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Shedding light on schema modes: a clarification of

the mode concept and its current research status

Jill Lobbestael*, Michiel van Vreeswijk** and Arnoud Arntz*

While the schema mode construct is one of the main concepts of schema-
focused therapy (SFT) for personality disorders (Young, 1990; Young &
Klosko, 1994; Young, Klosko, & Weishaar, 2003), the mode concept lacks
clear theoretical and scientific embedding, and therapeutic guidelines about
when to use modes in clinical practice are not always clear. Therefore, the
current article aims at clarifying schema modes theoretically and by thera-
peutic vignettes. Modes are different aspects of the self that reflect the cur-
rently active cluster of cognitions, emotions and behaviour (Young et al.,
2003). The different schema modes are presented, as well as mode concep-
tualisations for several personality disorders. The distinction between
healthy and pathological modes is outlined, as well as the link with disso-
ciation and the concept of mode switching. Furthermore, mode assessment
and SFT is addressed, next to theoretical studies on schema modes. Whilst
the recent progress in treatment possibilities and effectiveness of SFT is
impressive, basic tests of the modes are limited. Finally, directions for fur-
ther studies are suggested. (Netherlands Journal of Psychology, 63, 76-85.)

Keywords: Schema-focused therapy; schema modes; personality disorders;


mode assessment

Schema-focused therapy (SFT) is becoming an demonstrated SFT to be superior to psycho-


increasingly popular and widespread variant of dynamically based transference-focused psycho-
cognitive therapy for treating personality dis- therapy in reducing borderline personality dis-
orders (PDs). A study by Giesen-Bloo, et al. (2006) order (BPD)-specific and general psychopatho-
logical dysfunction and in improving quality of
life. Three main concepts are central in SFT. The
* Department of Clinical Psychology Research, Maastricht
first is that of early maladaptive schemas (EMSs),
University
which are broadly defined as the unconditional
** Delftland Mental Health Service, Outdoor Clinic, Loca-
and dysfunctional underlying beliefs about the
tion de Gravin, Delft
self and one’s relationship with others. EMSs are
Correspondence to: Jill Lobbestael, Department of Clinical
developed during childhood and serve to selec-
Psychology Research, Maastricht University, PO Box 616,
tively filter incoming experiences such that sche-
NL 6200 MD Maastricht, E-mail: jill.lobbestael@dmkep.
mas are extended and elaborated throughout an
unimaas.nl.
individual’s lifetime. Behaviours are embedded
Submitted 19 March 2007; revision accepted 21 June 2007.
Schema modes 77

in the coping styles that form the second main vides a different unit of analysis, making sche-
feature in SFT. Young postulates that a person mas and coping features more manageable.
can maintain his/her EMSs by means of three While some modes are primarily composed of
coping methods: overcompensation (fight the schemas, others mainly represent coping re-
schema as though the opposite were true), avoid- sponses. Schema modes reflect the emotional
ance (avoid the schema being activated) and sur- and behavioural state at a given moment in time
render (give in to the schema) (Young et al., in an individual, and comprise thoughts, emo-
2003). Because of the close link of both EMSs tions and behaviours. Thus, in essence, there are
and coping styles to basic cognitive theory con- two main differences between schemas and
structs (Beck & Freeman, 1990; Beck, Freeman, & modes. First, schemas reflect a one-dimensional
Davis, 2004) and the increasing number of stud- theme (e.g. Defectiveness), while modes are
ies targeting the theoretical underpinning of broader and reflect a combination of several
these constructs (see e.g. Ball & Cecero, 2001; schemas (e.g. the EMSs of Defectiveness and
Jovev & Jackson, 2004; Petrocelli, Glaser, Cal- Emotional Deprivation are both part of the
houn, & Campbell, 2001), EMSs and schema Lonely Child mode) and/or coping strategies.
coping are concepts that are well known in clin- Second, schemas are stable, trait constructs,
ical practice. However, most researchers, practi- while modes alter depending on the situation
tioners and patients are less acquainted with the one is in, and thus are state concepts that are
third SFT concept, schema modes. The unfamil- strongly related to the present emotional state of
iarity with the concept of schema modes is due the patient.
to the fact that it is a new and quite difficult con-
struct that emphasises many elements. There-
fore, the current article aims at clarifying the Frank, a 42-year-old postman with a major
mode concept, both on a theoretical level as well depression and an obsessive-compulsive per-
as on a clinical level. By means of clinical vi- sonality disorder, tells his therapist about a
gnettes the concept and how it is used in treat- situation where he helped a woman he liked
ment is illustrated. Also, the current status of and he thought liked him too. However, she
research on mode assessment and experimental sent him away after he had helped her with-
studies is described, and recommendations for out thanking him. This event triggered several
further studies are given. schemas within the patient: Mistrust/Abuse
because he thought the woman acted like
this on purpose to humiliate him, Abandon-
From schemas to schema modes ment because he was convinced the woman
abandoned him in favour of someone better,
While the schema approach proved to be a valu- Defectiveness because he felt stupid because
able model for treating many patients, schema of how he had acted and Emotional Depriva-
assessment in patients with BPD posed an extra tion because he felt he did not get the emo-
challenge because these patients recognise many tional support he wanted from the woman. In
different schemas, and several schemas can be response to this event, he called this woman
active at the same time (in extreme cases of BPD a couple of hours later and begged her to go
as many as 15 schemata at once), making it diffi- on a date with him (Overcompensation
cult to pinpoint concrete therapy goals. Further- coping method), till the point came when she
more, patients with severe PDs can seem calm told him to get lost. The therapist and the
and in control most of the time, and all of the patient are struggling with which schema or
sudden burst into anger or become very sad. coping method is most important in this situ-
These rapid changes in behaviour and feelings, ation. They conclude that these schemas and
reflective of emotional instability, cannot be ac- coping response co-occurred in reaction to a
counted for sufficiently by means of the EMS strong feeling of abandonment, making this
concept, since these schemas are conceptualised situation better to understand by clustering
as trait constructs referring to stable underpin- the schemas and coping response into the
ning of personality. Additionally, it appeared Abandoned and Abused Child mode. This is
that certain schemas and coping responses were an example of a situation that triggers so
always triggered together. Young blended a many schemas in a patient that it becomes
number of these schemas and coping strategies difficult to pinpoint the therapy goal. Conse-
together narrowing down the number of them, quently, in cases like these, it is more useful
and refers to these sets of matching schemas and to conceptualise the elicited thoughts, be-
coping responses as schema modes (Bamber, haviours and emotions in terms of a schema
2004; Young et al., 2003). The standard defini- mode.
tion of schema modes is: ‘those schemas or
schema operations − adaptive or maladaptive −
that are currently active for an individual’
(Young et al., 2003). This way, the introduction
of modes into SFT does not imply the addition
of a new content-related aspect, but merely pro-
78 Netherlands Journal of Psychology

Modes and dissociation Different schema modes

Each person holds several modes within him/ Modes can be comprised of both healthy and
herself, so the modes can be seen as different as- pathological aspects, and are centred round spe-
pects of one’s personality. These different parts cific, and very diverse themes. Maladaptive
of the self can cause a patient to feel fragmented modes can reflect a sort of regression into in-
in that some facets of identity have not been tense emotional states experienced as a child,
fully integrated with the self. This does not causing patients to appear very childish, while
imply that modes are entirely separated; al- other modes can be reflective of an overdevel-
though modes can operate independently of oped coping method, or the copying of behav-
each other, a person does have access to several iour displayed towards them by their parent that
modes at a certain moment in time. Thus, they has eventually been internalised (Young et al.,
do not operate without awareness of each other. 2003).
Therefore they cannot be seen as separate enti- Until now, 22 different schema modes have
ties that are divided by amnestic barriers, as is been identified. These include the ten central
for example thought to be the case in the disso- modes that are listed in Young et al. (2003), but
ciative identity disorder, in which it is assumed also subdivisions of these modes that are hy-
that certain aspects of personality are unaware of pothesised to characterise specific PDs. It is
the presence of others and function as indepen- likely that more modes will be identified in the
dent persons (Young et al., 2003). future, when mode conceptualisation of all PDs
is completed. The 22 schema modes can be
grouped into four main categories. The first
Jessica is a 25-year-old woman with a BPD group is that of child modes. These are innate
who calls her therapist in a crisis. She started and universal modes, meaning that all children
injuring herself and felt that something had are born with the potential to manifest them
to be done to prevent her from becoming (Young et al., 2003). On the one hand, maladap-
suicidal. She had had a fight with her boy- tive variants of Child modes develop when cer-
friend because she was very angry when he tain core needs were not met in childhood, and
refused to comfort her after she got scared can centre round themes of vulnerability, anger
when hearing of the death of a good friend, or lack of discipline. On the other hand, when
because he was too busy at that moment. As childhood needs are adequately met, a person
a first response, Jessica felt abandoned and develops a Happy Child mode, representing the
vulnerable (Abandoned/Abused Child mode). capacity to experience and express playful hap-
Her despair grew and she began to view her piness. The second group reflects the dysfunc-
boyfriend as no longer wanting her, which tional coping modes that correspond directly to
raised strong anger in her. She then got in a the three coping styles of Overcompensation,
furious rage, in which she accused her boy- Avoidance and Surrender. The Dysfunctional
friend of rejecting her and not loving her, and Parent modes form the third mode group and
yelled at him and hit him (Angry Child mode). reflect internalised behaviour of the parents to-
She left the house in anger, telling her boy- wards the patient as a child. More specifically,
friend that he had to move out of the house children internalise frequently displayed behav-
before she got back, and drove off in her car. iour of their parent towards them as a part of the
While driving her car in a rather dangerous self. The last mode group is that of the Healthy
manner, she gradually realised how she had Adult mode which includes functional cogni-
behaved towards her partner and started to tions, thoughts and behaviours (Young et al.,
feel guilty. When she returned home, her 2003). Detailed definitions of the 22 schema
boyfriend had indeed left, triggering her modes, and their division into the four central
abandonment feelings (Abandoned and categories and associated themes are depicted in
Abused Child) after which she started to feel appendix A (adapted from Bernstein & Arntz,
extremely guilty that she had sent him away submitted for publication and Young et al.,
and physically attacked him (Punishing Par- 2003).
ent). She then started to cut herself because
she felt she had to punish herself for her mis-
behaviour. When discussing this incident in Modes and personality disorders
the next therapy session, Jessica says the very
diverse emotions she felt and behaviours she Each person exhibits several characteristic
experienced made her confused about her schema modes, but some combinations appear
self. This example illustrates the difficulty typical for certain PDs. According to Young et al.
patients with very distinct modes can have in (2003), the BPD is characterised by four primary
maintaining a unified sense of self. Note that maladaptive schema modes: (1) the Abandoned
she was able to remember those different and Abused Child, which is not surprising given
emotional and behavioural states afterwards. the high prevalence of childhood abuse in bor-
derline patients, (2) the Angry Child that paral-
lels the central place of excessive and misplaced
Schema modes 79

anger in the DSM-IV BPD criteria, and (3) the ent, and the Lonely Child, while patients with
Punitive Parent mode that originates from the paranoid PD are characterised by an Avoidant
harshly punishing and rejecting family environ- Protector and a Humiliated and Abused Child
ment BPD patients often experienced (Young, mode (a variant of the Abandoned and Abused
2005; Young et al., 2003). Most of the time, how- Child mode). Both patients with obsessive-
ever, BPD patients find themselves in the (4) De- compulsive and paranoid personality disorder
tached Protector mode, providing them with the display the Overcontroller mode. The obsessive
opportunity to emotionally shut off from the type uses order, repetition, or ritual (Perfection-
negative emotions caused by the other dysfunc- istic Overcontroller), while the paranoid type
tional modes, and giving them a safe hiding attempts to locate and uncover a hidden (per-
place. Since patients seem quite at ease in this ceived) threat (Suspicious Overcontroller). To
mode, therapists often confuse this Detached conclude, the histrionic patient has the mode of
Protector mode state with the Healthy Adult Attention and Approval Seeker, Undisciplined/
mode, while in fact they are shutting off their Impulsive Child and the Ignored or Inferior
emotions and avoid dealing with them (Young et Child.
al., 2003).
To the best of our knowledge, only two studies
Although mode conceptualisation originated have tried to test the mode conceptualisations of
from the work with BPD, it is now applied to PDs in borderline and cluster C PDs (Arntz,
other diagnostic categories as well. The mode Klokman, & Sieswerda, 2005) and borderline and
conceptualisation of antisocial PD (ASPD) antisocial PDs (Lobbestael, Arntz et al., 2005), as
greatly resembles that of BPD in that the Aban- compared with healthy controls. Both studies
doned and Abused Child, Angry Child, Punitive found evidence that the hypothesised modes of
Parent, and Detached Protector are also central the Abandoned and Abused Child, Angry Child,
to ASPD patients. This can be explained by the Detached Protector and Punitive Parent were
similarity of the diagnostic criteria of BPD and specific for BPD. Antisocial patients displayed
ASPD (Lobbestael, Arntz, & Sieswerda, 2005; the same pattern of modes, and also demon-
Paris, 1997). However, Young postulates that strated the highest level of Bully and Attack
ASPD patients display a fifth additional mal- mode, although not significantly higher than
adaptive schema mode: the Bully and Attack the borderline patients.
mode. Additionally, the Angry Protector mode,
the Conning and Manipulative mode and the
Predator mode are assumed to play a central role Elisabeth, a 33-year-old patient with a BPD,
in antisocials high in psychopathy (Bernstein & is staring with a glazed look in her eyes. When
Arntz, submitted for publication). one of the patients in the therapy group asks
her what is going on, she answers; ‘Nothing’
The third personality disorder that has been con- (Detached Protector mode). When other pa-
ceptualised in terms of schema modes is the nar- tients say that they do not believe Elisabeth,
cissistic PD (NPD). Their default mode that that it seems as if she is detached, she be-
dominates self-representation is that of the (1) comes angry and says; ‘Oh just leave me
Self-Aggrandiser. In order to deal with emotions alone. Nothing I do is right. I destroy every-
of loneliness, NPD patients switch to the (2) De- thing. I do not deserve to live. I deserve a hor-
tached Self-Soother mode. Underneath the flam- rible death instead (Punishing Parent mode)’
boyant representation, lies the (3) Lonely Child When the therapist says that it must be hor-
mode, which narcissists avoid activating in order rible to feel so bad about yourself, Elisabeth
to cover up their vulnerability (Young et al., looks at him for a moment as if she wants to
2003). Arntz and Bögels (2000) elaborated this attack him, then it seems that she will give a
model with the (4) Enraged Child mode, which cynical response, but seeing how the other
narcissists switch to as a final defence to the group members are looking at her with inter-
eliciting of the inferior position of the Lonely est, she starts to cry (Abandoned and Abused
Child, when external causes can be found that Child mode). This fragment describes how a
can be attacked and destroyed. patient switches between three modes in a
short time span in response to reactions of
Recently, mode models for five other PDs have the other group members and the therapist.
been proposed. Modes that are hypothesised to
be central in avoidant PD are the Avoidant Pro-
tector (a variant of the Detached Protector in
which avoidance is the prominent strategy), the From normality to pathology
Compliant Surrender, the Lonely Child, and the
Critical Parent. The dependent PD is thought to Schema modes are not unique markers of path-
be characterised by the Compliant Surrender, in ology; to a certain degree, everybody holds sev-
combination with the Dependent Child, and the eral modes. Rather than reflecting distinctive
Critical Parent mode. Central for the obsessive- entities, modes of healthy people and patients
compulsive PD are the modes of the Critical Par- differ in a gradual way on several dimensions.
80 Netherlands Journal of Psychology

Firstly, healthy persons have recognisable modes Participants of the study by Arntz et al. (2005)
but their feeling of a unified sense remains in- filled out a state version of the SMI before and
tact, while dissociation between modes increases after a stress induction by means of a BPD-
with the severity of pathology (Young et al., specific emotional movie fragment. Results dem-
2003). Secondly, healthy people are able to simul- onstrated that the Detached Protector mode in-
taneously experience more than one mode at the creased significantly more in the BPD group as
same time and in this way blend modes together. compared with both control groups of cluster C
Movement to another mode often occurs gradu- PDs and healthy participants. Studies like these
ally and seamlessly. In contrast, patients with that manipulate emotions in the laboratory raise
severe PDs display more sudden shifts between the likelihood of assessing true changes in emo-
pure modes and experience only one mode at a tions, rather than merely on a hypothetical or
time, for example when anger takes over the pa- cognitive level, and in a way turn ‘cold’ cogni-
tient’s personality (Bamber, 2004; Young et al., tions into ‘hot’ ones. This makes emotion induc-
2003). Furthermore, healthy persons acknow- tions very valuable for gathering information on
ledge their modes more easily than patients, and how patients would react in daily life to emo-
their modes are more adaptive, mild and flex- tions, and provide the opportunity of studying
ible. So while patients display a higher number the effect of changing environmental stimuli on
and intensity of modes, they do not generally mode switching.
display different modes than healthy people
(Young et al., 2003). This way SFT provides a less
stigmatised view of pathology; it contains the Jack, a 36-year-old patient with antisocial PD
message that everybody has different sides to who has been in prison for killing his neigh-
them but in severe pathology the balance be- bour after a fight in which he felt offended, is
tween these modes is lost. receiving therapy for partner-relation prob-
lems. Jack comes to the fourth session, well
dressed and speaking in a very friendly and
Mode switching polite manner to the therapist. When the
therapist asks how he is doing and how his
While a person is characterised by several wife is, Jack avoids the question. The thera-
schema modes, at a given moment in time, only pist, surprised at his avoidance, confronts
one mode is predominant and determines the him: ‘Jack, I believe you were telling me last
current behaviour of patients with severe path- time that you had a quarrel with your wife.
ology. This dominant mode shuts off the other Now I am asking how the two of you are get-
modes. Predominant modes can become dor- ting along, you seem to be avoiding my ques-
mant and visa versa. This altering of modes is tion.’ It appears that this remark pushes one
often experienced as a sudden and abrupt shift of Jack’s emotional buttons as Jack suddenly
and is referred to as mode switching or ‘flipping’ snaps at the therapist to mind his own busi-
(Bamber, 2004; Young et al., 2003). This phenom- ness. This patient, who first seemed so
enon explains the abrupt changes in thoughts, friendly, suddenly becomes disproportionally
feelings and behaviour often observed in BPD furious and threatening.
patients. In contrast to most patients with PDs
who are often trapped in a rigid style (e.g.
obsessive-compulsive patients), borderline pa-
tients are often in a state of flux, with rapid Assessment of modes
altering in displayed behaviour and emotions.
When switching into a specific mode, this mode Dysfunctionality of modes can be assessed in two
appears to overshadow other modes that seem to ways: by mapping their frequency and their in-
disappear. Schema modes can elicit one another, tensity. In other words; a mode can be problem-
and appear in varying strength and order, with- atic when it dominates the person most of the
out the patient having control of this. Modes are time, or when it pops up extremely intensely. In
triggered in reaction to changes in the environ- general, there are three ways of tracing schema
ment or internal cues, linked to life situations to modes in patients. First, by probing patients
which people are oversensitive or which push about problematic situations and reframing
their ‘emotional buttons’. In order words, de- their displayed behaviour, thoughts and feelings
pending on the situation, a completely different in mode terms on a cognitive level. Secondly,
side of patients can be seen (van Genderen & modes can be retrieved by means of experiential
Arntz, 2005; Young, 1990). This way, the mode exercises in which patients are guided back to
model provides a valuable explanation why, de- the past. While these two methods can only be
spite severe pathology, patients with for instance applied in therapy, the third method includes
antisocial PD can appear so normal; at that mo- self-report by means of questionnaires, and is
ment there are probably no cues causing them to also suitable for research purposes. In practice, it
flip to aggressive modes, for example. is advisable to combine these three assessment
methods. Until now, there are two instruments
available for assessing modes: the Young Atkin-
Schema modes 81

son Mode Inventory (YAMI, Young, Atkinson, which can be used whenever the therapist feels
Arntz, Engels, & Weishaar, 2005) and the Schema working with schemas alone is inadequate (Bam-
Mode Inventory-revised (SMI-r, Lobbestael, van ber, 2004).
Vreeswijk, Arntz, Spinhoven, & ‘t Hoen, 2005).
The YAMI assesses the presence of the ten cen- Schema-focused therapy blends various forms of
tral modes as proposed by Young on frequency psychotherapy such as cognitive behavioural
by means of 187 items. The SMI-r measures 16 therapy, gestalt and interpersonal therapy. When
schema modes (marked with an asterisk in the maladaptive modes are less prominent and
mode overview) by means of 270 items that have healthy modes are in control most of the time,
to be scored on a six-point Likert scale measur- cognitive and behavioural techniques such as
ing frequency and ranging from ‘never or hardly multi-dimensional evaluation, pie charts, sche-
ever’ to ‘always’. All items of the YAMI are im- mas and mode diaries, positive logbooks, flash-
bedded in the SMI-r, and additional items of the cards, role plays and behavioural experiments
SMI-r are based on the SMI (Klokman, Arntz, & can be used effectively. However, when maladap-
Sieswerda, 2001), on suggestions by Beck et al., tive modes become more prominent, experimen-
(2004) and Young et al., (2003) and clinical obser- tal techniques such as (historical) role plays and
vations. The fact that the SMI-r assesses 16 imagination (see for example Arntz & Weert-
schema modes has the incremental quality of man, 1999; van Genderen & Arntz, 2005; Young
providing information on all disorder specific et al., 2003) are indicated. Art techniques can also
modes, and increases clinical relevance. Recently, be added and can give patients the opportunity
we also developed a short version of the SMI-r in to express what they are not able to say in words,
order to make mode assessment more practical or help them to get a grip on images of safety, for
for both clinical practice and research purposes. example by hanging drawings of a safe haven in
This short SMI-r contains 125 items. In the selec- their home (see also Haeyen, 2006). Lately, ex-
tion process of items that loaded uniquely on the perimental techniques as used in mindfulness-
different subscales, not enough unique items based cognitive therapy for depression (Segal,
could be selected for two of the modes (the Williams, & Teasdale, 2002) have also been
Lonely Child and the Overcontroller). Conse- adapted and enhanced to be used in SFT (van
quently, this short SMI-r measures the presence Vreeswijk, Broersen, & Schurink, 2006). Mind-
of 14 modes. Currently, the psychometric proper- fulness techniques can make patients become
ties of the Dutch version of the SMI-r are being aware of this mode triggering in which they
studied by Lobbestael, van Vreeswijk, Arntz and automatically respond to a situation or emotion.
Spinhoven (2007) in a large population of both Patients learn to view emotions, schemas and
clinical and non-clinical participants. Prelimin- modes as (dark) clouds that come and go and
ary data of this study provide support for the which they have to accept in order to gain con-
16-factor structure of the long version of the trol. In this way the emotional affect tone be-
SMI-r and for a 14-factor structure of the short comes less severe, different coping styles can
SMI-r by means of confirmatory factor analyses. come to mind and it becomes easier to make a
Furthermore, all subscales possessed good to thoughtful decision and give an adequate
very good internal reliabilities and test-retest healthy response.
reliabilities of all subscales.

Francine is a 26-year-old woman with dys-


Schema mode therapy thymia, social anxiety disorder and an
avoidant PD. One day she did not do her
The mode model provides a valuable therapeutic therapy homework and as she comes into the
framework for the understanding of personality therapy room she immediately apologises to
pathology. This is especially the case because by the therapist. When the patient and therapist
means of modes, the variety of complaints and are exploring this response of Compliant Sur-
dysfunctional beliefs displayed by patients with render and its function to avoid confronta-
complex PDs can be clustered together, which tion, Francine makes a harsh remark to her-
makes it easier to understand them and work self for failing to do her homework. She than
therapeutically with them, and because the switches into the Detached Protector, looking
switching between the modes provides a valu- away from the therapist and not responding
able explanation for the rapid changes in to his question. When the therapist asks
cognitive-emotional-behavioural states seen in Francine if she can come up with a memory
these patients. The goal of therapy is to from her childhood where she felt the same
strengthen the healthy sides of patients, and way as she feels now, the patient makes con-
weaken the strength and impact of the maladap- tact again by mentioning a memory in which
tive modes. Therapists help patients to flip from her mother is yelling at her for not doing well
dysfunctional to healthy modes. Schema-focused enough at school. The therapist asks Francine
therapy and schema mode therapy do not reflect to think of that situation and to introduce the
two separate therapies, rather mode work is seen Healthy Adult of Francine into that memory,
as an advanced component of schema work, who is listening to what little Francine needs
82 Netherlands Journal of Psychology

A third critical point concerns the fact that


and to speak up for her against her mother. modes are composed of three levels: cognitions,
While hesitating at first, there is some relief at emotions and behaviours. Mode theory pre-
the end when Francine reflects on the exer- sumes that these three levels are so consistent
cise. For the first time in her life she has stood with each other that they change synchronically.
up for herself, not accepting the punitive So when a person flips to another schema mode,
voice of her parent. this causes equal activation of that mode’s cogni-
tions, emotions and behaviours. This assump-
tion, however, has never been empirically tested.
Research targeting anger reactivity, for example,
Critical evaluation of modes and has demonstrated that changes in different
recommendations for further studies anger-related domains are not synchronic. A
study by Lobbestael, Arntz and Wiers (in press),
A first critical point with respect to schema for example, demonstrated low correlations be-
modes is when looking at the large number of tween self-reported emotions and physiological
modes that are and that will be identified, the indices. If discrepancies like these already occur
question arises what the ultimate goal of mode in a single emotion like anger, there is a possibil-
conceptualisation should be. Is this to describe ity that this will also be the case for complex con-
the specific modes of all PDs in all their nuances, structs such as schema modes.
or to provide a limited set of basic modes that
can be used to understand PDs in more general The paucity of experimental studies on this
terms. Clearly, the first option holds the risk of topic illustrates that research on schema modes
forming a never-ending list of modes. Therefore, is still in its infancy. Clearly, further studies are
perhaps it is sufficient to determine a set of warranted. In the first place, to underpin exist-
modes that are most prevalent for the most se- ing mode conceptualisations of borderline, anti-
vere PDs, but experience so far indicates that social and narcissistic PDs. Secondly, explorative
clinicians and researchers will continue to ‘in- research in other personality disordered groups
vite’ more modes because they feel these modes is necessary in order to provide insight on modes
are required to understand specific types of per- characterising these disorders, and to assist in
sonalities. the development and conceptualisation of new
submodes that are specific for these disorders.
A recent study by Lobbestael, van Vreeswijk and Thirdly, there is a need for hard measures on
Arntz (2007) assessed which modes characterise schema modes, providing insight into how
the different PDs by means of path analyses and modes are associated with displayed behaviour
found BPD to be associated with nine schema and emotional responses. Mood inductions are
modes. Although these comprised all modes that the techniques par excellence to answer this
were a priori hypothesised to be central to BPD, validity research question. Finally, in light of
several additional modes appeared to character- therapeutic effectiveness, there is a need for rep-
ise BPD as well. This high number of modes cen- lication of large-scale studies as that by Giesen-
tral to BPD is quite surprising given the fact that Bloo et al. (2006), and implementation studies of
the mode concept was developed because espe- SFT (as is currently being performed by Nadort,
cially borderline patients recognised so many 2006). Also, research into therapy effectiveness of
schemas that it was difficult to pinpoint specific SFT for other PDs besides borderline (currently
therapy goals. Thus, modes were developed to being conducted by Bamelis and Arntz, 2006, for
provide a more comprehensive clustering of the paranoid, histrionic, narcissistic, dependent,
these schemas and coping methods, narrowing avoidant and obsessive-compulsive PDs) and for
down the number of them. Since it appears that SFT group therapy (see van Vreeswijk & Bro-
borderline patients are also characterised by so ersen, 2006, for protocol) is warranted.
many modes, the question arises whether the
mode concept indeed simplifies the cognitive
conceptualisation of borderline patients.

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84 Netherlands Journal of Psychology

Appendix A: List of the 22 schema modes

Child modes Lack of discipline

Vulnerability Impulsive Child*


Acts on non-core desires or impulses from mo-
Lonely Child* ment to moment in a selfish or uncontrolled
Feels like a lonely child that is valued only inso- manner to get his or her own way, without re-
far as (s)he can aggrandise his/her parents. Be- gard to possible consequences for the self or
cause the most important emotional needs of the others. Often has difficulty delaying short-time
child have generally not been met, the patient gratification and may appear ‘spoiled’.
usually feels empty, alone, socially unacceptable,
undeserving of love, unloved and unlovable. Undisciplined Child*
Cannot force him/herself to finish routine or
Abandoned and Abused Child* boring tasks, gets quickly frustrated and soon
Feels the enormous emotional pain and fear of gives up.
abandonment, which has a direct link with the
abuse history. Has the affect of a lost child: sad, Happiness
frightened, vulnerable, defenceless, hopeless,
needy, victimised, worthless and lost. Patients Happy Child*
appear fragile and childlike. They feel helpless Feels at peace because core emotional needs are
and utterly alone and are obsessed with finding a currently met. Feels loved, contented, connected,
parent figure who will take care of them. satisfied, fulfilled, protected, praised, worth-
Humiliated/Inferior Child. A subform of the Aban- while, nurtured, guided, understood, validated,
doned and Abused Child mode, in which pa- self-confident, competent, appropriately au-
tients experience humiliation and inferiority tonomous or self-reliant, safe, resilient, strong,
related to childhood experiences within and out- in control, adaptable, optimistic and spontane-
side the family. ous.

Dependent Child
Feels incapable and overwhelmed by adult re- Maladaptive coping modes
sponsibilities. Shows strong regressive tenden-
cies and wants to be taken care of. Related to the Surrender
lack of development of autonomy and self-
reliance, often caused by authoritarian upbring- Compliant Surrender*
ing. Acts in a passive, subservient, submissive,
reassurance-seeking, or self-deprecating way
Anger towards others out of fear of conflict or rejec-
tion. Passively allows him/herself to be mis-
Angry Child* treated, or does not take steps to get healthy
Feels intensely angry, enraged, infuriated, frus- needs met. Selects people or engages in other
trated or impatient, because the core emotional behaviour that directly maintains the self-
(or physical) needs of the vulnerable child are not defeating schema-driven pattern.
being met. They vent their suppressed anger in
inappropriate ways. May make demands that Avoidance
seem entitled or spoiled and that alienate others.
Detached Protector*
*
Enraged Child Withdraws psychologically from the pain of the
Experiences intense feelings of anger that result schemas by emotionally detaching. The patient
in hurting or damaging people or objects. The shuts off all emotions, disconnects from others
displayed anger is out of control, and has the and rejects their help, and functions in an almost
goal of destroying the aggressor, sometimes lit- robotic manner. Signs and symptoms include
erally. Has the affect of an enraged or uncontrol- depersonalisation, emptiness, boredom, sub-
lable child, screaming or acting out impulsively stance abuse, bingeing, self-mutilation, psycho-
to an (alleged) perpetrator. somatic complaints and ‘blankness’.

Detached Self-Soother*
Shut off their emotions by engaging in activities
that will somehow soothe, stimulate or distract
them from feeling. These behaviours are usually
undertaken in an addictive or compulsive way,
* These modes are enlisted in the Schema-Mode Inventory- and can include workaholism, gambling, dan-
Revised (Lobbestael, van Vreeswijk et al., 2005). gerous sports, promiscuous sex, or drug abuse.
Schema modes 85

Another group of patients compulsively engage Predator mode


in solitary interests that are more self-soothing Focuses on eliminating a threat, rival, obstacle,
than self-stimulating, such as playing computer or enemy in a cold, ruthless, and calculating
games, overeating, watching television, or fanta- manner.
sising.
Attention and Approval Seeker
Angry Protector Tries to get other people’s attention and ap-
Uses a ‘wall of anger’ to protect him/herself from proval by extravagant, inappropriate, and exag-
others who are perceived as threatening and gerated behaviour. Usually compensates for
keeps others at a safe distance through displays underlying loneliness.
of anger.
Maladaptive Parent modes
Overcompensation
Punitive Parent*
*
Self-Aggrandiser This is the internalising voice of the parent, criti-
Behave in an entitled, competitive, grandiose, cising and punishing the patient. They become
abusive, or status-seeking way in order to have angry with themselves and feel that they deserve
whatever they want. They are almost completely punishment for having or showing normal
self-absorbed, and show little empathy for the needs that their parents did not allow them to
needs or feelings of others. They demonstrate express. The tone of this mode is harsh, critical,
superiority and expect to be treated as special and unforgiving. Signs and symptoms include
and do not believe they should have to follow the self-loathing, self-criticism, self-denial, self-
rules that apply to everyone else. They crave for mutilation, suicidal fantasies, and self-
admiration and frequently brag or behave in a destructive behaviour.
self-aggrandising manner to inflate their sense
of self. Demanding/Critical Parent*
Continually pushes and pressures the child to
Overcontroller* meet excessively high standards. Feels that the
Attempts to protect him/herself from a per- ‘right’ way to be is to be perfect or achieve at a
ceived or real threat by focussing attention, ru- very high level, to keep everything in order, to
minating, and exercising extreme control. Two strive for high status, to be humble, to put other
subforms can be distinguished: needs before one’s own or to be efficient or avoid
Perfectionistic Overcontroller. Focuses on perfec- wasting time. The person feels that it is wrong to
tionism to attain control and prevent misfortune express feelings or to act spontaneously.
and criticism.
Suspicious Overcontroller. Focuses on vigilance,
scanning other people for signs of malevolence, Healthy Adult mode*
and controls others’ behaviour out of suspicious-
ness. This mode performs appropriate adult functions
such as working, parenting, taking responsibil-
Bully and Attack* ity, and committing. Pursues pleasurable adult
Directly harms other people in a controlled and activities such as sex, intellectual, esthetical, and
strategic way emotionally, physically, sexually, cultural interests, health maintenance, and ath-
verbally, or through antisocial or criminal acts. letic activities.
The motivation may be to overcompensate for or
prevent abuse or humiliation. Has sadistic prop-
erties.

Conning and Manipulative mode


Cons, lies, or manipulates in a manner designed
to achieve a specific goal, which either involves
victimising others or escaping punishment.