What Is Schema-Focused Therapy?

Schema-focused therapy is a type of psychotherapy that involves changing unhealthy and self-defeating behavior patterns using a combination of cognitive, behavioral, and emotion-focused techniques. In addition, there is a focus on the patient-therapist relationship, daily life outside of therapy, and the impact of childhood traumas.

This article explains what schemas are and why they are unhelpful, the goals of schema-focused therapy, as well as schema therapy techniques, benefits, limitations, and effectiveness.

What Are Schemas?

Schemas are thought patterns that inform a person's worldview. Schemas could include negative ideas like "I'll never find love" or "I'm a damaged person."

Schemas can manifest in the following ways:

• Being overly dependent on others
• Constantly expecting failure
• Perfectionism
• Having a sense of entitlement
• Believing in harsh punishment

Childhood Needs and Maladaptive Schemas

Schema therapy addresses unmet childhood needs that create negative schemas. These schemas include:

• Abandonment: A belief that people will always leave and one will end up alone
• Mistrust/abuse: A belief that other people will eventually become abusive or hurtful
• Enmeshment/undeveloped self: A lack of identity when not around others
• Approval seeking: A sense that approval or recognition is more important than authentic self-expression
• Entitlement/grandiosity: Feeling superior to others and believing rules don't apply to you
• Punitiveness: Believing in harsh punishment for mistakes
• Social isolation: A pervasive sense of aloneness along with a feeling of alienation

Coping Styles Caused by Schemas

A cluster of schemas and negative coping styles is known as a mode, these include the following:

• Child modes: Becoming the vulnerable child (feeling lonely, misunderstood, worthless), angry child (being impatient and frustrated at unmet needs), impulsive or undisciplined child (appearing spoiled, frustrated, impatient)
• Maladaptive parent modes: Punitive parent (harsh and punishing) or demanding parent (has perfectionist standards, suppresses expression of feelings)
• Healthy adult mode: Nurtures, affirms, and supports the more vulnerable child mode, as well as pursuing adult responsibilities and interests
  

What Is the Goal of Schema-Focused Therapy?

There are several goals of schema-focused therapy, including:

• Replacing schemas and negative coping modes with a realistic and self-supporting view of the world
• Using the patient-therapist relationship to teach the person what a trusting relationship is like (also known as limited reparenting)
• Addressing childhood traumas
• Testing schemas through cognitive behavioral therapy (CBT) techniques
  

What Conditions Can Schema-Focused Therapy Help Treat?

Schema-focused therapy has been applied to several mental disorders, including:

• Borderline personality disorder (BPD)
• Avoidant personality disorder
• Dependent personality disorder
• Narcissistic personality disorder
• Paranoid personality disorder
• Histrionic personality disorder
• Depressive disorders
• Anxiety disorders
  
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Substance use disorders
• Alcohol use disorder

Techniques

After determining your core schemas, a therapist might use the following techniques:

• Limited reparenting: Providing some of the emotional needs that were unmet in childhood
• Empathetic confrontation: Validating a coping style before challenging it with reality
  
• Imagery re-scripting: Helping someone re-experience a stressful or traumatic memory and "re-script" it with a more helpful perspective
• Chair work: Role-playing exercises where the patient speaks to important people in their life
• Mode work: Replacing negative coping modes with positive adaptive modes
• Cognitive behavioral therapy (CBT): Changing behaviors through exercises like challenging schemas, exposure (slowly facing fears until they are no longer intimidating), and mindfulness (letting feelings pass through the body instead of avoiding them).
  

Benefits

There are many potential benefits to schema-focused therapy, including:

• The use of several psychotherapy techniques as part of the therapy approach
• Tailoring therapy to meet specific individual needs
• Healing unmet childhood needs, regardless of age
• Providing clarity and structure
• Can be used in individual or group therapy

Limitations

There are some limitations to schema-focused therapy, including:

• Possibility of not being as effective in inpatient settings in which catering to individual needs is difficult
• The process of change could include the emergence of intense emotions, which can overwhelm people
• Length of commitment and potential expense required for success (at least one year)
• It may require meeting more than one time a week or needing extra care from a therapist outside of meetings (such as through telephone calls)
• There is little research available on why some people don't respond to schema-focused therapy
• Studies and method guides are limited since schema-focused therapy was only recently developed

Effectiveness

Schema therapy might be more effective than "treatment as usual" for personality disorders. For example:

• People who underwent schema-focused therapy were less likely to drop out of treatment and more likely to feel healed after three years.
• A small study found that after 1.5 years, some people no longer met the criteria for having the disorder.
• Schema therapy has a lower dropout rate than other therapies.

The following are other disorders for which schema-focused therapy has shown promise:

• Depressive disorders, including chronic depression
• Anxiety disorders
• Eating disorders
• Substance use issues
• Post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD): A review found people living with PTSD and OCD could benefit from schema-focused therapy.

Schema therapy has also been studied for individuals convicted of crimes and hospitalized. One study showed it might reduce the likelihood of relapse and increase the chance of reintegrating into society.

How to Find a Qualified Therapist

Before finding a schema-focused therapy specialist, you'll want first to confirm what kind of mental health treatment is available, depending on your insurance coverage status.

If you have insurance, you may want to:

• Check if your company has a searchable directory
• See whether there are therapists with expertise in schema-focused therapy
• Confirm how many sessions your insurance will cover
• Ask your healthcare provider for a referral

If you don't have insurance you may consider:

• Asking a local clinic or your healthcare provider for a referral.
• Searching for sliding scale therapists online or locally.
• Asking therapists you are interested in if they take sliding scale clients.
• Using the Substance Abuse and Mental Health Services Administration (SAMHSA) mental health facilities locator
• Searching professional organizations like the American Psychological Association or the American Counseling Association for sliding scale or cash payment therapists.

Also ask about availability outside of sessions, since being available over email could help with your schema-based therapy.

In addition, you'll want to ask about a therapist's history and experience, including their "evidence-based" (backed by science) methods.

Summary

Schema-focused therapy combines several psychotherapy techniques to focus on changing maladaptive schemas, which are rigid patterns of thinking, feeling, and behaving. It uses cognitive, behavioral, and experiential based intervention as well as the power of the therapeutic relationship to facilitate change. The therapy was first found effective for borderline personality disorder, but it has been used to treat other personality disorders, anxiety and mood disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders.

A Word From Verywell

Finding the right kind of therapy is not an easy process, especially for those with unmet childhood needs and difficulty connecting. Schema-focused therapy is a great way to address many concerns while also having clear labels for confusing issues that can interfere with daily life. The method requires a long-term commitment, but it could provide just the support you need to work toward a more fulfilling life.