For many therapists working with borderline personality disorder, one question comes up again and again:

Should this client receive DBT or Schema Therapy?

In a recent episode of “What’s the Schemata”, Chris Hayes and Robert Brockman explored a new large randomised clinical trial comparing Dialectical Behaviour Therapy and Schema Therapy for people with severe borderline personality disorder.

Their conclusion was not a dramatic “winner takes all” result.

It was more clinically useful than that.

Both treatments worked.

Both produced large improvements.

Both appeared to maintain those gains after treatment ended.

And perhaps most interestingly, the study raised deeper questions about how different therapies may help clients reach similar outcomes.

No clear winner, but very good news

The study compared DBT and Schema Therapy across multiple outpatient clinics in the Netherlands. Clients received two years of treatment, followed by a year of follow-up.

Both treatments led to significant improvements in borderline personality disorder symptoms and other measures of wellbeing.

Chris and Rob noted that this is important because DBT and Schema Therapy come from quite different clinical traditions. DBT is often more skills-based, focused on emotion regulation, distress tolerance, interpersonal effectiveness and reducing high-risk behaviour. Schema Therapy is more attachment-focused, working with unmet emotional needs, schemas, modes and the development of a stronger Healthy Adult.

Yet in this trial, both pathways appeared to help.

For clinicians, this is a useful reminder: effective therapy does not always need to look the same on the surface to create meaningful change.

Skills, regulation and deeper emotional healing

One of the most useful parts of the discussion was Chris and Rob’s comparison of the mechanisms behind each model.

DBT may be understood as a more self-regulation model. The client learns skills, practises them, generalises them and uses them when emotions become overwhelming.

Schema Therapy, by contrast, often begins as more of a co-regulation model. Through limited reparenting and the therapeutic relationship, the therapist helps the client experience emotional regulation, care and protection in vivo. Over time, the hope is that this becomes internalised as Healthy Adult functioning.

This distinction matters clinically.

Some clients may need immediate skills to manage crises, reduce self-harm or survive intense emotional storms. Others may be ready to explore the deeper emotional meanings underneath their patterns: shame, abandonment, mistrust, defectiveness or unmet childhood needs.

The episode also raises a practical question: do therapists need to treat these models as competing, or can they learn from each other?

Can DBT and Schema Therapy be integrated?

Chris and Rob were careful not to reduce the discussion to “Schema Therapy versus DBT.”

A more useful question may be:

What does this client need, at this stage of treatment?

For example, DBT skills may be helpful inside Schema Therapy when a client is highly distressed between sessions. Skills such as distress tolerance, grounding or temperature-based regulation may help reduce the intensity of a mode so the client can stay safe and return to deeper work.

Equally, Schema Therapy may help explain why a client is not using a skill they already know. A Detached Protector, Angry Child, Punitive Parent or Vulnerable Child mode may be blocking access to the client’s healthier capacities.

This is where the clinical conversation becomes interesting. DBT may help clients manage the storm. Schema Therapy may help them understand why the storm keeps forming.

Both matter.

Dropout and readiness for treatment

The study also showed relatively high dropout rates across both treatments.

Chris and Rob reflected on what this might mean. Was it the intensity of a two-year treatment? The group format? The severity of the client group? Readiness for change? Practical issues? Or, in some cases, did some clients leave because they had improved enough to return to work or life demands?

The key point is that dropout should not be treated as a side issue. For services offering intensive treatment, readiness, preparation and fit may be just as important as the model itself.

What should therapists take from this?

The episode’s most practical message is that both DBT and Schema Therapy can be highly effective when delivered in a structured, consistent way by trained clinicians.

For therapists choosing training pathways, DBT may be especially relevant for high-risk, crisis-heavy, emotionally dysregulated presentations. Schema Therapy may offer broader transdiagnostic value, particularly for personality disorders, entrenched patterns, trauma-related presentations and treatment-resistant clients.

But the larger message is not about defending one model.

It is about becoming more thoughtful in matching treatment to the client.

Who needs skills first?

Who needs attachment-based emotional repair?

Who is ready to go deeper?

Who needs more stabilisation before they can do that work?

Chris and Rob unpack these questions in more depth in the full episode of What’s the Schemata. To listen, press play below.

We’re back with another episode of What’s the Schemata, the Schema Therapy podcast for therapists with ISST-accredited schema therapy supervisors and trainers Chris Hayes and Rob Brockman.

This time, we’re joined by Graham Kell — a rare “unicorn” in the schema world, accredited in schema therapy for both adults and child/adolescent practice. With two decades of youth work behind him, plus lived experience parenting teens, Graham brings a grounded and practical perspective on how schema therapy for teenagers actually works in the room.

If you’ve ever sat across from a teenager in a hoodie, eyes down, giving you very little, this episode will feel familiar.

What This Episode Teaches About Schema Therapy for Teenagers

In this candid and practical conversation, Graham unpacks why teen silence is rarely rudeness. More often, it’s vulnerability without language. In schema therapy for teenagers, the Detached Protector can look like disengagement, but underneath it is usually a young person trying to stay safe. Rather than confronting that head-on, Graham explains how to build safety first and how giving teens vocabulary for their internal states can slowly make the silence less necessary.

He shares how he uses “side doors” into emotion through characters, memes, anime, books, music and pop culture. Instead of pushing for direct emotional disclosure, he invites teens to talk about a character first. This approach makes schema therapy for teenagers feel less exposing and more collaborative. It creates distance, lowers shame, and often opens the path to deeper work.

The conversation also explores how to begin cognitively when needed and then gently shift into experiential work. The Detached Protector may tolerate logic before it tolerates closeness, and that sequencing matters. The model remains intact, but the delivery shifts. In effective schema therapy for teenagers, schemas might become “instincts” or “predictions”, modes might become a cast of characters, and parts work becomes story work. The formulation is still there, but the language feels developmentally aligned.

Graham also speaks about the strengths-based nature of schema therapy for teenagers. Because schemas are still forming, there is a powerful opportunity to build pride in strengths early. When teens begin to see themselves as capable, the pull of unhealthy coping can weaken. It is less about removing protection and more about expanding the range of options available to them.

Parent coaching is another key theme. When safe and appropriate, working with caregivers becomes central to change. In schema therapy for teenagers, helping parents respond to the mode rather than react to the moment can significantly reduce conflict at home. Graham introduces a simple CALM framework focused on curiosity, allowing feelings, limiting chaos and modelling regulation. Even small shifts in how a parent mirrors their teen can reshape how that teen sees themselves.

The episode also addresses what happens when parents are not a resource. In those cases, schema therapy for teenagers shifts towards strengthening the adolescent’s coping capacity and autonomy. Rather than lowering the teen’s perception of the problem, the work often involves raising their confidence in their ability to manage it.

Empathic confrontation with teens is handled carefully. Validation tends to run longer before confrontation is introduced. Metaphor often does the heavy lifting, whether that’s castle walls and drawbridges or animal instincts. Across the discussion, Graham makes clear that schema therapy for teenagers is not about correcting attitude, but understanding function.

Throughout the episode, one message stands out: work with teen modes, not teen attitude. When we understand the purpose behind the behaviour, engagement becomes more possible and the work becomes more humane.

Listen to the Podcast

The full episode, Introducing Graham Kell on Schema Therapy for Teenagers, is available now on What’s the Schemata.

Listen on your preferred podcast platform and explore how schema therapy can be thoughtfully and creatively adapted for adolescents.

We’re back with another episode of What’s the Schemata, the Schema Therapy podcast for therapists with ISST-accredited schema therapy supervisors and trainers Chris Hayes and Rob Brockman.

This time, we’re joined by Graham Kell — a rare “unicorn” in the schema world, accredited in schema therapy for both adults and child/adolescent practice. Graham brings two decades of youth work experience, the lived reality of parenting teens, and a grounded, practical understanding of what actually works in the room with adolescents.

If you’ve ever sat across from a teenager in a hoodie, eyes down, giving you very little, this episode will feel familiar.

What you’ll hear in this episode

In this candid and practical conversation, Graham unpacks why teen silence is rarely rudeness. More often, it’s vulnerability without language. The Detached Protector might look like disengagement, but underneath it is usually a young person trying to stay safe. Rather than confronting that head-on, Graham explains how to build safety first and how giving teens vocabulary for their internal states can slowly make the silence less necessary.

He shares how he uses “side doors” into emotion through characters, memes, anime, books, music and pop culture. Instead of pushing for direct emotional disclosure, he invites teens to talk about a character first. It creates distance, lowers shame, and often opens the path to deeper work.

The conversation also explores how to begin cognitively when needed and then gently shift into experiential work. The Detached Protector may tolerate logic before it tolerates closeness, and that sequencing matters. The model doesn’t change, but the delivery does. Schemas might become “instincts” or “predictions”, modes might become a cast of characters, and parts work becomes story work. The formulation remains intact, but the language becomes youth-friendly.

Graham speaks about the strengths-based nature of adolescent schema therapy. Because schemas are still forming, there’s a powerful opportunity to build pride in strengths early. When teens begin to see themselves as capable, the pull of unhealthy coping can weaken. It’s less about ripping away protection and more about expanding the range of options available to them.

Parent coaching is another key theme. When safe and appropriate, working with caregivers becomes a central part of change. Graham describes helping parents respond to the mode rather than react to the moment. He introduces a simple CALM framework focused on curiosity, allowing feelings, limiting chaos and modelling regulation. Even small shifts in how a parent mirrors their teen can reshape how that teen sees themselves.

The episode also doesn’t shy away from the complexity of when parents aren’t a resource. In those cases, the focus turns to strengthening the adolescent’s coping capacity and autonomy. Rather than lowering the teen’s perception of the problem, the work often involves raising their confidence in their ability to manage it.

Empathic confrontation with teens is handled carefully. Validation tends to run longer before confrontation is introduced. Metaphor often does the heavy lifting, whether that’s castle walls and drawbridges or animal instincts. The aim is not to shame or corner the protector but to invite it to lower the drawbridge just enough.

Throughout the conversation, one theme stands out: work with teen modes, not teen attitude. When we understand the function of the behaviour, engagement becomes more possible and the work becomes more humane.

What’s the Schemata: Episode 61 with Graham Kell

The full episode, Introducing Graham Kell and Schema Therapy for Adolescents, is available now on What’s the Schemata.

Listen to the episode on your preferred podcast platform and explore how schema therapy can be thoughtfully and creatively adapted for adolescents.

In this episode of “What’s the Schemata” we chat with trainer, writer and Advanced Schema Therapist Remco van der Wijngaart (Netherlands) about how best to develop skills in Schema therapy, new developments within the model and perspectives on empathic confrontation.

Our latest episode of What’s the Schemata? is now live, and this one features Chris in a solo exploration of something that has become central to Schema Therapy practice: chair work and experiential mode work.

In the episode, Chris talks through why chair work wasn’t emphasised in the early days of Schema Therapy, how it gradually became a core part of the model, and why so many therapists find it both powerful and challenging. He reflects on his own training, the influence of Dutch researchers and practitioners, and how experiential techniques have evolved over the past twenty years.

Chris also spends time discussing those “tricky” clinical moments — the ones where chair work feels uncertain, unusual, or hard to navigate — and offers a grounded, practical sense of how he now uses it in his own sessions.

If you’re interested in strengthening your experiential confidence or understanding how chair work really fits into the broader model, this episode is a thoughtful place to start.

https://open.spotify.com/episode/0mVhjlt7KldflhBWfNqRnO?si=2AUpRNacT4asFWTaIzd2aw

New Episode: August 15, 2025

Episode: What’s the Schemata? — “Nuanced Imagery Rescripting: Social Isolation, Abandonment & More”
Hosts: Chris Hayes & Dr. Robert Brockman (ISST-accredited supervisors)

Schema Therapy is always developing. Techniques are refined, language becomes clearer, and therapists learn to adapt more fluidly to the unexpected. In this episode of What’s the Schemata?, Hayes and Brockman unpack some of the most challenging aspects of imagery rescripting. They explore what to do when the usual approaches don’t land, offering concrete strategies that therapists can put into practice straight away.

Why this episode matters: Episode 59: What’s the Schemata

Imagery rescripting is one of the most powerful interventions in Schema Therapy, but it is also one of the most challenging. Therapists often find themselves improvising in the moment, stepping into the client’s memory without a script. This discussion focuses on how to adapt when the scene isn’t straightforward and how to stay grounded in the core principle of meeting unmet needs.

Social Isolation: when rescuing can isolate further

Rescuing as an adult authority figure may unintentionally reinforce the client’s sense of being “different”. Instead, step into the memory as a same-age peer and bring the child into your group. Inclusion in something as simple as a playground game creates a vivid corrective experience. When appropriate, you can also draw on supportive peers from later life to strengthen the sense of belonging.

Abandonment: a slow repair

Abandonment imagery often unfolds over the long term rather than in a single breakthrough. For pre-verbal memories, the intervention is simple but powerful: pick up the baby, soothe, and stay. Avoid unrealistic repairs such as bringing a lost parent back. Focus instead on validating grief, modelling availability, and planting the seed of hope that stable connections are possible.

Insufficient Self-Control and Self-Discipline: firm but caring limits

This schema calls for limit-setting delivered with warmth. If the child in the image wants to avoid school or act impulsively, step in with a calm, clear boundary: school first, play later. When the original caregiver reinforced impulsivity, part of the repair is resetting norms and modelling accountability without shaming.

Enmeshment and Self-Sacrifice: creating safe distance

When a distressed caregiver overshares, the child can be overwhelmed. One solution is to move the child out of the conversation—invite them to play or draw in another room while you address the adult. Use empathic confrontation to acknowledge the caregiver’s stress while firmly protecting the child from inappropriate emotional burden.

Contemptuous antagonists: keeping control of the scene

Not every antagonist will back down. Some are dismissive or mocking. In these cases, maintain control. Mute them, remove them from the image, or impose boundaries within the imagined space. Aim your firm stance at the behaviour, not the person, to model healthy protection.

Newer lenses: fairness and coherence

• Basic Fairness: Correct clear injustices in the image and consider creating behavioural bridges, such as encouraging the adult client to buy themselves the symbolic item they were denied.
• Coherence of Self and Others: Children suffer when events make no sense. Offer age-appropriate explanations to restore clarity. Mode maps and formulations in therapy often land with the powerful realisation: “Now it makes sense.”

Key takeaways

• Enter imagery just before the painful moment, not after.
• Encourage first-person, present-tense engagement.
• Speak differently to adults and children: limits and confrontation for adults, warmth and protection for the child.
• Use creative but believable fantasy elements like distance, allies, or volume control.
• Balance autonomy with safety—avoid over-rescuing.

Coming soon: full-session recordings

Hayes and Brockman also preview a new filmed series of ten full one-hour schema therapy sessions, showing complete start-to-finish clinical work. Titled Inside the Room: The Schema Therapy Sessions, this project is due for release in September or October 2025.

Listen now

This episode of What’s the Schemata? is packed with clinical insights, practical tips, and honest reflections on the challenges of imagery rescripting. Whether you are new to Schema Therapy or refining advanced skills, it offers ideas you can use immediately in your practice.

Listen now to the full episode on your favourite podcast platform.

New Overcompensation Mode Variants

In this episode Robert Brockman and Chris Hayes discuss the variants of the Overcompensation Mode.

These are written about by David John Arthur Edwards in a paper available here: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.763670/full

The paper discusses various overcompensation modes in the context of schema therapy, focusing on how these modes reflect certain coping strategies. One such mode is the Pollyanna Overcompensator, characterized by an overly optimistic and sometimes unrealistic outlook as a way of coping with underlying issues. This mode, like others in the overcompensation category, represents a psychological mechanism where individuals adopt certain behaviors or attitudes to manage or mitigate deeper, often unaddressed emotional or psychological challenges.

Dr Georgie Paulik White, an associate professor of clinical psychology and the visionary behind the Perth Voices Clinic. Georgie specializes in working with individuals who hear voices—a phenomenon often associated with complex trauma histories. Through her groundbreaking research, she has adapted schema therapy techniques, especially imagery rescripting, to effectively help voice hearers heal and improve their quality of life.

Diving Deep into Schema Therapy and Voice Hearing

Last week we interviewed Georgie about her work. We delved into the fascinating and crucial intersection of schema therapy and voice hearing. Many individuals who hear voices have complex trauma histories, and Georgie’s groundbreaking work focuses on using imagery rescripting techniques to help them heal.

Imagery Rescripting: Adapting Techniques for Complex Trauma

One of the most enlightening parts of our discussion was how traditional imagery rescripting can be modified to safely and effectively assist clients who hear voices. Georgie shared how even within the constraints of limited session numbers, significant progress can be made. This is especially important considering the challenges many therapists face with session limitations.

Addressing the “Too Hard” Cases

We also tackled the topic of working with clients who might seem \”too hard\” to reach. Georgie’s insights into how schema therapy can be applied to these individuals were truly inspiring. It’s a reminder that with the right approach and understanding, we can make a meaningful impact on even the most challenging cases.

Why You Should Tune In

If you’ve ever wondered about the intersection of voice hearing, trauma, and schema therapy—or how to work with clients who might seem beyond reach—this episode is a must-listen. Georgie’s energy and expertise are both infectious and enlightening, and I left our conversation feeling invigorated about the possibilities for clinical practice.

Schema Therapy is continually advancing with new ideas and techniques, making continuous learning essential for therapists seeking to enhance their practice. The latest episode of "What's the Schemata," titled "45: Fresh Learnings for 2024," dives into the transformative power of learning. This episode offers a rich mix of reflections and insights from recent workshops, providing practical advice for therapists committed to professional growth.

Schema Therapy supervisors Chris Hayes and Rob Brockman share their experiences from their semi-annual retreat in Bali. During the retreat, they spent a week immersed in intensive training and knowledge exchange. Three outstanding presenters introduced fresh ideas and nuanced approaches to Schema Therapy, significantly influencing Hayes' and Brockman's practice over the past year. They emphasize the importance of integrating new concepts and refining established techniques.

One of the key themes in this episode is the role of the healthy adult mode in Schema Therapy. Hayes and Brockman highlight how engaging the client's healthy adult mode effectively responds to vulnerabilities and coping mechanisms. They share examples of dialogues between the vulnerable child and healthy adult that foster self-trust and resilience in clients.

The episode also explores the concept of empathic confrontation, a technique that balances empathy and confrontation to help clients address maladaptive behaviors. The discussion underscores the importance of tailoring this approach to the client's level of activation, ensuring that interventions remain both supportive and effective.

Reflecting on their experiences at the recent ISST conference in Warsaw, Hayes and Brockman discuss the use of somatic resourcing in Schema Therapy. They emphasize the power of physical posturing, self-soothing techniques, and grounding exercises to enhance the therapeutic process and support clients in managing distress.

This episode of "What's the Schemata" highlights how learning transforms therapeutic practice. By continuously seeking new knowledge and refining techniques, therapists can better support their clients in their journey towards healing and growth. Hayes' and Brockman's insights and practical advice provide valuable guidance for therapists looking to elevate their Schema Therapy practice.

Dr Andrew Phipps on Play and Happy Child Mode

Dr Andrew Phipps, known as Dr Happy, shares his journey to Schema Therapy and explores the vital role of play in therapy.

In conversation with Chris Hayes and Robert Brockman, Dr Andrew delves into how play can be used to frame, understand, and strategize with clients. His insights into the play literature and working with different clients offer valuable perspectives for practitioners.

“Getting into the play literature and figuring out how to work with clients to understand how to work with different clients was really interesting,” says Dr Andrew.

A particularly compelling insight from Dr Andrew highlights the connection between play and self-discovery:

“If you don’t know who you like, how can you know who you are?”

Dr Andrew explains how allowing ourselves to access Happy Child Mode by entering the play state enables us to access joyful states, providing a unique perspective on therapeutic growth.