Key Takeaways
Schemas are the ideas and beliefs that help us make sense of ourselves and our environment. Negative schemas can result from adverse childhood experiences, often with primary caregiver(s).
Schema therapy helps people identify unhelpful patterns that stem from the past. It’s designed to challenge deep self-beliefs, so it may take longer than other forms of care.
Schema therapy has been used to treat personality disorders, anxiety, depression, and more. It can help improve your self-esteem, self-regulation, and relationships.
Schema therapy [1] was originally created as a treatment for personality disorders and treatment-resistant conditions like persistent depression. Today, it’s used to help treat a variety of other conditions [2]. It builds on concepts from cognitive behavioral therapy [3] (CBT) to help people overcome unhelpful beliefs.
Schema theory states that if we don’t have our basic needs met as children, we may develop negative beliefs about ourselves in adulthood [2]. These negative beliefs can affect how we feel about ourselves and the world around us. Schema therapy works by helping people uncover, address, and replace these beliefs with more functional ones.
Understanding different types of schemas
The challenges that lead to the development of negative schemas can vary from person to person. But experts have identified a few consistent themes within this experience.
The five main categories of schemas [4] are:
Disconnection and rejection: This schema often develops due to an insecure attachment. When a child experiences rejection or neglect from their caregiver, they grow up to expect that people will abandon them. This can lead to rocky or unstable adult relationships.
Impaired autonomy and performance: This schema can result from overprotective parenting. When a child doesn’t get to practice solving problems and exploring the world, they may come to see themselves as incapable. They may have a hard time developing a sense of agency or independence as adults.
Impaired limits: This schema can arise due to overly permissive parenting or if caregivers don’t set healthy boundaries. Without experience adhering to limits, a person may go on to have trouble with self-regulation or impulse control.
Other directedness: This schema can develop if a person grows up believing that love is conditional. They may come to believe that they have to perform a certain way to “earn” their caregivers’ love. Later in life, they may experience people-pleasing tendencies or frequently put others’ needs before their own.
Overvigilance and inhibition: This schema can occur in people who grew up with overly strict or authoritative parents. The dynamic can cause them to develop a rigid sense of morality that prevents them from expressing themselves authentically.
How schema-focused therapy works
Schema therapy is founded on the belief that schemas are adaptable. While you can’t change your childhood experiences, you can evolve how you see yourself and relate to others.
The main goals of schema therapy [5] are to:
Help people meet their emotional needs in healthy ways
Reduce avoidance and unhealthy coping strategies
Improve self-regulation and reduce reactivity
Overcome self-criticism and negative self-talk
Much like in CBT, schema therapy views the therapist–client relationship as an important part of healing and personal growth. During sessions, therapists use an intervention called “limited reparenting” [6] to:
Explore, with their client, which schema(s) they resonate most with, often with the use of questionnaires [7]
Provide clients with healthy, corrective emotional experiences (within professional boundaries)
Validate their client’s feelings and create a safe environment for them to open up
Help their client understand where their schema framework came from
There’s no set number of sessions for schema therapy. Treatment duration depends on the person’s needs and preferences. However, because schema therapy is designed to dismantle core beliefs, it can take longer [8] than other forms of care.
For example, the goal of CBT is to identify and replace unhelpful thoughts to inspire behavior change. CBT assumes that this shift can occur relatively quickly with the right support. But because schema therapy is intended to explore deeper themes, it often lasts longer.
What is schema therapy used for
Schema therapy was first created to treat personality disorders [3] and help people who haven’t found relief from other forms of care. While research on schema therapy is limited, there’s evidence to suggest that it can help people living with:
Substance use disorders [9] (SUDs)
Anxiety disorders [2]
Obsessive-compulsive disorder [2] (OCD)
Post-traumatic stress disorder [2] (PTSD)
Eating disorders [10] (EDs)
Depression [10]
Taking the first steps toward schema therapy
To get started with schema therapy, search online directories and teletherapy platforms for providers who practice it. You can also ask a current provider (your doctor, psychiatrist, etc.) for a referral.
Feel free to ask prospective therapists if they use schemas in their approach if you aren’t sure. Even if it’s not a main area of focus, it might be something they can incorporate into your sessions.
Once you start schema therapy, remember that it may take some time to see progress. Schema shifts can be subtle. But you’ll know that it’s working when you begin to see yourself as separate from your past experiences, have more self-esteem, and feel more confident in your relationships.
Clinician's take
Schema therapy can be especially helpful for people who haven’t found relief with shorter-term treatments because it goes deeper. Instead of only focusing on thoughts or behaviors, it helps uncover long-standing emotional patterns that started in childhood and continue to shape how a person feels, reacts, and connects with others.
Find care with Rula
Schema therapy is designed to help people counteract negative beliefs that stem from childhood. It was first created for treatment-resistant symptoms and personality disorders. But it's now used to help people with anxiety disorders, depression, OCD, PTSD, and more. Over time, it can help people overcome unhelpful beliefs, improve their self-esteem, and form healthier adult relationships.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
