420-428. DOI: 10.1037/a0019549.
  • Cuijpers, P., et al. (2019). The role of common factors in psychotherapy outcomes. Annual Review of Clinical Psychology, 15, 207-231. DOI: 10.1146/annurev-clinpsy-050718-095424.
  • Cuijpers, P., et al. (2024). Absolute and relative outcomes of psychotherapies. World Psychiatry, 23, 267-275. DOI: 10.1002/wps.21203.
  • Edwards, D., & Arntz, A. (2012). Schema therapy in historical perspective. In M. van Vreeswijk, J. Broersen, & M. Nadort (Eds.), The Wiley-Blackwell handbook of schema therapy (pp.3-26). John Wiley and Sons.
  • Joshua, P. R., et al. (2023). Is schema therapy effective for eating disorders? Cognitive Behaviour Therapy, 52, 213-231. DOI: 10.1080/16506073.2022.2158926.
  • Kopf-Beck, J., et al. (2024). Schema therapy vs CBT vs supportive therapy. Psychotherapy and Psychosomatics, 93, 24-35. DOI: 10.1159/000535492.
  • Lambert, M. J., & Ogles, B. M. (2004). In M. J. Lambert (Ed.) Bergin and Garfield’s handbook of psychotherapy and behavior change (pp. 139-93). Wiley.
  • Leichsenring, F., et al. (2013). CBT and psychodynamic therapy for social anxiety. American Journal of Psychiatry, 170, 759-767. DOI: 10.1176/appi.ajp.2013.12081125.
  • Lockwood, G. (2008). The schema therapy model. International Society of Schema Therapy. https://schematherapysociety.org/Schema-Therapy
  • Martin, R., & Young, J. E. (2010). Schema therapy. In K. S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (pp.317-346). Guilford Press.
  • McGinn, L. K., & Young, J. E. (1996). Schema-focused therapy. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy (pp.182-207). Guilford Press.
  • Moorey, S., et al. (2020). Brief work: Schema informed CBT. In G. Heath & H. Startup (Eds.), Creative methods in schema therapy (pp. 301-315). Routledge.
  • Peeters, N., et al. (2022). Schema therapy for anxiety disorders, OCD, or PTSD. British Journal of Clinical Psychology, 61, 579-597. DOI: 10.1111/bjc.12324.
  • Poulsen, S., et al. (2014). Psychoanalytic vs CBT for bulimia. American Journal of Psychiatry, 171, 109-116. DOI: 10.1176/appi.ajp.2013.12121511.
  • Rafaeli, E., et al. (2014). Working with modes in schema therapy. In N. Thoma & D. McKay (Eds.), Working with emotion in cognitive behavioral therapy (pp. 263-287). Guilford Press.
  • Roth, A., & Fonagy, P. (2005). What works for whom? (2nd ed.). Guilford Press.
  • Skewes, S. A., et al. (2015). Short-term group schema therapy. Frontiers in Psychology, 5, 1592. DOI: 10.3389/fpsyg.2014.01592.
  • Strupp, H. H. (1978). In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (2nd ed.) (pp.3-22). Wiley.
  • Tschacher, W., et al. (2014). Towards a taxonomy of common factors. Clinical Psychology and Psychotherapy, 21, 82-96. DOI: 10.1002/cpp.1822.
  • Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate (2nd ed.). Routledge.
  • Wampold, B. E., et al. (1997). Meta-analysis of outcome studies. Psychological Bulletin, 122, 203-215. DOI: 10.1037/0033-2909.122.3.203.
  • Wolitzky-Taylor, K. B., et al. (2008). Psychological approaches for phobias. Clinical Psychology Review, 28, 1021-1037. DOI: 10.1016/j.cpr.2008.02.007.
  • Van Vreeswijk, M., et al. (2014). Mindfulness and schema therapy: A practical guide. John Wiley and Sons.
  • Young, J. E., et al. (2003). Schema therapy: A practitioner’s guide. Guilford Press.
  • Young, J. E., et al. (2002). Combining EMDR and schema-focused therapy. In F. Shapiro (Ed.), EMDR as an integrative psychotherapy approach (pp. 181-208). APA.
  • Zhang, K., et al. (2023). Schema therapy for personality disorders. Nordic Journal of Psychiatry, 77, 641-650. DOI: 10.1080/08039488.2023.2228304.
  • Zarbo, C., et al. (2016). Integrative psychotherapy works. Frontiers in Psychology, 6, 2021. DOI: 10.3389/fpsyg.2015.02021.

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