Understanding Schema Therapy

Schema therapy tackles deep-rooted patterns by addressing unmet emotional needs and unhelpful thinking styles.

Schema therapy, developed by Jeffrey Young in 1990, is an integrative treatment approach combining cognitive, behavioral, object relations, gestalt, constructivism, attachment models, and psychoanalysis (Young, Klosko, & Weishaar, 2003).

It was originally designed to treat clients with personality disorders, chronic depression and anxiety, and other difficult problems that were not responding well to traditional cognitive-behavioral therapy (CBT).

Schema therapy focuses on identifying and modifying early maladaptive schemas (self-defeating emotional and cognitive patterns) and schema modes (moment-to-moment emotional states) that are thought to underlie chronic psychological disorders.

The goal is to help patients develop healthier schemas and coping strategies to improve their interpersonal relationships and overall functioning.

Early Maladaptive Schemas

The main premise is that psychological problems arise from unmet core emotional needs in childhood and adolescence, which lead to the development of early maladaptive schemas (EMS).

EMSs are pervasive patterns of memories, emotions, cognitions, and bodily sensations regarding oneself and relationships with others (Young et al., 2003). They are self-perpetuating and resistant to change.

Schemas strongly influence individuals’ views of themselves (e.g., “I am a terrible person”), their relationships to others (e.g., “Others will leave me anyway”), and the world as a whole (e.g., “The world is a dangerous place”).

Schema therapy aims to identify and modify EMSs and maladaptive coping styles so that core emotional needs can be met in healthy, adaptive ways.

Early maladaptive schemas are the core pathological themes or patterns that develop from unmet emotional needs, traumatic experiences, or toxic interactions with parents and peers during childhood (Young et al., 2003).

Unmet Core Childhood Needs

1. Safe attachment: love, validation, protection, acceptance
2. Free expression of emotions and needs
3. Playfulness, spontaneity
4. Autonomy, competence, sense of identity
5. Realistic limits, self-control

EMSs are dimensional – they range from mild to severe. More pervasive EMSs cause greater distress and life impairment. EMSs develop from an interplay between the child’s innate temperament and the early environment.

Four main types of early experiences lead to schema acquisition (Young et al., 2003):

1. Toxic frustration of needs
2. Traumatization or victimization
3. Too much of a good thing
4. Selective internalization or identification with significant others

Once formed, EMSs are maintained through cognitive distortions, self-defeating behavior patterns, and maladaptive coping styles. They are triggered by life events that resemble the original schema-forming experiences.

18 EMSs have been identified, grouped into 5 domains based on the core needs they relate to:

Early Maladaptive Schemas and Unmet Core Childhood Needs

1. Disconnection and rejection

Unmet core childhood need: Secure attachment: care, acceptance, protection, safety, love, validation.

• Emotional deprivation: The core belief that one’s basic needs for nurturance, empathy, guidance, and protection will never be fulfilled.
• Defectiveness/Shame: The core belief of being inherently defective, unworthy and unlovable, leading to expectations of rejection.
• Mistrust/Abuse: The belief that others are exploitative, self-serving, and cannot be trusted due to their abusive, manipulative intentions to hurt or use you.
• Social isolation/Alienation: An all-encompassing feeling of aloneness and alienation from others.
• Abandonment/Instability: An ingrained expectation of abandonment, unreliability in others, fragility of relationships, inevitable loss, and ending up alone.

2. Other directedness

Unmet core childhood need: Free expression of needs and emotions.

• Approval seeking/Recognition-Seeking: Prioritizing external approval, attention and recognition over authentic self-expression and living true to oneself.
• Subjugation: The belief that one must submit to the control of others to avoid punishment or rejection.
• Self-Sacrifice: An excessive focus on voluntarily sacrificing one’s own needs and desires for the sake of others.

3. Overvigilance and inhibition

Unmet core childhood need: Spontaneity, playfulness.

• Negativity/Pessimism: A predominant belief that the negatives in life vastly outweigh the positives, accompanied by pessimistic expectations for the future.
• Emotional Inhibition: The belief that rigidly controlling self-expression is necessary to avoid rejection or criticism from others.
• Unrelenting Standards: An incessant need to be the best, to strive for perfection, and to avoid any mistakes at all costs.
• Punitiveness: Belief in harsh punishment for mistakes.

4. Impaired autonomy and performance

Unmet core childhood need: Support for autonomy, competence, sense of identity.

• Enmeshment/Undeveloped Self: A lack of an established individual identity separate from significant others.
• Failure: The pervasive belief in one’s own inadequacy and the expectation of inevitable failure or underperformance.
• Vulnerability to harm/Illness: An ever-present sense that the world is perilous, disaster is imminent, and one will be overwhelmed by life’s daunting challenges.
• Dependence/Incompetence: The belief that one is incapable of making sound decisions and judgments, requiring an overreliance on others to guide day-to-day functioning.

5. Impaired limits

Unmet core childhood need: Realistic limits, self-control.

• Insufficient Self-Control/Self-Discipline: Stuck feeling unable to achieve goals due to tedium or frustration, while also prone to impulsive actions that sabotage progress.
• Entitlement/gGandiosity: Grandiose sense of entitlement leading to rule-breaking and disregard for consequences

Coping Styles

Coping styles are automatic ways of responding to schema activation. While adaptive in childhood as survival mechanisms, coping styles often become rigid and maladaptive in adulthood, perpetuating rather than healing the schemas.

These coping strategies develop in childhood to help the child adapt to and lessen painful emotions in a distressing environment. But over time, they often become rigid, automatic, and maladaptive, impairing relationships and self-regulation and perpetuating difficulties in key life areas.

The rigid coping prevents childhood needs from being met in adulthood and maintains the maladaptive schema.

Three broad coping styles are described (Young et al., 2003):

1. Surrender – Giving in to the schema, accepting it as truth. For example, in the defectiveness/shame schema, gives up and accepts self as without worth.
2. Avoidance – Trying to avoid schema activation through cognitive, emotional, or behavioral avoidance.
3. Overcompensation – Fighting the maladaptive schema by thinking, feeling, and behaving in the opposite extreme as a coping style to counterattack and control; may be somewhat adaptive at times (e.g., perfectionistic overcontrollers at work).

For Example

When the mistrust schema is activated in interpersonal situations, patients experience intense anxiety, a sense of threat, and mistrust. They cope with this schema in three main ways:

1. Surrender: Patients choose abusive relationships that repeat their childhood history, despite the emotional pain, because it feels familiar, and they believe alternatives are hopeless or would be even more painful. They remain in these abusive relationships.
2. Avoidance: Patients avoid relationships entirely or avoid being vulnerable, sharing personal information, or trusting others. This protects them from hurt and painful emotions in the short term but leads to loneliness and a lack of close relationships in the long term. Their schema stays stable without opportunities for corrective experiences.
3. Overcompensation: Patients abuse and mistreat others to feel in control, strong, and safe from being hurt themselves. The emotional pain of their schema is denied or unconscious. However, this also damages relationships and prevents corrective experiences, maintaining the schema.

Schema Modes

A schema mode, or simply “mode,” combines an activated schema and a coping strategy, describing the momentary emotional-cognitive-behavioral state active at a given time. Patients can quickly switch from one mode to another, whereas a schema is rigid and enduring (i.e., schema = trait, mode = state).

This concept is convenient in clinical practice, as it helps patients and therapists track and explain the frequent and sometimes sudden shifts in emotion, cognition, and behavior. Specific treatment strategies and goals for each dysfunctional mode have been developed to help patients learn healthier coping methods.

The concept of modes was necessary to explain the rapidly shifting symptoms of borderline personality disorder (BPD) patients.

Young (2003) discovered that patients with borderline personality disorder (BPD) and other severe personality pathologies exhibited multiple competing schemas managed by different coping strategies.

The complexity of the possibilities (18 schemas × 3 coping styles = 54 possibilities) made it challenging for both the patient and therapist to maintain an overview.

Moreover, the schema concept was not optimal for explaining and working with these patients’ rapid mood and behavior changes.

To address this, Young extended the schema theory with the mode model approach, which was initially developed specifically for BPD and later for narcissistic PD.

Four main categories of modes have been identified:

1. Child modes: Schema-triggered reactions in adulthood related to childhood unmet emotional needs. In these modes, patients experience intense negative emotions:

• Vulnerable Child: Fear of abandonment, loneliness, helplessness, sadness, or mistrust.
• Angry Child:  Anger, rage because their vulnerable child’s needs have not been met.
• Impulsive/Undisciplined Child: Acts impulsively to get needs and desires met without thinking about long-term consequences or taking care of others. Has difficulties with rules, discipline, and finishing routine or boring tasks; is frustrated quickly and gives up soon.
• Happy Child: Feels happy and contented because core emotional needs are met; has a sense of being loved, connected to others, valued, understood, hopeful, resilient, optimistic, and spontaneous.

2. Maladaptive Coping modes: Overused survival strategies that are triggered when schemas related to trauma and unmet needs are activated. These include flight (avoidance), fight (overcompensation), and freeze (surrender)

• Compliant Surrenderer: The individual behaves passively, submissively, and seeks reassurance to avoid conflicts, disharmony, or rejection by others. They allow others to control their life, mistreat them, and remain in invalidating or even violent relationships.
• Avoidant protector: Distances themself from other persons and emotions by shutting off all emotions (e.g., by consuming drugs or alcohol, through dissociation or distraction), withdrawing from relationships, and keeping others at a distance.
• Overcompensator: The self-aggrandizer, attention- and approval-seeking, perfectionistic overcontroller, suspicious overcontroller, and bully and attack modes are dysfunctional coping strategies characterized by grandiosity, inappropriate attention-seeking, perfectionism, suspiciousness, and aggression.

3. Dysfunctional Parent modes (Demanding/punitive inner critic modes): Internalized negative aspects from significant others (e.g. parents, teacher, siblings or peers). Includes punishing and harsh messages (punitive critic) and setting unreachable expectations and standards (demanding critic)

• Punitive Parent/Critic: Characterized by self-devaluation, self-hatred, guilt, and shame, which align with the internalized negative self-beliefs acquired from significant others during childhood.
• Demanding Parent/Critic: Involves extremely high standards for oneself, also mentioned as a characteristic of the dysfunctional parent modes.

Healthy adult mode: Performs appropriate adult functions, such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, esthetical, and cultural interests; health maintenance; and athletic activities. Has functional attitudes toward emotions and needs and uses appropriate assertiveness when functional.

4. Healthy Adult mode: Adaptive functioning modes that are associated with a sense of fulfillment and well-being

• Happy or contented child: Associated with joy, fun, play, and spontaneity.
• Healthy adult: Individuals can manage emotions, care for their needs, solve problems, and form healthy relationships. They are aware of their needs, possibilities, and limitations, acting in accordance with their values, needs, and goals.

The Healthy Adult mode serves an “executive” role to nurture the Vulnerable Child, set limits for the Angry and Impulsive Children, and counter the Maladaptive Coping modes. Well-functioning people have a strong, active Healthy Adult mode. A major goal of schema therapy is to help clients develop their Healthy Adult.

Treatment Strategies

Schema therapy integrates cognitive, experiential, relational and behavioral interventions. The therapist’s general stance is one of empathic confrontation – empathizing with the client’s schemas and coping responses while encouraging change (Young et al., 2003).

The ultimate goal of ST is to help patients find adaptive ways to get their emotional needs met and cope with frustration when needs cannot be met. This involves changing maladaptive schemas, coping styles, and modes underlying symptoms and problems.

Treatment focuses on healing schemas and breaking patterns of maladaptive coping.

By integrating three channels of change – experiential, cognitive, and behavioral – ST provides a holistic approach to treatment that targets both the underlying schemas and modes that drive patients’ problems, as well as the thoughts, emotions, and behaviors that maintain them. This comprehensive approach is designed to lead to lasting change and improved functioning for patients with a range of psychological disorders.

1. Cognitive strategies

Empirically testing and challenging the validity of schemas; identifying cognitive distortions and reframing early experiences

Cognitive techniques in ST include traditional cognitive-behavioral therapy (CBT) techniques, such as Socratic dialogue and challenging negative thoughts.

However, ST also places a strong emphasis on psychoeducation, which involves teaching patients about:

• Universal emotional needs and emotions
• The etiology of psychological problems
• The effects of abuse and neglect
• The intergenerational transmission of psychopathology
• Increasing awareness of modes by working out typical trigger situations and moderated cognitions, body reactions, emotions, and behaviors

By providing this information, patients can better understand the origins of their problems and develop a more compassionate and understanding stance towards themselves.

Other cognitive techniques used in ST may include:

• Reframing past experiences in a more adaptive light
• Identifying and challenging cognitive distortions
• Developing healthier, more balanced thoughts and beliefs
• Reviewing pros and cons, especially for coping modes

2. Therapeutic Relationship Techniques

Early maladaptive schemas often develop through childhood interpersonal traumatization, especially from parents.

Therefore, the therapeutic relationship is a central focus throughout schema therapy, serving as an antidote to those adverse experiences.

The therapeutic relationship aims to provide corrective interpersonal and emotional experiences to change the early maladaptive schemas.

1. Limited reparenting: Within appropriate boundaries, the therapist partly meets the client’s unmet early needs and models healthy adult functioning. The therapist adjusts their relational style to the patient’s specific needs, schemas, and modes. Thus, they always behave a little bit differently with each patient.
2. Empathetic Confrontation: Empathetic confrontation involves the therapist empathizing with the patient’s underlying emotions and intentions behind problematic behaviors, while also clearly confronting the need for change and the consequences of those behaviors.
3. Attunement: Attunement refers to the therapist’s ability to understand and connect deeply with the client’s ‘internal reality’ and emotional state.
   
   It’s like being on the same wavelength, where the therapist can pick up on the client’s feelings both from what they say and how they say it (body language, tone of voice). The therapist acknowledges the client’s emotional experience and validates their perspective.

3. Experiential strategies

Using imagery, dialogue work, and trauma processing to link schemas to early experiences and facilitate emotional change

Experiential techniques are used to activate emotions, process childhood memories, and provide corrective experiences. These techniques are often inspired by experiential therapies such as gestalt therapy.

The goal is to help patients access and process emotions on a deeper level, going beyond cognitive insight. This is particularly important for patients with personality disorders who may intellectually understand a concept but not feel it emotionally.

Experiential techniques allow therapists to work with patients at the developmental level of the child who experienced the negative events that contributed to their current problems.

By providing corrective experiences and information at a developmentally appropriate level, patients can better integrate these new experiences into their memory representations of past events.

Examples of experiential techniques used in ST include:

1. Imagery rescripting: Patients imagine and rewrite traumatic or painful childhood memories, with the therapist guiding them to create a more positive outcome. Diagnostic imagery starts with a current disturbing situation, vividly imagined.
   
   The therapist bridges the felt emotion to a related childhood memory/image. Exploring the childhood scene’s feelings and needs clarifies dysfunctional pattern origins. Rescripting imagery reworks the meanings of those childhood events.
2. Chair dialogues: Patients engage in dialogues between different parts of themselves (e.g., child modes, parent modes) or with significant others from their past, allowing them to express unmet needs, process emotions, and gain new perspectives (see overview in Kellogg, 2014).
3. Mode work: Helping clients identify and change maladaptive modes, while strengthening the Healthy Adult mode.

There are specific goals and therapeutic tasks for each mode:

• Child modes are healed through validating emotions/needs, emotionally processing childhood maltreatment, and providing corrective experiences. Angry/impulsive child modes also require learning anger management and limit setting.
• Parent modes (punitive, demanding) are reduced as much as possible by the therapist challenging them and helping patients develop self-compassion.
• Maladaptive coping modes are gradually replaced with healthier coping as the Healthy Adult mode strengthens. Their protective function is first validated.
• The Healthy Adult mode is enhanced to become dominant, enabling patients to meet the above goals themselves and have healthy relationships. The Happy Child mode is also promoted.

4. Behavioral pattern-breaking

Replacing maladaptive coping behaviors with healthier behavioral responses through exposure, skills training, and homework assignments

Behavioral techniques in ST are similar to those used in traditional CBT and may include:

1. Exposure therapy: Gradually exposing patients to feared situations or triggers to help them overcome avoidance and build coping skills.
2. Role-playing: Practicing new behaviors or ways of interacting with others in a safe, controlled environment (Arntz & Weertman, 1999). This structure helps the patient experience both their own feelings and needs as a child and the perspective of the other person. The insight from the perspective of the other person can especially help the patient understand the motivation and causes for the perpetrator’s behavior and, thereby, the meaning of the situation.
3. Homework assignments: Encouraging patients to practice new skills and behaviors outside of therapy sessions. This works best if the exercises are performed at a good challenge that is neither too hard nor too easy.

One specific behavioral technique emphasized in ST is behavioral pattern breaking. This typically occurs towards the end of treatment when patients are encouraged to identify and change dysfunctional patterns in their behaviors and choices.

The goal is to help patients break free from repeating unhealthy cycles and to experiment with new, more functional ways of living.

Empirical Support

Research on mechanisms of change in schema therapy (ST) is still in its early stages. The therapeutic alliance appears important, with better patient-rated alliance predicting less dropout and more clinical improvement in borderline personality disorder (BPD) (Spinhoven et al., 2007).

More intensive use of ST techniques by therapists was associated with better outcomes and less dropout in a non-BPD trial (de Klerk et al., 2017; Bamelis et al., 2014). Reductions in the vulnerable child mode and increases in the healthy adult mode mediated improvements in this trial (Yakin et al., 2020).

Imagery rescripting has been shown effective as a stand-alone technique across disorders like PTSD, social anxiety, and depression (Arntz et al., 2007; Grunert et al., 2007; Raabe et al., 2015; Brewin et al., 2009; Frets et al., 2014; Nilsson et al., 2012; Wild & Clark, 2011; Wild et al., 2008; Wheatley et al., 2007).

A meta-analysis supported its transdiagnostic use for aversive memories (Morina et al., 2017). Qualitative studies highlighted imagery rescripting as a powerful change process (de Klerk et al., 2017; Tan et al., 2017).

Other experiential ST techniques, like chair dialogues, need more research, though one study found no differences from present-focused CBT for non-BPD PDs (Weertman & Arntz, 2007).

An RCT on schema therapy-based art therapy showed large effects (Haeyen et al., 2018). Component analyses testing different ST technique combinations could clarify mechanisms further.

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Arntz, A. (2012). Imagery rescripting as a therapeutic technique: Review of clinical trials, basic studies, and research agenda. Journal of Experimental Psychopathology, 3(2), 189-208.

Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37(8), 715–740.

Arntz, A., Klokman, J., & Sieswerda, S. (2004). An experimental test of the schema mode model of borderline personality disorder. Journal of Behavior Therapy and Experimental Psychiatry, 36, 226–239.

Arntz, A., Tiesema, M., & Kindt, M. (2007). Treatment of PTSD: A comparison of imaginal exposure with and without imagery rescripting. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 345-370.

Bamelis, L. L., Evers, S. M., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171(3), 305-322.

Brewin, C. R., Wheatley, J., Patel, T., Fearon, P., Hackmann, A., Wells, A., … & Myers, S. (2009). Imagery rescripting as a brief stand-alone treatment for depressed patients with intrusive memories. Behaviour Research and Therapy, 47(7), 569-576.

de Klerk, N., Abma, T. A., Bamelink, S., & Arntz, A. (2017). Authentic trait or response? Obstacles among therapists in identifying patients’ emotional processes during immersive imagery in schema therapy. Professional Psychology: Research and Practice, 48(5), 336–344.

Farrell, J., & Shaw, I. A. (2022). Schema therapy: Conceptualization and treatment of personality disorders.

Farrell, J. M., & Shaw, I. A. (2017). Experiencing schema therapy from the inside out: A self-practice/self-reflection workbook for therapists. Guilford Publications.

Frets, P. G., Kevenaar, C., & van der Heiden, C. (2014). Imagery rescripting as a stand-alone treatment for patients with social phobia: A case series. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 160-169.

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., et al. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649–658.

Grunert, B. K., Smucker, M. R., Weis, J. M., & Rusch, M. D. (2007). When prolonged exposure fails: Adding an imagery-based cognitive restructuring component in the treatment of industrial accident victims suffering from PTSD. Cognitive and Behavioral Practice, 10(4), 333-346.

Haeyen, S., van Hooren, S., van der Veld, W. M., & Hutschemaekers, G. (2018). Improving emotional functioning after childhood abuse: A randomized controlled trial on the outcome of trauma-focused schema therapy. European Journal of Psychotraumatology, 9(1), 1460717.

Kellogg, S. (2014). Transformational chairwork: Using psychotheraputic dialogues in clinical
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Lobbestael, J., van Vreeswijk, M. F., & Arntz, A. (2008). An empirical test of schema mode conceptualizations in personality disorders. Behaviour Research and Therapy, 46, 854–860.

Nilsson, J. E., Lundgren, J., & Dahlström, Ö. (2012). Reconstructing subjective experiences of social anxiety disorder in imagery rescripting. Case Studies in Clinical Practice, 1, 48-55.

Morina, N., Lancee, J., & Arntz, A. (2017). Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 6-15.

Raabe, S., Ehring, T., Marquenie, L., Olff, M., & Kindt, M. (2015). Imagery Rescripting as stand-alone treatment for posttraumatic stress disorder related to childhood abuse. Journal of Behavior Therapy and Experimental Psychiatry, 48, 170-176.

Schmidt, N. B., Joiner, T. E., Young, J. E., & Telch, M. J. (1995). The Schema Questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemata. Cognitive Therapy and Research, 19, 295–321.

Spinhoven, P., Giesen-Bloo, J., van Dyck, R., Kooiman, K., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder. Journal of Consulting and Clinical Psychology, 75(1), 104-115.

Tan, Y. M., Lee, C. G., Tan, E. S. Q., Felida, Q. Q. L., Chee, C. Y. I., & Rush, A. J. (2017). Perceptions of Asian patients with borderline personality disorder about the utility of schema therapy. Psychotherapy, 54(3), 315.

van Asselt, A. D., Dirksen, C. D., Arntz, A., Giesen-Bloo, J. H., van Dyck, R., Spinhoven, P., et al. (2008). Outpatient psychotherapy for borderline personality disorder: Cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy. British Journal of Psychiatry, 192, 450–457.

Welburn, K., Coristine, M., Dagg, P., Pontefract, A., & Jordan, S. (2002). The Schema Questionnaire—Short Form: Factor analysis and relationship between schemas and symptoms. Cognitive Therapy and Research, 26, 519–530.

Weertman, A., & Arntz, A. (2007). Effectiveness of treatment of childhood memories in cognitive therapy for personality disorders: A controlled study contrasting focused and unfocused narratives. Behaviour Research and Therapy, 45(4), 851-866.

Wheatley, J., Brewin, C. R., Patel, T., Hackmann, A., Wells, A., Fisher, P., & Myers, S. (2007). “I’ll believe it when I can see it”: Imagery rescripting of intrusive sensory memories in depression. Journal of Behavior Therapy and Experimental Psychiatry, 38(4), 371-385.

Wild, J., & Clark, D. M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioral Practice, 18(4), 433-443.

Wild, J., Hackmann, A., & Clark, D. M. (2008). Rescripting early memories linked to negative images in social phobia: A pilot study. Behavior Therapy, 39(1), 47-56.

Yakin, D., Navarro-Montes, R., Majchrzak, M., & Arntz, A. (2020). Emotion dysregulation as a mediator between pathological traits and psychosocial problems. Journal of Psychopathology and Behavioral Assessment, 42(3), 472-485.

Young, J. E., Klosko, J. S., & Weishaar, M. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford Publications.

Required Readings

• Behary, W. T. (2020). The art of empathic confrontation and limit-setting. In G. Heath & H. Startup (Eds.), Creative methods in schema therapy: Advances and innovation in clinical practice (pp. 227–236). Routledge.
• Behary, W. (2021). Disarming the narcissist (3rd ed.). New Harbinger Publications.
• Behary, W. T., & Dieckmann, E. (2013). Schema therapy for pathological narcissism: The art of adaptive reparenting. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism (pp. 285–300). American Psychological Association.
• Behary, W. T., Farrell, J. M., Vaz, A., & Rousmaniere, T. (2023). Deliberate practice in schema therapy. American Psychological Association. https://doi.org/10.1037/0000326-000
• Farrell, J. M., Reiss, N., & Shaw, I. A. (2014). The schema therapy clinician’s guide: A complete resource for building and delivering individual, group and integrated schema mode treatment programs. John Wiley & Sons. https://doi.org/10.1002/9781118510018
• Farrell, J. M., & Shaw, I. A. (2018). Experiencing schema therapy from the inside out: A selfpractice/self-reflection workbook for therapists. Guilford Press.
• Roediger, E., Stevens, B. A., & Brockman, R. (2018). Contextual schema therapy. New Harbinger Publications.
• Young, J. E., Klosko, J. S. & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.