Schema Therapy Bulletin May 2015 , Issue 1

THE SCHEMA THERAPY

BULLETIN
The Official Publication of the International Society of Schema Therapy

Introducing the Inaugural Schema Therapy

Bulletin
We are delighted to introduce the
Schema Therapy Bulletin, the
newest e-publication designed to
update members on the latest
thoughts, activities and practices
related to Schema Therapy.

The exciting world-wide growth of

Schema Therapy has expanded the
number of schema therapists as
well as the populations receiving
treatment by schema therapists.
Our members, in 26 different
countries have advanced the
original model developed to treat patients with long-standing personality disorders and
chronic mental health conditions to include couples, children, and groups; medically ill
patients, people with gender and sexuality issues, dissociative diseases and more. Therapeutic
interventions continue to include imagery, flash cards, and limited re-parenting, and have
expanded to include mode work using chairs, empathic confrontation, and an expanded view of
working with difficult modes.

The Schema Therapy Bulletin will be published quarterly. Each issue will focus on a specific
theme: a population, a technique, or a theoretical or practical question related to schema
therapist. Future issues will also include a “Meet the ISST Board” column, to introduce our
hard-working and highly skilled board to the members at large. Other thoughts have included
clinical case-“discussion” focusing on a case relevant to the issues theme, or a question-and-
answer forum also focused on the issues theme. 

We welcome your input, involvement (and articles!) in this endeavour!
Editors,
Lissa Parsonnet, PhD., LCSW (USA)
Chris Hayes, Clinical Psychologist (Australia)

Schema Therapy Bulletin 1

Schema Therapyfrom
A message Bulletinthe ISST May 2015 , Issue 1

President
First  of  all:  Congratula4ons  to  Lissa  
In this May Issue
Parsonnet  and  Chris  Hayes  geGng  the   Self-pity/Victim: A
Schema  Therapy  Bulle4n  started!  I  am  very   Surrenderer Schema
happy  because  this  means  another  
Mode- Dave Edwards
important  landmark  enhancing  the  
exchange  between  our  members.   Ways to Strengthen
Jeff  stated  in  his  lecture  in  Istanbul  on  our  last   the Healthy Adult- Remco Van der
conference  that  the  model  has  to  be   Wijngaart
developed  further.  Schema  therapy  is  s4ll  
growing  and  expanding  –  in  the  number  of   Face to Face With “Anger Modes” Sturdy
members  as  well  as  in  terms  of  a  broader   and Secure In The Treatment Room-
applica4on.  Star4ng  with  successfully  trea4ng   Wendy Behary
Borderlines  in  the  last  years  it  has  been  
applied  to  people  with  other  personality   New Directions for Working with
disorders  including  forensic  pa4ents  but  in   Dysfunctional Parent Modes- Offer
other  formats  as  well:  In  groups,  for  couples   Maurer and Eshkol Rafaeli
and  for  children  and  adolescents.  Meanwhile  
concepts  for  combining  Schema  therapy  and  
This  progress  lasts  on  two  legs:  It  needs  the  
Axis-­‐I-­‐disorder  treatments  are  on  the  way  
crea4vity  and  sound  clinical  judgement  of  
too,  e.g.  for  addic4ons,  ea4ng  disorders,  
experienced  clinicians  developing  the  
depression  and  OCD.    
concepts  as  well  as  researchers  who  carefully  
plan  and  conduct  high  quality  clinical  trials  
proving  their  evidence.  We  all  know  how  
much  the  approval  of  Schema  therapy  by  the  
scien4fic  community  is  based  on  the  studies  
of  Arnoud  Arntz  and  his  team  of  collaborators  
published  in  achieved  journals!  This  deserves  
our  greatest  respect!    

We  are  star4ng  this  first  volume  with  

contribu4ons  resul4ng  from  clinical  prac4ce  
but  we  will  report  on  outcome  studies  as  
soon  as  they  are  published  keeping  you  
updated  with  the  progress  in  Schema  
therapy.  So  please  don´t  hesitate  submiGng  
the  results  of  your  work.  Let´s  be  a  crea4ve  
and  vivid  community!  

 Kind  regards,    

Eckhard  Roediger    (ISST  President)                                                                                

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Self Pity/Victim: A Surrender Schema Mode

David Edwards
Rhodes University and Schema Therapy Institute of South Africa
One of the psychological games described by Eric Berne (1964) is “Alcoholic” in which
the addict draws others into two kinds of relationship with him/or her, as persecutor or
rescuer. Stephen Karpman’s (1968) “drama triangle” extended this by describing three
roles: persecutor, rescuer and victim. He pointed out how troubled individuals may
switch from one role to another within the same relationship. In Berne’s game, then, the
alcoholic is the victim whom others may either persecute or rescue. The point about the
drama triangle is that none of
these positions is an authentic
way of relating. They are all, in
the language of schema therapy,
coping modes.

In mode terms, it is easy to see

that the rescuer is a Compliant
Surrenderer. Although the
persecutor can be seen as a Bully
and Attack mode, it is also an
aspect of the Self-Aggrandizer
that puts itself above others by
being disdainful of them. When
this expresses itself in self-
righteous scolding, I like to call it
a “Scolding
Overcontroller” (Edwards, 2012). But what about the victim? Self-pity has been widely
described in the literature. In Karen Horney’s (1937, pp. 255-6) telling words, such
patients present themselves as an “innocent martyr ... a living reproach.” Self pity is
implicit in several other of Berne’s original games (e.g. ‘ain’t it awful,’ ‘wooden leg,’ ‘look
how hard I’ve tried’) and in Transactional Analysis it is often subsumed under the
broader title of “Poor me” (James, 1977). However, there is a remarkable absence in the
schema therapy literature of a mode that captures this position. It is a coping mode in
the surrender category, where the patient accepts all the EMS based beliefs, “I’m
unlovable, I don’t fit in, I’m a failure etc.” But this does not open up the Vulnerable
Child (VCh) to receive care. Instead, the therapist is pushed away by a barrage of
complaints, or a sullen mood that says, “You don’t understand,” or a string of arguments

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about why change is not possible - Eric Berne described this as the game, “Why don’t
you .... Yes, but ...” I call it the Self-pity/Victim (SPV) mode (Edwards, 2012).

In his Cognitive Appraisal Therapy, Richard Wessler sees self-pity as a significant

obstacle to healing.He developed this after recognizing the limitations of Ellis’s REBT,
just as Young developed schema therapy to address what he saw as limitations of Beck’s
cognitive therapy. Wessler, Hankin, and Stern (2001) write about the “help-rejecting
complainer” (p. 81), “a litany of complaints about trivia” (p. 139) and a list of “If only”s
(e.g. “If only I could have another chance”) as typical of this mode (p. 186). Self-pity is
also an aspect of narcissistic pathology. O’Brien’s (1987) Multiphasic Narcissism
Inventory has three factors. The first captures the narcissist’s exploitativeness and lack
of empathy and reciprocity. The second captures the
The therapist is entitlement to control others (what I call Scolding

pushed away by a Overcontroller). O’Brien calls the third the

“narcissistically abused personality,” (p. 503) while it is
barrage of referred as the “‘poor me’ narcissistic defense” by
complaints, or a Waller and Campbell (2007, p. 261), in their schema
based approach to eating disorders. It is characterized
sullen mood that by a sense of martyrdom, striving to avoid criticism,
says, “You don’t and feeling unwilling to or resentful about being asked

understand” to undertake the tasks of therapy.

Liotti (2004) relates the confusing switches between

drama triangle roles (victim, persecutor, rescuer) that characterize patients with
disorganized attachment. This means we are particularly likely to encounter the SPV
mode in personality disorders and complex trauma. It is, of course, common in
addiction, as evidenced by Berne’s naming of the game “Alcoholic” (described above)
and by the catch phrase from Alcoholics Anonymous, “Poor me, poor me ... pour me a
drink.” This latter neatly captures the way the SPV mode legitimates a permission
giving belief (“it’s alright to self-soothe by drinking when I’ve been treated so unfairly”)
and undermines access to or strengthening of the Healthy Adult (HA). Because of its
strong surrender quality, in some of its guises, the SPV could be mistaken for the VCh.
However, Wessler at al (2001, p. 300) warn that trying to offer care to this mode is
counterproductive: “caretaking fosters self-pity and anger ... by enhancing their sense of
helplessness and distress.” It is a defining characteristic of this mode that it does not
respond to reparenting. We have to bypass it to get to the VCh. I encountered this in a
couple. He felt misunderstood and uncared for despite the fact that for years she had
patiently listened to his expressions of distress. She was confused and frustrated. He
was apparently vulnerable, but she felt shut out. It was only by unmasking and

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empathically confronting his SPV mode that we could break through the impasse.
Another patient was confused between the VCh and self-pity in a different way.
Whenever she got close to the VCh, she shut down, saying, “I am just going into self-
pity.” But this was the voice of her Punitive Parent disdaining her genuine feelings (a
legacy of narcissistic parenting). It was hard work to undo this and help her accept her
VCh feelings and so open up to the possibility of reparenting.

The literature on schema

therapy gives remarkably
little prominence to the
SPV mode. There is nothing
like it in the 22 modes listed
by Lobbestael, van
Vreeswijk, and Arntz (2007).
Bernstein andvan den
Broeck’s (2009) Schema
Mode Observer Rating Scale
(SMORS) does include a
mode that “complains,
whines, and demands in a
victimized, dissatisfied manner; expresses his dissatisfaction in an off-putting manner
that masks his real feelings and needs.” This nicely captures the victim, complaining
aspects of the SPV mode. They call it the Complaining Protector and comment on some
overlap with the Angry Protector mode. However, calling it “Protector” suggests schema
avoidance rather than schema surrender. In spite of it being on their rating scale, I
could not find any reference to this mode in any of the recent published work from
Bernstein’s group.

I believe it is important to put the SPV mode more firmly on the schema mode map.
Like many other coping modes, SPV is not easy to shift. There are payoffs from the
externalization of blame characteristic of SPV: the patient is protected from feeling
shame and self-criticism and enjoys a self-righteous satisfaction that has a self-
aggrandising quality. But like all coping modes, SPV traps patients in endless cycles of
dissatisfaction. It keeps them out of touch with their true needs with the result that they
will never be met, and, despite the seeming vulnerability associated with this mode,
while in it patients are not able to receive meaningful care, so reparenting is impossible.
This mode firmly obstructs the two main pillars of change in schema therapy - the
hostile, dependent helplessness prevents building the HA; the self-righteous
resentment does not allow access to healing the VCh. So schema therapists need to be

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able to recognize it, name it and, in due course, empathically confront it and help
patients re-evaluate their investment in such a self-defeating way of coping.

References
Berne, E. (1964). Games people play. Harmondsworth, UK: Penguin.
Bernstein, D. P., & van den Broek, E. (2009). Schema Mode Observer
From Wendy Rating Scale (SMORS). Department of Psychology, Maastricht
Behary, chair of University.
the Brainstorming Edwards, D. J. A. (2012, May). Overcoming obstacles to reparenting the
Committee: inner child. Workshop presented at the Conference of the
International Society of Schema Therapy, World Trade Center, New
Jeff Young joins me in York.
acknowledging the efforts Horney, K. (1937). The neurotic personality of our time. London: Kegan
of Brainstorming Paul, Trench, Trubner & Co.
Committee members James, M. (Ed.). (1977). Techniques in transactional analysis for
Lissa Parsonnet and Chris psychotherapists and counsellors.Reading, MA: Addison-Wesley.
Hayes in the Karpman, S. (1968). Fairy tales and script drama analysis.
development of this new Transactional Analysis Bulletin, 7(26), 39-43.
E-Bulletin, and asked that Liotti, G. (2004). Trauma, dissociation and disorganized attachment:
I express his excitement
Three strands of a single braid. Psychotherapy:Theory,
and support for the
Research, Practice, Training, 41(4), 472-486. doi:10.1037/0033-
launching this new
3204.41.4.472
endeavor
Lobbestael, J., van Vreeswijk, M., & Arntz, A. (2007). Shedding light
on schema modes: a clarification of the mode concept and its
current research status. Netherlands Journal of Psychology, 63,
Self Pity/ Victim a 76-85.
Listserve O'Brien, M. L. (1987). Examining the dimensionality of pathological
narcissism: Factor analysis and construct validity of the
Discussion
O'Brien Multiphasic Narcissism Inventory. Psychological
Reports, 61(2), 499-510.
In May we are
encouraging ISST Waller, G., & Campbell, M. (2007). Narcissistic features in eating-
members to discuss the disordered behaviors. InternationalJournal of Eating
topic of playing a Disorders, 40(2), 143-148.
“Victim”/ self pity as a Wessler, R., Hankin, S., & Stern, J. (2001). Succeeding with difficult
coping mode via the ISST clients: Applications of Cognitive Appraisal Therapy. San Diego,
CA: Academic.
listserve.

Schema Therapy Bulletin 6

Schema Therapy Bulletin May 2015 , Issue 1

The Healthy Adult Mode; Ways to

Strengthen the Healthy Adult of Our
Patients
Remco van der Wijngaart
The Netherlands

As schema therapists we all strive for the same common goal in treating our patients, to
strengthen the healthy adult part of the patient by validating basic core needs. We often
explained this therapy goal to patients and for most of them this explanation was clear
and sufficient. Some patients however, have questions about this healthy adult part of
them. Questions like ‘How do I connect to that Healthy side of me?’ or ‘What does a
healthy adult do?’. These
questions let us think about
ways to make the concept of the
Healthy Adult less abstract for
our patients. Although some
authors describe different
aspects of the Healthy Adult
(Artnz&Jacob, 2012,
Farrell&Shaw, 2012, Van, Jacob,
Genderen & Seebauer, 2012)
our patients were in need of
even more simple guidelines to
learn Healthy Adult behaviour.
This article describes these
methods and techniques and
will enable the schema therapist
to explain the concept of the
Healthy Adult in an easy to
understand manner. It also will
give a simple step-by-step training of that Healthy Adult.

Visualizing the Healthy Adult

The patient needs to learn to visualize the Healthy Adult to make it a less abstract
concept. The way to do that is to start with the therapist explaining about his own
Healthy Adult. The therapist self discloses on a memory where he was able to deal with
a difficult situation in a healthy way. The therapist mentions all the different aspects of

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the Healthy Adult; emotional- cognitive and behavioural aspects. He might say things
like: ‘That moment I felt confident. And that confidence felt strong; I was holding
myself straight, head held high and shoulders straight. And I felt calm, a calm feeling in
my belly but at the same time connected, as if I could focus on my feelings but also be
aware of the reality that I was facing. And just talking about it now makes me feel that
same way. If I had to draw myself being in that mode I would look tall, looking calmly
but strong. If I’m now confronted with an upsetting situation, standing up straight with
my head held high and my shoulders straight, I do connect to my Healthy Adult,
connecting me to that calmness and strength.”

The therapist then explains that the patient

needs similar gateways to their Healthy Adult as
well as a vivid visual image of their Healthy
The therapist then
Adult. The therapist asks the patient to close her explains that the
eyes and get a memory of a situation in which patient needs similar
she was connecting to that healthy part. In our
experience every patient will have such a
gateways to their
memory or more then one; rare moments like Healthy Adult as well
deciding to break up a bad relationship. as a vivid visual image
Visualizing the Healthy Adult they were in that
situation is a way to identify the different
of their Healthy Adult.
aspects of their Healthy Adult. The homework
assignment at the end of that session will be to practise visualizing that Healthy Adult
daily in non-challenging situations.

This is the start of internalising a sense of the Healthy Adult of the patient. Next, we
need to explain healthy adult behaviour in looking after the needs of the Vulnerable
Child. We explain this using a simple plan called ‘the 3 steps of the Healthy Adult’.

The ‘3-steps of the Healthy Adult’

In our experience, patients really love this simple 3-step plan; it gives them clear
instructions and it easy to remember. The first step is to acknowledge the feelings and
distress of the Vulnerable Child. A healthy Adult says things like “I see you’re upset”, “I
totally understand that this is painful”, “If I was in that situation I would feel bad
myself”. So the patient has to learn to say things like “I’m upset and that’s
understandable, I never learned to feel safe in these situations. It’s my Vulnerable Child
that has been triggered”. This acknowledgement of the suffering is a soothing way of
connecting.

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The second step is to offer hope, a different perspective. Acknowledgment is a

necessary first step but if it would just be acknowledgment then it wouldn’t be enough.
Words like “This will go away, that’s a fact”, “It will change” give a clear and healthy
message that distress can be overwhelming but that it will not stay that way, how strong
that overwhelming feeling may be. It’s important that the patient learns remind
themselves of this message and make it more then just hollow words.

The third and final step of the Healthy Adult is to deal with reality. Dealing with reality
may mean different things. It often relates to deal with parent modes or coping modes
that were triggered and were part of the reason why the patient was in so much pain.
Dealing with reality also means making healthy behavioural choices how to solve a
problem or cope with a difficult situation.

The three steps have to be

taken in this specific
order. One common
pitfall is that a person
immediately tries to solve
things when faced with an
upsetting situation, to
take action. Although
action is a necessary step
it’s only effective if it is
first acknowledged how
much the other is in pain.
In some way we’re all
aware of that necessary
first step. Just imagine that you feel bad because of what happened at work, return to
your home and talk about these difficulties with your loved ones. When these loved
ones immediately start to give advice how to deal with that situation (“What you should
do is…”, “What I would do is…”) that might feel irritating. Although these solutions
may be very wise, it’s too soon. First we need to hear that our pain is acknowledged,
understood, before we can be open to suggestions how to take action.

Depending on the pathology of the patient we tend to start to visualize the Healthy
Adult during the middle phase of the therapy. Next, that Healthy Adult of the patient is
present in imagery exercises while the therapist does the rescripting. Then we start to
explain about the 3 steps so the patient will cognitively understand what she needs to

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learn to do for herself. The therapist may still do the rescripting but will also explicitly
point out these 3 steps to the patient. In the last phase of therapy the patient is coached
to practise the Healthy Adult herself. The therapist will ask questions like “Did you do
the 3 steps?’ and thereby coaching the patient to
“White Nights” strengthen her Healthy Adult.
Summer School
June 2015 St References
Petersburg Russia Arntz, A., & Jacob, G. (2012). Schema therapy in practice: an
introductory guide to the schema mode approach. New York: Wiley.
Do you want to enhance your
skills and expertise as a schema J. M. Farrell & I. A. Shaw (2012). Group schema therapy for borderline
therapist? personality disorder—A step-by-step treatment manual with patient
workbook. West Sussex, UK: Wiley-Blackwell.
ISST invites you to join us for
Summer School June 11, 12, 13 Genderen, H. van, Jacob, G. & Seebauer, L. (2012). Patronen
2015. We will be hosting top doorbreken, Negatieve gevoelens en gewoonten herkennen en veranderen.
experts in the field of schema Amsterdam: Uitgeverij Nieuwezijds.
therapy to present at
workshops designed to help Special thanks to my collegues of the day time clinic in
you broaden and expand your Maastricht, specifically Judith van Hommerig who was the
work with select populations first to mention the 3 steps of the Healthy Adult.
and areas. To for more
information see
www.schematherapysociety.org
Face to Face With “Anger
ISST New Website Modes” Sturdy and Secure
2015 brings us a new and In The Treatment Room
improved ISST website. Wendy T. Behary
www.schematherapysociety.org
The new look website now has The Cognitive Therapy Center of NJ
new features such as an The NJ-NYC Institutes for Schema Therapy
improved blog area, an
international events calendar,
“find a Therapist/ Supervisor” Whether it’s the ornery cynicism launched by the
facilities. obnoxious narcissist, defiantly refusing to engage in
your “silly emotional strategies”…. Or the patient who
In the coming months
the website will continue to flips into a desperate angry child mode, hurling guilt-
expand with video features and activating blame at you for daring to call it ‘vacation
schema resources for time’ when she knows you are really ‘looking forward to
members.
getting away from the hopelessly pathetic and forgettable
person that she is, and that you are just like everyone else in
her life who doesn’t care’ … Or perhaps it is the partner in
your couple’s treatment who offends his significant other (and you) with contemptuous

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rants of “I’ll show you” and “I don’t need you” bullying statements and gestures… Or it
might even be the patient who nods and “yes’s” your every word in a somewhat
mechanical mode of compliance, and then proceeds to arrive 20 minutes late to each
session that ends with an agreement to engage in emotional work “next time we meet”…
and when you inquire about any hidden anger, frustration, or resentment toward you
(perhaps linked to feelings of subjugation, shame, or mistrust) for confronting blocking
modes, they become punitively self-critical for being such a “loser and a waste of your
time”.

We struggle to keep a sturdy posture when We hear the anger as

ANGER enters our treatment rooms. Whether
the anger is directed at us, at an attending
a siren, a blaring
partner, or through an unabashed reenactment emergency vehicle
of a recent event: “… and then I got really mad that alerts us to the
when… and then I showed him! I just let him have
it!!” we may find ourselves overwhelmed – dazed
message that
with fear, glazed in apologies, hazed with “someone is in
resentment, or simply amazed by the speed with
trouble” or simply
which the deep red hue of humiliation arrives
on our faces. “help is needed”!
However, when responding from our healthy adult mode… we become harnessed in
an awareness of the “importance” of anger modes and the underlying experience. We
hear the anger as a siren, a blaring emergency vehicle that alerts us to the message that
“someone is in trouble” or simply “help is needed”! From a sturdy mode we hear the
siren and empathically listen for cues to distinguish between an angry childlike helpless
mode, a rebellious teen-like bully, or a demandingly entitled, resentful, or defiantly
detached adult. Only from this mode can we discover and be reminded of the patient’s
unmet needs for: safety, limit setting, empathy, acceptance, and/or attachment. We
appreciate the internalized experience imbedded in a story of fractured attachment and
communicate to our patients how a seemingly “important” message seems to have gotten
lost in the delivery. From the healthy adult mode we are better equipped to confront or
embrace angry modes with the effective and targeted strategies founded in the Schema
Therapy approach… be it imagery, mode dialogues, limit-setting, or empathic
confrontation.

It is essential to label the Anger Mode with a personally customized descriptor, in

order to fully capture the motivating driver behind the mode – one of helplessness,
resentment, fear, or rejection – linking it to early experience, EMS, coping styles, and

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hypothesized temperament. The personal label may also be helpful for linking the
physical experience, as identified by the sensory system, i.e., locating the feeling in the
body at onset and during escalations. The personal mode descriptor may also serve to
remind us, as well as our patients, to mindfully anticipate (and review in the aftermath)
the precipitating condition(s): those most likely to activate the anger mode, such as:
being teased, ignored, controlled, or betrayed. Customized anger mode labels may be
designed like this: “Bully Joe”, “Pressure-Cooker Peter”, “Seething Sue”, “Little Angry
Laura”, or simply “Tough-Guy”… “Stormy”… or “Cranky Pants”.

Given the nature of our species

and the architecture of the primitive
brain, most humans are likely to
experience some degree of anger,
agitation, frustration, and aggression –
whether in the natural early years of
development when frustration and
discomfort is expressed in the form of
wailing cries, moaning monologues of
sounds and words, or even physical
aggression. Differentiated in the
treatment room, schema-driven anger
is identified as marked intensity of
reaction to stimuli (not necessarily
loud or violent) typically linked to an
overestimation of a “threat” to their
emotional survival, linked to the
patient’s longstanding unmet needs
and self-defeating reactive patterns of
defiant detachment, controlling-demands,
attacking-criticalness, internalized
punitiveness, or desperate efforts to satisfy the need to aggress frustrations safely, as we
find with BPD patients in the angry child mode.

Anger can cause great distraction for therapists, causing us to flip into our own
maladaptive modes in order to protect us from sensed threats and schema-activated
discomfort. These modes thwart the sturdiness and realness that is necessary for the
healthy adult caregiving role. When triggered, receptivity and accessibility for
attunement and attachment healing is impacted, thus compromising our ability to help
patients navigate the challenging freedom journey from prevailing maladaptive modes.

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Being stuck in our “lost adult” and maladaptive-reactive

Schema Special modes also impedes our capacity to model and co-
Interest construct adaptive, flexible, coping stances – necessary
Groups- get for engaging patients in getting their needs met in a
involved! healthy way.
There are a number of
Schema Keeping a few (child and adolescent) photographs of
Therapy Special interest
your patient in the chart can act as healthy adult
groups
that meet regularly to fortifiers for us, helpful reminders in session (as you
discuss look into the faces in the photos) and recall the stories
specific aspects of schema of these suffering and vulnerable parts that lie beneath
therapy. These include (noisy, obnoxious, cynical, raging) angry over-
- couples work
compensators, defiantly detached protectors, bully,
- forensic work
- eating disorders controlling, and demanding modes; and to also remind
- child and adolescent us of the anger that lies trapped within the child who
was not only deprived, abused, or abandoned, but also
To be a part of these group suffered the absence of the natural relief that comes
visit the ISST website.
from the freedom to naturally express frustration
Research Blog without harming or neglectful consequences… anger
For recent developments in that is met with embrace, empathy, and healthy
Schema Therapy research constructive discipline.
see the new ISST research
blog-
The ongoing maintenance of our wellbeing as
www.schematherapysociety.
org/Research-Blog caregivers is imperative to the effective discernment and
engagement with this important emotion when it shows
up in our treatment rooms. Self-therapy, supervision,
and personal therapy are a few of the ways we can remain steadier (not robotic) and also
informed by our humanness (our own vulnerability) and thereby appreciative of the
impact the patient’s anger may be having on others in deleterious ways.

Sturdy and secure in our Healthy Adult caregiver modes, and with a keen
conceptualization of schemas, modes, and unmet needs of our patients, we are better
able to extract the meaningful messages imbedded in the anger that is being used to
block emotions… maintain rank/status… protect against shame/loss/abuse… aggress
punishment in the name of injustice, control, or impulse… or simply release frustration
in a safe place.
Coming Soon – Paper in Press:
Beyond the Angry Child: A New Conceptualization of Anger Modes and Their Treatment
Dr. John Gasiewski and Wendy Behary

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Schema Therapy Bulletin May 2015 , Issue 1

New Directions for Working with

Dysfunctional Parent Modes
Offer Maurer and Eshkol Rafaeli
The Israeli Institute for Schema Therapy
It is a well-known fact that some individuals are their own worst enemies. This
phenomenon has been recognized by many approaches which described the
dynamic using various terms. Common to all these approaches is the recognition
that through identification and introjection, children learn to treat themselves in just
the same ways their parents treated them – ways that are at times quite
dysfunctional. Although the terms introduced by Young to label hurtful internalized
self-states in the Schema Therapy (ST) model point directly to the parents as their
source (e.g., the Punitive Parent or the Demanding Parent Modes), neither we nor
Young himself take it to imply that all critical, punitive, or demanding modes must
always be the result of direct internalization of parental figures (Young, Klosko &
Weishaar, 2003). At times, these modes echo the words and actions of other
influential sources like siblings, peer groups or even broader society’s messages.

One of the most

important goals in ST
is to help the client
identify these modes,
view them as ego-
alien voices,
assertively stand up to
them, and learn to
protect and shield the
Vulnerable Child
mode from their
destructive effects.
Various tools can be
employed in ST for this
purpose, yet ST’s most powerful tools for combatting the Dysfunctional Parental
Modes (DPM) are experiential strategies, particularly chairwork (Kellogg, 2004) and
Imagery Rescripting (ImRS; Arntz & Jacob, 2012, Rafaeli, Bernstein & Young, 2011).

When therapists request permission and enter an image, they typically do so with
four broad goals in mind. They want to (1) bypass the various coping modes which
often block feeling. They aim to (2) nurture or re-parent the child modes, especially

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Schema Therapy Bulletin May 2015 , Issue 1

the Vulnerable Child. By doing so, they hope to (3) model adaptive parenting so that
the patient’s own healthy adult mode is strengthened. Often times, this involves (4)
confronting or combating the internalized parent or perpetrator modes.

Of these goals, we find the first three incontrovertible. This is not the case, however,
with regards to the fourth goal – the one tied to addressing parent or perpetrator
modes. In recent years, we have begun to doubt whether directly and forcefully
“taking on” the internal hurtful self-states of our patients is the only clinical avenue
possible. We have no doubt that this avenue
should exist, nor that there is convincing We have begun to
evidence for its utility (e.g., Arntz, Klokman & doubt whether
Sieswerda, 2005; cf., Bamelis, Giesen-Bloo,
Bernstein, & Arntz, 2012). Still, our own clinical directly and
impressions, those of our supervisees, and those forcefully “taking on”
of therapists from various (quite compatible)
schools of therapy point to other clinical
the internal hurtful
options, ones which might hold promising self-states of our
merits (Rafaeli, Maurer & Thoma, 2014). patients is the only
To illustrate our thinking about this issue, we clinical avenue
would like to share an instructive experience
one of us (OM) had while studying with Dr. Suzette Boon, an internationally
renowned trauma expert who’s best known for her work with patients suffering from
Dissociative Identity Disorder (DID). After watching some video clips from real
patients’ sessions she presented at a workshop, I was struck by the tremendous
amount of respect (and even what I felt to be genuine gentleness!) she showed
towards pretty horrific malevolent self-states within her dissociative patients. This, of
course, stood in stark opposition to the ST model’s approach. Curious, I came up to
her during the break and asked her about this discrepancy. Dr. Boon told me about
her own experience with ST, during which she had attempted to confront malicious
self-states in the manner prescribed by the model. The results, she said, were at
times problematic. In particular, though patients seemed to be experiencing some
relief in session, the internal attackers came back to haunt and punish the patients
later at home with even more vengeance then before. Some patients, she said, would
then need even more care and protection due to an increase in their suicidality.
These experiences and others led her, she said, to change the way she worked with
critical or punitive self-states to a one that’s more respectful and gentle to them (S.
Boon, personal communication, May 18, 2011).

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Schema Therapy Bulletin May 2015 , Issue 1

This and other clinical observations have served as an important starting point for us
in our search to expand our own (and our supervisees’) toolbox for engaging and
working with DPMs. Today, when we encounter these modes, we often view them as
internal representations of parents (and others) who just did not - and maybe still do
not - know how to treat their children right, mainly because of their own deficient
upbringing. After realising we’re not against them, these modes often come out, with
some tentativeness, and seek counsel with us. Many of them agree to change their
ways after getting enough reassurance and guidance (Maurer, 2015).

One way to think about this style of work is by analogy to the therapeutic stance
adopted when working with real parents in parental-guidance sessions. In many
instances, parents enter hoping to be discuss their child’s symptoms, only to discover
that the clinician conceptualizes things quite
Recent Schema differently; in particular, it often becomes evident (at
Book/ Chapter least to the clinician) that the underlying cause of the
releases presenting problems resides with the unmet (or
inadequately met) needs of the child. With
Breaking Negative Thinking
forthcoming families, a discussion focused on the
Patterns (2015) Gitta Jacob,
Hannie van Genderen, and child’s needs and the parents’ responses to it often
Laura Seebauer leads to a recognition of the parents’ schemas and
modes and to their developmental origins; such
"Schema Therapy with
Oncology Patients and recognition later leads to personal growth and change
Families” (2015) Dr. Lissa both in the parents and in the child.
Parsonnet, in Handbook of
Oncology Social Work: Sensible therapists typically wouldn’t begin parent
Psychosocial Care for People
training interventions with forceful confrontation, but
with Cancer,
instead would try to empathize or understand the
Narcissistic Personality parents, even as they attempt to correct problematic
Disorder Wendy Behary &
behaviours. We propose that the same principle
Denise Davis. Cognitive
Therapy for Personality applies to work with a DPM. As we’ve seen repeatedly,
Disorders (2014, 3rd ed). most parents who were overly demanding, strongly
Borderline Personality critical or mercilessly punitive were so not because of
Disorder Arnoud Arntz . a wish to hurt their child (although sadly this might
Cognitive Therapy for indeed be the case in the minority of cases) but
Personality Disorders (2014,
because they themselves were activated into a
3rd ed.)
Maladaptive Coping Mode or a DPM of their own,
making it impossible for them to respond to their
child’s needs in a good enough manner.

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Schema Therapy Bulletin May 2015 , Issue 1

A related point has to do with the notion that treating the violence of the DPM with
violence could prove to be quite problematic in the long run. When we strive to to
‘banish’ the parental modes, or when we treat them harshly, we may be just repaying
them with the same old coin. Although the Vulnerable Child Mode may actually
value this (and at times really need this, especially when it’s done to save or protect
her/him from severe maltreatment) he/she is actually missing out an important
chance to learn new ways of interacting and negotiating, ways marked by compassion
and empathy.

To conclude, we’d like to reiterate that these new directions involving a softer
response to the DPMs are proposed here not as replacement of the established ST
way, but rather as a variant to it. Developing this variant could expand the diversity
of tools available to present-day schema therapists. Over time, we hope to elaborate
on the specifics of this line of intervention: when should it be used in the course of
therapy, how should it be combined with the more classic approach, and how should
one determine which is superior in any particular juncture in therapy.

Bibliography

Arntz, A., Klokman, J., & Sieswerda, S. (2005). An experimental test of the schema
mode model of borderline personality disorder. Journal of Behavior Therapy
and Experimental Psychiatry, 36(3), 226-239.
Arntz, A., & Jacob, G. (2012). Schema therapy in practice: an introductory guide to the
schema mode approach. New York: Wiley.
Bamelis, L., Giesen-Bloo, J., Bernstein, D., & Arntz, A. (2012). Effectiveness studies of
schema therapy. In M. Vreeswijk, J. Broersen, & M. Nadort (Eds.) The Wiley-
Blackwell Handbook of Schema Therapy: Theory, Research and Practice (pp.
495-510). New York: Wiley.
Kellogg, S. (2004). Dialogical encounters: Contemporary perspectives on ‘chairwork’
in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 41, 310–
320.
Lobbestael, J., Arntz, A., Cima, M., & Chakhssi, F. (2009). Effects of induced anger in
patients with antisocial personality disorder. Psychological Medicine, 39, 557-568.
Maurer, O. (2015). A Failure with a Capital F. In: Rolef Ben Shahar, A. & Shalit, R.
(Eds.) Therapeutic Failures. London: Karnac. (In Press)
Rafaeli, E., Bernstein, D. P., & Young, J. (2011). Schema therapy: Distinctive features.
New York: Routledge.

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Schema Therapy Bulletin May 2015 , Issue 1

Rafaeli, E., Maurer, O., & Thoma, N. (2014). Working with modes in schema therapy.
In N. Thoma & D. McKay (Eds.), Engaging Emotion in Cognitive Behavioral
Therapy: Experiential Techniques for Promoting Lasting Change. NY: Guilford.
Van der Hart, O., Nijenhuis E.R.S. & Steele, K. (2006). The Haunted Self. New York:
Norton.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's
guide. New York: Guilford.

Announcement- 2016 International Society of Schema Therapy

ConferenceVienna, Austria

The ISST board is very pleased to announce the 2016 conference to be held in Vienna,
Austria on June 30 - July 2 2015 at the Messe Wien Exhibition & Congress Center.

The conference will be the focal point of of schema therapy practice and research and
will host a number of key note speakers from around the world.

Details and registration details will be available soon at http://

www.schematherapysociety.org

Schema Therapy Bulletin- Upcoming Editions

The Bulletin is dependent on member involvement. We are looking for contributors for
upcoming editions of the Schema Therapy Bulletin. In the coming 18 months we hope
to have to have material focusing on-

-Schema Therapy and Medical Conditions (Release date- September 2015) ,

- Schema Therapy and Couples Therapy

- Trauma and Schema Therapy

If you are willing to contribute an article to your society, please email Lissa Parsonnet
[email protected] or Chris Hayes [email protected]. We look forward to
hearing from you!

Schema Therapy Bulletin 18