Schema therapy for adults, online across New Zealand

What is schema therapy?

Schema therapy is an integrative psychological therapy developed by Jeffrey Young that combines cognitive behavioural, experiential and relationship-based methods. It targets schemas, deep-rooted beliefs about yourself and others that form when core emotional needs go unmet, and modes, the emotional states you switch into when those schemas are triggered. It was designed for long-standing patterns rather than single symptoms.

Schemas, in plain language

A schema is a theme that runs through your life so consistently you stop noticing it, the way you stop noticing your own accent. The International Society of Schema Therapy describes them as broad, pervasive patterns about yourself and your relationships with others, formed in childhood and elaborated over a lifetime. Jeffrey Young's model names eighteen, grouped around five core emotional needs: secure connection, autonomy and competence, freedom to express needs and feelings, spontaneity and play, and realistic limits.

Some of the most common, with the sentence that usually goes with them:

• Abandonment: "People leave. It's only a matter of time." You check your partner's location, read tone into a short text, and brace for the ending from the first date.
• Defectiveness: "If they really knew me, they'd be gone." You keep people at a careful distance, deflect compliments, and feel exposed when praised at work.
• Unrelenting standards: "Good enough isn't." You get the promotion and feel nothing but the next deadline. Rest feels like laziness.
• Subjugation: "My needs come last." You say yes to the extra shift, the family Christmas you dread, the friend's move, and then feel quietly furious.
• Mistrust: "People will use you if you let them." Even kindness gets scanned for the catch.

Schemas form for good reasons, usually because an important need wasn't reliably met when you were young. The problem is that they keep running long after the circumstances that created them have gone, and they are self-confirming: an abandonment schema makes you cling or test, which pushes people away, which proves the schema right.

Modes: why you can feel like a different person within five minutes

If schemas are the themes, modes are the states you flip into when a schema fires. Most people recognise these immediately once they are named.

Picture a disagreement over dinner about money. Within seconds one person has gone flat and silent, scrolling their phone (the detached protector, which numbs feeling to stay safe). The other is suddenly eight years old and terrified of being left (the vulnerable child). Later that night one of them lies awake with a voice listing every way they have failed (the punitive or demanding critic, an internalised version of early critical voices). The next morning, someone makes a cutting joke and leaves before the conversation can happen (the angry child, or an overcompensating mode that attacks before it can be attacked).

Schema therapy's goal is to strengthen a different mode, the healthy adult: the part of you that can notice the child's fear, talk back to the critic, set limits on the overcompensator, and choose how to act. Everyone has this mode. In people with strong schemas it tends to be quiet, and much of the work is turning its volume up.

Who schema therapy suits

Schema therapy was built for difficulties that are long-standing, pervasive and resistant to shorter treatments. It tends to suit people who:

• have had the same emotional patterns since adolescence or earlier, rather than a problem that started recently;
• notice the same difficulties in relationship after relationship, whether choosing unavailable partners, losing themselves in relationships, or ending things before they can be ended;
• live with a harsh inner critic, perfectionism or chronic shame that no amount of achievement quiets;
• have done CBT and found it helpful but partial: you can see the thought is irrational, and you still feel it is true;
• have low mood or anxiety that keeps returning after treatment; or
• have been told, or suspect, that their difficulties fit a pattern of personality difficulty, such as borderline or avoidant traits.

It is usually not the first choice for a single, recent problem, where a shorter, more targeted therapy will get you further faster. It is also not a crisis treatment. If you are in crisis now, please use the numbers at the bottom of this page.

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What the evidence says

The strongest evidence for schema therapy is in personality disorders. A multicentre Dutch trial published in the American Journal of Psychiatry in 2014 randomised more than 300 people with personality disorders to schema therapy, another specialised psychotherapy, or treatment as usual over two years. Recovery rates were higher with schema therapy, and dropout was markedly lower (around 15 percent versus 40 percent for usual care). A 2022 trial in JAMA Psychiatry across five countries, including Australia, found that combined individual and group schema therapy reduced the severity of borderline personality disorder substantially more than usual treatment.

Beyond personality disorders, the picture is promising but thinner. A 2017 systematic review found that schema therapy changed both schemas and symptoms in eleven of twelve studies, mostly in personality disorders, and called for stronger trials elsewhere. A 2021 review of schema therapy for anxiety disorders, OCD and PTSD found beneficial effects on symptoms and schemas across six studies, but noted methodological weaknesses in most of the research.

We think that is worth saying plainly. If your main difficulty is a specific anxiety disorder or OCD, treatments such as CBT and ERP have the stronger evidence and we would suggest those first. Schema therapy earns its place when the problem is the long-standing pattern underneath.

How schema therapy differs from CBT

Schema therapy grew out of CBT and still uses its tools, but the emphasis is different in four ways.

Timeframe. Standard CBT is present-focused: what is keeping the problem going this week, and what can you do differently. Schema therapy spends real time on where the pattern came from, not to dwell, but because understanding the original need makes the present reaction make sense, and makes it easier to respond to with compassion rather than contempt.

Feelings as well as thoughts. CBT works largely at the level of thoughts and behaviour. Schema therapy adds experiential methods. In imagery rescripting you revisit an early memory in imagination and, with your psychologist, change what happens so that the child's need is met. In chair work you literally move between chairs to give the critic, the vulnerable part and the healthy adult separate voices. These techniques target the felt sense of a belief, which is what stays stubborn after the logic has been dealt with.

The relationship. In schema therapy the relationship with your psychologist is a deliberate part of treatment, called limited reparenting: within professional limits, your psychologist aims to provide some of what was missing, such as warmth, consistency, honest feedback and appropriate limits.

Length. CBT for a specific problem might run six to twenty sessions. Schema therapy is longer, as the next section explains.

What sessions involve, and how long it takes

The early sessions are assessment and mapping. You complete questionnaires such as the Young Schema Questionnaire, talk through your history and the situations that reliably trigger you, and build a shared "mode map" of your patterns. Many people find this stage alone clarifying; seeing your life as a small number of repeating themes rather than a long list of failures changes the story.

The middle phase is the change work: cognitive challenging of the schemas, imagery rescripting, chair work, and behavioural experiments where you try acting from the healthy adult in real situations, such as saying no to your mother, asking a partner for reassurance directly instead of testing them, or leaving work at five. The later phase consolidates gains and plans for the schemas firing again, which they will, with you responding differently.

On length we would rather be honest than optimistic. For a focused goal, several months of weekly or fortnightly sessions may be enough. For pervasive, lifelong patterns, the research trials ran for one to three years, often with one or two sessions a week at first, spacing out later. At $199 + GST ($228.85 incl. GST) per session this is a significant commitment, and it is worth discussing openly in the first sessions, including what your health insurer covers (see our guide to insurance and psychology in NZ), what a realistic plan looks like for your budget, and how you will review progress together.

Doing schema therapy online

People sometimes assume experiential work needs a therapy room. In practice it adapts well. Imagery rescripting is done with your eyes closed, guided by your psychologist's voice, and a familiar room can make that easier rather than harder. Chair work needs two chairs and a bit of floor; your lounge has both. The relationship, which is the heart of this therapy, builds across a screen in much the same way it does in person, and a 2021 meta-analysis of 43 treatment studies found video-delivered therapy produced outcomes largely equivalent to face-to-face care.

What online schema therapy does need is a private, uninterrupted hour. This is not a therapy to do from the car between meetings. Headphones, a closed door and an honest conversation with the people you live with about not being disturbed make a real difference, particularly on imagery days.

What to expect at Mindwell

Katherine Lee is the psychologist on our team who practises schema therapy. Alongside schema therapy she works with CBT, ACT, DBT and EMDR, and sees adults, parents and older adults.

Your first 50-minute session covers your history, the patterns you want to change and what you have tried before, and Katherine will give you an honest view of whether schema therapy is the right fit or whether a shorter approach would serve you better. If you proceed, you agree a plan with review points built in.

Sessions are $199 + GST ($228.85 incl. GST), booked and paid online, with receipts for insurance. No GP referral is needed. After booking you receive a confirmation email with your video link and a short intake form; everything you share is held under the Health Information Privacy Code 2020.

Related support: CBT therapy · Relationships and attachment · Emotional dysregulation · Trauma therapy