Integrating the mode and the schema models can sound complicated but there are ways to integrate the models in a way that is both simple and enhances treatment. It can even be fun...(pretty much...)
What are the benefits of integration?
The short answer to why one may choose to integrate schemas and modes is that they perpetuate each other. Schemas trigger modes and modes perpetuate schemas, they operate in a loop. For example, the defectiveness and shame schema may trigger the dysfunctional messages of the critic which in turn perpetuate the defectiveness and shame schema itself.
As Jeff Young said in his 2019 ENLIGHT presentation, “failure to link each mode with specific schemas for a patient often makes it impossible to change behaviours in the coping modes. Long-term mode change usually requires making deeper changes at the schema level first.”
When should I integrate the models?
If you learn schemas first and modes second, it can be easy to get the impression that the schema and mode models are independent of each other, rather than models that work in harmony.
I believe there are benefits to integrating schemas and modes regardless of how many (or few) schemas a client presents with. The main benefit being that you are more likely to address the factors perpetuating the client’s presenting problem, including dysfunctional behaviour. By considering the schemas associated with modes it will also let you know the flavour of the mode which in turn helps with treatment. For example, an overcompensating mode, driven by the mistrust abuse schema will present differently than a one driven by unrelenting standards.
Integrating with ease
So this all sounds good but how can you achieve this in a practical sense?
First start by understanding the main modes associated with the presenting issue and build a mode map if you wish. Then think through the main schemas associated with the vulnerable child mode, coping and critic modes. By knowing which schemas inform the client’s modes it will help you to treat the modes and tailor your reparenting.
For example, Sally worries she will experience a medical catastrophe (frightened child mode {a subvariant of the vulnerable child}; vulnerability to harm schema), she beats herself up for being irrational and feels inadequate for thinking this way (demanding critic mode; unrelenting standards and defectiveness), and she copes by switching off her emotions (detached protector; emotional inhibition).
By knowing the schemas associated with the vulnerable child, we can explore the origins of these schemas, perhaps by floating back to memories that trigger the same feelings and helps to tailor the reparenting messages. To address the vulnerability to harm schema a message such as “I can see how worried you are that something bad will happen. And it makes sense given your history with your dad and his sudden illness growing up. I want you to know that I know you I believe in your ability to cope and that you will be ok. Also know that it wasn’t like when you were a child, you are no longer alone, I’m here to support you, your friends…your partner….”
Sally’s demanding critic mode is underpinned by unrelenting standards and defectiveness. Therefore, interventions should target these schemas when conducting critic work. Finally, her main coping mode is the detached protector and it’s important to manage the emotional inhibition that drives this to access and provide nurturance for the vulnerable child mode.
At times, it is not always clear which schemas drive which modes but exploring the unmet needs behind each mode may both point to the underlying schemas and heal the schemas.
In conclusion, as schemas and modes operate in a loop considering both schemas and modes may assist with treatment planning.
If you are interested in this topic, I am presenting at Enlight Melbourne on 16 March, 2023. See here for more info about ENLIGHT.
Tena Davies is a Clinical Psychologist and Advanced Certified Schema Therapist in Melbourne, Australia. She is an active member of the schema therapy community. Tena is the founder and co-admin of the schema therapy interest group on Facebook and the current chair of the ISST bulletin committee.
ARE YOU INTERESTED IN GROUP SCHEMA THERAPY?
Comments