Lost in fragmentation; schema modes, childhood trauma, and anger in borderline and antisocial personality disorder

While the schema mode construct is one of the main concepts of Schema-Focused Therapy (SFT) for personality disorders (young, 1990; young & Klosko, 1994; young, Klosko, & Weishaar, 2003), the mode concept lacks clear theoretical and scientific embedding, and therapeutic guidelines about when to use modes in clinical practice are not always clear. Therefore, the current article aims at clarifying schema modes theoretically and by therapeutic vignettes. Modes are different aspects of the self, that reflect the currently active cluster of cognitions, emotions and behaviours (young et al., 2003). The different schema modes are presented, as well as mode conceptualizations for several personality disorders. The distinction between healthy and pathological modes is outlined, as well as the link with dissociation and the concept of mode switching. Furthermore, mode assessment in SFT is addressed, next to theoretical studies on schema modes. Whilst recent progress in treatment possibilities and effectiveness of SFT is impressive, basic tests of the modes are limited. Finally, directions for further studies are suggested. INTRoDUCTIoN Schema-Focused Therapy (SFT) is becoming an increasingly popular and widespread variant of cognitive therapy for treating personality disorders (PDs). A study by Giesen-Bloo, van Dyck, Spinhoven, van Tilburg, Dirksen et al. (2006) demonstrated SFT to be superior to psychodynamically based Transference-Focused Psychotherapy in reducing borderline PD (BPD)-specific and general psychopathologic dysfunction and in improving quality of life. Three main concepts are central in SFT. The first is that of early Maladaptive Schemas (eMSs), which are broadly defined as the unconditional and dysfunctional underlying beliefs about the self and one's relationships with others. eMSs are developed during childhood and serve to selectively filter incoming experiences such that schemas are extended and elaborated throughout an individual's lifetime. Behaviours are embedded in the coping styles that form the second main feature in SFT. young postulates a person can maintain their eMSs by means of three coping methods; overcompensation (fight the schema as though the opposite were true), avoidance (avoid the schema to be activated) and surrender (give in to the schema) (young et al., 2003). Because of the close link of both eMSs and coping styles to basic cognitive theory constructs (Beck & Freeman, 1990; Beck, Freeman, & Davis, 2004) and the increasing number of studies targeting the theoretical underpinning of these constructs (see e.g., Ball & Cecero, 2001; Jovev & Jackson, 2004; Petrocelli, Glaser, Calhoun, & Campbell, 2001), eMSs and schema coping are concepts that are well known in clinical practice. However, most researchers, practioners and patients are less acquainted with the third SFT concept of schema modes. The unfamiliarity with the concept of schema modes is due to the fact that it is a new and quite a difficult construct that emphasises many elements. Therefore, the current article aims at clarifying the mode concept, both on a theoretical level as well as on a clinical level. By means of clinical vignettes the concept and how it is used in treatment is illustrated. Also, the current status of research on mode assessment and experimental studies is described, and recommendations for further studies are given.