Patients and therapists bring to therapy their emotional schemas—beliefs and strategies about their emotions, others’ emotions, and how to regulate or respond to emotions. These beliefs reflect how emotions were handled during childhood and in other important relationships, constituting a significant part of transference and countertransference. In this chapter, we take an integrative cognitive behavioral approach to identify, conceptualize, and modify problematic beliefs and strategies about emotion that may arise in the course of therapy. In particular, we focus on “schematic mismatch” where therapist and patient have conflicting styles and strategies which inadvertently may confirm the patient’s negative beliefs about their emotions and how others will respond. A model of case conceptualization is provided which can guide the exploration of these processes in therapy and help the therapist and patient avoid further confirmation of negative emotional schemas.