A mode is the set of schemas or schema operations—adaptive or maladaptive—that are currently active for an individual. We developed the concept of a mode as we focused the model on patients with increasingly severe disorders, especially those with BPD and narcissistic personality disorder. Although we originally developed mode work to treat these types of patients, we now use it with many of our higher functioning patients as well. Mode work has become an integral part of schema therapy.
In our practice, the higher functioning the patient is, the more likely we are to emphasize schemas, and the more severely disordered the patient is, the more likely we are to emphasize modes. We tend to blend the two approaches together with patients in the middle range of functioning.
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: for example, when two parts of the self are locked in opposition about a major life decision. Finally, we generally emphasize modes with patients who display frequent fluctuations in affect, such as often occurs with patients with BPD.
We have identified four main types of modes: Child modes, Maladaptive Coping modes, Dysfunctional Parent modes, and the Healthy Adult mode. Each type of mode is associated with certain schemas (except the Healthy Adult and Happy Child) or embodies certain coping styles.
The Child modes are the Vulnerable Child, the Angry Child, the Impulsive/Undisciplined Child, and the Happy Child. We believe that these child modes are innate. We have identified three broad types of Mal-adaptive Coping modes: the Compliant Surrenderer the Detached Protector, and the Overcompensator. They correspond, respectively, to the coping processes of surrender, avoidance, and overcompensation. We have identified two Dysfunctional Parent modes: the Punitive Parent and the Demanding Parent. The Healthy Adult mode is the part of the self that serves an “executive” function relative to the other modes. 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 accord with the principles of reciprocity and self-discipline; and (3) battling or moderating the Mal-adaptive Coping and Dysfunctional Parent modes. During the course of treatment, patients internalize the 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 so. Gradually the patient takes over the Healthy Adult role.
We have developed seven general steps in 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 modes 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.
In the next chapter, we apply modes to the assessment and treatment of borderline personality disorder.