Using Schema Modes for Case Conceptualization in Schema Therapy: An Applied Clinical Approach

Abstract

This article is situated within the framework of schema therapy and offers a comprehensive and clinically useful list of schema modes that have been identified as being relevant to conceptualizing complex psychological problems, such as those posed by personality disorders, and, in particular, the way that those problems are perpetuated. Drawing on the schema therapy literature, as well as other literature including that of cognitive behavior therapy and metacognitive therapy, over eighty modes are identified altogether, categorized under the widely accepted broad headings of Healthy Adult, Child modes, Parent modes and coping modes which are, in turn, divided into Surrender, Detached/Avoidant, and Overcompensator. An additional category is included: Repetitive Unproductive Thinking. This draws attention to the recognition by metacognitive therapists that such covert behaviors play a significant role in amplifying distress and perpetuating a range of psychological problems and symptoms. In addition to the modes themselves, several concepts are defined that are directly relevant to working with modes in practice. These include: default modes, blended modes, mode suites and mode sequences. Attention is also drawn to the way in which Child modes may be hidden “backstage” behind coping modes, and to the dyadic relationship between Child modes and Parent modes. Also relevant to practice are: (1) the recognition that Critic voices may have different sources and this has implications for treatment, (2) the concept of complex modes in which several submodes work together, and (3) the fact that in imagery work and image of a child may not represent a Vulnerable Child, but a Coping Child. The modes and mode processes described are directly relevant to clinical practice and, in addition to being grounded in the literature, have grown out of and proved to be of practical use in conceptualizing my own cases, and in supervising the cases of other clinicians working within the schema therapy framework.

Identifying the research priorities for schema therapy: A Delphi consensus study

“…As a case in point, there are differing views on how to advance the mode model. To illustrate, Young initially described 10 modes, whilst Arntz et al (2021) listed more than 40 and Edwards (2022) listed more than 80. As the model has expanded to address a wider range of presenting issues, more modes have been identified.…”

“…Researchers have commented on the need for a parsimonious model, whilst identifying an adequate number of modes to adequately reflect the heterogeneity and idiosyncrasies in individual presentations (Lazarus et al, 2020). On the one hand, awareness of many different modes is argued to help clinicians obtain a more differentiated understanding of what is maintaining a client's problems and facilitate a flexible, client‐centered approach to therapy (Edwards, 2022). However, as the number of modes increases, the ease with which clinicians can apply the model moment to moment in practice may decrease, potentially impacting both clinician uptake and treatment fidelity.…”

Emotional self-states and coping responses in patients with chronic tinnitus: a schema mode model approach

“…In this mode, patients may either act in seemingly passive, approval-seeking or self-deprecating ways or disempower themselves by showing inflexible self-pitying tendencies. This interaction style may lead to complex interpersonal dynamics in the multiprofessional team as well as patients’ lives that should be thoroughly assessed and addressed throughout psychological therapy ( 48 , 49 ).…”

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“…Of course, other Overcompensation Coping Modes can also play a role in perfectionistic patients, as can Surrender Coping Modes (e.g., submitting to the demands of others) and Detached/Avoidant Coping Modes (e.g., excessive work to distract from unpleasant feelings, procrastination, substance use, actions to neutralize obsessive thoughts). Modern schema therapy also describes a number of coping modes that are summarized under Repetitive Unproductive Thought Processes and DOI: 10.1159/000532044 which can be relevant in perfectionism [Stavropoulos et al, 2020;Edwards, 2022]. These include rumination (e.g., about one's own inadequacy or behavior in past social interactions), worrying or catastrophizing, but also excessive mental comparison with others (e.g., with regard to appearance, successes, competencies) or overanalyzing of various life issues.…”