Young's Schema Therapy

Presentation

Schema Therapy is an integrative psychotherapeutic approach developed in the 1990s by Jeffrey E. Young, a clinical psychologist trained by Aaron Beck. Recognizing the limitations of classical CBT for personality disorders and chronic problems, Young created a model integrating CBT, attachment theory, Gestalt therapy, psychodynamic approaches and emotion-focused therapy.

The central concept is the 'Early Maladaptive Schema' (EMS): a deep emotional and cognitive theme or pattern formed in childhood through unmet core emotional needs (safety, autonomy, limits, free expression, spontaneity). Once activated, these schemas produce intense emotions and dysfunctional coping behaviors that perpetuate suffering.

Founder: Jeffrey E. Young (born 1950), clinical psychologist, Columbia University

Core Principles

Young identified 18 early maladaptive schemas grouped into 5 domains corresponding to unmet emotional needs: disconnection and rejection, impaired autonomy and performance, impaired limits, other-directedness, overvigilance and inhibition.

The model also distinguishes 'schema modes' — emotional and behavioral states activated at any given moment: the vulnerable child, angry child, critical parent, detached protector, healthy adult. Therapeutic work aims to strengthen the healthy adult mode to care for the vulnerable child and limit the influence of the internalized critical parent.

Three maladaptive coping strategies are identified: surrender (submitting to the schema), avoidance (fleeing activating situations) and overcompensation (acting in rigid opposition to the schema). Therapy helps develop more flexible and adaptive responses.

Main Indications

• Personality disorders (borderline, narcissistic, avoidant, dependent)
• Chronic and recurrent depression
• Anxiety disorders resistant to classical CBT
• Repetitive relationship difficulties
• Emotional dependency
• Chronic eating disorders
• Deep self-esteem issues
• Recurrent self-destructive life patterns

Session Overview

Schema therapy typically spans 1 to 3 years with weekly sessions of 50 to 90 minutes. Initial sessions focus on schema assessment (questionnaires, life history exploration, diagnostic imagery). The therapist then establishes a personalized case conceptualization.

The change phase uses four types of techniques: cognitive (testing schema validity, developing alternative perspectives), experiential (reparenting imagery, chair dialogues with modes), behavioral (breaking behavioral patterns) and relational ('limited reparenting' — the therapist provides a corrective relationship within the therapeutic frame). Imagery techniques, where the patient revisualizes childhood scenes and intervenes to protect the vulnerable child, are particularly powerful.

Variations and Sub-techniques

• Individual schema therapy (standard format)
• Group schema therapy
• Schema therapy for couples
• Schema therapy for adolescents
• Schema mode therapy
• Inpatient schema therapy

Contraindications

• Acute psychotic episode
• Active unstabilized addiction
• Severe structural dissociation (unstabilized dissociative identity disorder)
• Inability to tolerate affect during imagery exercises
• Lack of motivation for long-term therapeutic work