Schemas are broad themes or frameworks through which a person understands their relationships, self, or the world. Schema therapy aims to address maladaptive schemas, which can contribute to mental health conditions.
Schema therapy draws from other areas of psychology, containing elements of attachment theory, cognitive behavioral therapy (CBT), and more.
Read on to learn more about schema therapy, including what it does, what the main schemas are, the benefits, and how it compares to CBT.
Schema therapy is a type of talk therapy that focuses on schemas. Schemas are frameworks, or belief systems, through which people understand themselves and the world around them.
Practitioners believe people begin forming schemas in childhood, particularly around their family and immediate environment. These schemas then inform thoughts, emotions, and behavior.
Maladaptive schemas are unbalanced or unrealistic. For example, a child may learn they must always be perfect, or that they can never trust anyone. This may contribute to anxiety or other mental health conditions.
Maladaptive schemas can develop due to abuse or mistreatment, but they can also develop for benign reasons, such as a child feeling different from their siblings.
Schema therapy aims to gradually replace maladaptive schemas with healthier ones so that a person experiences less emotional distress. This may help them with self-esteem, their relationships with others, and daily functioning.
Schema therapists organize maladaptive schemas into five broad categories, or “domains,” based on the emotional needs children have during development:
When maladaptive schemas form, they prevent children from getting these needs met, creating:
Disconnection and rejection
Children with these schemas can feel that others are not reliable, caring, or safe to be around. This may come from a home environment that is cold, unstable, or abusive.
Specific schemas include:
- abandonment/instability, in which people feel that others will leave them
- mistrust/abuse, in which a person feels others will hurt, humiliate, or cheat them
- emotional deprivation, in which a person feels others will not support or love them enough
- defectiveness/shame, which causes someone to feel they are bad or inferior
- social isolation/alienation, which causes a person to feel they do not belong
Impaired autonomy and performance
These schemas are about a person’s ability to survive or perform. It may come from a home environment that is overprotective or that does not help build a child’s confidence.
These schemas include:
- dependence/incompetence, in which a person feels they cannot handle challenges alone
- vulnerability to harm or illness, which is when a person believes they will experience a catastrophic event
- enmeshment/undeveloped self, which comes with excessive closeness with a loved one, causing a person to feel they cannot survive without them
- failure, which causes a person to feel they have failed, will fail, or that they are less competent than others
These schemas come from a lack of boundaries or responsibility, which may stem from an environment that was overindulgent, lacked rules, or taught the child to feel superior. Specific schemas include:
- entitlement/grandiosity, in which a person believes they are special or superior to others
- insufficient self-control/self-discipline, in which a person refuses to control their impulses, or has difficulty doing so
These schemas involve excessive concern for the feelings of others. They often come from a home environment where love is conditional, causing children to suppress their own needs or parts of their personality to gain approval. Specific schemas include:
- subjugation, in which a person feels their wants or needs are less important or valid than others
- self-sacrifice, or the excessive need to please others no matter the cost to oneself
- approval-seeking/recognition-seeking, which is an excessive emphasis on gaining approval or fitting in
People with these schemas may still feel angry that their needs do not come first, but they may not be aware of it.
Overvigilance and inhibition
These schemas come from a desire to control one’s feelings or choices, or to meet rigid internal rules and expectations. Often, this comes from growing up in a demanding, critical, or punishing family environment.
Specific schemas include:
- negativity/pessimism, which causes a focus on the negative aspects of life
- emotional inhibition, in which a person feels they must hide their emotions to avoid shame or loss of control
- unrelenting standards/hypercriticalness, which causes a person to strive to meet unrealistic standards
- punitiveness, which is the belief that people, including oneself, deserve harsh punishments for mistakes
While schemas are frameworks through which people interpret the world, schema modes are emotional states that affect daily interactions. In schema therapy, these modes consist of:
- a child mode, which resembles how a person felt as a child
- a parent mode, which looks or sounds similar to how adults treated them as a child
- adult mode, which is healthy and balanced
Depending on a person’s experiences, their child mode, or inner child, may be:
Similarly, parent modes resemble one or more caregivers or authority figures in a person’s childhood. It may be:
- demanding or critical
There are also coping modes that describe how a person responds to distress, which include:
- overcompensator, in which a person compensates for their unmet needs by exaggerating, manipulating, or rebelling
- compliant surrender, in which a person surrenders their own needs to avoid rejection, criticism, or punishment
- detached protector, in which a person cuts themselves off from their own feelings and from others
In contrast, healthy adult mode is a mediator. It nurtures and regulates the child mode, moderates or reduces the impact of parent mode, and adjusts or limits unhealthy coping modes. Eventually, a healthy adult’s balanced perspective can replace unhealthy schemas.
The original purpose of schema therapy was for treating personality disorders, but today, therapists use it for a range of conditions.
The analysis suggested that maladaptive schemas may play a role in anxiety disorders, and that schema therapy could help relieve symptoms. But the authors caution that more research is necessary.
In a 2021 study, researchers tried schema therapy for people with personality disorders who had also committed violent crimes. One group received standard treatment, while the other received schema therapy.
Although both groups improved, the schema therapy group showed greater improvements, including higher levels of rehabilitation and lower levels of personality disorder symptoms.
CBT is a highly researched form of psychotherapy. It focuses on changing unhelpful thought patterns in order to prevent distressing emotions or unhelpful behavior. This is similar to schema therapy, but scientists have studied CBT in more extensively.
CBT tends to focus more on present-day problems, rather than past experiences. It does not ignore the impact of childhood or past trauma, but exploring them is not the main priority. Instead, it focuses on teaching practical skills for managing symptoms in day-to-day life.
For some, this is not an issue, but people with more long-term or persistent symptoms may prefer to address the root causes through another type of therapy.
People can find a licensed schema therapist by searching online or getting recommendations from clinicians. Some therapist directories also allow people to search by the type of therapy they want.
When looking for a therapist, it is important to find someone a person feels comfortable with. For some, this may mean a person who is a certain gender, for example. A person can also consider:
- the therapist’s credentials and experience
- their location
- whether sessions will be online or in-person
- availability of appointments
- insurance coverage
Schema therapy is a type of talk therapy that focuses on schemas, which are frameworks people use to make sense of themselves and their surroundings. It aims to replace unhealthy or unrealistic schemas with balanced ones, in order to improve mental well-being.
Schema therapy is a newer type of therapy in comparison to CBT, but some studies have shown promising results for a range of conditions. People interested in schema therapy can look for a therapist who has experience with this approach.