Wetenschappelijk onderzoek uitgelicht: (ENG) Understanding the role of schema modes in therapeutic change: An in-depth analysis of the healthy adult.

Evidence in favor of schema therapy effectiveness in treating personality disorders (PD) is ever-growing. But understanding the evidence in terms of mechanisms of change is yet to be realized.1 Key aspect herein is self reparenting. ST aims to help patients strengthen their healthy adult mode, recognize their core emotional needs, and hence, heal the vulnerable child mode. Gradual internalization and integration of reparative parenting provided to the vulnerable child by the therapist in the patient’s own healthy adult has, as such, been recognized as the effective mechanism of ST2. Thus, the ultimate aim of schema therapy is to use your Healthy Adult to heal or take care of your Vulnerable Child. However, despite the popularity of the schema mode model within schema therapy, we have yet to identify the most essential schema modes and whether relations between schema modes may provide effective mechanisms of change. Hence, we aimed to empirically establish the connection between schema modes inducing change in PD symptoms. The results revealed that the relationship between the Healthy Adult and the Vulnerable Childworks both ways. Importantly, independent of treatment style, putting the main focus on the connection between the Healthy Adult and the Vulnerable Child is most effective for PD symptom recovery.3

Recently, we conducted face-to-face interviews with participants who possibly have a relatively stronger healthy adult mode to understand how the relationship between the Healthy Adult and the Vulnerable Child supports effective change3. Participants were asked to “help” the children modes reflected in pictures. As originally suggested in schema theory2, qualitative analysis of the interviews’ verbatim transcriptions revealed three Healthy Adult dimensions (i.e., nurturing, limit-setting, and bouncing back from setbacks created by the parent modes). Importantly, results also revealed that the relationship between the Healthy Adult and the Vulnerable Child is not only top-down (from an informative adult level to emotional embodiment of the child) but also bottom-up. That is, participants rated “healthier” in their responses can approach the children in images using skills generated with the help of their own child modes. Healthy connection with their own child modes enables participants to understand the unmet needs of the children reflected in the pictures better and motivates them to generate spontaneous solutions with the help of their own playful child. Effectivity is thus highest when the connection happens in both ways; when the child gets reparented by the adult as much as the adult is supported by the child modes. Hence, harmony between schema modes seems to be essential.

Door: Dugyu Yakin, psycholoog bij i-psy (Parnassia Groep) en onderzoeker bij de UvA.


1 Taylor, C. D. J., Bee, P., & Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy, 90(3), 456–479. doi:10.1111/papt.12112

2 Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York, NY: Guilford Press. doi: 10.1017/S135246580421186

3 Yakın, D, Grasman, R. & Arntz, A. (2020). Mechanism of change in schema therapy: Evidence for Schema Modes as universal mechanisms of

change in personality pathology and functioning. Behaviour Research and Therapy, 126. doi: 10.1016/j.brat.2020.103553

4 Yakin, D., Rijkeboer, M., & Arntz, A. (2020) Understanding the reparative effects of schema modes: An in-depth analysis of the healthy

adult. Manuscript in preparation.