Category: psychotherapy, online psychotherapy

Schema therapy session usually lasts 50 minutes and can take different formats depending on the therapist’s style and the client’s needs. A few formats that you might encounter include:

• Individual therapy: which involves working one-on-one with a therapist.
• Group therapy: which involves a small group of individuals who share a common goal.

During a schema therapy session, the therapist helps the client identify their schemas and understand how they affect their thoughts, feelings and behaviors. The therapist then works with the client to develop strategies to challenge and modify the schemas. This process is known as schema healing and includes fulfilling unmet core emotional needs. During the session you and your therapist might connect with your vulnerable part to feel it, hear it, listen it which might be challenging or unpleasant, and healing at the same time. In addition, you and your therapist will agree on the frequency of having sessions and homework assignments.

Schema therapy offers many cognitive, emotion-focused, and behavioral interventions that facilitate the healing and transformation of schemas and modes.

Persons with narcissistic traits reflect a high sense of self-importance, a lack of empathy, and a need for admiration (Levy, Reynoso, Wasserman, & Clarkin, 2007). People who have narcissistic traits may not necessarily have narcissistic personality disorder (NPD), which is a mental health condition that affects how they relate to others and themselves (Skodol, Bender, & Morey, 2014). Narcissistic traits can vary in severity and expression among different people. They can also change over time depending on the person’s life circumstances and experiences (Ronningstam, 2022).

Some of the common narcissistic traits:

• Grandiosity: This is the belief that one is superior, special, or unique and deserves recognition and respect from others. People with this trait may exaggerate their achievements, talents, or appearance and expect others to admire them (Miller, Crowe, & Sharpe, 2022).
• Entitlement: This is the expectation that one should receive special treatment, favors, or privileges from others without reciprocating or being grateful.
• Exploitativeness: This is the tendency to take advantage of others for one’s own benefit or gain.
• Lack of empathy: This is the inability or unwillingness to recognize and care about the emotions, thoughts, and experiences of others (Weinberg & Ronningstam, 2011).
• Envy: This is the feeling of resentment or anger towards others who have something that one desires.
• Arrogance: This is the attitude of superiority, contempt, or disdain towards others who are seen as inferior.

Narcissistic traits can be expressed in different ways depending on the context and the person’s personality. Some people may display overt narcissism, which is more obvious and visible to others. Others may display covert narcissism, which is more subtle and hidden (Ronningstam, 2022).

Effects

Narcissistic traits can have negative effects on one’s personal and professional life. They can cause problems in relationships, work, school, or finances. They can also lead to low self-esteem, depression, anxiety, anger, or loneliness (Weinberg & Ronningstam, 2011).

How psychotherapy could help?

People with narcissistic traits may benefit from psychotherapy, which can help them improve their self-awareness and empathy, understand their behavior patterns, identify their dominant schemas, and strengthen their healthy adult mode (Kealy, Goodman, Rasmussen, Weideman, & Ogrodniczuk, 2017; Dimaggio, 2022).

References

Weinberg, I., & Ronningstam, E. (2011). Narcissistic Personality Disorder: Progress in Understanding and Treatment. Harvard Review of Psychiatry, 19(3), 146–160.de.

Dimaggio, G. (2022). Treatment principles for pathological narcissism and narcissistic personality disorder. Journal of Psychotherapy Integration, 32(4), 408–425. https://doi.org/10.1037/int0000263

Kealy, D., Goodman, G., Rasmussen, B., Weideman, R., & Ogrodniczuk, J. S. (2017). Therapists’ perspectives on optimal treatment for pathological narcissism. Personality Disorders: Theory, Research, and Treatment, 8(1), 35–45. https://doi.org/10.1037/per0000164

Levy, K. N., Reynoso, J. S., Wasserman, R. H., & Clarkin, J. F. (2007). Narcissistic personality disorder. In W. O’Donohue, K. A. Fowler, & S. O. Lilienfeld (Eds.), Personality disorders: Toward the DSM-V (pp. 233–277). Sage Publications. https://doi.org/10.4135/9781483328980.n9

Miller, J. D., Crowe, M. L., & Sharpe, B. M. (2022). Narcissism and the DSM–5 alternative model of personality disorder. Personality Disorders: Theory, Research, and Treatment, 13(4), 407–411. https://doi.org/10.1037/per0000534

Ronningstam, E. (2022). Narcissistic personality disorder. In S. K. Huprich (Ed.), Personality disorders and pathology: Integrating clinical assessment and practice in the DSM-5 and ICD-11 era (pp. 375–389). American Psychological Association. https://doi.org/10.1037/0000310-017

Skodol, A. E., Bender, D. S., & Morey, L. C. (2014). Narcissistic personality disorder in DSM-5. Personality Disorders: Theory, Research, and Treatment, 5(4), 422–427. https://doi.org/10.1037/per0000023

Anxiety affects a person’s daily functioning and well-being and may require professional treatment. It may have different causes such as stress, trauma, medical conditions or substance use. It can be a symptom of generalized anxiety disorder, panic disorders or phobias.

Symptoms of anxiety are:

• Nervousness, restlessness, or irritability
• Feeling of fear or dread
• Trouble concentrating or sleeping
• Rapid heartbeat, sweating, trembling, or dizziness
• Shortness of breath or chest pain
• Nausea, stomachache, or headache
• Avoidance of situations that trigger anxiety etc.

Some of the possible ways to cope with anxiety are:

• Exercise daily and eat well-balanced diets
• Maintain a positive attitude and practice relaxation techniques
• Seek social support from friends, family, or groups
• Learn what triggers anxiety and try to reduce or manage it
• Stop smoking and limit caffeine and alcohol intake
• Seek professional help if anxiety interferes with daily life or causes significant distress.

There are different types of psychotherapy that can be effective for anxiety, depending on your specific needs and preferences. The best way to find out what type of psychotherapy works for you is to consult with a qualified mental health professional who can assess your situation and recommend the most appropriate treatment plan for you.

Key References

General Overview & Causes

• American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM‑5‑TR). American Psychiatric Publishing. Provides diagnostic criteria for generalized anxiety disorder, panic disorder, and phobias.
• National Institute of Mental Health (NIMH). (2023). Anxiety Disorders. Explains causes such as stress, trauma, medical conditions, and substance use, and describes how anxiety affects daily functioning.
• Mayo Clinic. (2023). Anxiety disorders – Symptoms and causes. Lists common causes and risk factors, including genetics, brain chemistry, and environmental stressors.

Symptoms

• Cleveland Clinic. (2023). Anxiety Disorders: Causes, Symptoms, Types & Treatment. Details physical and psychological symptoms such as restlessness, rapid heartbeat, sweating, dizziness, and avoidance behaviors.
• NIMH. (2023). Generalized Anxiety Disorder: When worry gets out of control. Describes hallmark symptoms like excessive worry, irritability, sleep problems, and difficulty concentrating.

Coping & Treatment

• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. Confirms CBT as an effective psychotherapy for anxiety disorders.
• Mayo Clinic. (2023). Anxiety treatment. Outlines lifestyle changes (exercise, diet, limiting caffeine/alcohol), relaxation techniques, and psychotherapy options.
• American Psychological Association. (2023). Managing anxiety. Offers practical coping strategies such as positive thinking, social support, and gradual exposure to triggers.

Psychotherapy is an approach for treating personal issues by talking with a psychotherapist. It can help you learn about your specific issues and how your thoughts, emotions and behaviors affect your moods. It can help you developing healthy ways of coping and improve life quality.

To prepare for psychotherapy, you may want to consider the following steps:

• Find a psychotherapist who can meet your needs and preferences.
• Think about your personal goals, main issues or challenges that you want to address. You can write down some basic goals, main challenges and bring them to your first session.
• Be open-minded and honest with your therapist. Psychotherapy is a collaborative process that requires trust and communication between you and your therapist. Try to be as honest and respectful as possible.
• Your therapist may give you some homework assignments, such as reading materials, exercises, or journaling, to help you practice what you learned in therapy. Try to complete these tasks as best as you can, and report back to your therapist on how they went. 
• Be patient and persistent with yourself and the process. Psychotherapy is not a quick fix or a magic solution. It takes time, effort, and courage to explore your feelings and experiences, and to make positive changes in your life.
• You may face some challenges or setbacks along the way, but don’t give up.  Please remember that you couldn’t resolve your personal issues if you give up the process.

Core emotional needs in schema therapy are the basic psychological and emotional requirements that every child needs to develop healthily and happily.

• Secure attachment. This means feeling safe, protected, loved, and valued by others, especially the primary caregivers. Children who have secure attachment develop trust, confidence, and empathy. 
• Autonomy, competence, and identity. This means having a sense of independence, self-reliance, and self-esteem. Children who have autonomy, competence, and identity learn to explore their environment, express their opinions, make choices, and cope with challenges. 
• Freedom to express valid needs and emotions. This means being able to communicate one’s feelings, thoughts, and desires without fear of rejection, criticism, or punishment. Children who have freedom to express valid needs and emotions develop emotional awareness, regulation, and assertiveness. 
• Spontaneity and play. This means having opportunities to enjoy oneself, have fun, and be creative. Children who have spontaneity and play develop curiosity, imagination, and joy. 
• Realistic limits and self-control. This means having clear and consistent boundaries that guide one’s behavior and foster responsibility and respect. Children who have realistic limits and self-control learn to follow rules, cooperate with others, and delay gratification. 

Schema therapy aims to help people meet their core emotional needs in healthy ways by changing their schemas and coping styles.

Mindfulness is the practice of gently focusing your awareness on the present moment over and over again.

Mindfulness programs can help you learn how to incorporate mindfulness in your daily life and cope with various challenges. There are many simple ways to practice mindfulness. Some examples are: paying attention to your senses and the environment around you, living in the moment and accepting yourself, focusing on your breathing and relaxing your body, doing body scan meditation or sitting meditation, etc.

Mindfulness has many benefits for your physical and mental health. Some of the benefits are: improvement of cognitive ability and slowing brain aging, increasing a sense of well-being, decrease of the pain and improving quality of life for those living with chronic conditions, diabetes control, improving attention, sleep etc…

There is no definitive answer to how long you should practice mindfulness each day, as different sources may suggest different durations. However, some general guidelines are:

• Aim to practice mindfulness every day for about six months. Over time, you might find that mindfulness becomes effortless.
• You can start with as little as 5 minutes per day and gradually increase the length of your sessions. 
• Find what works best for you and enjoy the benefits of mindfulness.

I hope this helps you plan your mindfulness practice. Remember to be patient and gentle with yourself. Mindfulness is not a competition or a performance. It is a way of being present and aware of yourself and your surroundings. 

Therefore, there is evidence that mindfulness can support the development and maintenance of healthy adult mode by enhancing your cognitive and psychological well-being.

In schema therapy, a mode is defined as a momentary state that integrates emotions, cognitions, bodily sensations, and coping responses, reflecting how a person experiences themselves and others in a given situation (Young, Klosko, & Weishaar, 2003; Rafaeli, Bernstein, & Young, 2011). Modes are more fluid than schemas—they shift depending on context and can rapidly change within the same day (Arntz & van Genderen, 2009).

Modes in schema therapy are grouped into four main categories (Young, Klosko, & Weishaar, 2003; Arntz & van Genderen, 2009):

• Child modes: These are emotional states that resemble how you feel. They can be positive (happy child) or negative (vulnerable child, angry child, impulsive child, etc.).
• Parent modes: These are internalized voices of your parents or caregivers. They can be supportive (healthy parent) or critical (punitive parent, demanding parent, etc.).
• Coping modes: These are ways of dealing with your schemas and emotions. They can be adaptive (problem-solving, self-care, etc.) or maladaptive (surrendering, avoiding, overcompensating, etc.) (Rafaeli, Bernstein, & Young, 2011).
• Healthy adult mode: This is the optimal mode that schema therapy aims to develop. It is a balanced and realistic way of thinking, feeling, and behaving that meets your needs and respects others (Young et al., 2003).

You can also consult a therapist who specializes in schema therapy if you want to learn more about your modes and how to change them (Arntz & van Genderen, 2009).

References

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Arntz, A., & van Genderen, H. (2009). Schema therapy for borderline personality disorder. Wiley-Blackwell.

Rafaeli, E., Bernstein, D. P., & Young, J. E. (2011). Schema therapy: Distinctive features. Routledge.

Overcoming schemas can be challenging, but it is possible with structured therapeutic work. Schema therapy emphasizes that schemas are enduring patterns of thought, emotion, and behavior formed in childhood when core emotional needs were unmet (Young, Klosko, & Weishaar, 2003; Rafaeli, Bernstein, & Young, 2011). Because schemas are deeply ingrained, change requires time, awareness, and consistent practice (Arntz & van Genderen, 2009).

Steps in psychotherapy include:

• Identify your schemas: You and your therapist assess which schemas are active and how they affect your thoughts, feelings, and behaviors. Tools such as questionnaires and worksheets are often used (Young et al., 2003).
• Challenge your schemas: Cognitive techniques help examine evidence for and against your schemas. Flashcards, affirmations, and alternative perspectives reinforce more balanced beliefs (Rafaeli et al., 2011).
• Heal your schemas: Emotion-focused techniques such as imagery rescripting, role-play, and limited reparenting allow you to access unmet needs and receive corrective emotional experiences (Arntz & van Genderen, 2009).
• Replace your schemas: Behavioral experiments and reinforcement strategies encourage healthier coping aligned with the Healthy Adult mode, reducing reliance on maladaptive patterns (Young et al., 2003).

Overcoming schemas requires integration of all four strategies. Cognitive work challenges beliefs, experiential work heals emotions, behavioral experiments build new habits, and relational strategies provide corrective attachment experiences. Together, they strengthen the Healthy Adult mode and reduce reliance on maladaptive coping.

Timeframe: There is no definitive answer to how long it takes to overcome schemas. Progress depends on the number and severity of schemas, therapy frequency, motivation, and co-occurring challenges. Schema therapy is generally considered a long-term treatment, often lasting between 6 months and 2 years, and sometimes longer (Rafaeli et al., 2011; Arntz & van Genderen, 2009). Commitment and patience are essential for lasting change.

References

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

Arntz, A., & van Genderen, H. (2009). Schema therapy for borderline personality disorder. Wiley-Blackwell.

Rafaeli, E., Bernstein, D. P., & Young, J. E. (2011). Schema therapy: Distinctive features. Routledge.