EFT vs Schema Therapy for Couples: When the Cycle Isn’t the Problem

You feel it coming a beat before it arrives. He drops his eyes to the carpet. Her voice climbs half a step, and the same seventeen words from last week land in the room again, in the same order. You know there are seventeen because you counted the second time you heard them. This is the room where EFT and schema therapy for couples begin to diverge.

Session four, 6:40 on a Tuesday evening. Nine days ago, in these same two chairs, they softened. You watched it happen.

You did the work correctly. Tracking the cycle, you stayed with the fear under her criticism, and helped him step toward her from shame rather than from strategy. He reached. She let him. You wrote a note afterward that said “breakthrough.”

Then tonight, and the wall is back exactly where it was.

Your notes from session two say she carries a raw spot about not mattering.

Those nine days are what the EFT vs schema therapy for couples question is actually about, at least for practitioners. Not theory. Nine days. They are also where couples quietly decide to stop booking.

Where I stand on EFT and schema therapy for couples

I am Travis Atkinson, LCSW, LICSW, a Certified EFT Couples Therapist and Supervisor, among the first therapists and supervisors certified in New York. As a founding member of the New York Center for Emotionally Focused Therapy (NYCEFT), I served on its first executive board. I was fortunate enough to take many trainings from Sue Johnson, and I still supervise in her model every week.

On the other side of my training, I am Director of the Schema Therapy Training Center (STTC) and Vice President of Media for the Jeffrey Young Schema Therapy Association (JYSTA). I am a Certified Advanced Schema Therapist, Supervisor, and Trainer in Schema Therapy for Individuals and Couples. A founding member of the International Society of Schema Therapy (ISST), I am also an Honorary Lifetime Member. I began training directly under Jeffrey Young in 1994, and I helped co-develop the couples adaptation of his model. My training with Sue did not begin until 2006.

That is the reverse of the order most people assume, and it is why I am not neutral about either model. I had also trained in the Gottman Method and have been certified in it since 2006. What sent me looking for Sue was nine or ten couples in my own practice, the ones whose gains would not hold. I had run into something neither framework I held gave me adequate language for.

Watching Sue Johnson work with my own couples

Then I watched her work, over several years, with couples of my own. I brought them to the EFT Externship in Midtown Manhattan, sponsored by the Ackerman Institute. They volunteered for it. Sue would take the session. I sat beside her, in front of my own clients and a room full of clinicians, close enough to watch her choose.

Every time, the same thing happened. Sue found each partner inside a few minutes. Between the two of them, she built something that had not existed when they sat down. She ran the interventions so cleanly that you stopped noticing they were interventions. There were tears in most of those sessions, mine included on more than one occasion. They ended somewhere neither partner could have reached alone.

What I was watching was the thing schema therapy has always called its engine and that we were badly underusing in couples work. Experiential change, in the room, with the emotion alive. Emotionally focused therapy expanded the most crucial task in schema therapy for couples, which is working experientially to create change events.

One detail from those sessions matters for everything that follows. Sue spoke to different parts of each partner as though they were separate people in the room: the side of him that goes quiet, the side of her that pushes, and the younger part sitting underneath both. She addressed those parts directly, and they answered her. What she did not do was name them, give them a history, or connect them to anything older than the marriage. There was no cast list, because emotionally focused therapy does not ask for one. Schema therapy for couples calls those same parts modes and ties each one to the schema it is protecting. The parts were already in the room when Sue worked. What differs is the bookkeeping.

Why a change event holds for some couples and not for others

If that sounds like what this article is asking of you, it should. It is the same move, running the other way. The same nine or ten couples now arrive in the EFT supervision hours I hold, and the question usually reaches me as an apology. I did the steps. It landed. It did not hold.

Why does a change event hold for some couples and evaporate for others?

The answer only makes sense after one reframe, so the reframe first.

The reframe took me years to arrive at. When a well-executed softening reverses, that reversal is not evidence about your attunement or your model fidelity. It is data about what is driving the cycle, and reading it that way makes the next nine days informative rather than demoralizing.

One thing to settle before we go further, since the title says “versus.” The word belongs to conference debates, not to any room I have worked in. I do not run emotionally focused therapy until it stalls and then reach for schema therapy. Both are in the room from the first session, doing different jobs. I am comparing them so you can tell the jobs apart, not so you can pick a camp.

Every raw spot is real, and every one is particular. But raw spots have addresses. Five of schema therapy’s eighteen schemas sit in the disconnection and rejection domain. The other thirteen are about competence, limits, standards, and self-sacrifice, and they walk into couples work every day wearing attachment’s clothes. EFT finds the wound. Schema therapy tells you which one you found.

Key takeaways for your couples therapy practice

• There is no versus in a real room. Both models run from intake, aimed at different parts of the same problem.
• A raw spot and a schema describe the same wound at two magnifications.
• What you call secondary reactive emotion, schema therapy calls a coping mode, and what you call primary emotion, schema therapy calls the Vulnerable Child.
• Schema therapy for couples opens a second healing route for when a partner cannot yet be the healer.
• Both models aim at the same endpoint: secure connection, with play in it.

If you already run emotionally focused therapy well and keep meeting the same handful of couples whose gains will not hold, you are the clinician I am writing to.

The reason it repays the hour is narrow and practical. The couples who terminate politely at session fourteen are the ones this distinction reaches, and neither certification pathway teaches it.

What emotionally focused therapy already gets right

Emotionally focused therapy (EFT) remains the most coherent account of couple distress in the field, and it is in the room from the first session in all of my own couples cases. Susan M. Johnson, whom none of us ever called Susan, built it on a premise that has held up across decades of mental health research. Partners fall into rigid cycles because attachment needs go unspoken and because the emotion that would organize repair stays out of reach. Attachment theory gave the field a research-based framework for understanding human emotions inside relationships, and Johnson turned that framework into moves you can make at 6:40 on a Tuesday.

The structure is disciplined. Across three stages and nine steps, you de-escalate the cycle, restructure interactions, then consolidate. Two change events define success: in withdrawer re-engagement, the withdrawn partner steps toward the relationship from grief or shame, and in blamer softening, rejecting anger becomes a direct bid for closeness. Evocative responding, heightening, and the RISSSC voice keep affect alive without flooding the room, and enactments move the work into partner-to-partner contact, where change consolidates. EFT aims to create a secure bond between partners, and every step in the sequence serves that aim.

The raw spot, and why it earns its keep

One piece of that apparatus deserves particular credit, because everything I say later is built on it. Johnson’s raw spot, described in Hold Me Tight, names a hypersensitivity formed when an attachment need went repeatedly unanswered, leaving a person feeling deprived or deserted. She distinguishes it from an attachment injury: a specific abandonment at a moment of acute need inside the relationship.

That term does something remarkable. It gives two frightened people shared, non-blaming language for a vulnerability, fast enough to de-escalate a live cycle. That is palpation: you find exactly where the tenderness is, in the room, in minutes. Few clinical concepts in any model earn their keep that quickly, and I have never stopped using it. Emotionally focused therapy is particularly effective in relational contexts, helping couples express primary emotions accurately, which is exactly the capacity everything later depends on.

It also improves emotion regulation relationally: partners learn to metabolize activation with each other rather than around each other. Because emotion regulation of that kind generalizes across interpersonal relationships, gains often appear at work and with children, and marital satisfaction is usually the first thing to move. It works with emotional states as they arise in the room rather than with the history behind them.

EFCT, EFT, and Emotion-Focused Therapy: sorting the labels

One clarification, since the abbreviations collide in mental health training. Johnson’s Emotionally Focused Therapy for Couples is now written as EFCT. Emotion-focused therapy, Leslie Greenberg’s individual model, shares its experiential roots and its priority on live processing over insight. Greenberg’s label is emotion-focused therapy (EFT) as well, which is part of why the abbreviations confuse people. Emotion-focused therapy gave us much of our language for self-critical processes; emotion-focused therapy chairwork remains the clearest teaching example of a two-chair split, and clinicians who already use emotion-focused therapy with individuals will recognize a good deal of what follows.

In practice, the labels blur. Plenty of us say emotion-focused therapy when we mean the couples model, and the databases index the couples literature under both. I use the shorter form myself further down this page. Where the difference between Greenberg’s model and Johnson’s actually changes what you would do, I will say which one I mean.

If you are EFT-trained, you already hold the framework that carries most of the emotional work in any couples room, including mine. My interest is in what a second set of instruments does alongside it, with every couple from intake, and most visibly with the handful you do not yet have language for, which is also the focus of my work described on the Travis Atkinson schema and couples training page.

What is schema therapy for couples, and what are its core principles compared with EFT?

Schema therapy for couples adapts Jeffrey Young’s model to the dyadic setting. Rather than treating the interaction cycle as the primary unit, the schema therapy model treats the mode cycle: the repeating collision between each partner’s coping modes when their schemas activate.

Its stated goal will sound familiar, because it is already yours: a consistent, stable pattern of secure connection between partners. The couples literature grounds that goal in adult attachment research. It also frames each partner as the antidote to their own mode cycle rather than as its cause.

Four terms carry most of the weight.

• Early maladaptive schemas. Enduring themes about self and others, formed when core emotional needs went unmet in childhood. Eighteen of them, across five domains.
• Schema modes. The states a person shifts into when a schema activates: Vulnerable Child, Angry Child, Detached Protector, Punitive Parent, Demanding Parent, Healthy Adult. Maladaptive coping styles, meaning surrender, avoidance, and overcompensation, determine which mode arrives.
• Limited reparenting. Inside the therapeutic relationship and within professional boundaries, the clinician meets unmet emotional needs directly, so the care becomes part of the client’s Healthy Adult mode.
• Empathic confrontation. Tenderness and firmness at once: naming a mode and its cost while staying warm about why it developed.

EFT and schema therapy for couples, side by side

Three experiential interventions carry the work, and the first one is not ours.

The enactment is the most effective intervention in emotionally focused therapy, and schema therapy for couples does not improve on it by replacing it. The connection dialogue is the enactment with the parts named. Same structure, same orchestration, the same synchrony you learned to conduct. What changes is who is speaking. Not the pursuer and the withdrawer in general. This partner’s Vulnerable Child, with the Detached Protector asked to step aside first, and the other partner’s Healthy Adult invited to answer. Naming the parts is what makes the timing precise.

Chairwork for couples and imagery rescripting for couples are the other two. All three work through emotion in the room, which both models treat as the engine of change. The schema model names the destination slightly differently: not only a secure bond, but modified schemas and new core beliefs about what a relationship can reliably be.

Session length, present focus, and shared lineage

Two practical differences follow from that table. Emotionally focused therapy is often shorter in duration, whereas the schema model takes longer with complex presentations. And emotionally focused therapy addresses current emotional attachment issues and present emotional states rather than working explicitly with childhood origins, which is a design choice rather than an oversight, and it is what makes the model quick in a couples therapy room.

One lineage note, and it applies to both models. Schema therapy grew out of cognitive work with clients who did not respond to standard protocols, then absorbed attachment theory, Gestalt, and object relations. That inheritance is still visible in the flashcards and diaries, though the change engine is experiential. Emotionally focused therapy took a similar integrative approach from the other direction, drawing experiential and systemic core principles into an attachment frame. Both therapies integrate techniques from multiple therapeutic approaches, enhancing their efficacy, and both are stronger in the consulting room for having done it. Where CBT focuses on present-day thoughts and behaviors, schema therapy works back to where they were learned.

None of this matters until a change event you executed correctly comes apart in the room. That is the seam where the two models pull away from each other.

Why does a well-executed change event sometimes reverse?

A change event reverses when the softening exposes a vulnerability the couple has no container built to hold. The modes that formed to prevent that exposure come back on duty within days. The part that runs against intuition is the timing. Your most skilled emotionally focused therapy work can precipitate the fastest reversal.

A real softening exposes the Vulnerable Child mode. That exposure is the point. Exposure without a container built to hold it also wakes everything built to prevent it. A Punitive Parent mode arrives that night with an old verdict about weakness. A Detached Protector, which kept a nine-year-old functional in a house where reaching was dangerous, is back on duty by Thursday. Neither is in the room during the enactment.

I learned this on my own couch before I learned it anywhere else. I had a couple I was proud of, three change events in, and I watched the whole thing reset over a weekend at his mother’s house. My conclusion at the time was that I had rushed the softening. I had not. I had simply never met the two people who undid it on the drive home.

The fight is not about the dishes, and it is not about the withdrawal. It is two children’s unmet emotional needs negotiating through two adult bodies, using adult vocabulary and adult money and adult contempt.

Notice what you already knew. Johnson asks partners whose face is standing behind their lover when the alarm goes off. She has always pointed at development. The question is what happens when you follow that pointing all the way down.

Are raw spots and schemas the same thing? Translating a raw spot into an abandonment schema

Not quite, and the difference is resolution rather than substance. A raw spot and a schema describe the same wound at two magnifications, and the magnification determines how specific your next move can be. The raw spot you named earlier locates where a partner is tender, which is a general and enormously useful thing to know. A schema tells you how that tenderness was built, which mode guards it, and where the original scene is, which is a differentiated thing to know.

That difference has a practical edge. A general name produces general strategies, and general strategies land close to the mark often enough to feel like they should have worked. A differentiated name produces a specific one.

Palpation and imaging, then. Feeling the sore place through the skin is the harder clinical skill, and schema therapy is the imaging that shows the structure underneath. Neither replaces the other, and no one images a patient they have not first examined. Nothing that follows asks you to hold attachment theory more loosely; I certainly do not.

The division of labor is straightforward once you see it. Schema therapy pinpoints. Emotionally focused therapy carries. Schema therapy for couples brings the assessment, which is the part attachment work has always been thinnest on: the YSQ-3, the Young Parenting Inventory, and the Schema Mode Inventory tell you which of eighteen schemas you are working with and which modes will arrive to defend them. Emotionally focused therapy brings the alliance and the emotional depth, which is what makes the targeting survivable in the room. Each model does its best work through emotion, and each is stronger for the other one being there.

What the higher resolution gives you

The higher resolution gives you four things, in ascending order of consequence.

One, a name and a lineage. A raw spot is one container. Schema therapy for couples differentiates it into eighteen early maladaptive schemas across five domains, and unmet needs in childhood become schemas that quietly select for partners who confirm them. Each one distorts the meaning of the other person’s behavior in its own direction. Six account for most of what arrives in couples work: Emotional Deprivation, Abandonment/Instability, Defectiveness/Shame, Mistrust/Abuse, Subjugation, and Unrelenting Standards/Hypercriticalness.

“He does not see me” reads one way when Emotional Deprivation drives it and another entirely when Defectiveness/Shame does. The first partner needs attunement. The second needs evidence that being seen is survivable, which is why self-esteem is never the target and the schema underneath it always is. Two partners can hand you the identical three words, and the intervention that reaches one will slide off the other. That is what targeting buys you.

Two, the coping mode, which is what you actually work with in session. The raw spot is the injury. The mode is the armor.

The vocabularies line up closely, and this is the correspondence most EFT clinicians find useful the fastest. What you call primary maladaptive emotion, I call the Vulnerable Child. What you call secondary reactive emotion, schema therapy calls a coping mode: the flatness, the reasonable tone, the fast apology, the sudden competence that arrives instead of the fear. Every time you slow a partner down and move her off the reaction toward what sits underneath it, you are doing what schema therapy calls getting past a coping mode to reach the Vulnerable Child. You are already good at this.

Where the vocabularies stop matching

What the mode language adds is a cast list. When a withdrawer will not re-engage, however carefully the enactment is set up, you are not meeting reluctance about attachment. You are meeting a Detached Protector doing the job it was hired for at age nine. Schema therapy for couples names the armor separately from the injury, which gives you something to speak to rather than something to work through. It also tells you when to expect nothing, since secondary reactive emotion needs an emotion present in the room, and the Detached Protector announces itself by there not being one.

The maps come apart on what else you find once the armor is off, because the child is rarely alone in there. The Punitive Parent is speaking too, and attachment work has no construct for a voice that is neither the partner nor the wound.

Three, an origin with an address. A raw spot is worked with in the present, through the cycle, which is often enough. A schema has a scene, an age, and a face attached, and imagery rescripting and other experiential techniques let you go there. Modifying early maladaptive schemas runs slower than shifting cognitive patterns, because the earliest and most severe of them were laid down before the child had language for what was happening to her, and they are encoded as feelings rather than as proposition. That is the difference between soothing a wound and revising the sentence the wound wrote. Schemas laid down before language keep organizing adult lives until something reaches them.

When the partner cannot be the healing agent

Four, a second healing route that does not depend on the partner. This one is load-bearing. In emotionally focused therapy, the partner is the primary healing agent, and the model works by making one spouse newly available as a secure base. Where both partners can occupy that role it is elegant and frequently sufficient. Where one partner’s own modes prevent it, the healing has nowhere to route: a Detached Protector cannot stay in the room long enough to receive anything, and a Punitive Parent turns every bid into fresh evidence.

Six raw spots translated into schema therapy for couples

A raw spot is more than a tender area that gets rubbed. Each one carries a conviction about what is going to happen next, and that conviction is the schema. Name what the raw spot is certain of, and you have named the schema, which is the whole of the translation. The left-hand column below states the certainty rather than the sore point, because the certainty is what an intervention has to reach.

These six are common examples rather than a full inventory. Eighteen schemas have been empirically validated, and any of them can sit under a raw spot. The six below are the ones an EFT therapist recognizes fastest, because you are already describing them in different words every week.

Abandonment/Instability carries two halves, and the second one does most of the work here. The first half is the certainty of being left, which is the fear you already track well. The second is the certainty that availability itself is unreliable, which is why the origin column for that row reads as availability that changed without warning. The question underneath is not will you leave me. It is will you be the same tomorrow as you were tonight.

That distinction changes what helps. A partner braced against instability is not braced against distance, which is steady and therefore survivable. They are braced against the good stretch, because the warm week was the signal that the drop was coming. A well-executed softening raises availability sharply, which is the shape they learned to distrust, so warmth without predictability raises the peak they are watching. Pace the softening, say the wobble out loud before it arrives, and make the next contact small, scheduled and unremarkable.

Read one of your own stuck cases across the table before you go further.

Two notes on using it. In schema therapy, coping modes are not resistance; they are a child’s best available solution, which is why you negotiate with them rather than remove them. An abandonment schema in one partner and a defectiveness schema in the other will produce marital conflicts that look identical from the outside and need different rooms. Chairwork also sits in the Gestalt two-chair lineage that emotion-focused therapy draws on, so the mechanics may feel familiar. What differs is the cast: you speak to a named mode with a documented origin.

Where the full schema therapy for couples sequence is taught

If you want to see how the whole sequence is taught, the schema therapy for couples training program page is there whenever you want it, and you can stay current on developments through the Schema Therapy Training Center blog on schema therapy advances and training resources. The rest of this article works fine without it.

Reading a table is one thing. Watching the same moment go two different ways at 6:40 p.m. is another.

Pursuer and withdrawer, at higher resolution

Sue used to say that if you were going to get stuck in EFT, it would be with the angry pursuer. She was right, and the same is true at the other end of the cycle, for a reason worth naming. Pursuer and withdrawer are positions. They are not one thing each.

There is a second reason the angry pursuer is where we get stuck, and it is not about the couple. The model assumes your own schemas activate in the room and gives you a working vocabulary for it. If a raised voice reliably pulls you toward soothing, it helps to know that by name. The same goes for a quiet alliance with the calmer partner. Better before Thursday at six than in supervision three weeks later.

The schema model differentiates both into subtypes with different origins, different needs, and different interventions. Treat every withdrawer the same way and you will be right often enough to keep doing it. You will also be wrong in the way that costs you the harder couples.

Withdrawer and pursuer subtypes, mode by mode

Read that table as an EFT therapist and you will notice something. The interventions in the right-hand columns are not new to you. Most of them are things you already do. What the mode map changes is which one you reach for, and when.

The part that surprised me most

I noticed this first in my own EFT trainings. It took me a while to understand what I was seeing. I could name the core theme in a couple within a session or two. Clinicians I admired were still circling it several sessions later.

That was not talent. It was that I came in holding a set of instruments they had never been handed. The Young Schema Questionnaire (YSQ-3), the Young Parenting Inventory and the Schema Mode Inventory are completed between sessions. They cost you no session time, and they come back with the core themes already sorted, named, and scored. Cycle tracking gets to the same place. It gets there later, because it has to build the map out of live material while you are also managing the room.

That difference compounds. Every session you spend narrowing is a session the couple spends in the cycle. The couples most likely to leave early are the ones who most need you to be fast.

The feedback session earns its own mention. Handing two people their schema profiles and walking them through what those profiles predict is frequently the first de-shaming moment in the whole treatment. It arrives well before any softening does. Partners hear that the thing they have been calling selfishness has a name, an age, and a history in someone else’s house. Some of the best sessions I have are the ones where nothing happens except that.

The nine days

One more thing the assessment buys, and it goes straight back to the couple in those two chairs.

When you know which schema is loaded and which mode guards it, you can tell a couple what is coming. Not vaguely. Specifically: on Thursday, the voice that calls you a whiner is going to arrive, and we already know what we do when it does.

The couples model also assigns considerably more between-session work than I was trained to assign in EFT. Mode diaries. Flashcards written in the partner’s own words, to be read at the moment the schema fires. Practice aimed at the specific schema rather than at communication in general.

Sue’s position was that the in-session experiential work outperformed homework, and she was right about that. Mine is that the combination outperforms either alone. The couples-specific evidence for it does not exist yet. What does exist is the general homework literature, and it is stronger than most clinicians realize.

Kazantzis, Whittington and Dattilio (2010) pooled 46 studies and found a moderate effect favoring homework, d = 0.48. The comparison held the treatment constant and varied only whether homework was assigned. That is individual cognitive and behavioral work rather than couples work, so it does not transfer automatically. It is still why I keep assigning it.

That is the nine days. It is also the stretch most couples models leave to hope.

The same couple, the same moment, two rooms

Nadia and Marcus are the couple from the first paragraph, a composite drawn from patterns I see repeatedly among high-functioning professional couples. Three years of escalating conflict. An emotional affair six months ago, which Marcus found out about. She describes feeling invisible; he describes shutting down and working until midnight.

The same moment, twice: 6:40 p.m., her voice climbing, his eyes on the carpet.

The emotion-focused therapy room

You name it in her language. “There is a raw spot here about not mattering, and it just got rubbed.”

Nadia nods hard. You slow the room and stay with what sits under the frustration until she finds it: “I reach for you because I am terrified of losing you.” Marcus, given room and a slower voice, gets there too: “I go quiet because I do not know how to be enough for you.”

She hears him. Something in the room settles. That is a good session, and you were right about the raw spot.

Nine days later, Marcus is working late again. What was missing was not warmth, depth, or accuracy. It was a target specific enough for the depth to land on.

The schema therapy for couples room

The same moment, at higher resolution.

Before the scene, one caveat, because it matters more than the scene does. I do not work in two rooms. Both sets of instruments are in the room from session one, and on most evenings, the sequence below occurs within a single hour. I have separated them below so you can see which model is doing what.

Nadia’s tenderness has a name now: Emotional Deprivation, formed with a mother whose availability changed by the hour and reinforced by a Punitive Parent mode that calls needing anything childish. Marcus carries Defectiveness/Shame, formed at a dinner table where his father corrected his performance and never asked about his day. His Detached Protector stands in front of it.

Today you add a chair. Placement matters, so the Protector’s chair goes between Marcus and the chair set closest to you, and it stays in that spot for the rest of therapy.

“Marcus, in a moment I am going to ask you to stand up and sit here, next to me. Before you do, notice that the place you are sitting now belongs to the side of you that goes quiet. When you stand, leave that side there, as if it were glued to the seat.”

He moves. You turn to the empty chair and drop your volume.

“I know you came for a reason. You kept a boy functional in a house where reaching got him corrected. I am not asking you to leave. What I am asking is that you step aside for the rest of this session, so I can talk with him directly. I will not let anyone humiliate him while you are off duty.”

Speaking to the child, then coaching the connection dialogue

Then you turn to Marcus beside you and speak more softly than you did to the Protector. “That side of you has carried this alone since you were nine. What happens in your chest when Nadia’s voice climbs?”

Marcus says: tight. Says: braced. Says, after a pause, “Like I am about to be graded.”

Nadia has been watching, and her face has changed. She is not watching a man who does not care. She is watching a nine-year-old being graded at dinner.

Now the connection dialogue. You coach her past the accusation into the request, in the smallest words available. “Stop attacking me” becomes “Help me feel like I matter to you.” Her Punitive Parent arrives on schedule: “Who wants to be with a whiner?”

Empathic confrontation goes to the mode rather than to her. “That voice is not you. That is the one that told you needing anything made you a brat. I am not going to let it run this conversation.” Then you turn to Marcus. “She just took a real risk. What is it like to hear her say it that way?”

Marcus answers with recognition rather than reassurance, because he knows her history: “That is the same fear you had with your dad. You are not a brat. I want to know what you need.”

On the days he cannot get there, I meet the need myself while he watches. Limited reparenting keeps the session moving when the designated healer is unavailable.

Later, imagery rescripting for couples extends the principle. Marcus returns to the dinner table with his eyes closed while Nadia stays present. Early on I do the rescripting; within a few sessions she is the one who speaks to his father.

Where this lands

Schema therapy for couples aims at something more specific than a quieter cycle. The target is the healthy mode triad, my term for the three modes worth strengthening in a romantic relationship, which I set out in chapter 13 of Creative Methods in Schema Therapy: a Healthy Adult who notices what is happening, a Vulnerable Child who can say what she needs, and a Happy Child who is allowed back into the room.

Notice which mode is on that list. The Vulnerable Child is not a state a couple graduates out of. Some schema therapists, particularly those arriving from a more cognitive tradition, treat it as a weakness to be managed or a temperature to be brought down. I take the opposite position, and the triad is where I put it. In a healthy romantic relationship you want more access to that mode, not less. A partner who can say what she needs, in the moment she needs it, is not fragile; she is doing the one thing that lets the other person reach her.

If that sounds like something you already believe, it is the same conviction that put primary emotion at the center of your work rather than at the edge of it. It is also why I built the endpoint of the couples model the way I did.

The triad came out of a problem I could not solve any other way. Couples I had de-escalated successfully were calmer and still not close. Building sturdier Healthy Adults, on its own, produced careful, well-regulated partners who had stopped playing entirely. The third chair had to go into the model explicitly, or the work kept stopping one step short of what people came for.

Happy Child mode, and the playfulness couples grieve

That third mode is what the fourth conversation in Hold Me Tight reaches for. It is also what couples grieve most when it goes. Schema therapy for couples gives it a name and a developmental account: Happy Child mode gets suppressed in homes where play and spontaneity were restricted or simply not valued. A couple’s lost playfulness becomes a treatment target rather than a hoped-for side effect.

What replaces the mode cycle is reciprocal disclosure that invites responsiveness, running both directions. The two partners have become each other’s antidote instead of each other’s trigger.

Knowing that is the endpoint changes what you do on Monday morning, which is the next thing to settle.

Which model leads at which moment

Use this Monday. You do not need me to use it.

Both models are in the room from the first session. The question is never which one you are doing; it is which one is leading the moment you are in.

Emotionally focused therapy (EFT) leads when:

• You are building the alliance, which is the precondition for everything else.
• You are deepening emotion in the room, in either partner, at any stage of the work.
• Both partners can reach primary emotion with reasonable therapist support.
• The couple needs the gains to generalize, out of this session and into the week.
• The presentation is disengagement, cycle-locked conflict, or a discrete attachment injury.

Schema therapy leads when:

• You are assessing. The Young Schema Questionnaire (YSQ-3), the Young Parenting Inventory, and the Schema Mode Inventory give you a map at intake that cycle tracking alone will not produce.
• You need a specific target rather than a general one, which is most of the time with the couples below.
• A Detached Protector facing an Angry Child, where every bid raises the armor it is aimed at.
• A Punitive Parent mode converting the softening partner’s vulnerability into evidence against her within days.
• Unrelenting Standards meeting Emotional Deprivation, so effort keeps arriving where attunement is needed.
• Mistrust/Abuse in either partner, where an enactment reads as exposure rather than repair and emotional safety has to be established before any imagery work.
• Fluent, performative emotional expression in session while nothing shifts at home.

The reversals clinicians bring to consultation

In my consultation groups, those five account for most of the reversals clinicians bring in, and major depressive disorder in either partner compounds all of them. Emotional patterns that look like character in the room are usually early maladaptive schemas doing exactly what they were built to do. None of them calls for switching models. Each calls for a targeted intervention delivered with the emotional depth that EFT is better at producing than anything else in the field.

A second composite makes it concrete, and I should say where my footing on it comes from. Sue and I co-produced EFT’s first training video on working with LGBTQ+ couples. I am still glad to have my name on it. Ellis and Jonah have been together eleven years. Jonah is warm, articulate, and hard to reach; Ellis alternates between accommodation and withering criticism. Enactments go well, then dissolve within a week. Jonah grew up as the competent child in a family that praised composure and never asked about fear, and his Detached Self-Soother is more reliable than any bid Ellis makes. Until someone speaks to that mode by name, Ellis is bidding against a survival strategy older than the relationship.

Standing still has a cost, and I will name it plainly. It is not dramatic. It looks like a polite termination at session fourteen, a referral out that felt like defeat, and a slow narrowing of which couples you let onto your calendar.

Hold those particular couples in mind. The last part of this article is about what you would do differently with them, starting the week after next. Those couples are the reason the couples schema training program exists.

When borderline personality disorder and emotion regulation change the plan

Where one partner carries borderline features, the couples frame usually has to wait for individual work to build enough stability to hold a softening. Emotion regulation is the capacity that decides when that point has arrived. You can usually feel it in the room before any screening form confirms it. One partner answers in a flat register, sleeps badly, and describes the marriage as one more thing she is failing at. Comorbidity is the norm in mental health settings, so screening for depressive symptoms, eating disorders, and trauma belongs in any model.

Major depressive disorder complicates the picture most often. Withdrawal is then not only a coping mode, and enactments can outrun what the depressed partner can metabolize. Where depressive symptoms are severe I sequence rather than combine, and supportive therapy for the depressed partner often has to come before couples therapy resumes. Schema therapy has reached chronic depressive presentations with early promise (Renner and colleagues, 2016), though the evidence for major depressive disorder stays thinner than for personality disorders. Mode work also shifts cognitive emotion regulation strategies such as rumination and self blame, and symptom reduction there tends to precede any change in the couple. Self defeating patterns in one partner will outlast any behavioral agreement the couple signs.

Eating disorders and obsessive compulsive disorder

Secrecy is structural in eating disorders, so a frame that rewards disclosure can expose one partner faster than her Healthy Adult can hold. A randomized clinical trial by McIntosh and colleagues (2016) compared cognitive behaviour therapy, appetite-focused cognitive behaviour therapy, and schema therapy for binge eating. Eating disorder symptoms improved without clear separation between the three, and the clinical picture in bulimia nervosa is similar. With obsessive compulsive disorder, the couple dynamics get misread as control. One small open trial of schema-informed exposure and response prevention, with patients who had not responded to standard treatment, reported reductions in obsessive compulsive disorder and depressive symptoms at follow-up. Specialist care for eating disorders and the other two comes first. Schema therapy improves emotion regulation through mode work, and better emotional regulation makes couples therapy possible.

All of which invites the question this audience always asks next, usually with some skepticism attached.

What does the outcome literature show about the effectiveness of schema therapy and EFT?

The outcome literature is strong for schema therapy with personality disorders treated individually. It is promising but thin for chronic depression, and effectively silent on the couples adaptation, which has no completed randomized trial. Emotionally focused therapy has the better couples evidence base of the two.

One caution before those numbers. The couples literature is smaller and messier than the individual literature, and a fair amount of it sits in regional journals that are hard to appraise. You will find small emotion focused trials in narrowly defined samples, divorced women processing a separation in one, university students in another, several of them in educational sciences journals rather than clinical ones, and many never reach the databases most of us search. Read each abstract and ask what the present study actually measured, how many couples it followed, and for how long. The present study framing in a results section can quietly cover a sample of thirty couples and a follow-up window of eight weeks.

Precision matters more than enthusiasm. One standard applied to both literatures, and no verdict at the end. The trials were never designed to compare these models against each other. I will stay inside what the effectiveness of schema therapy research can support, and say where it stops.

Schema therapy evidence for personality disorders

Schema therapy’s strongest evidence sits with personality disorders. Giesen-Bloo and colleagues (2006) found schema-focused therapy superior to transference-focused psychotherapy for borderline personality disorder in Archives of General Psychiatry. The four-year economic follow-up of that trial (van Asselt and colleagues, 2008, British Journal of Psychiatry) recorded recovery in 52 percent of the schema-focused therapy patients, against 29 percent in the transference-focused psychotherapy arm, an active comparison rather than treatment as usual. Mean four-year societal costs ran to roughly 37,800 euros for schema-focused therapy against 46,800 euros for the comparison arm, so it came out both less costly and more effective on recovery. Farrell, Shaw and Webber (2009) reported a randomized clinical trial of group schema therapy for borderline personality disorder in the Journal of Behavior Therapy and Experimental Psychiatry. The effectiveness of schema therapy is best documented there, and the effectiveness of schema therapy in couples work is still being established.

Bamelis and colleagues (2014), in the American Journal of Psychiatry, randomly assigned 323 patients across twelve Dutch centers to three groups. Worth noting what the sample was: cluster C, paranoid, histrionic, and narcissistic personality disorder, not borderline. The primary outcome was recovery three years after treatment started, rated by blinded interviewers, and roughly four in five recovered in the active arm against roughly half in the treatment as usual control group. Dropout ran the same direction. Gülüm (2018), pooling eight schema therapy studies in Research in Psychotherapy, found a weighted mean dropout rate of around 23 percent, so under a quarter of patients left early.

Cost-effectiveness, reviews, and imagery rescripting

The economic evaluation of the same Dutch trial went further (Bamelis and colleagues, 2015, Journal of Clinical Psychiatry). It put the probability that the model was the most cost-effective option at 78 percent at zero willingness to pay, rising to 96 percent at a willingness to pay of 37,500 euros per additional recovery. A comprehensive review of that literature appeared in Clinical Psychology Review (Sempértegui and colleagues, 2013). On components, a meta-analysis of imagery rescripting across nineteen studies found large effects that grew by follow-up (Morina, Lancee and Arntz, 2017), though only five of the nineteen used any control group. The longer version of this survey sits in a separate piece on whether schema therapy is evidence based.

Rameckers and colleagues (2023) set that number in wider context. Their multilevel survival meta-analysis in Psychological Medicine pooled 111 studies, 159 treatment arms and 9,100 patients, and schema therapy showed the lowest dropout of any treatment examined. Dropout concentrated in the first quarter of treatment, and individual formats held better than group formats. The model has also been tested well outside its original outpatient frame. Group schema therapy delivered in day clinic settings for severe personality disorders, reported in Clinical Psychology and Psychotherapy, held dropout low. That is a harder test than it looks, because day clinic settings put considerably more pressure on a treatment than weekly outpatient work does. Jacob and Arntz mapped the whole picture in the International Journal of Cognitive Therapy (2013), still the most efficient way in if you want one paper rather than twelve.

Four qualifications about the effectiveness of schema therapy

Four qualifications about the effectiveness of schema therapy, and they cut against my own side first.

Most schema therapy trials excluded the comorbidities that fill real caseloads. Bipolar disorder, psychotic disorders, dissociative identity disorder, ADHD, and substance use requiring detoxification were screened out. In the Giesen-Bloo trial, roughly half of those screened were eligible to enter. Effect sizes from tightly selected samples are not promises about the couple booked for Thursday at six, and estimates of the effectiveness of schema therapy therefore describe a narrower population than yours.

The design record is uneven rather than uniformly strong. Giesen-Bloo compared schema therapy against an active, established treatment with independent assessors and a credible control group, which is the standard worth wanting. Elsewhere, reviewers have questioned control groups, one trial showed a baseline imbalance despite randomization, and much of the work comes from teams close to the model. Independent replication outside a few centers remains thin, so the effectiveness of schema therapy is better supported in some trials than in others. Taylor, Bee and Haddock (2017), reviewing schema change across mental health disorders in Psychology and Psychotherapy, found schema change and symptom change together in eleven of the twelve studies that measured schemas at all, and noted that formal mediation studies are still missing. The mechanism I am selling you is plausible and not yet demonstrated.

Blinded raters, self-report, and the couples gap

The Bamelis team used blinded interviewers to collect data, and that choice mattered more than it sounds. On interview-based measures, the statistical analysis separated the three groups. On self-report data the separation disappeared, though nothing about the statistical analysis itself had changed. That distance between what a blinded rater sees and what a patient reports is worth knowing before anyone quotes a recovery figure at you, including me.

Then the one that matters most in an article about couples: almost none of it is couples research. The strong findings are for personality disorders treated individually or in groups, and the effectiveness of schema therapy with couples specifically remains an open question.

What the EFT couples outcome literature shows

On the emotionally focused therapy side, Makinen and Johnson (2006) in the Journal of Consulting and Clinical Psychology remains the clearest account of repairing a specific rupture, and marital satisfaction is the outcome most of that literature reports. The meta-analysis that anchors the model is older and still the reference point. An early meta-analysis of EFT for couples, Johnson, Hunsley, Greenberg and Schindler (1999), found that roughly seven out of ten distressed couples moved into the non-distressed range by the end of therapy, with a large effect size and improvement rates in marital satisfaction higher than any other couple intervention reported at the time. That deserves saying plainly. It is also the study behind the success rate quoted for EFT in couples therapy at every externship.

Later work is steadier and more modest, which is what maturity looks like in an outcome literature. Rathgeber and colleagues (2019), in the Journal of Marital and Family Therapy, pooled thirty-three randomized trials covering 2,730 participants and found no significant effect size difference between emotionally focused couples therapy and behavioral couple therapy. Beasley and Ager (2019) surveyed nineteen years of results and used a repeated measures analysis to show that gains held at follow-up. Wiebe and Johnson (2016) drew the whole picture together in Family Process, and it is still the best single overview of where couples research on the model stands. Read together they say something worth carrying. EFT works, it works about as well as the other established couples model, and it keeps working after you stop.

Two cautions, and where the schema therapy for couples evidence stops

Two cautions travel with every figure in this section, mine included. Numbers cross models badly, because these trials recruited different populations and measured different endpoints, so none of them settle the question this article asks. Where marital satisfaction is the only measure, symptom reduction in either partner can go unrecorded entirely, and a couple can score as recovered while one of them is still depressed. One practical note as well, since the naming is inconsistent. Databases index this work under emotion focused therapy eft, emotionally focused therapy, and emotionally focused couple therapy, and the three result sets do not fully overlap.

Schema therapy for couples itself has no completed randomized clinical trial. It is an established clinical model with a strong parent literature and an unfinished outcome literature. Claims about the effectiveness of schema therapy for couples should be read as clinical rather than empirical. Neither literature says much yet about couples where one partner carries major depressive disorder.

If you would rather follow this as it develops than take my summary for it, two sources do most of the work. The International Journal of Cognitive Therapy carries a good share of the schema measurement and review literature, and the Journal of Marital and Family Therapy remains the home of the couples outcome work. Between them you can watch both models argue with themselves, which is the more instructive read.

None of which should decide anything for you. Choose between these models on clinical fit, using the aid a few sections up, the way you would with any model.

ICEEFT and ISST, side by side

I hold credentials on both sides, so this is a comparison rather than a recommendation.

ICEEFT, the International Centre for Excellence in Emotionally Focused Therapy. A four-day externship, core skills training, required hours of EFT-specific supervision with video review, and recorded work demonstrating model fidelity. Twelve to twenty-four months is common.

ISST. An approved curriculum, supervised casework, and demonstrated competence. Couples certification builds on individual foundations, so the pathway takes longer. ISST policy also holds that didactic and dyadic training material cannot be pre-recorded, apart from demonstrations of specific interventions, which is why live attendance is what counts toward certifiable hours. Requirements sit with ISST and can change, so I never promise an outcome an external body controls. The full route is written out separately, in a guide to ISST certification in schema therapy and a companion piece on choosing an ISST-approved training program.

Neither pathway teaches you the model, though. That happens somewhere much smaller.

Inside the STTC schema therapy for couples program

The Schema Therapy Training Center of New York built this program for clinicians who are already good at couples work and are carrying the couples described above. Participants join from private practice, hospital teams, university clinics and counseling centers, and nearly all arrive with an attachment-based model already in hand.

The couples who quietly stop booking at session fourteen are the ones the cohort works on. Not textbook examples. The ones you are carrying, presented the way you would present them in any consultation group.

It is an apprenticeship rather than a webinar series. A cohort capped at twenty meets live online for experiential role-plays and case discussion, so you practice chairwork with feedback in the moment instead of watching a demonstration from a stage.

There is evidence for that format, and it comes from the trial cited a few sections up. Bamelis and colleagues ran two cohorts of therapists, the first trained primarily with lectures and the second primarily with exercises. The second cohort produced better patient outcomes, and the authors put it in their conclusions. How schema therapists are trained showed up in how their patients did, which is equally true for how we address schema therapy supervision challenges when we are shaping therapists’ skills over time.

Three things make that worth your time. You learn the mode cycle and the healthy mode triad from the person who formulated them, and from someone who also holds EFT certification and supervises in the model, so the translation happens in your language rather than at you. The room stays small enough that the discussion stays on cases people are actually stuck on, rather than on teaching examples. Your hours also count toward a recognized ISST pathway.

What the schema therapy for couples training covers

The teaching portions are recorded and stay available to you for one year. The experiential sections are not, which is partly a privacy matter and partly why live attendance is what counts toward ISST hours.

How is it structured? Before live sessions begin, you complete prerecorded preparatory material on the eighteen schemas, the five domains, core emotional needs, modes, and maladaptive coping styles. That module is groundwork rather than certifiable hours, since every hour counting toward ISST is live. In the first weeks you map a mode cycle for a couple you are working with now. In the middle stretch you stage your first couples chairwork sequence and get corrected on it. By the later weeks you are running connection dialogues.

Three months in, you should be able to do three things you cannot do now. Name the two modes colliding in a stalled couple. Speak to a coping mode without shaming the person carrying it. Route the reparenting through the partner rather than holding it yourself.

The curriculum follows the ISST curriculum for couples work. Educational consultations, also known as supervision, are available separately from the coursework for clinicians working toward certification, and I will walk you through how that fits when you apply. If you are weighing this against the wider credentialing question, there is a separate piece on couples therapy certification for clinicians. Tuition and payment plans are on the couples schema therapy training page. Admission requires a master’s degree or higher in a mental health field and a license to practice in your jurisdiction. Applications are reviewed against those requirements rather than counted, and enrollment closes once the twenty places are taken.

Applying, and who the program fits

Applying is a conversation rather than a purchase. You send the form, we talk about your caseload and whether this is the right year for you, and either of us is free to say not yet. Nobody is enrolled by filling in a field.

This is the right training for you if you recognized two or more of those mode configurations in your own caseload, you are already carrying couples whose softenings will not hold, you want the developmental map rather than another set of techniques, and you would rather practice chairwork badly in front of a small group than watch it performed well on a stage.

If two or three couples came to mind while you were reading, this is probably the year to stop working on them alone.

Who this program is not for. If you need CE hours and do not intend to practise the model, this is the wrong purchase. Without an active couples caseload, the applied components will not work. If you want self-paced study, the live cohort will frustrate you. The program suits master’s-level and doctoral mental health professionals, LMFT, LCSW, PsyD, PhD, LPC, licensed in their jurisdiction and carrying couples they cannot unstick, whether you work solo, on an agency team, or in one of the counseling centers where the waitlist never gets shorter.

Frequently asked questions

These are the questions that actually reach me, usually by email after a talk or a supervision group.

I already work with raw spots. Is this just a relabeling?

Schema therapy for couples is not a relabeling of raw spot work, and be suspicious of anyone who cannot answer that clearly. Both terms name the same wound. Schema therapy adds three things the term does not carry: which of eighteen schemas drives it, which mode guards it, and which scene you can go to. Repackaged vocabulary would leave your change events reversing on the same schedule.

Will this pull me away from EFT?

This training does not pull you away from emotionally focused therapy, and I am the evidence. I hold my EFT certification and supervise in the model, and I use both with every couple I see. Graduates do not alternate between two models or hold one in reserve. They assess with schema instruments, build the alliance and deepen emotion the way they always have, and target with modes when the moment calls for a target. Clinicians who also use emotion focused therapy methods with individuals find the chair transitions transfer quickly.

Do I need prior schema therapy training to enroll?

No prior schema therapy training is required to enroll. The prerecorded material covers the model from the ground up, and you finish it before live sessions begin. Participants arrive from emotionally focused therapy, the Gottman Method, and psychodynamic backgrounds.

What is the weekly commitment, and will this work with my caseload?

Plan for the prerecorded material before the cohort starts, then weekly live sessions plus applied practice. The structure assumes a full caseload, because everyone in the room has one. It works best when you are applying the model to your own current work, which is why the learning transfers.

What does it cost, and are there payment plans?

Tuition and payment plans stay on the program page, since figures change between cohorts. Better that you read the real number than an approximation.

Does this training count toward ISST certification?

Yes, it puts you on the pathway. Supervised hours, case submissions, and community requirements are set by ISST rather than by me, and we map your individual route when you apply.

Is the program open to clinicians outside the United States?

The program is open to clinicians outside the United States. The cohort is international by design and meets live online across time zones, and the case material reflects how differently interpersonal relationships are organized across cultures. You need a master’s degree or higher in a mental health field, a license to practice where you work, and an active couples caseload. United States regulations prevent us from enrolling participants in a small number of countries.

How does schema therapy compare with cognitive behaviour therapy, acceptance and commitment therapy, IFS, or RLT?

Cognitive behaviour therapy targets the thought, the behaviour and the loop that reinforces both, and it remains the most tested frame in the field. That frame treats a schema as a belief to be tested, where the schema model treats it as an unmet need, so the interventions diverge even when the formulation looks similar. I set that comparison out separately in schema therapy vs CBT.

Acceptance and commitment therapy builds cognitive flexibility and values-based action, and clinicians integrate acceptance and commitment therapy skills with couples work productively, particularly where self compassion is thin in one partner. Self compassion work and mode work aim at the same unmet core needs from different directions. Acceptance and commitment therapy does not map why a specific cycle reassembles, which is what the couples model adds to it. The two-chair work in emotion focused therapy is a closer cousin of schema chairwork, and therapists who already use those experiential techniques tend to integrate schema therapy quickly. This article stays inside the attachment frame, because that is the frame you work in. For a parts-based comparison, see IFS vs schema therapy. For a structural, power-and-accountability model, see Terry Real’s RLT vs schema therapy.

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Where to start with the couples you are carrying

Take the case you were thinking about three paragraphs in. You know where that couple is tender, because you have been palpating it accurately for months. Name the schema, name the mode standing in front of it, and you will know what to say at 6:40 p.m. next Tuesday, when the same seventeen words arrive.

Six months on, the session I want for you is quieter and funnier than the one you are dreading. He stays. She asks. Neither of them needs you to hold the room, and the Happy Child that neither has seen since the second year is sitting in a chair nobody had to place.

The clinician you are becoming is the one colleagues call after a couple has failed two rounds of therapy. You will still be an EFT therapist when you get there. You will simply have more to reach for on the nights the softening does not hold. If that is the practice you want, the next cohort is small and applications are open. The first step is one conversation about the couples you are carrying. Details are on the schema therapy for couples training program page.

Selected references

Representative rather than exhaustive, and grouped so you can go straight to the part you want. Every figure quoted above comes from one of these.

Emotion focused therapy (EFT) and couples outcomes

• Johnson, Hunsley, Greenberg and Schindler (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6, 67 to 79.
• Makinen and Johnson (2006). Resolving attachment injuries in couples using emotionally focused therapy: Steps toward forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74, 1055 to 1064.
• Wiebe and Johnson (2016). A review of the research in emotionally focused therapy for couples. Family Process.
• Rathgeber and colleagues (2019). The efficacy of emotionally focused couples therapy and behavioral couples therapy: A meta-analysis. Journal of Marital and Family Therapy.
• Beasley and Ager (2019). Emotionally focused couples therapy: A systematic review of its effectiveness over the past 19 years. Journal of Evidence-Based Social Work.

Schema therapy trials, costs and dropout

• Giesen-Bloo and colleagues (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy versus transference-focused psychotherapy. Archives of General Psychiatry.
• van Asselt and colleagues (2008). Out-patient psychotherapy for borderline personality disorder: Cost-effectiveness of schema-focused therapy versus transference-focused psychotherapy. British Journal of Psychiatry.
• Farrell, Shaw and Webber (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 40, 317 to 328.
• Bamelis and colleagues (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry.
• Bamelis and colleagues (2015). Economic evaluation of schema therapy and clarification-oriented psychotherapy for personality disorders: A multicenter, randomized controlled trial. Journal of Clinical Psychiatry.
• Gülüm (2018). Dropout in schema therapy for personality disorders. Research in Psychotherapy: Psychopathology, Process and Outcome, 21.
• Rameckers and colleagues (2023). Dropout from psychological treatment for borderline personality disorder: A multilevel survival meta-analysis. Psychological Medicine.

Reviews, components and comorbidity

• Sempértegui, Karreman, Arntz and Bekker (2013). Schema therapy for borderline personality disorder: A comprehensive review of its empirical foundations, effectiveness and implementation possibilities. Clinical Psychology Review, 33, 426 to 447.
• Taylor, Bee and Haddock (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy: Theory, Research and Practice.
• Jacob and Arntz (2013). Schema therapy for personality disorders: A review. International Journal of Cognitive Therapy, 6, 171 to 185.
• Morina, Lancee and Arntz (2017). Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 6 to 15.
• Renner and colleagues (2016). Schema therapy for chronic depression: Results of a multiple single case series. Journal of Behavior Therapy and Experimental Psychiatry, 51, 66 to 73.
• Atkinson and Perris (2020). Schema therapy for couples. In Heath and Startup (Eds.), Creative Methods in Schema Therapy: Advances and Innovation in Clinical Practice, chapter 13, 210 to 224. Routledge.
• McIntosh and colleagues (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 to 420.
• Kazantzis, Whittington and Dattilio (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17, 144 to 156.