Being academically minded but emotionally sensitive, I am passionate about practising schema therapy because it allows me to be both systematic and empathetic. Schema therapy originates from CBT and draws insights from psychodynamic and humanistic therapies, making this integrative approach goal-directed, flexible, dynamic, and deep. As an ISST-accredited schema therapist with both psychological and medical background, I am experienced in applying schema therapy for complex mental conditions in both neurotypical and neurodivergent people, as well as in improving the mental wellbeing of people without clinical diagnoses. In addition to individual therapy, I offer couples and family consultations.

Schema Therapy Philosophy

In schema therapy, we believe that all people, regardless of their gender, nationality and neurotype, have emotional needs. It means that for a human being it is not enough to be dressed and fed, we need much more to thrive. Children and also adults need social connections to feel protected, loved unconditionally and soothed when in distress. At the same time, humans need support and guidance while discovering their strengths and developing healthy autonomy. This is what we call ‘blue leg’ and ‘red leg’, the two social tendencies for connection and individuation, together contributing to a balanced life.

It is not uncommon that during our childhood, emotional needs are not fully met by the parents or by the wider environment. The experience of having your needs unmet results in the formation of schemas—patterns of memories, emotions, beliefs, and physical sensations that get activated when a current situation is somehow similar to the traumatic past. When schemas are activated, we might experience intense reactions while thinking, on a cognitive level, that there is nothing to worry about. To deal with negative emotions, all people tend to develop so-called coping modes—our parts or states that aim at helping us but often can make it worse. For example, one might try hard to control every aspect of their life so as not to face the anxiety of uncertainty, or be very nice to other people so they won’t reject them, or avoid their own feelings while engaging in eating, drinking, or working.

Schema therapy analyses current behaviour but goes deeper into its roots in the traumatic past and unmet needs. People don’t behave the way they do because of being stupid, rather they have developed coping modes because, at some point, it was essential for their psychological survival. To change this, we need to address the schemas, confronting negative beliefs coming from the past and learning to acknowledge and meet our emotional needs. Negative beliefs mostly come from the messages we have heard from others, which are internalised as so-called critic modes. Critic voices tend to make nasty comments in our heads and can cause much distress even when life is not that bad. External and inner critics attack the vulnerable child mode, the part of us feeling anxious or sad, and sometimes enrage our angry child. Finally, there is always a healthy adult part, the wise captain of the boat observing other modes and hopefully being able to manage this diverse team.

Schema Therapy Techniques

So, in brief, this is how we view one’s internal landscape in schema therapy. Technically, we start our work with conceptualisation, mapping out the unmet needs, schemas and modes. Then, we use experiential techniques, meaning that we support our clients in experiencing something new rather than only providing them with our smart ideas about how they can do better. One experiential technique is imagery rescripting, where we float back to the traumatic memories and relive them, while the therapist and client’s healthy adult intervene to meet the child’s needs. Rescripting serves to build new networks in the brain, and new pathways of feeling and behaving. Another experiential technique is chair work. We use chairs in the room to represent different modes, and we work with them to find new ways of dealing with the complexity of our emotions. The general idea is to reduce the influence of critic modes, take the feelings of child modes seriously and with compassion, and to meet our true needs instead of relying on coping modes. This is creative and intense work on understanding yourself and trying out new ways of acting.

In addition to experiential techniques, schema therapy includes more traditional cognitive work. I find it especially helpful to integrate the idea of defusion from ACT (Acceptance and Commitment Therapy), learning to regard thoughts as thoughts rather than the way things are, thus liberating ourselves from negative beliefs. Also, I often use skill training and role-play to support clients in implementing the gains from therapy in real life. Homework assignments and mindfulness practice are other important components that support the efficacy of schema therapy.

Schema Therapy Efficacy

Schema therapy is an evidence-based method. Studies have shown that it is effective for people with personality disorders (1, 2), complex trauma (3), depression (4), anxiety disorders (5), and eating disorders (6). Often, schema therapy is used as a second-line approach when other methods have failed to help. However, I believe schema therapy is also a wonderful first-line treatment, which easily integrates other therapeutic modalities and is flexible enough to be adjusted for clients with various needs.

While some references are provided below, you can find an extensive list of schema therapy studies here.

(1) Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M. & Arntz, A. (2006) Outpatient psychotherapy for borderline personality disorder: Randomised trial of schema-focused therapy versus transference-focused psychotherapy Archives of General Psychiatry, 63(6) 649-658. DOI: 10.1001/archpsyc.63.6.649

(2) Bamelis, L., Evers, S., Spinhoven, P., & Arntz, A. (2014) Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. The American Journal of Psychiatry, 17(3), 305-322. DOI: 10.1176/appi.ajp.2013.12040518

(3) Boterhoven de Haan, K.L., Lee, C.W., Fassbinder, E. et al. (2017) Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design. BMC Psychiatry 17, 165. DOI: 10.1186/s12888-017-1330-2

(4) Carter, J., McIntosh, V., Jordan, J., Porter, R., Frampton, C. & Joyce, P. (2013). Psychotherapy for depression: a randomized clinical trial comparing schema therapy and cognitive behavior therapy. Journal of Affective Disorders, 151(2), 500-505. DOI: 10.1016/j.jad.2013.06.034

(5) Gude, T. & Hoffart, H. (2008). Change in interpersonal problems after cognitive agoraphobia and schema focused therapy versus psychodynamic treatment as usual of inpatients with agoraphobia and Cluster C personality disorders. Scandinavian Journal of Psychology, 49, 195-199. DOI: 10.1111/j.1467-9450.2008.00629.x

(6) McIntosh, V. V., Jordan, J., Carter, J. D., Frampton, C. M., McKenzie, J. M., Latner, J. D., & Joyce, P. R. (2016). Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry research, 240, 412-420. DOI: 10.1016/j.psychres.2016.04.080