Schema therapy is a therapeutic approach that can be effective in treating personality disorders and other mental health conditions. It combines elements from a variety of therapies and theories, including cognitive behavioral therapy (CBT), gestalt therapy, emotionally focused therapy (EFT), and attachment theory.

Schema therapy can be particularly effective for:

• Borderline personality disorder (BPD)
• Anxiety
• Depression
• Posttraumatic stress disorder (PTSD)

The fundamentals of schema therapy

This type of therapy relies on four main concepts:¹

• Core needs are the basic set of emotional needs we all have as children. These include security, affection, connection, autonomy, play, self-expression, nurturing, and identity.
• Early maladaptive schemas are negative themes or patterns that repeat throughout our lives in the way we think about ourselves and interact with others. They usually develop during childhood when our core needs aren’t met. They’re also shaped by each person’s specific life experiences and temperament.
• Coping styles are the ways we react to situations that cause us stress. Because of maladaptive schemas, people may develop coping styles that are unhelpful or actively harmful.
• Schema modes are temporary states of mind we all move through. They are a combination of our maladaptive schemas, our coping style, and our emotional state in a given moment. They’re often triggered by upsetting situations.

Schema therapy helps people identify and meet their core needs by changing their maladaptive schemas, coping styles, and modes.

Core needs

Core childhood needs can go unmet because of:

• Instability at home
• Abuse or neglect
• Trauma
• Overprotective or overindulgent parenting
• Lack of age-appropriate boundaries
• Controlling or demanding parenting

Schemas

“Schemas” are the assumptions we develop about ourselves and the world around us that help us interpret our lives. When our core needs are not met in childhood, we may develop an “early maladaptive schema.” These schemas lead to unhealthy behaviors, and the focus of schema therapy is addressing and meeting the needs that created them.

Clinicians have identified 18 early maladaptive schemas that are separated into five categories called schema domains.²

Domain 1: Disconnection and rejection

• People with an abandonment/instability schema believe they can’t trust others to provide support or protection.
• A mistrust/abuse schema is built on the belief that others will harm you if given the chance.
• An emotional deprivation schema focuses on not trusting others to provide basic emotional support or care (like listening, showing affection, or offering guidance).
• In a defectiveness/shame schema, you believe there’s something wrong with you and that you’re unlovable as a result.
• In a social isolation/alienation schema, you believe you’re all alone and don’t fit in with others.

Domain 2: Impaired autonomy and performance

• A dependence/incompetence schema relies on the belief that you can’t take care of yourself without other people’s help.
• In a vulnerability to harm or illness schema, you believe you’re always on the brink of catastrophe (such as being diagnosed with a terminal illness).
• An enmeshment/undeveloped self schema is a pattern in which you feel you don’t have an identity outside of other people or relationships.
• A failure schema involves constantly thinking about past failures and feeling that you’re bound to fail in the future.

Domain 3: Impaired limits

• An entitlement/grandiosity schema is built on the belief that you’re better than others and deserve special treatment.
• People with an insufficient self-control/self-discipline schema are unable to control their emotions and impulses to achieve their goals.

Domain 4: Other-directedness

• A subjugation schema happens when you suppress your own needs, emotions, or opinions in order to protect yourself.
• People with a self-sacrifice schema neglect their own needs voluntarily so they can meet the needs of others.
• In an approval-seeking/recognition-seeking schema, people seek out praise or attention at the cost of developing a true, secure sense of self.

Domain 5: Overvigilance and inhibition

• In a negativity/pessimism schema, you tend to focus on the negative parts of your life while ignoring positive ones.
• An emotional inhibition schema is built on the belief that suppressing your emotions will protect you from judgment.
• People with an unrelenting standards/hypercriticalness schema focus on perfection, rules, and efficiency.
• A punitiveness schema centers on the belief that punishment, rather than forgiveness or empathy, is the appropriate response to mistakes.

Coping styles

We all cope with unhelpful schemas in different ways. Two people with the same early maladaptive schema may behave entirely differently because they have different coping styles.

Schema therapy recognizes three maladaptive coping styles.³

• Surrender: You give in to the negative schema and let it inform your thoughts and emotions.
• Avoidance: You try to find a way to escape or avoid any triggers for your schema, usually by disconnecting.
• Overcompensation: You try to resist your schema by doing the opposite of what it prompts you to do.

A single unhealthy schema can present in several ways, depending on which coping style you use to manage it. For example, if you’re a student with an unrelenting standards/hypercriticalness schema, you might cope in one of the following ways:

• Surrender: You try to achieve perfection by pulling all-nighters and neglecting your social life.
• Avoidance: You stop keeping track of your grades and tell yourself you don’t care what they are.
• Overcompensation: You skip school and fail your classes.

Schema modes

“Schema modes” are temporary states we all experience that combine our schemas, preferred coping styles, and emotional states in a specific moment. They’re often activated in response to something that threatens our sense of safety, and they work somewhat like scripts to inform our actions. Though schema modes are part of us, they’re also disconnected from our true selves—almost like roles we’re playing.

We can move from one schema mode into another, and multiple schema modes can be active in one person. Some schema modes are healthy, while others are considered dysfunctional.

Schema modes are separated into four categories: innate child, maladaptive coping, maladaptive parent, and healthy adult.

Innate child modes

• Vulnerable child: You feel helpless, needy, weak, and misunderstood. You have needs but don’t know how to meet them.
• Angry child: You feel intensely angry that your needs aren’t being met.
• Impulsive/undisciplined child: You focus on fulfilling your wants instead of your needs, leading to selfish or risky behavior.
• Contented child: You feel loved and supported. Your needs have been met.

Maladaptive coping modes

• Compliant surrenderer: You tolerate poor treatment or abuse and struggle with boundaries, fearing conflict or rejection.
• Detached protector: You cut yourself off from others as a way to protect yourself. You may feel detached from the world to the point of dissociation.
• Overcompensator: You become a large, overbearing presence, trying to assert control and get your needs met.

Maladaptive parent modes

• Punitive parent: You react to mistakes by actively punishing yourself or others.
• Demanding or critical parent: You have an internal set of rules that you strive to attain, insisting on perfection.

Healthy adult mode

• Healthy adult: You validate, limit, support, and moderate the other schema modes in yourself as necessary. You experience life in a healthy, functional way.

How does schema therapy work?

Schema therapy focuses on identifying your schemas, coping styles, current schema modes, and unmet core needs. Then your therapist will use a variety of techniques to challenge and change your unhealthy schemas, including:

• Limited reparenting:⁴ Your therapist can offer some of the validation and support you needed but didn’t get from your parents as a child. This helps address and resolve your unmet core needs.
• Empathetic confrontation: Your therapist will help you gently but firmly confront your schemas in a nonjudgmental way so you can commit to change.
• Cognitive strategies: Your therapist may encourage you to think over and question the stories your schemas tell you. For example, if you have the “vulnerability to harm or illness” schema, you may be asked to list all the signs that you’re not on the brink of catastrophe.
• Emotional strategies: Your therapist may teach you techniques to express your emotions in healthier ways.
• Behavioral strategies: Your therapist may assign you homework where you practice certain activities that challenge your schemas.

How to find support

If you’re ready to begin addressing any unhealthy patterns that are impacting your life, search our directory to find a licensed mental health professional near you.

If you’re in crisis, help is available now. For free, confidential 24/7 support, call or text the 988 Lifeline at 988, or text HOME to 741741 to chat with a crisis counselor.