Therapy approaches, explained

Schema therapy

When basic emotional needs go unmet for long stretches in childhood, they leave an old set of lenses for seeing yourself and others. Schema therapy uses that history to make sense of why someone keeps landing in the same trouble today, and then helps them step by step to separate from the old pattern.^[1,2]

Start with the basics Meet our team

What is schema therapy?

Have you noticed that certain situations hit you the same way every time? It's eleven at night and your manager messages, "Can we talk tomorrow?" without saying what about. Your stomach drops, you're sure you've done something wrong, and then you redo the slides all night or can't bring yourself to reply. Change company, change manager, and the same reaction comes along. You know, in theory, that it may be just a meeting. So why does the feeling arrive faster than the reasoning, and weigh more?

1The worldview

Why the same reaction replays: need, schema and coping, each feeding the next

Schema therapy doesn't treat that sinking feeling over a single message as oversensitivity; it looks for where the reaction came from. It was developed by the American psychologist Jeffrey Young, who combined cognitive behavioural, attachment, psychodynamic and emotion-focused traditions into one structured treatment. It was first used mainly for long-standing, recurring difficulties, and has been studied most in borderline personality disorder. Chinese names vary: 「圖式治療」 is common in Hong Kong, and 「基模治療」 is also common in mainland China and Taiwan. The word "mode" in its second core idea (below) is often rendered 「模式」.^[2,3]

Its starting point is core emotional needs. Young proposed that children have a handful of basic needs: safe, stable connection with others; autonomy and a sense of competence; freedom to express needs and feelings; spontaneity and play; and realistic limits. When these are persistently ignored, suppressed or over-met, the child builds early maladaptive schemas: deep-seated patterns of belief, emotion, bodily feeling and memory that start in childhood and run through life, sounding like "I am unlovable", "I'm not good enough" or "people eventually leave". Young described 18 schemas in five domains, though later research suggests the five-domain grouping doesn't hold up fully (see Limits).^[1,4]

A schema is more than a thought. It works like a lens on the world, and when something triggers it, strong emotion comes with it. People usually cope in one of three ways: surrender (accept its story and replay it, such as repeatedly choosing a cold partner), avoidance (steer clear of what triggers it, or numb out through withdrawal or addiction) and overcompensation (fight it by doing the opposite, so someone who feels not good enough chases perfection or dominates others). These ways of coping helped in childhood, but in adulthood they tend to keep the schema going: surrender confirms it, avoidance means it is never tested, and overcompensation brings new costs.^[1,2]

So the night at the start wasn't an isolated glitch. Put together, this is a self-reinforcing loop: childhood needs go unmet and leave a schema; the schema is triggered later; the person copes by surrendering, avoiding or overcompensating; and that coping keeps the schema alive while the need stays unmet. Therapy works on each link: seeing the need, loosening the schema, changing the coping.

NeedAn emotional need left unmet through childhood
SchemaThe deep belief left behind, flooding in with strong emotion when triggered
CopingSurrender, avoidance or overcompensation, which keep the schema going

Modes: when your stomach drops, which part of you is in charge

The loop explains why it replays, but not who you turn into in that moment. A schema is a long-standing point of view; a mode is the state that is in charge right now, meaning the whole emotional and coping state you are in once something is triggered. People shift between modes quickly, and this is not pathological: everyone has them. Schema therapy groups modes into four kinds. In borderline personality disorder, for example, five are commonly described: the vulnerable child, the angry or impulsive child, the detached protector, the punitive parent and the healthy adult. The examples below return to the night at the start: your manager messages, "Can we talk tomorrow?" without saying what about.^[1,2]

Modes are not a diagnosis and not "multiple personality": they are language for saying why you suddenly feel like a different person. The aim is not to eliminate any mode but to reorganise the inner structure: strengthen the healthy adult, soothe the vulnerable child, let coping modes that are no longer needed step back, and put a stop to the parent modes' harshness.

1Child modes
The feelings and urges of childhood: the vulnerable child who is hurt, frightened or lonely; the angry or impulsive child; and the "happy child" who is relaxed and playful. This is where needs show up most directly.
Stomach drops; sure you've done something wrong and are about to be found out.
2Coping modes
Ways of protecting yourself: the compliant surrenderer, the detached protector who numbs and withdraws, and the overcompensator who protects by fighting back. They once protected you, and now they mostly keep you stuck.
Reworking the slides all night (overcompensation), or not replying at all (detachment).
3Parent modes
Internalised voices of caregivers: a punitive critic, or a demanding insistence on high standards. They often sound like things that were actually said.
"You can't even get this right. What are you doing here?"
4Healthy adult
The part that can see the facts, look after you and soothe the vulnerable child. The aim of therapy is to make it strong enough to take charge when other modes surge.
"I don't know what it's about yet. Sleep first, ask tomorrow."

2The method

Four stages: assess, bond, change, become autonomous, swapping the old reaction step by step

Once the loop and modes are clear, the question is how to change them. Schema therapy has a clear order. First assess and draw your own map of schemas and modes; then, in the three phases Kellogg and Young describe, work through bonding and emotion regulation, schema mode change, and the development of autonomy. The change phase rests on four mechanisms: limited reparenting, experiential imagery and dialogue work, cognitive restructuring and education, and behavioural pattern breaking. The four stages map onto the three links above: assessment sees the loop; bonding gives a safe base so the need can be seen in a relationship; change loosens the schema and swaps the coping; autonomy takes the new ways back into daily life.^[1,2]

1Assessment and formulationLife history, schema and mode questionnaires (such as the Young Schema Questionnaire) and imagery exercises, to map your schemas, modes and where they came from, togetherNeedSchemaCoping
2Bonding and emotion regulationBuild a relationship you can trust and learn to steady your emotions before touching more painful experiencesNeed
3Schema mode changeUse cognitive, experiential and behavioural techniques to loosen the schema and replace the copingSchemaCoping
4AutonomyCarry the new ways into work and relationships, and rely less and less on therapyCoping

An example: the message from the start, answered by the old schema and by a new response

1At eleven at night your manager messages: "Can we talk tomorrow?" It doesn't say what about.

Old schema in chargeSchema recognised, healthy adult present

The moment it hits

Old schema in chargeStomach drops. You must have done something wrong and are about to be found out.

Schema recognised, healthy adult presentYou recognise the feeling: the defectiveness and shame schema is triggered. It is an old alarm, not necessarily the facts.

Which mode

Old schema in chargeThe vulnerable child is frightened and a punitive voice is saying: "You've messed up again."

Schema recognised, healthy adult presentYou can tell them apart: this is the vulnerable child and a critical voice, not the whole of what's happening.

Coping

Old schema in chargeChecking and redoing the slides overnight (overcompensation), or not replying at all (avoidance).

Schema recognised, healthy adult presentYou reply: "Sure, what time? Is it about anything in particular?" Then you sleep.

Afterwards

Old schema in chargeWhatever happens, it feels like you escaped only by staying up all night: the schema was never tested, and sinks in deeper.

Schema recognised, healthy adult presentWhatever the talk is about, you notice you didn't stay up and nothing collapsed. The schema's story was gently questioned once.

That answers the opening question: the feeling outruns and outweighs the reasoning because more than this one message has been triggered; an old schema has too. Set against the method above: assessment finds the defectiveness and shame schema and where it came from; cognitively, you write down the old story with the evidence against it; experientially, you work with the childhood scene; behaviourally, you practise not staying up and asking directly. The right-hand column doesn't appear overnight: it is what becomes possible some of the time after months or longer of work, and the old feeling usually still comes, only smaller and shorter. Use the thought record to write down the trigger and the old story

3The skills

Six ways of working: each at its own link of the loop, swapping the old reaction

The right-hand column of the example comes from these six ways of working, the mechanisms of change above made concrete. They combine rather than follow a fixed order, and you and the therapist choose among them by stage and by what is needed in the moment. They are grouped by the link each mainly works on. Imagery rescripting and chair work stir deep emotion and must be led by a trained therapist; this page offers no do-it-yourself version, and there is no AI exercise for them.

Need: giving what was missing then

In the relationship and in imagination, let the old need be seen and answered for the first time.

Imagery rescripting: returning to a childhood scene and giving the child what was needed
When a schema is tied to a childhood picture, the therapist may invite you to close your eyes and return to that scene, see it through the child's eyes and feel what was needed; then your adult self (the therapist at first, if your emotions aren't steady) steps into the scene to do what was missing: stop the harsh person, comfort the child, ask what he or she needs. It ends back in a safe place. The technique is also used for other difficulties built around painful memories; research is promising overall, but mostly before-and-after studies, with few randomised trials. It needs enough trust and emotion regulation first, a trained therapist and the freedom to say stop at any time; with traumatic or abusive memories it should not be tried alone.^[2,5,6]
Hear it in a session
1. Therapist
  Last time you mentioned the scene where your dad looked at your report card. Would you like to go back to it today? If it gets too much, tell me and we stop.
2. Client
  Yes. I'd like to try.
3. Therapist
  Good. First notice your feet and the chair. Then close your eyes and see the scene. How old are you? Where are you?
4. Client
  Eight. In the living room. I'm holding my report card, ninety-five. He glances at it and says, "Why not a hundred?"
5. Therapist
  Eight years old: what is it like inside right now?
6. Client
  I'm shrinking a bit. As if nothing is ever enough.
7. Therapist
  What does this child need? No need to fix anything yet, just say it.
8. Client
  I want him to say, "Well done, I can see how hard you worked."
9. Therapist
  Now bring your adult self into the living room. What would you like to say to your dad? What would you do?
10. Client
  (Pause) I'd stand between him and the child and say, "She got ninety-five. She worked hard. You don't need to ask again."
11. Therapist
  And then? Turning to the child, what would you like to do?
12. Client
  I crouch down and tell her, "You're good enough already." She looks at me… still not quite believing it.
13. Therapist
  Not believing is fine. She needs time. You can stay with her a little longer, then we'll bring her somewhere safe and comfortable. When you're ready, open your eyes and tell me how you are now.
14. Client
  My chest is a bit looser. But I still feel like crying.
Notice: This is imagery rescripting, showing the need. The therapist first checks she is willing and can stop at any time, using a childhood scene of moderate intensity (not a trauma). She sees it first through the child's eyes and says the need; the therapist invites her adult self into the scene, letting her decide what to say and do rather than writing the ending for her. The child relaxes only partly and stays wary, and the exercise ends back in a safe place with a check on how she is now. One rescripting doesn't make the old feeling vanish; it is usually repeated across different scenes.
Method based on^[1,2,5]
Limited reparenting: answering old needs within professional boundaries
Schema therapy is less neutral than the traditional stance: the therapist is warmer and more direct, validates your feelings, shows care when appropriate, and gently but firmly confronts the coping modes that keep you stuck, with reasonable limits, so you experience a "good enough" relationship. This is called limited reparenting. The word limited is the point: the therapist is not your parent and doesn't replace relationships in your life, and everything stays within professional boundaries. Researchers have described the process as noticing a schema being triggered, validating your experience, exploring where the schema came from, and then answering the unmet need within professional boundaries.^[2,8]

Schema: loosening the old story

Through evidence and dialogue, stop the schema being taken for granted.

Cognitive work: checking the evidence, writing flashcards
Back to the night at the start and its "I must have done something wrong": the schema's claim (and "I'm not good enough" too) is put on the table and you gather the evidence for and against it, including the parts of your life that fit and don't fit; the pros and cons of your coping style are weighed too. A common tool is the schema flashcard: the trigger, the feeling it sets off, the old claim and a more balanced view, to be read when the schema surges. This is the part closest to cognitive behavioural therapy.^[1,2]
Try the thought record
Chair work: talking with the inner critic and the protector
A mode is "placed" on a chair so it can speak, and you move to another chair to answer it: the punitive critic, the detached protector and the vulnerable child might each have a chair. The therapist often takes the vulnerable child's side and speaks directly to the critic, rather than leaving you to fight it alone; then you are invited to sit as your healthy adult and learn to answer in your own words. It is related to the chair work of emotion-focused therapy and has roots in gestalt practice, but here the aim is to fit the dialogue between modes into a structured treatment plan. Again, it must be led by a trained therapist, on top of a trusting relationship and enough emotion regulation.^[1,2,7]
Hear it in a session
1. Client
  There's a voice in my head that keeps saying, "You can't even get this right. What are you doing here?"
2. Therapist
  That sounds like a very harsh voice. Shall we try something a bit different? We put it on this empty chair and let it speak. I'll be beside you, and you can stop any time.
3. Client
  …OK, let's try.
4. Therapist
  (To the empty chair) I want to speak to you directly. You keep talking to her like this. What are you trying to protect her from?
5. Client
  (Sitting in the critic's chair) …I'm afraid she'll be shown up. When I wasn't good enough as a child, I got told off.
6. Therapist
  (To the chair) I understand what you intend. But your way hurts her. Even when she makes mistakes she deserves to be treated well. What she needs now isn't scolding.
7. Therapist
  Please move to this chair, as your adult self now, and answer it in your own words.
8. Client
  (Healthy adult) I know you want to protect me. But I'm not eight any more. I can handle this, and you don't have to scold me.
9. Therapist
  As you say it, notice your voice, and your body.
10. Client
  My voice is steadier than usual. My shoulders aren't quite so tight. But it'll probably come back.
11. Therapist
  It very likely will. That's what we'll practise over the next few sessions: how you answer when it does.
Notice: This is chair work, showing the schema. The marker is her mention of a harsh voice, the same one that said "You've messed up again" on the night at the start. The therapist asks consent and says she can stop at any time; rather than asking her to shout back at the critic, the therapist stands on the vulnerable child's side and speaks to the critic, protecting the client. Only then does she answer as her healthy adult. The critic doesn't vanish, only gets a little quieter, and this kind of work usually recurs over several sessions.
Method based on^[1,2,7]

Coping: recognising modes, changing what you do

Notice which mode is in charge, and practise another response in daily life.

Recognising which mode you are in
This is the foundation for the rest. The therapist and you name the modes (people often choose very personal names) and map what triggers each one and what happens in your body and behaviour when it appears. The aim is practical: once you notice "this is the surrenderer talking", you have a little room not to be carried off by it.^[1,2]
Behavioural work: breaking the habits that feed the schema
Change has to happen in real life. The therapist and you list the behaviours that keep the schema going (staying up to compensate, avoiding conflict, pleasing everyone), begin with an easier one, rehearse it by role-play in session, try it in life and review it next time. Each time you don't act the old way and the world doesn't collapse is a small piece of evidence against the old schema. This is the exit for all the earlier work, and is close to behavioural experiments in cognitive behavioural therapy.^[1,2]

The dialogues are illustrative composites, not real clients; skills that stir strong emotion or touch on trauma should be done with a trained therapist.

What does a course look like? Long, but ordered

Now you know how it sees a person and how it works. The next questions: what is it actually like, does it work, and what is it not for?

The trial results come from long courses. Schema therapy is long-term: in the large trials for borderline personality disorder it ran two to three years, at two sessions a week at first and tapering later, and in the trial for other personality disorders it was 50 sessions. It can be individual, or individual plus group. A course broadly runs like this.^[10,11,12]

1Assess and mapReview your life history, do questionnaires and imagery exercises, and together map your schemas and modes, where they came from and what triggers them.
2Build trust and learn to steady yourselfBuild a relationship you can trust and learn to steady yourself when emotion surges, before touching more painful experiences. This phase sometimes takes a good while.
3Change schemas and modesAlternate cognitive, experiential and behavioural work: flashcards, imagery rescripting, chair work, practising new responses in life. Progress differs from person to person and goes up and down.
4Grow autonomyUse the new ways at work, in relationships and in choices, with you leading more and the therapist stepping back.
5Taper, then finishSessions become less frequent and then end, with a plan agreed in advance for stressful times afterwards.

What can schema therapy help with?

It has been studied most in borderline personality disorder, then in other personality disorders and with violent offenders in high-security settings; it has also been tried for eating disorders, anxiety and post-traumatic stress, though evidence there is still thin.^[3,9,11,14]

Borderline personality disorder (intense emotions, unstable relationships, fear of abandonment)
Other personality disorders such as avoidant, dependent and obsessive-compulsive
Long-standing, recurring difficulties that other therapies have changed little
Eating disorders, chronic depression and anxiety (less evidence)
Violent offenders in high-security settings

Everyone is different. If you have a history of childhood trauma or abuse, tell the therapist, who will decide with you when and how to approach it at your pace. If you are thinking of hurting yourself or ending your life, please don't face it alone: call The Samaritans' 24-hour line on 2896 0000, or 999 in an emergency.

Does the path hold up? What the research says, and what is still a hypothesis

Having seen the path for rewriting the old reaction, the natural question is whether it has been tested. Schema therapy has several larger randomised trials (participants are randomly assigned to groups, then different approaches are compared) against specialised psychotherapy or usual treatment. But the evidence is concentrated in personality difficulties such as borderline personality disorder, and the main trials were run by teams that include the therapy's proponents or trainers. Below, from firmer to more preliminary, is what each question rests on.

Borderline personality disorder: better than a specialised psychodynamic therapy
A trial of 88 people compared schema therapy with transference-focused psychotherapy (a psychodynamic therapy designed for this diagnosis), each for three years at twice a week: both groups improved clearly, but fewer people dropped out of schema therapy, and more had recovered or clearly improved by year three. It is one of the few comparisons with a real rival, but it is a single trial, run by a team that includes a leading proponent of the therapy.^[10]
Other personality disorders: better than usual treatment
A trial of 323 people with avoidant, dependent, obsessive-compulsive, paranoid, histrionic or narcissistic personality disorder compared 50 sessions of schema therapy with usual treatment and with another "clarification-oriented" psychotherapy: after three years more people no longer met the diagnosis, and fewer dropped out. But the differences showed up on interviews by independent assessors and not on self-report questionnaires, and the therapists trained mainly through exercises did better than those trained mainly through lectures.^[11]
Group formats: individual plus group did best
In a trial across 15 sites with 495 people, two years of the combined individual-plus-group format reduced borderline symptoms more than usual treatment, with fewer dropouts, while the mainly-group format did not differ significantly from usual treatment. An earlier trial of only 32 people, adding a group to existing individual therapy, also found better results. But these trials' teams again include the therapy's proponents and trainers.^[12,13]
High-security forensic hospitals: faster steps back into the community
A trial of 103 men with violent offences and personality disorders found that three years of schema therapy, compared with usual treatment, helped them gain leave sooner and reduce personality disorder symptoms faster; both groups improved. It is a single study in Dutch secure forensic hospitals and needs more research, including replication elsewhere.^[14]
Depression, anxiety, eating disorders and other difficulties
Some studies have applied schema therapy to eating disorders, anxiety, post-traumatic stress and more, with encouraging early results, but a systematic review found rigorous evidence beyond personality disorders to be sparse. If your difficulty isn't a personality disorder, whether schema therapy suits you depends more on your preference and the therapist's professional judgement.^[3]
Does it really change schemas?
Of 12 studies reviewed, 11 found both schemas and symptoms improved, as the theory predicts. But few tested whether schema change is why people get better: in borderline personality disorder only three studies analysed this, and only as correlations. So "the schema model explains why therapy works" remains a hypothesis to be tested.^[3]

A few more points. The main trials' teams mostly include proponents or trainers of schema therapy; participants were mostly women (over 80% in the largest trial) and all the trials were in Europe, Australia or the US, so how well they carry over to Hong Kong and Chinese communities is still to be studied; the rivals were a specialised psychodynamic therapy, usual treatment and a "clarification-oriented" therapy, so these trials don't say how schema therapy compares with dialectical behaviour therapy (DBT). The treatment is often long and intensive (two sessions a week for two to three years), which is part of its effect and part of its cost. So schema therapy looks effective for serious, long-standing difficulties such as borderline personality disorder, but "better than every other therapy" has not been shown.^{[10,11,12,13,14]}

To be honest: it has evidence, but it isn't a cure-all, and it isn't for doing alone

Its evidence is firmer than many approaches', but it is some way from fully established. Besides what's above, a few things are worth knowing:^[3,4,8]

1Evidence concentrated in personality disorders

The positive results come mainly from borderline and other personality disorders. For other diagnoses there are only early studies, so it shouldn't be assumed to have equal evidence for every kind of difficulty.

2Who delivers it matters, and it takes time and money

In one trial, therapists trained mainly through exercises did better than those trained mainly through lectures, so the quality of training matters. Courses in the trials ran two to three years at two sessions a week, which real life may not allow, and cost and time are barriers. The International Society of Schema Therapy (ISST) lists approved training programmes, and you can ask a therapist about their training.

3The edges of limited reparenting

This is where schema therapy deliberately departs from the traditional neutral stance, being warmer and more direct, and also where the therapist has to judge carefully: what counts as within professional boundaries varies from case to case, and research on how it works is still preliminary. If you wonder, ask the therapist how they handle this boundary and what you can expect.

4Much overlaps with other approaches, and the schema map is contested

Schema therapy was built by integrating cognitive behavioural, attachment, psychodynamic and emotion-focused practices, so it is hard to say which parts are uniquely its own. Researchers also found Young's 18 schemas fit the data better as four domains than five, and one study concluded that grasping the philosophy behind the therapy matters more than any single technique. So treat the 18 schemas as a useful map, not a final verdict.

5Chair and imagery work need a safe frame

Imagery rescripting and chair work can stir very deep feelings and belong in a trusting therapeutic relationship with someone trained, where you can stop at any time. This page therefore offers no do-it-yourself version.

So, back to the night a single message made your stomach drop: schema therapy is a powerful way to understand why you keep repeating the same trouble, especially for long-standing, deep-seated difficulties, but it isn't the only way; a good therapist adjusts to where you are and what you need.

Take this with you

The part of you that shrinks in that moment isn't weakness; it is a child no one caught back then. Therapy doesn't set out to rip out the old alarm, but to let the adult you are now learn, slowly, to walk over and say: "I'm here. I'll deal with this."

A self-guided schema path

Not ready to see a therapist yet? Start with these three steps at your own pace. Deeper work such as imagery rescripting and chair work is best kept for therapy.

Courses

Beyond this path, which neighbouring paths are there?

Schema therapy stands where cognitive behavioural, attachment, psychodynamic and emotion-focused traditions meet, with many neighbours around it.

Cognitive behavioural therapy (CBT)One of schema therapy's roots: cognitive restructuring and behavioural experiments come from here. Schema therapy adds attention to childhood needs and modes, and moves much more slowly.^[2]
Psychodynamic therapyAlso traces how the past shapes the present. In a borderline personality disorder trial, schema therapy was compared head to head with a specialised psychodynamic therapy (transference-focused psychotherapy).^[2,10]
Object relationsThe strand of psychodynamic thought on how early relationships are internalised, kin to schema therapy's schemas and parent modes.^[2]
Dialectical behaviour therapy (DBT)Another well-known treatment developed for borderline personality disorder, centred on skills training; schema therapy puts more weight on childhood needs and modes.^[2,16]
Emotion-focused therapy (EFT)Also uses chair dialogues, but centred on telling emotions apart and transforming them; schema therapy's chair work sits inside its structure of modes.^[2,7]
Internal Family Systems (IFS)Also sees a person as made of different parts, but assumes every part has a positive intention and centres a core Self; similar vocabulary, a different model.^[17]
Compassion-focused therapy (CFT)Also works with harsh self-criticism and shame, centred on building a compassionate inner voice.^[18]

Other therapy approaches

FAQ

Are 圖式治療, 基模治療 and 模式治療 the same thing?

Both 圖式治療 and 基模治療 are Chinese names for schema therapy, the treatment Jeffrey Young developed. 「模式」 is mode, the state that is in charge in the moment and a second core idea in the therapy, so some people call the whole thing 「模式治療」; but it is not a different therapy.^[1,2]

What's the difference between schema therapy and cognitive behavioural therapy (CBT)?

CBT mostly starts from present thoughts and behaviour and is usually shorter. Schema therapy borrows its cognitive and behavioural techniques but adds attention to childhood needs, attachment experience and modes, uses experiential methods such as imagery and chair work, values the therapeutic relationship more, and usually takes longer.^[1,2]

Does it have to take two or three years?

The large trials in borderline personality disorder ran two to three years, and the trial for other personality disorders 50 sessions. The real length depends on how severe the difficulty is and what you aim for, and is agreed with your therapist; milder difficulties may take less, but the research evidence mainly comes from these longer courses.^[10,11,12]

Does "reparenting" mean the therapist becomes my parent?

No. Limited reparenting means the therapist, within professional boundaries, answers the needs you lacked in a warmer, more direct way, such as validating your feelings, showing care and setting limits when needed. The therapist doesn't replace relationships in your life. If you want details, ask your therapist how they see that boundary.^[2,8]

Can I do imagery rescripting or chair work at home on my own?

We don't recommend it. Both stir deep emotion and should be led by a trained therapist, on a trusting relationship and enough emotion regulation. If you want to start on your own, try the lighter exercises on this page's path, such as emotion awareness and self-compassion.^[2,5]

Is schema therapy only for personality disorders?

No, but the firmest evidence so far is in personality disorders. For depression, anxiety, eating disorders and other difficulties there are encouraging early studies, with rigorous evidence still scarce; whether it suits you can be weighed with the therapist according to your situation and preference.^[3]

How do I find a schema therapist in Hong Kong?

Look for specific schema therapy training, such as in a programme approved by the International Society of Schema Therapy (ISST), and membership of a professional body; the ISST website also has a therapist directory. Further down are TreeholeHK's therapists who use schema therapy; read their backgrounds before you book.^[15]

References

1.Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press. guilford.com
2.Kellogg, S. H., & Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62(4), 445–458. doi.org/10.1002/jclp.20240
3.Taylor, C. D. J., Bee, P., & 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(3), 456–479. doi.org/10.1111/papt.12112
4.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(4), 328–349. doi.org/10.1080/16506073.2017.1410566
5.Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3(2), 189–208. doi.org/10.5127/jep.024211
6.Morina, N., Lancee, J., & Arntz, A. (2017). Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 6–15. doi.org/10.1016/j.jbtep.2016.11.003
7.Greenberg, L. S. (n.d.). Two-chair technique. Common Language for Psychotherapy (CLP) Procedures. commonlanguagepsychotherapy.org
8.Gülüm, I. V., & Soygüt, G. (2022). Limited reparenting as a corrective emotional experience in schema therapy: A preliminary task analysis. Psychotherapy Research, 32(2), 263–276. doi.org/10.1080/10503307.2021.1921301
9.Jacob, G. A., & Arntz, A. (2013). Schema therapy for personality disorders: A review. International Journal of Cognitive Therapy, 6(2), 171–185. doi.org/10.1521/ijct.2013.6.2.171
10.Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658. doi.org/10.1001/archpsyc.63.6.649
11.Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3), 305–322. doi.org/10.1176/appi.ajp.2013.12040518
12.Arntz, A., Jacob, G. A., Lee, C. W., Brand-de Wilde, O. M., Fassbinder, E., Harper, R. P., Lavender, A., Lockwood, G., Malogiannis, I. A., Ruths, F. A., Schweiger, U., Shaw, I. A., Zarbock, G., & Farrell, J. M. (2022). Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: A randomized clinical trial. JAMA Psychiatry, 79(4), 287–299. doi.org/10.1001/jamapsychiatry.2022.0010
13.Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317–328. (Corrigendum published 2018, 60, 111.) doi.org/10.1016/j.jbtep.2009.01.002
14.Bernstein, D. P., Keulen-de Vos, M., Clercx, M., de Vogel, V., Kersten, G. C. M., Lancel, M., Jonkers, P. P., Bogaerts, S., Slaats, M., Broers, N. J., Deenen, T. A. M., & Arntz, A. (2023). Schema therapy for violent PD offenders: A randomized clinical trial. Psychological Medicine, 53(1), 88–102. doi.org/10.1017/S0033291721001161
15.International Society of Schema Therapy (Schema Therapy Society e.V.). (n.d.). Home: Find a therapist; Approved training programs. schematherapysociety.org
16.Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press. guilford.com
17.IFS Institute. (n.d.). The Internal Family Systems model outline. ifs-institute.com
18.Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353–379. doi.org/10.1002/cpp.507

Want someone alongside you?

You can do the exercises on your own. When you're stuck, a trained therapist can take you further.

Book therapy

Schema therapy

Imagery rescripting: returning to a childhood scene and giving the child what was needed

When a schema is tied to a childhood picture, the therapist may invite you to close your eyes and return to that scene, see it through the child's eyes and feel what was needed; then your adult self (the therapist at first, if your emotions aren't steady) steps into the scene to do what was missing: stop the harsh person, comfort the child, ask what he or she needs. It ends back in a safe place. The technique is also used for other difficulties built around painful memories; research is promising overall, but mostly before-and-after studies, with few randomised trials. It needs enough trust and emotion regulation first, a trained therapist and the freedom to say stop at any time; with traumatic or abusive memories it should not be tried alone.^[2,5,6]

Hear it in a session

Therapist
Last time you mentioned the scene where your dad looked at your report card. Would you like to go back to it today? If it gets too much, tell me and we stop.
Client
Yes. I'd like to try.
Therapist
Good. First notice your feet and the chair. Then close your eyes and see the scene. How old are you? Where are you?
Client
Eight. In the living room. I'm holding my report card, ninety-five. He glances at it and says, "Why not a hundred?"
Therapist
Eight years old: what is it like inside right now?
Client
I'm shrinking a bit. As if nothing is ever enough.
Therapist
What does this child need? No need to fix anything yet, just say it.
Client
I want him to say, "Well done, I can see how hard you worked."
Therapist
Now bring your adult self into the living room. What would you like to say to your dad? What would you do?
Client
(Pause) I'd stand between him and the child and say, "She got ninety-five. She worked hard. You don't need to ask again."
Therapist
And then? Turning to the child, what would you like to do?
Client
I crouch down and tell her, "You're good enough already." She looks at me… still not quite believing it.
Therapist
Not believing is fine. She needs time. You can stay with her a little longer, then we'll bring her somewhere safe and comfortable. When you're ready, open your eyes and tell me how you are now.
Client
My chest is a bit looser. But I still feel like crying.

Notice: This is imagery rescripting, showing the need. The therapist first checks she is willing and can stop at any time, using a childhood scene of moderate intensity (not a trauma). She sees it first through the child's eyes and says the need; the therapist invites her adult self into the scene, letting her decide what to say and do rather than writing the ending for her. The child relaxes only partly and stays wary, and the exercise ends back in a safe place with a check on how she is now. One rescripting doesn't make the old feeling vanish; it is usually repeated across different scenes.

Method based on^[1,2,5]

FAQ

Are 圖式治療, 基模治療 and 模式治療 the same thing?

What's the difference between schema therapy and cognitive behavioural therapy (CBT)?

Does it have to take two or three years?

Does "reparenting" mean the therapist becomes my parent?

Can I do imagery rescripting or chair work at home on my own?

Is schema therapy only for personality disorders?

How do I find a schema therapist in Hong Kong?

References

1.Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. Guilford Press. guilford.com
2.Kellogg, S. H., & Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62(4), 445–458. doi.org/10.1002/jclp.20240
3.Taylor, C. D. J., Bee, P., & 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(3), 456–479. doi.org/10.1111/papt.12112
4.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(4), 328–349. doi.org/10.1080/16506073.2017.1410566
5.Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3(2), 189–208. doi.org/10.5127/jep.024211
6.Morina, N., Lancee, J., & Arntz, A. (2017). Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 6–15. doi.org/10.1016/j.jbtep.2016.11.003
7.Greenberg, L. S. (n.d.). Two-chair technique. Common Language for Psychotherapy (CLP) Procedures. commonlanguagepsychotherapy.org
8.Gülüm, I. V., & Soygüt, G. (2022). Limited reparenting as a corrective emotional experience in schema therapy: A preliminary task analysis. Psychotherapy Research, 32(2), 263–276. doi.org/10.1080/10503307.2021.1921301
9.Jacob, G. A., & Arntz, A. (2013). Schema therapy for personality disorders: A review. International Journal of Cognitive Therapy, 6(2), 171–185. doi.org/10.1521/ijct.2013.6.2.171
10.Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658. doi.org/10.1001/archpsyc.63.6.649
11.Bamelis, L. L. M., Evers, S. M. A. A., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3), 305–322. doi.org/10.1176/appi.ajp.2013.12040518
12.Arntz, A., Jacob, G. A., Lee, C. W., Brand-de Wilde, O. M., Fassbinder, E., Harper, R. P., Lavender, A., Lockwood, G., Malogiannis, I. A., Ruths, F. A., Schweiger, U., Shaw, I. A., Zarbock, G., & Farrell, J. M. (2022). Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: A randomized clinical trial. JAMA Psychiatry, 79(4), 287–299. doi.org/10.1001/jamapsychiatry.2022.0010
13.Farrell, J. M., Shaw, I. A., & Webber, M. A. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40(2), 317–328. (Corrigendum published 2018, 60, 111.) doi.org/10.1016/j.jbtep.2009.01.002
14.Bernstein, D. P., Keulen-de Vos, M., Clercx, M., de Vogel, V., Kersten, G. C. M., Lancel, M., Jonkers, P. P., Bogaerts, S., Slaats, M., Broers, N. J., Deenen, T. A. M., & Arntz, A. (2023). Schema therapy for violent PD offenders: A randomized clinical trial. Psychological Medicine, 53(1), 88–102. doi.org/10.1017/S0033291721001161
15.International Society of Schema Therapy (Schema Therapy Society e.V.). (n.d.). Home: Find a therapist; Approved training programs. schematherapysociety.org
16.Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press. guilford.com
17.IFS Institute. (n.d.). The Internal Family Systems model outline. ifs-institute.com
18.Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353–379. doi.org/10.1002/cpp.507

Schema therapy

What is schema therapy?

Why the same reaction replays: need, schema and coping, each feeding the next

Modes: when your stomach drops, which part of you is in charge

Four stages: assess, bond, change, become autonomous, swapping the old reaction step by step

An example: the message from the start, answered by the old schema and by a new response

Six ways of working: each at its own link of the loop, swapping the old reaction

Need: giving what was missing then

Imagery rescripting: returning to a childhood scene and giving the child what was needed

Limited reparenting: answering old needs within professional boundaries

Schema: loosening the old story

Cognitive work: checking the evidence, writing flashcards

Chair work: talking with the inner critic and the protector

Coping: recognising modes, changing what you do

Recognising which mode you are in

Behavioural work: breaking the habits that feed the schema

What does a course look like? Long, but ordered

What can schema therapy help with?

Does the path hold up? What the research says, and what is still a hypothesis

Borderline personality disorder: better than a specialised psychodynamic therapy

Other personality disorders: better than usual treatment

Group formats: individual plus group did best

High-security forensic hospitals: faster steps back into the community

Depression, anxiety, eating disorders and other difficulties

Does it really change schemas?

To be honest: it has evidence, but it isn't a cure-all, and it isn't for doing alone

1Evidence concentrated in personality disorders

2Who delivers it matters, and it takes time and money

3The edges of limited reparenting

4Much overlaps with other approaches, and the schema map is contested

5Chair and imagery work need a safe frame

A self-guided schema path

Courses

Beyond this path, which neighbouring paths are there?

Other therapy approaches

FAQ

References

Want someone alongside you?

Schema therapy

What is schema therapy?

Why the same reaction replays: need, schema and coping, each feeding the next

Modes: when your stomach drops, which part of you is in charge

Four stages: assess, bond, change, become autonomous, swapping the old reaction step by step

An example: the message from the start, answered by the old schema and by a new response

Six ways of working: each at its own link of the loop, swapping the old reaction

Need: giving what was missing then

Imagery rescripting: returning to a childhood scene and giving the child what was needed

Limited reparenting: answering old needs within professional boundaries

Schema: loosening the old story

Cognitive work: checking the evidence, writing flashcards

Chair work: talking with the inner critic and the protector

Coping: recognising modes, changing what you do

Recognising which mode you are in

Behavioural work: breaking the habits that feed the schema

What does a course look like? Long, but ordered

What can schema therapy help with?

Does the path hold up? What the research says, and what is still a hypothesis

Borderline personality disorder: better than a specialised psychodynamic therapy

Other personality disorders: better than usual treatment

Group formats: individual plus group did best

High-security forensic hospitals: faster steps back into the community

Depression, anxiety, eating disorders and other difficulties

Does it really change schemas?

To be honest: it has evidence, but it isn't a cure-all, and it isn't for doing alone

1Evidence concentrated in personality disorders

2Who delivers it matters, and it takes time and money

3The edges of limited reparenting

4Much overlaps with other approaches, and the schema map is contested

5Chair and imagery work need a safe frame

A self-guided schema path

Courses

Beyond this path, which neighbouring paths are there?

Other therapy approaches

FAQ

References

Want someone alongside you?