日本行動療法学会 第35回研修会

Schema Mode Work
Young Hee Choi

Director:Mettaa Institute of Cognitive Behavior Therapy & Schema Therapy



During past 20 years of my own clinical experience, I learned so called evidence-based psychotherapeutic approaches and applied them to my patients. Sometimes the result was good and sometimes not. Fortunately, I have been able to find the solution whenever I had encountered treatment-resistant cases. Most of treatment-resistant cases were related with personality problems.
 We usually call them Axis II problems. I could always find the mechanism that the underlying contents are tightly connected with superficial symptoms which complained by the patient. Whatever names were labeled to those underlying contents, I needed the solution which could directly target those contents that control all kind of one’s response.
 Among the various solutions, I can rate Schema Therapy as best solution. As a certified schema therapist, I owe Dr. Jeffrey Young a lot. That is why I choose to cite the summary of ‘Schema Mode Work’ chapter in Jeff’s excellent book Schema Therapy: A practitioner’s guide as my abstract of workshop at 37th JABT annual conference.
 A mode is the set of schemas or schema operations (adaptive or maladaptive) that are currently active for an individual. The concept of a mode was developed by Jeffrey Young and his colleagues as they focused the model on patients with increasingly severe disorders, especially those with BPD and narcissistic personality disorder. Although mode work was originally developed to treat these types of patients, it is used with many of higher functioning patients as well. Mode work has become an integral part of schema therapy
 A therapist can shift from a schema approach to a mode approach when the therapy seems stuck and the patient’s avoidance or overcompensation cannot be broken through. A mode approach might also work when the patient is rigidly self-punitive and self-critical or has a seemingly unresolvable internal conflict. Finally, therapist generally emphasizes modes with patients who display frequent fluctuations in affect, such as often occur with patients with BPD.
 Four main types of modes (Child modes, Maladaptive Coping modes, Dysfunctional Parent modes, and the Healthy Adult mode) were identified. Each type of mode is associated with certain schemas (except the Healthy Adult and Happy Child) or embodies certain coping styles.
Building the patient’s Healthy Adult to work with the other modes more effectively is the overarching goal of mode work. Like a good parent, the Healthy Adult mode serves the following three basic functions: (1) nurturing, affirming, and protecting the Vulnerable Child; (2) setting limits for the Angry Child and the Impulsive/Undisciplined Child, in accordance with the principles of reciprocity and self-discipline; and (3) battling or moderating the Maladaptive Coping and Dysfunctional Parent modes. During the course of treatment, patients internalize therapist’s behavior as part of their own Healthy Adult mode. Initially, the therapist serves as the Healthy adult whenever the patient is incapable of doing do. Gradually the patient takes over the Healthy Adult role.
 Participants of this workshop would learn seven general steps on schema mode work: (1) identify and label the patient’s modes; (2) explore the origin and (when relevant) adaptive value of the mode in childhood or adolescence; (3) link maladaptive mode to current problems and symptoms; (4) demonstrate the advantages of modifying or giving up one mode if it is interfering with access to another mode; (5) access the Vulnerable Child through imagery; (6) conduct dialogues among the modes; (7) help the patient generalize mode work to life situations outside therapy sessions.

 Young, J., Klosko, J., Weishaar M. (2003) Schema Therapy: A practitioner’s guide. The Guilford Press.
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