Wendy Behary Addresses NJ-ACT on Schema Mode Therapy

By Lynn Mollick

On Sunday, December 13, Wendy Behary addressed NJ-ACT on “Working with the Mode Approach in Schema Therapy.” Schemas are interconnected, deeply held beliefs, emotions, and behavioral tendencies toward the self, the world, and other people.

According to Young, schemas develop in childhood. When patients do not experience enough love and affection and/or do not feel safe in their relationship with their parents, they develop early maladaptive schemas — ways of perceiving, behaving, and feeling that are helpful in childhood, but unhelpful in later life.

Schemas are traits, stable parts of the personality.

Schema modes are states, temporary emotions, cognitions, and behaviors that individuals experience in particular situations. They may be short-lived or they may endure for long periods of time. Modes include one or more schemas that are evoked by specific situations. Working with Schema Modes is extremely helpful in treating personality disorders.

Four Child Modes

1. Vulnerable Child is a basic, fundamental Mode. The Vulnerable Child feels lonely, sad, misunderstood, fragile, pessimistic, anxious, defective, weak, helpless, and needy.
2. Angry Child is enraged, frustrated and impatient because fundamental needs to feel loved and be protected have not been not met.
3. Impulsive/Undisciplined Child is also angry. The impulsive/undisciplined Child seeks short-term gratification and may appear spoiled.
4. Contented Child feels loved, protected, guided, validated, self-confident and appropriately autonomous.

Three Maladaptive Coping Modes

1. Compliant Surrender is passive, unassertive, subservient, and approval-seeking, fearing of conflict and rejection and therefore tolerating abuse.
2. Detached Protector cuts off feelings, detaches from other people, rejects help and feels bored, empty, and disconnected. The Detached Protector self-soothes with compulsive behaviors and often adopts a cynical stance.
3. Overcompensator is grandiose, aggressive, competitive, devaluing, dominating, critical of others, exploitative, and status-seeking. These behaviors developed to compensate for needs that were never met.

Three Parent Modes

1. Punitive Parent is blaming, punishing or abusive toward the self. In this Mode, patients self-mutilate.
2. Demanding or Critical Parent tries to be perfect, to perform at the highest level at all times, and to be orderly and efficient. In this Mode, patients deny their own needs or put others’ needs ahead of their own.
3. Healthy Adult Mode. In this mode, the person works, loves, parents, and functions well in the adult world. This is the Mode that cares for the Vulnerable Child in an appropriate way, by being understanding of the self’s fundamental needs. The Healthy Adult puts limits on the angry and impulsive child modes and supports the Healthy Child mode.

According to Ms. Behary, the Angry Modes and the Detached Protector mode are the most difficult Modes to work with in treatment. She showed a video tape and described several techniques for to demonstrate various techniques:

Therapeutic Techniques for Working with Schema Modes

1. Ask patients to recognize, experience, and explore each mode when it appears during a session. This helps patients recognize the mode when they experience it in their lives.
2. Call each mode by a special name that is meaningful to the patient, e.g. call the Vulnerable Child Mode ‘Little Joe.’
3. Ask patients to imagine experiencing mode that do not appear during sessions. This provides details about the Mode. Ask questions: “What was ‘Little Joe’ like? What did he look like? How did his parents treat him? What did ‘Little Joe’ want from his parents? Who were his friends?”
4. Ask the patient to bring in old photographs. They are likely to provoke past feelings, cognitions and behaviors of the mode.
5. Use Gestalt Therapy’s “chair technique” to evoke mode affect and explore mode cognitions. Get conversations going between an imagined parent and one of the child modes, or ask different schema modes to talk to each other. Changing chairs gives patients a clearer understanding of each mode. Standing in a different place works as well as sitting in different chairs.
6. Imagined conversations between modes clarify the characteristics of each mode. Add an imaginary parent who offers the love and understanding that the patient wanted, but never received.
7. Empathic Confrontation means validating the sense and the usefulness of the mode in the past, while telling the patient that the mode is counterproductive to adult functioning.
8. Discuss the pros and cons of continuing to use a mode or to change.
9. Record a comforting message or a useful instruction that the patient can listen to between sessions.
10. Provide limited “reparenting.” Ask yourself “How would a good parent respond to the patient in this situation?” Convey a great deal of warmth and understanding. Be authentic, self-disclose within limits, and offer a little extra attention with occasional emails or text messages to make the patient feel special. But be careful not to develop a relationship outside therapy. When you start to feel irritated at the patient, imagine a child’s face in place of the patient’s.
11. Help the patient differentiate the past from the present. Link patterns that were helpful in the past to self-defeating patterns in the present. Be understanding, but hold patients accountable for change and making their situation better.