Schema therapy

Schema therapy is a structured talking therapy that helps you understand and shift deep, long-standing patterns, known as schemas, that formed early in life and keep showing up in how you think, feel and relate to others as an adult. It draws on cognitive behavioural therapy, attachment theory and experiential techniques.

What is schema therapy?

The term ‘schema’ describes a pattern, built from repeated experiences, often in childhood, about what you can expect from yourself, other people and the world. A schema might sound like ‘my needs come second’ or ‘if I get close to someone they will eventually leave’, and it usually formed as a sensible response to whatever was happening at the time. The difficulty is that these patterns tend to persist long after the original circumstances have changed, shaping choices in relationships, work and self-worth in ways that can feel automatic rather than chosen.

Schema therapy, developed by the psychologist Jeffrey Young, brings together cognitive behavioural techniques, ideas from attachment theory, and experiential methods such as imagery and role play. Rather than focusing only on a single symptom or a recent difficult event, it looks at the wider pattern underneath, and at the coping styles, sometimes called modes, that a person moves between when a schema is triggered.

When it helps

Schema therapy tends to be most useful when patterns have been present for a long time, have shown up across several relationships or settings, and have not shifted much with shorter or more symptom-focused therapy. Common reasons people seek it out include a persistent sense of not being good enough, difficulty trusting others or letting people get close, a pattern of putting everyone else first, or cycles of anxiety or low mood that keep returning even after treatment. It can also be relevant where earlier experiences have left a lasting mark on how safe, valued or secure someone feels in adult life.

It is not the right starting point for every difficulty. Where a problem is recent, specific and has not been tried with a shorter approach before, a more focused therapy such as cognitive behavioural therapy may be tried first. An initial assessment looks at your history and current difficulties together to work out whether schema therapy, another approach, or a combination, fits best.

How schema therapy differs from CBT

Standard cognitive behavioural therapy usually works on the thoughts, feelings and behaviours connected to a current problem, often over a relatively defined number of sessions. Schema therapy shares some of the same tools, thought records, behavioural experiments and structured sessions, but widens the lens to include where a pattern came from and how it plays out across a person’s whole life, not just the presenting problem.

Two other things mark it out. First, it makes more use of experiential work, such as imagery exercises that revisit an early memory connected to a schema, or chair work that gives voice to different parts, or modes, of the self. Second, the relationship between client and clinician is treated as an active part of the work. Within clear professional limits, the clinician offers a consistent, attuned presence that can itself help correct some of what a schema predicts about other people, an idea Young called limited reparenting.

What to expect

Schema therapy is usually a longer piece of work than short-term CBT, often running from several months to a year or more, though this varies from person to person and is reviewed as treatment goes on. Sessions typically begin with mapping out your main schemas and the modes you move into when they are triggered, drawing on your history and current patterns.

From there, sessions combine talking through current situations, connecting them back to underlying patterns, and experiential exercises such as guided imagery or written exercises between sessions. Change tends to be gradual. It is common to notice a pattern intellectually well before it shifts in how you actually respond in the moment, and the work often involves practising a different response repeatedly, in session and in daily life, until it feels less effortful.

Sessions here take place online by secure video, so you will need a private space and a stable connection. Experiential exercises such as imagery work are adapted for video and remain a core part of sessions rather than something dropped because of the format.

The evidence for schema therapy

Schema therapy has been studied since the 1990s, initially in people with longstanding difficulties with emotions and relationships who had not responded well to other therapies. A well known Dutch trial by Giesen-Bloo and colleagues found schema therapy produced greater improvement than another established therapy for people with complex emotional difficulties, and later studies have extended this evidence to chronic depression, eating difficulties and other longstanding presentations.

NICE guidance for these difficulties (which it calls ‘borderline personality disorder’) does not recommend schema therapy specifically, and lists it among the treatments that need more research. Schema therapy is offered in some NHS and independent specialist services. For more straightforward, shorter-term anxiety and depression, NICE-recommended approaches such as CBT are usually tried first, with schema therapy considered when patterns have proved more entrenched.

Schema therapy in Bromley

Clinical psychologists for Bromley and south east London work online with adults here, so people in BR1 and BR2, and in Beckenham, Chislehurst, Shortlands, Bickley, Hayes and Petts Wood, can access this way of working from home rather than needing to travel. Bromley South and Bromley North stations bring people in from further afield too, and sessions are arranged around ordinary working patterns rather than requiring a trip into the town centre.

There are no named clinicians on this site. At the moment all our sessions are online by secure video. Every enquiry begins with an initial conversation to check that schema therapy is a good fit before any longer-term work is agreed.

Frequently asked questions

The questions below cover some of what people commonly ask before starting schema therapy. If your question is not answered here, it is worth raising it in an initial conversation.