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The mode model
By means of questionnaires (e.g. the mode questionnaire, SMIr), through clinical observation and partly also through imaginations used diagnostically, an individual mode concept is created for each patient at the beginning of treatment. As on a map, his primary parent and child modes are shown in a right column and his coping modes are shown in a left column (see Fig. 3)
Fig. 3: Mode concept Laura T.
Interventions used in schema therapy can be divided into four classes:
In schema therapy, the model is transparent and fully explained to the patient. The individual mode concept is worked out together with the patient and the therapy plan is discussed. Psychoeducationally, information from the theory of emotions, social psychology, evolutionary theory and neurobiology is given. (Socratic) schema dialogues or cognitive testing of dysfunctional coping strategies, pro and contra lists, memo cards, diaries are important.
The schema therapist works with (mode) behavioral analyzes, the entire repertoire of behavioral therapy for the gradual change in dysfunctional behavior, homework (with behavioral analysis if it could not be carried out).
Emotion activating interventions
Imaginations and chair work play a special role in schema therapy. Imaginations are used on the one hand for scheme / mode identification and in the sense of "Imagery Reprocessing and Rescripting Therapy (IRRT)" for scheme / mode change.
In the imagination, the patient moves with his eyes closed on the way back through a current, emotionally charged scene to an emotionally analogous childhood scene. In this scene, reported in the present tense and cognitively / emotionally / sensorially detailed, on the one hand the failure of basic needs can be re-experienced and thus the origin of today's emotion can be understood, on the other hand the scene can also be imaginatively changed and "rewritten" in the sense of catching up on needs Patients receive new degrees of freedom for today's actions.
In particular, vulnerable parts of the child can be sought out in the imagination and given their rights in relation to dysfunctional parenting modes.
In so-called chair work, which is borrowed from Gestalt therapy, dialogues with and between individual modes are created, with the patient taking on the role of one mode on a particular chair and the other chairs serving as placeholders for other modes.
This technique can be used to address particularly maladaptative coping modes and dysfunctional parents, but also angry children. It is also well suited for the integration performance of the "healthy adult".
There are numerous other emotion-activating options: Bringing old photos or childhood objects, visiting childhood places, old Super-8 films or videos, etc.
The therapeutic relationship is particularly actively shaped in schema therapy and used as a therapeutic instrument. Under the key question “What do the child parts need in this situation?”, The therapist has various strategies available, from temporary secondary parents (limited reparenting) to empathic confrontation.
The technique of mode-appropriate intervention means the differentiated handling of different modes.
The dysfunctional coping modes are countered with a lot of validation, but in the case of the overcompensatory modes also with a clear limitation (empathic confrontation). The latter also applies to angry parts of the child and in an even clearer form (limit setting) in the encounter with dysfunctional parenting modes, towards which the therapist acts as a resolute and protective advocate of injured child parts and which he can clearly in their place or even out of the way in imagination and chair work Scene shows. In this context, in order to prevent negative therapeutic reactions on the part of the patient, it is important to point out that the discussion is less with the real parents than with the internalized parental images, which today usually have a much greater power over the patient.
Disorder-oriented therapy concepts are now available for borderline personality disorder, narcissistic PKS and cluster C personality disorders. Otherwise, schema therapy is a cross-disorder method in which individual mode and case concepts can be created for patients with different disorders.
To a certain extent, the Ariadne thread of therapy is the search for the injured (lonely or abandoned) child. In the case of the narcissistic PKS and the cluster C-PKS, there are initially significant barriers to overcome from coping modes (chair work!). After appropriate rescripting in the center of the labyrinth, which is often filled with frightening memories (see Fig. 4), the path to freedom can be started while maintaining limited reparenting: Recognizing and accepting all one's own shares, integrative chair work and increasingly cognitive-behavioral interventions (memory cards , Exposure etc.) mark the path to cognitive control and the integrative management of the "healthy adult".
Fig. 4: The search for the injured child as an Ariadne thread of therapy
Modes of the therapist
The reaction patterns of therapists can also be conceptualized in the mode model without having to use constructs such as “countertransference” or “oscillating perpetrator-victim dyads”. In any case, it is important that the therapist has a mode-oriented self-awareness.
Certain patient behavior can trigger the simultaneous activation of conflicting modes in the therapist. For example, the lamentable demand for a distanced protective patient mode in the therapist can on the one hand call for a demanding parenting mode with the involved scheme of self-sacrifice, on the other hand a separate distanced protective mode - for example, if the therapist suffered from complaining parents in childhood.
Also, for example, the demanding-reproachful behavior (angry child) of a patient can be experienced by the therapist like a parent and trigger an angry protective mode or an angry child mode in him, which in turn activates a punishing parent in the patient with self-hatred, which e.g. leads to self-harm. The (inexperienced) therapist may react to this with increased "anger" (angry child or angry protector) with a corresponding reaction, etc.
In the neuropsychology of Theory of Mind, a distinction is made between cognitive perspective adoption (“I can imagine what you feel” - actual ToM) and affect induction, presumably mediated by mirror neurons (“I feel what you feel” - actual empathy). The phenomenon of affect induction not only explains why we feel sadness in contact with a sad person and why joy or fear can be contagious, but also why the angry or angry counterpart directly induces anger and anger in us.
The schema model, which is based on the cognitive VT, distinguishes 18 cognitive-emotional schemata, which have arisen from the frustration of different basic needs, with the three possible forms of coping: endurance, avoidance or compensation.
The more emotion-focused mode model differentiates between 14-16 overall emotional-cognitive states, which, depending on their origin and function, are understood as child, parent or coping modes.
With emotion-activating, cognitive-behavioral and relationship-oriented interventions, the mode concept tries to find the primary and frustration-related emotions of the vulnerable child mode, to strengthen them against critical and punitive self-parts and to make them an accepted part of an adult overall personality.
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