What Happens When One Therapy Isn’t Enough? Schema Therapy, CBT and EMDR

For some people, therapy is relatively straightforward. There is one clear problem, one clear treatment, and a focused piece of work.

For others, things are more layered.

They may understand themselves intellectually, but still carry old emotional reactions, harsh beliefs about themselves, and ways of coping that developed long before they knew they had a choice.

In those situations, it can make sense to use different therapies at different stages of the same journey.

1. Schema therapy: understanding where the pattern came from

Schema therapy is often a useful starting point when somebody has a complicated background or longstanding emotional and relationship patterns.

It looks at what may have been missing in childhood as well as what happened.

That distinction matters.

If something important was missing when you were growing up — emotional safety, reassurance, protection, consistency, permission to have needs — you may not have known it was missing. You had no comparison.

Instead, you adapted.

You may have learned to organise yourself around:

• pleasing other people

• not causing trouble

• caring for everyone else

• shutting down your own feelings

• working excessively

• staying in control

• avoiding dependence on others

Very often, there is also a harsh internal voice underneath all of this: a sense that you are doing things badly, getting things wrong, or are somehow fundamentally not good enough.

Schema therapy helps make those patterns visible.

It allows the client and therapist to understand where they came from, what they protected against, and what they cost in adult life.

Just as importantly, it allows the therapeutic relationship to develop gradually. This can matter enormously for people who arrive in therapy already carrying shame, self-criticism or difficulty trusting that their needs will be taken seriously.

2. Building the Healthy internal Adult

In schema therapy, one of the aims is to strengthen what is sometimes called the Healthy Adult.

This is the part of you that can recognise what you need, set boundaries, tolerate emotion, make balanced decisions, and respond to yourself with more care and less criticism.

For somebody who grew up without enough emotional support, this can feel unfamiliar.

They may know how to look after other people but not themselves.

They may know how to perform, achieve or cope, but not how to rest, ask for help or recognise when something is too much.

Therapy begins to make those missing needs more visible and helps the person meet them differently in adult life.

Once life feels more stable and the person has a clearer understanding of themselves, other therapies can sometimes become useful.

3. CBT: noticing what happens in real life

CBT can be particularly useful once someone has enough stability and headspace to start observing what happens in everyday life.

In some ways, CBT can work like applied mindfulness.

You become a kind of reporting scientist on yourself.

You notice:

• what happened

• what you thought

• what you felt

• what you predicted

• what you did next

• what effect that had

Then you bring that information back into therapy.

Together, therapist and client begin to see the pattern more clearly and make small changes as experiments.

What happens if you do something differently?

What happens if you stop checking?

What happens if you say no?

What happens if you allow somebody else to be disappointed?

What happens if you stay in the situation rather than avoiding it?

CBT is not only about understanding thoughts. It is about gathering evidence from real life and helping the brain update through experience.

For people who have been very overwhelmed, this kind of work may be much more useful later in therapy than right at the beginning.

4. EMDR: when the past still feels present

Sometimes a person reaches a point where they understand their history very well.

They know where the pattern came from.

They understand the coping strategy.

They have grieved what was missing.

They are functioning better.

And yet something still feels stuck.

Their rational mind knows one thing, but their body or emotional system seems to know another.

That is where EMDR can sometimes be helpful.

EMDR involves less talking than many other therapies.

The person remains anchored in the present with the therapist — feet on the floor, aware of the room, supported by the relationship — while also making contact with an earlier painful memory or emotional experience.

Through bilateral stimulation such as tapping or eye movements, the brain is given the opportunity to process material that still feels emotionally “live.”

People often describe this in quite unusual ways.

A memory may still exist, but it no longer carries the same charge.

A place that once triggered panic may simply become a place.

A thought that once felt completely true may begin to feel like something that belonged to an earlier time.

The past does not disappear.

It just stops feeling as though it is still happening now.

5. Rewriting the story

The final stage is not about pretending the past was different.

It is about changing the meaning the person carries forward.

Instead of:

“There is something wrong with me.”

it may become:

“I adapted to what was happening around me.”

Instead of:

“I have to keep everyone else okay.”

it may become:

“Other people can have feelings without me being responsible for them.”

Instead of:

“If I stop coping, everything will fall apart.”

it may become:

“I can have needs, limits and support.”

This is where therapy becomes about more than simply feeling less distressed.

The person is not just feeling less anxious or less distressed.

They are starting to organise their life differently.

Different therapies can do different jobs

Schema therapy, CBT and EMDR do not necessarily compete with one another.

For some people, they can be used at different stages:

Schema therapy helps make sense of longstanding patterns and unmet needs.

CBT helps identify what is happening in the present and test new ways of responding.

EMDR can help process emotional material that still feels as though it belongs to the present even when the person knows rationally that it is in the past.

The sequence will not be the same for everyone.

But for people with more complicated histories, treatment can sometimes work best when it is guided by formulation rather than forcing every difficulty into one model.

At Connection Psychotherapy, we use different evidence-based approaches according to what the person needs at each stage of therapy.