The Wiley-Blackwell Handbook of Schema Therapy (Theory, Research, and Practice) || Theoretical Model

2

Theoretical Model Schemas, Coping Styles, and Modes

Hannie van Genderen , Marleen Rijkeboer and Arnoud Arntz

Schemas hold a prominent position in modern psychotherapies, especially those in which there is attention to chronic personality - related disorders. There is a long history behind the concept of a schema. The defi nitions that are used within the current cognitive therapies were created in the 1980s, infl uenced by constructivism (see Rijkeboer, van Genderen and Arntz, 2007 ).

Well - known clinic - oriented scientists, such as Beck, Segal, and Young, developed explanatory models for psychopathology, with schemas and related concepts such as schema processes, coping styles, and schema modes as central parameters. In the meantime, use of the term “ schema ” has become widespread within the psycho-therapy world and is growing. Across the diverse schema theories, many defi nitions are used, resulting in just as much obfuscation (see James, Southam and Blackburn, 2004 ). The terms “ coping style ” and “ mode ” also have several defi nitions. This chapter will explain these concepts, as defi ned by Young, Klosko, and Weishaar (2003, 2005) . However, Young ’ s schema approach continues to develop. In a forum of therapists and researchers, the discussion now is about the nature of the different concepts and their mutual relationships. This chapter will therefore conclude with a short summary of the main issues.

In Practice

Early m aladaptive s chemas

The term schema comes from data processing theory, which states that information is ordered in our memory thematically (Williams, Watts, MacLeod and Mathews, 1997 ; Vonk, 1999 ). The idea is that experiences are saved in our autobiographic memory by way of schemas from the fi rst years of life (Conway and Pleydell - Pearce,

The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research, and Practice, First Edition. Edited by Michiel van Vreeswijk, Jenny Broersen, Marjon Nadort.© 2012 John Wiley & Sons, Ltd. Published 2012 by John Wiley & Sons, Ltd.

28 The Wiley-Blackwell Handbook of Schema Therapy

2000 ). Schemas consist of sensory perceptions, experienced emotions and actions, and the meaning given to them, such that early childhood experiences are memorized non - verbally (Young et al ., 2005 ; Arntz, van Genderen and Wijts, 2006 ; Rijkeboer et al ., 2007 ). In addition, schemas function as fi lters through which people order, interpret, and predict the world. Most people have developed schemas that help them to better understand themselves, the behavior of others, and events in the world. This enables them to develop a positive self - image and a differentiated image of others, and to solve problems adequately. People with personality problems have developed maladaptive schemas and therefore handle life less well. According to Young et al . (2005) , these maladaptive schemas are developed at an early age as a result of the interactions between factors such as the temperament of the child, the parenting style of the parents, and any signifi cant (sometimes traumatic) experiences (see Figure 2.1 ). With this hypothesis, Young et al . (2005) proposed a development model of personality and psychopathology in which Bowlby ’ s attachment theory (1988) plays an important role. They hypothesize that maladaptive schemas refl ect the unfulfi lled yet important emotional needs of the child and represent adaptations to negative experiences, for example, family quarrels, rejection, hostility, or even aggression from parents/educators and peers, lack of love and warmth, and inade-quate parental care and support. Research has shown that infl uences from relation-ships are important for the emotional development of the child, and disturbances can lead to a deregulation of emotions (Maughan and Cicchetti, 2002 ; Cohen, Crawford, Johnson and Kasen, 2005 ). The development of a personality pathology is often linked to traumatic events (e.g., violence or abuse; Grover, Carpenter, Price, Gagne, Mello and Tyrka, 2007 ), but a constant pattern of negative or inadequate reactions toward a child can also lead to the development of pathology (Johnson, Cohen, Kasen, Smailes and Brook, 2001 ). Although maladaptive schemas are normally adap-

Figure 2.1 Origin of maladaptive schemas

Temperament

Influence of

parents

Maladaptive

schemas

Maladaptive

coping styles

Symptoms and

problems

Traumatic

events

Theoretical Model: Schemas, Coping Styles, and Modes 29

tive in early childhood, and endorsed by the circumstances, it is assumed that they also interfere to a considerable extent with completing the developmental tasks well. This can lead to continuous negative experiences, which means that the schema becomes more and more worn and rigid. Whilst the infl uence of the temperament of the child should not be exaggerated, one child can be more “ bothered ” by a certain education than another (Gallagher, 2002 ). Furthermore, temperament itself appears to be infl uenced by factors such as the environment and the regulation styles that the child develops.

The more someone has problems in a certain area, and the more severe the expe-rienced traumatic events are, the more rigid and strong certain beliefs will be, and the more the subject will be troubled by it in his current life. Schemas are more or less active or infl uential at any one time. When circumstances show similarities with situations that have led to the development of the schema, then that schema will come to the fore. A subject with the Defectiveness/Shame schema may be troubled very little by this schema in a situation in which he is surrounded by good friends and his work is relatively stable. But as soon as he starts to have diffi culties with his friends, or when there is a lot of uncertainty at work (e.g., in the event of company restructuring), the dormant schema will become active and the subject may start to have, for example, symptoms of depression. This may complicate the search for schemas, especially if the patient has also developed ways of avoiding being disturbed by his schemas. A patient with the Defectiveness/Shame schema can, for instance, avoid this by choosing a job in which he runs little risk of criticism and by building a circle of friends who are non - judgmental. In other words, a person not only has schemas, but also strategies to avoid being bothered by them (see coping styles).

Describing the Schemas

In the original version of the Young Schema Questionnaire (YSQ) (Young and Brown, 1994 ; Dutch translation and adaption: Sterk and Rijkeboer, 1997 ), 16 schemas were defi ned. In Young et al . (2005) , 18 schemas were described, and the Social Undesirability schema had been dropped (see Part V, Chapter 3 ). For prag-matic reasons, all 19 schemas are described here (see Table 2.1 , Part VI Chapter 4), even though some (indicated by an asterisk) must still be investigated with regard to their psychometrical qualities.

Coping Styles

Maladaptive schemas are often maintained because the patient avoids situations that could correct them, or because he is looking for people who will confi rm his schemas, and/or because he has no eye for information that would nuance his schemas. The patient learned to behave like this in childhood, in order to survive diffi cult or threatening situations. At the time that may have been the best way to deal with these kinds of situations, but in the patient ’ s current life, this behavior may be far from optimal and it serves to maintain the schemas. There are three ways in which one can deal with schemas, or coping styles: Surrender, Avoidance, and

Table 2.1 Schemas

Emotional Deprivation

The patient expects that others will never or not adequately meet his primary emotional needs (e.g., for support, nurturance, empathy, and protection). He feels isolated and lonely.

Abandonment/Instability

The patient expects that signifi cant others will eventually abandon him. Others are unreliable and unpredictable in their support and connection. When the patient feels abandoned he switches between feelings of anxiety, grief, and anger.

Mistrust and/or Abuse

The patient is convinced that others will intentionally abuse him in some way or that they will cheat or humiliate him. These feelings vary greatly and the patient is continuously on edge.

Social Isolation/Alienation

The patient feels isolated from the world and believes that he is not part of any community.

Defectiveness/Shame

The patient believes that he is internally fl awed and bad. If others get close, they will realize this and withdraw from the relationship. The feeling of being worthless often leads to a strong sense of shame.

Social Undesirability

The patient believes that he is socially inept and physically unattractive. He sees himself as boring, dull, and ugly.

Failure The patient believes that he is incapable of performing as well as his peer group. He feels stupid and untalented.

Dependence/Incompetence

The patient feels extremely helpless and incapable of functioning independently. He is incapable of making day - to day decisions and is often tense and anxious.

Vulnerability to Harm and Illness

The patient believes that imminent catastrophe will strike him and signifi cant others, and that he is unable to prevent this.

Enmeshment/Undeveloped Self

The patient has an excessive emotional involvement and closeness with one or more signifi cant others (often his parents), as a result of which he cannot develop his own identity.

Subjugation The patient submits to the control of others in order to avoid negative consequences. The patient ignores his own needs because he fears confl ict and punishment.

Self - Sacrifi ce The patient focuses on voluntarily meeting the needs of others, whom he considers weaker than himself. If he pays attention to his own needs, he feels guilty, and he gives priority to the needs of others. Finally, he becomes annoyed with the people he is looking after.

Approval - Seeking * The patient focuses excessively on gaining recognition, approval, and attention, at the expense of his own development and needs.

Emotional Inhibition

The patient inhibits emotions and impulses because he believes that any expression of feelings will harm others or lead to embarrassment, retaliation, or abandonment. He lacks spontaneity and stresses rationality.

Unrelenting Standards/Hypocritical

The patient believes that whatever he does is not good enough and that he must always strive harder. He is hypercritical of himself and others, and he is a perfectionist, rigid, and extremely effi cient. This is at the expense of pleasure, relaxation, and social contacts.

Negativity and Pessimism *

The patient is always focused on the negative aspects of life and ignores or plays down the positive aspects. He is frequently anxious and hyper - alert.


Punitiveness * The patient believes that people should be harshly punished for making mistakes. He is aggressive, intolerant, impatient, and unforgiving.

Entitlement/Grandiosity

The patient believes that he is superior to others and entitled to special rights. He insists that he should be able to do or have what he wants, regardless of what others think. The core theme is power and being in control of situations or people.

Insuffi cient Self - Control/Self - Discipline

The patient has no tolerance of frustration and is unable to control his feelings and impulses. He cannot bear dissatisfaction or discomfort (pain, confl icts, or overexertion).

* = Schemas that are not in the YSQ.

Table 2.1 (Continued)

Over - Compensation. In the short term, these coping styles often provide some relief, but in the long run, they lead to diffi culties in essential areas of life. Using a coping style is generally not a conscious choice, but an automatic reaction to a threatening or diffi cult situation. Coping styles may be particularly visible in the behavior of the patient, but they also contain cognitive transformations.

Surrender (to the s chema). The patient gives in to his schema and adapts his feelings and thoughts to this end:

BEHAVIOR: Repeating behavioral patterns from childhood by looking for people and situations that are similar to the circumstances that led to the forming of the schema.

THOUGHTS: Selective processing of information, i.e., seeing only the information that corresponds with the schema and not the information that diminishes the schema.

FEELINGS: The emotional pain of the schema is felt directly.

Avoidance (Schema - a voiding b ehavior). The patient avoids activities that trigger the schema and the emotions that accompany it. The result is that the schema is not open to discussion and it becomes impossible to have a corrective experience.

BEHAVIOR: Active and passive avoidance of all kinds of situations that could trigger the schema.

THOUGHTS: Denial of events or memories, depersonalization or dissociation. FEELINGS: Smoothing over feelings or feeling nothing at all.

Over - Compensation (Showing the o pposite b ehavior in o rder to fi ght the s chema)

The patient behaves, as much as possible, in the opposite direction from the core of his schema, in order not to be bothered by it. This leads to an underestimation of the infl uence that a schema can have, and also often to excessively assertive, aggres-sive, or independent behavior.


Normally, patients have only one coping style. Although a coping style such as Surrender can be dominant, in the course of time, you can see a patient adopting other coping styles as well. Surrendering to the Self - Sacrifi ce schema for a long period and in a very intense manner, in which thoughts about the wishes and interest of others are prominent, fi nally leads to exhaustion and a growing need to see their own needs fulfi lled for once. Accordingly, this can lead to a (probably short) period of Over - Compensation. Sometimes the patient can strive for his own aims in an aggressive way, without having any consideration for others. Switching from Surrender to Over - Compensation is more abrupt and more strongly visible in severe forms of psychopathology (see Elliott and Kirby Lassen, 1999 ). If it all becomes too much, the patient may try to escape from the strong feelings that evoke Surrender or Over - Compensation by Avoidance. The patient may then, for instance, avoid situations in which something could be asked of him. He cannot keep this up for ever, so at some point this takes him back to Surrender or Over - Compensation. In this way, each of these coping styles leads to the maintenance of the schema.

BEHAVIOR: Showing behavior that is opposite (often exaggerated) to the schema. THOUGHTS: Thoughts are opposite to the content of the schema as well. The patient

denies that he has the schema. FEELINGS: The patient masks uncomfortable feelings belonging to the schema with

opposite feelings (e.g., power as a cover for powerlessness; pride as a cover for a sense of inferiority). However, the uncomfortable feelings may return if the over - compensation fails.

Three k inds of c oping s tyles

Proceeding from the Abandonment/Instability schema, someone decides never to enter into a relationship again (avoidance). He thus gains temporary relief, because no one can hurt him by leaving him. However, in the long run, he becomes very lonely, because he avoids all intimacy.

If he decides to compensate for his Over - Compensation schema, he starts looking for the “ perfect relationship ” with someone who will never abandon him. During the initial period of being in love, he might succeed, but after a while, when the partner wants to have more autonomy, he will claim the other person and demand constant availability. There is a good chance that the partner will not be able to tolerate this and will leave him. This way, the schema is confi rmed.

If he submits to the Surrender schema, he settles for a relationship that offers him insuffi cient support and security (e.g., with a partner who is often unfaith-ful or a on/off relationship). In a sense, this feels familiar, but in the long run, the patient remains lonely and unhappy.


Schema Modes

It appears that, particularly with the more complex personality problems, patients recognize themselves in many different schemas and in addition, deal with diverse coping styles in a fl exible way. Therefore, mood and behavior changes can often occur within a very short period of time. This observation has resulted in the development of a so - called “ schema mode model ” for borderline personality dis-order (and later also the narcissistic personality disorder by Young et al ., 2005 ). According to Young et al . (2005) , schema modes are the instantaneous, continu-ously changing, but dominant states of mind a patient can fi nd himself in. Whereas schemas are stable ( “ trait ” ), modes are short - term situations ( “ state ” ). And whereas a schema represents a one - dimensional theme (e.g., Defectiveness/Shame), a schema mode refl ects a constellation of schemas and coping styles that are active at that moment (the Vulnerable Child, for example, consists of the Defectiveness/Shame schema and Emotional Deprivation; Lobbestael, van Vreeswijk and Arntz, 2007 ).

Schema modes, just like schemas, are not only present in people with a personality disorder, but play a role in everyone. The difference is the degree to which the modes operate independently from each other as well as their strength.

The healthier a person is, the more independent the modes are, and the less the maladaptive modes dominate. In an unpleasant situation, a healthy person can experi-ence grief, anger, and the tendency not to think about it more or less simultaneously, and can control and integrate these emotions and this behavior. Someone with a personality disorder has much more diffi culty. However, schema modes are never completely distinct from each other, so there is the idea of the patient having discrete parts. A schema mode is a state that is prominent at a certain moment. In the case of a patient with a few maladaptive modes, one mode is prominent, but the other modes remain in the background (see “ simultaneous chess playing in a pinball machine, ” in Arntz and van Genderen, 2009 ).

After the development of a mode model for borderline and narcissistic personality disorder (Young et al ., 2003 ), a similar mode model for the other personality disor-ders was developed. However, these models are still in an experimental stage (Bernstein, Arntz and de Vos, 2007 ; Lobbestael et al ., 2007 ; Arntz, 2010 ; and see Part IV, Chapter 12 and Part VI, Chapter 2 ).

In Table 2.2 , the modes that have been developed thus far are described. A number of modes have been investigated by Lobbestael et al . (2007) , in terms of their psy-chometric qualities, and some are still in the experimental stage (Arntz et al ., 2009 ; Arntz, 2010 ). These last modes are, among other things, based on experiences with patients with both forensic problems and Cluster C personality disorders.

Because more research into the existence of modes in BPD has been con-ducted, and because the effi cacy of ST with regard to these problems has been studied intensively (Young et al ., 2003 ; Giesen - Bloo et al ., 2006 ; Arntz, 2007 ; Arntz and van Genderen, 2009 ), the mode model for this disorder is described in detail.

Table 2.2 Schema modes

Child modes

Vulnerable Child The patient believes that nobody will fulfi ll his needs and that everyone will eventually abandon him. He mistrusts others and believes that they will abuse him. He feels worthless and expects rejection. He is ashamed of himself and he often feels excluded. He behaves like a small, vulnerable child that clings to the therapist for help, because he feels lonely and believes there is danger everywhere.

Angry Child The patient feels intensely angry, enraged, and impatient because his core needs are not being met. He can also feel abandoned, humiliated, or betrayed. He expresses his anger in extreme manifestations, both verbal and nonverbal, just like a small child who has an outburst of anger.

Enraged Child The patient feels enraged for the same reason as the Angry Child, but loses control. This is expressed in offensive and injurious actions toward people and objects, in the same way as a small child hurts his parents.

Impulsive Child The patient wants to satisfy his (non - core) desires in a selfi sh and uncontrolled manner. He cannot control his feelings and impulses and he becomes enraged and infuriated when his (non - core) desires or impulses are not met. He often behaves like a spoiled child.

Undisciplined Child

The patient has no tolerance of frustration and cannot force himself to fi nish routine or boring tasks. He cannot bear dissatisfaction or discomfort (pain, confl ict, or overexertion) and he behaves like a spoiled child.

Happy Child The patient feels loved, satisfi ed, protected, understood, and validated. He is self - confi dent and feels competent, appropriately autonomous, and in control. He can react spontaneously, is adventurous and optimistic, and plays like a happy, young child.

Maladaptive coping Modes Compliant

Surrender The patient devotes himself to the desire of others in order to avoid

negative consequences. He suppresses his own needs or emotions and bottles up his aggression. He behaves subserviently and passively, and hopes to gain approval by being obedient. He tolerates abuse from other people.

Detached Protector

The patient cuts off strong feelings because he believes that such feelings are dangerous and can get out of hand. He withdraws from social contacts and tries to cut off his feelings (sometimes this leads to dissociation). The patient feels empty, bored, and depersonalized. He may adopt a cynical or pessimistic attitude to keep others at arm ’ s length.

Detached Self - Soother

The patient seeks distraction in order not to feel negative emotions. He achieves this by self - soothing behavior (e.g., sleeping or substance abuse) or by self - stimulating activities (being fanatical or occupied with work, the internet, sport, or sex).

Child modes

Over - Compensator Modes Self - Aggrandizer The patient believes that he is superior to others and entitled to

special rights. He insists that he should be able to do or have what he wants, regardless of what others think. He shows off and denigrates others to augment his self - esteem.

Bully and Attack The patient wants to prevent being controlled or hurt by others, and therefore he tries to be in control of them. He uses threats, intimidation, aggression, and force to this end. He always wants to be in a dominant position, and takes sadistic pleasure in hurting others.

Maladaptive parent Modes Punitive Parent The patient is aggressive, intolerant, impatient, and unforgiving toward

himself. He is always self - critical and feels guilty. He is ashamed of his mistakes and believes he has to be punished severely for them. This mode is a refl ection of what (one of) the parents or other educators used to say to the patient in order to belittle or punish him.

Demanding Parent

The patient feels that he must fulfi ll rigid rules, norms, and values. He must be extremely effi cient in meeting these. He believes that whatever he does is never good enough and that he must strive harder. Therefore, he pursues his highest standard until it is perfect, at the expense of rest and pleasure. He is also never satisfi ed with the result. These rules and norms are also internalized by (one of) the parents.

Healthy mode Healthy Adult The patient has positive and neutralized thoughts and feelings about

himself. He does things that are good for him and this leads to healthy relationships and activities. The Healthy Adult mode isn ’ t maladaptive.

Modes not yet investigated Angry Protector The patient uses a wall of anger to protect himself against others,

considered to be a threat. He keeps others at a safe distance with great displays of rage. However, his anger is more under control than that in the Angry or Enraged Child.

Obsessive Over - Controller

The patient tries to protect himself against supposed or actual threats by keeping everything under extreme control. He uses repetitions or rituals to achieve this.

Paranoid The patient tries to protect himself against supposed or actual threats by containing others and exposing their real intentions.

Conning and Manipulative

The patient cheats, lies, or manipulates in order to achieve a specifi c aim, the purpose of which is to victimize others or to avoid punishment.

Predator The patient eliminates threats, rivals, obstacles, or enemies in a cold, ruthless, calculating way.

Attention - Seeker The patient tries to obtain the approval and attention of others by exaggerated behavior, erotomania, or grandiosity.

Table 2.2 (Continued)


Mode Model in Borderline Personality Disorders

In order to meet the diagnosis borderline personality disorder, a patient must score on fi ve out of nine criteria of the DSM - IV (American Psychiatric Association, 1994 ). Nevertheless, this descriptive diagnosis doesn ’ t provide an explanatory model for the disorder. These patients have a number of characteristics in common, namely switching moods, problems with relationships, and uncertainty about their identity. Therefore, most patients aren ’ t capable of completing their studies, fi nding suitable work, or entering into a stable relationship. The means of expression can be very different. One patient with a BPD may have many confl icts with the people around him, while another often withdraws and lives in a very iso-lated manner. By looking at the combination of schemas and coping styles, the therapist can get a better insight into this. Translating this information into a mode model makes the problems more understandable for the therapist and the patient.

The modes in a borderline personality disorder are:

Linda is 21 years old when she is treated for her borderline personality disorder. She comes from a family of fi ve children, in which, in particular, the two youngest children were neglected because the parents were alcohol-ics and couldn ’ t handle the large family. Her parents were often verbally abusive and sometimes also physically abusive. Linda was more or less raised by her eldest sister, but when Linda was 10 years old, her sister left home. From that moment on, Linda ’ s brother started to abuse her sexually. In order to keep this a secret, he threatened her and said that their parents wouldn ’ t believe her anyway and that they would call her a whore. Linda has lived away from home for a year, and she dropped out of school after six months. At the moment, she lives on social security. To earn some money, she occasionally works in a coffee shop. She smokes a lot of can-nabis. When she is desperate, she cuts her arms and legs. Recently, she made a suicide attempt.

The therapist tries to fi nd out who it was who said all those negative things about her, and so who modelled the Punitive Parent. In Linda ’ s case, this was, in particular, her mother and her brother. Linda calls this “ my punitive side ” and she draws a very big ball, because it exerts the most control over her life. She calls the Detached Protector “ ways to feel nothing ” and this mainly consists of smoking cannabis and sleeping. At a very young age, Linda learned that she could protect herself best by going to her bedroom and locking the door. The thick lines between the Protector and the three other modes indicate that she feels a wall around her when she smokes cannabis or hides in her bed, through which she feels little, but is also not bothered by the Punitive Parent. Little Linda is bigger than angry Linda, because she isn ’ t angry very often.


• Vulnerable Child • Angry Child • Punitive Parent • Detached Protector • Healthy Adult

On the basis of the information obtained, the therapist and the patient make a mode model together in which the different modes are described as much as possible in the patient ’ s own words. The patient can refl ect on the degree to which the mode infl uences his life by drawing a bigger or smaller ball. He can also draw lines or arrows, which may clarify the model for him. In Figure 2.2 , a mode model is shown which was made with the patient Linda.

The information about the schemas isn ’ t put into the model, but it is important for the therapist to know which schemas play a role in each mode, so he knows which emotions and thoughts play a role if the patient is in a certain mode. The same goes for the information about the life history and therefore the origin of the modes (see also Part II, Chapter 6 ).

Ways to feelnothingBlowing

Laying in bed

Feeling nothing

Talking about

nothing

Little LindaI am nothing

Suspicious and afraid

Fear of abandonment

Doesn’t dare to express needs

and feelings

Angry LindaUnexpected outbursts of anger

when someone disappoints me

or abandons me.

Punitive sideYou are stupid and ugly and you

deserve to be punished (self-injurious

behavior)

You are a whore

Everything that goes wrong is your

own fault

HealthyAdult

Figure 2.2 Linda ’ s schema mode model


Current Situation and the Future

In the meantime, there is a distinction within the schema - focused approach between adherents of the schema model and those of the schema mode model. Schemas and schema modes are worked with both within clinical practice and scientifi c practice, and there is a lot of discussion about these concepts.

Within clinical practice, most therapists work particularly with schemas and coping styles, but with borderline and narcissistic personality disorders they also use a mode model. The latest development is to use the mode model for other personality dis-orders, but this is still in an experimental stage. The participants in the treatment studies of Arntz report that they can work well with these new mode models and that the patients recognize themselves well in these models.

Within scientifi c practice, research is carried out regarding newly developed con-cepts within each model. The study of and the developments within both models seem to be carried out relatively separately. But is it correct to design these two movements so independently of each other?

The mode model was established because patients with more severe (and in an emotional perspective, stronger) forms of psychopathology normally present with a complexity of simultaneously active schemas and varying coping styles, so that a transparent analysis of the problems is complicated. The mode model simplifi es this, since the unit of analysis – the mode – is a combination of active schemas and coping styles. However, Lobbestael et al . (2007) showed that in the case of bor-derline patients, there are, once again, many modes that play a role. It appears that the mode model does not prevail in terms of frugality. Furthermore, more and more modes are being identifi ed (at the time of writing 14 have been researched and seven proposed), something that is also found within the schema model. The ques-tion arises: is there really that much difference between the schemas and coping styles on the one hand, and modes on the other hand? Aren ’ t most child modes similar to the surrender to, or over - compensation of, core schemas such as: Emotional Deprivation, Abandonment/Instability, Mistrust and/or Abuse, or Insuffi cient Self - Control/Self - Discipline? Aren ’ t the maladaptive coping modes the surrender to schemas that originated as a reaction to the core schemas (e.g., isn ’ t the Compliant Surrender the submission to the Subjugation schema)? Similarly, can the Bully and Attack mode not be seen as over - compensation of the Mistrust and/or Abuse schema?

Furthermore, it can be noted that a part of the modes includes externalizing problems. This is partly due to the fact that a number of modes were developed as an explanation for personality problems such as those described in the forensic fi eld. In line with this, Rijkeboer (2005) , in her analysis of the schema inventory, states that the existing set of schemas particularly represent internalizing problems. She therefore concludes that an extension of the set might be necessary, for instance with schemas that are more externalizing in nature.

These practically parallel developments illustrate that schemas and schema modes should cover a broad range of personality problems, and that both concepts are prob-ably more related to each other than fi rst assumed. At the moment, there are several initiatives underway, led by different researchers, to shed more light on this subject.


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Documents

The Wiley-Blackwell Handbook of Schema Therapy (Theory, Research, and Practice) || Theoretical Model