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The Schema Therapy Bulletin

The Official Publication of the 

International Society of Schema Therapy

In This Issue

In this June Issue - Working with Strong Coping Modes in Schema Therapy by Lissa Parsonnet & Chris Hayes 

Schema Mode Therapy: Working with the Overcontroller Mode by Susan Simpson (Scotland)

Should I stay or Should I go? Navigating the Angry Protector Mode with Forensic Clients by Kerry Bickley (UK)

Handling Overcompensation Modes by Dr Odette Brand-de Wilde & Maria Rocher (The Netherlands)

Behind the Pleasure - Working with Self-Soother Mode by Sergio Alejandro Morales Hernández (Mexico)

"Behind the pleasure"

WORKING WITH SELF-SOOTHER MODE

Sergio Alejandro Morales Hernández

Master in Multidisciplinary Prevention and Treatment of Addictions

Mexico 

Addiction, Schemes and Modes. 

An addiction is conceived as a repetitive usage of any substance or a compulsive consequence behavior which modifies the internal system (neurochemical changes and neuronal activity) so that an immediate reinforcement takes place, but whose negative long-term effects are harmful or cause a significant deterioration in social development. From the Scheme Therapy approach, these addictive patterns are formed departing from the avoidance of early maladaptive schemes; the individual avoids cognitions, affections or behaviors, so that the scheme is not activated.

The fundamental goal of the Addiction Scheme Therapy treatment is, according to Jeffrey Young, to help patients to modify dysfunctional vital patterns and adaptively satisfy, outside the therapy environment, his essential needs by modifying schemas and modes. (Farrel p.45)


Schema Therapy applied in Substance Use Disorders.
The precursor to the application of schematic therapy in addictions in comorbidity with personality disorders was Samuel A. Ball in 1998 in his program to which "Dual-Focus Scheme Therapy".  This psychotherapy is guided by a 24-week manual working on 16 core topics and 12 individualized for each patient based on the evaluation of personality disorders and the conceptualization of early maladaptive schemes and coping strategies.

Strategies of the relapse prevention model were used by Marlatt and Gordon (1985), this training in coping skills (self-monitoring, conflict resolution and social skills) and classic techniques of schema therapy. (Ball, Cobb-Richardson, Connolly, Bujosa and O'Neil, 2005; Ball 2007).

Ball focused himself on schemas and not on the schema  modes. The models of “schema modes” in Young’s addictions (substance abuse and gambling) are defined as evasive coping styles, the Self-Soother Mode and the Self-Stimulating Mode.  


The Self-Soother Mode is activated when the individual avoids the discomfort that appears with the activation of the scheme through addictive behaviors and compulsions such as substance use (mainly depressants like alcohol and opiates), gambling and compulsive shopping, binge eating, Internet overuse; and the Self-Stimulating Mode with high risk behaviors (parachuting, extreme sports, driving at high speed), abuse of stimulants (cocaine, amphetamines (Ball, 1998).


Truus Kersten mentions that drug abuse is associated with the activation of other modes of schemas; stimulant drugs work to intensify over-compensating modes,
depressive drugs to intensify avoidant modes or the combination of drugs to intensify infant and parenting modes with substances such as alcohol and cocaine.

Working with Modes.

This model arises before the complexity of the personality disorders and patients with multifactorial problems is necessary the integration of this model. The objectives of working with modes are the following ones:

1.Identifying and tagging patients’ modes.

2.Exanimating the origin and (where relevant) the adaptive value of the mode during childhood or adolescence.

3.Linking maladaptive modes to current problems and symptoms.

4.Demonstrating the upsides of modifying or abandoning a mode if it is interfering with access to another mode.

5.Accessing the vulnerable child through the imagination.

6.Developing dialogues between modes. Initially, the therapist will model a healthy adult mode; subsequently, the patient will perform that mode.

7.Helping the patient to generalize the work  of ways to the vital situations external to the therapeutic sessions.

For working with patients with addictions, work is initially done to identify early maladaptive regimens and modes associated with drug use, as well as associated modes.For example, working with the Vulnerable Child is important to help you feel protected and understood to meet your real needs and not to meet them through consumption.  With the Angry/Impulsive Child it is necessary to teach him how to express his needs and emotions in a functional and healthy way, that does not endanger his health, freedom and support networks.

Under the pressure of the Parental modes, the patient seeks to escape from the discomfort through consumption, so it is important to establish limits and to get rid of internalized demands and self-punishment. 


Working with Self-Soother Mode.

This working mode manifests itself throughout consumption behaviors, which is why it is important, initially, that the patient identifies his Start-Upmode in order to strengthen his decision to avoid consumption behaviors and substitute them with healthier behaviors so as to avoid Start-Up schemes.

Working with this mode is complex since for the user the drug is the only way to avoid the discomfort that the schemes produce.

Initial intervention work focuses on identifying the associated elements to the Start-Upmode; for example, the tools he uses to consume (pipes, syringes, droppers, rolling paper, ashtrays, etc.), associated places (specific streets, pubs, nightclubs), consumer friends, and such. Once we have identified these elements, it is important to give them a “voice”, a content to Self-Reassuring mode: they are usually permissive messages, such as “you deserve it”, “just once”, “nothing bad will happen”.

Once the consumer has identified the Self-Soother Mode and the triggers to the consumption, we start working with Dialogues with Chairs mode. The Self-Soother Mode defends itself based on the low perception of consumption damages, for example, talking about marijuana it will contend “it is just a plant”, “it is a natural thing”, “it comes from the ground”; about tobacco it will contend “everybody smokes”, “it does not cause damage that fast”; about cocaine it will say that he (the consumer) is not really consuming that much, etcetera. That is why it is important to work departing from empathic confrontation: on the one hand the therapist “understands” that the consumption has helped the patient to avoid meaningful issues in addition to generating pleasure, however, showing the patient the consequences of consumption helps to strengthen the Healthy Adult. It also helps to identify risks if we confront consumption using a child as an example:

Therapist: - “L. ‘The Cheater’ (Self-Soother mode) you are telling me marijuana does not really causes health damages, if so, why wouldn’t you consider giving marijuana to “M”, your daughter (6 year old)?”

Patient: - “Because even though I consume, ‘The Cheater’ (Self-Soother Mode) knows that it is not healthy, doctor”.

 Once the patient has identified that the Self-Soother Mode  brings bigger consequences than advantages, it is easier to confront him with role-playing exercises with chairs.

Self-Soother Mode strength consists in being a “faster” solution to drug consumption problems, which is why teaching the patient to confront this mode is very important so that the patient develops self-control and also to strengthen the Healthy Adult in him.

Patients, throughout developing role-playing with the Self-Soother mode and the other modes, empower themselves as well as they learn how to self-regulate their consumption until contending that: “I do not want to consume because it will bring many negative consequences to me, it is the Self-Soother mode who wants to avoid my schemes”. Consumers gradually develop self-control and seek for new pleasurable and healthy activities than consumption.


Group Therapy in Addictions.

 A Therapeutic Community requires the presence and the intervention of a multidisciplinary and interdisciplinary technical team, whit a strong predominance of medical, psychosocial and educational components. We can consider that life in a Therapeutic Community is an attempt to reproduce a real daily life; the patients in a Therapeutic Community become active participants and are also responsible for their own therapeutic process, which, undoubtedly, favors the strengthening of self-confidence, their concept of themselves and their autonomy to achieve change.

 There are different therapeutic activities that are used in this kind of treatment to manage the Self-Soother mode:

“New networks” therapy: we work it by role-playing in front of the group; first, the therapist takes the role of the patient and  the patient takes the role of the Self-Soother Mode, all the group members take turns to identify the different “shapes” and arguments this dysfunctional mode has.

¬Play Therapy: different games and activities are used to encourage new coping strategies, which in the wake of Self-Reassuring mode, make the patient choose healthier activities. This therapy also integrates rules, realistic limits, connection and acceptance, autonomy during the different games and group activities.

¬Relapse prevention: we work with Marlatt and Gordon’s model (1985) but adding experiential and cognitive exercises to confront the Self-Soother Mode.

¬Modes and drawings workshop: during this workshop, patients are taught about the origins and functions of the Self-Soother Mode, as well as the identification of “their voice” by drawing and writing letters.

oPatients are requested to draw the Self-Soother Mode. Choosing the characteristics it would have, for example a person, an animal, an object, etcetera, as well as name it. Identifying upsides and downsides of this mode and also identifying the need to turn to it. To describe it as a “partner”. To practice experiential exercises rejecting the Self-Soother Mode  with the image they drew.

¬Writing and creativity workshop: letters of farewell and grief from the Self-Soother Mode are worked. “Trip to the past” letters, where they give their child selves (Infant mode) an advice not to “talk” to it, not to accept it as a “friend”, not to allow the Self-Soother Mode into their lives. As well as letters to their parents asking for help to confront the Self-Soother Mode

¬Crafts and healthy personality workshop: masks, puppets, dolls, Self-Soother Mode image cards, as well as the Parental and Infant mode in order to produce dialogues between modes and experiential exercises are made during this workshop.

References: "Behind the Pleasure” Working with Self-Soother Mode

ïArntz, A., & Jacob, G. (2012). Schema therapy in practice: an introductory guide to the schema mode approach. New York: Wiley.

ïBall, S.A. (1998) Manualized treatment for substance abusers with personality disorders: dual focus schema therapy. Addictive Behaviors, 23, 883–891

ïBall, S.A. (1998) Manualized treatment for substance abusers with personality disorders: dual focus schema therapy. Addictive Behaviors, 23, 883–891.

ïBall, S.A. (2007) Comparing individual therapies for personality disordered opioid dependent patients. Journal of Personality Disorders, 21(3), 305–321.

ïYoung, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. New York: Guilford

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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