78
Theme Article
The schema mode model for personality disorders
E. Fassbinder1; U. Schweiger1; G. Jacob2; A. Arntz3
1Universität
zu Lübeck, Klinik für Psychiatrie und Psychotherapie; 2GAIA AG, Hamburg; 3University of Amsterdam, Department of
Clinical Psychology, Amsterdam
Keywords
Summary
Personality disorders,
schema mode model,
schema therapy
Schema therapy (ST) based on the schema mode approach is currently one of the major developments in the treatment of personality disorders (PD). ST is a transdiagnostic approach,
but also provides disorder-specific models for most PDs. The mode model gives a clear
structure for the development of an individual case conceptualization, in which all current
symptoms and interpersonal problems of the patient and the connection with their biographical context can be accommodated. The therapeutic interventions are adapted to the
present mode in the specific situation. In addition to cognitive and behavioral techniques
there is a special focus on experiential techniques (especially chair dialogues and imagery
rescripting) and on specific features of the therapeutic relationship (‘limited reparenting’).
This paper provides an overview of the theoretical background and practical application of
schema mode-based ST for PDs. An individual case conceptualization and the therapeutic
techniques are illustrated with a case example of a patient with histrionic PD.
Schlüsselwörter
Zusammenfassung
Persönlichkeitsstörung,
Schema-Modus-Modell,
Schematherapie
Schematherapie (ST) mit dem Schema-Modus-Ansatz ist derzeit eine der wichtigsten Entwicklungen in der Behandlung von Persönlichkeitsstörungen (PS). ST ist zwar grundsätzlich als transdiagnostischen Ansatz zu verstehen, bietet aber auch störungsspezifische Modelle für die meisten PS. Das Modusmodell bietet eine klare Struktur für die Erarbeitung eines individuellen Störungsmodells, in dem alle aktuellen Symptome und zwischenmenschliche Probleme des Patienten und die Verbindung mit dem biografischen Kontext eingeordnet werden können. Die therapeutischen Interventionen werden dem jeweils aktiven Modus
angepasst. Hierbei stehen neben kognitiven und behavioralen Techniken insbesondere
emotionsaktivierende Techniken (v.a. Stuhldialoge und Imaginationstechniken) und eine
spezifische Gestaltung der Therapiebeziehung („limited reparenting“) im Vordergrund. Der
folgende Artikel gibt einen Überblick über die theoretischen Grundlagen und die praktische
Anwendung des schematherapeutischen Modus-Modells. Eine schematherapeutische Fallkonzeptualisierung sowie die schematherapeutischen Techniken werden mit einen Fallbeispiel einer Patientin mit histrionischer PS illustriert.
Das schematherapeutische Modusmodell für Persönlichkeitsstörungen
Die Psychiatrie 2014; 11: 78–86
Eingegangen: 17. Februar 2014
Angenommen nach Revision: 19. März 2014
S
chema therapy (ST) based on the schema mode model
is one of the major current developments in the field
of psychotherapy for personality disorders (PD). For most
PDs a specific mode model has been described (1, 2). The
first and best evaluated is the mode model for Borderline
Personality Disorder (BPD) (3, 4). Several studies have
shown that treatment based on that model is very effective
Die Psychiatrie 2/2014
for patients with BPD (5–8). But also for other PDs results
are encouraging: In a randomized controlled trial in six
other PDs with a majority of patients with cluster-C-PDs
(avoidant, dependent, and obsessive-compulsive) ST based
on the mode model was superior to comparison conditions
(9). Recent reviews summarize current research findings
on ST for BPD (10) and PDs in general (11).
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79
Theme Article
This paper provides an overview of the theoretical
background and practical application of the schema mode
model for PDs. Case conceptualization and therapeutic
techniques are illustrated with a case example. As most
publications on ST so far focus on BPD and to a lesser extent on cluster-C-PD, narcissistic and antisocial PD we
present an example of a patient with histrionic PD.
of psychological problems: The mode
• Normalization
model incorporates both a broad spectrum of psycho-
•
What characterizes schema therapy?
ST derives from cognitive behavior therapy (CBT) and was
originally developed by Jeffrey Young for patients, who
did not respond to standard CBT. These patients typically
showed chronic, rigid, complex psychological problems
and in many cases had comorbid PDs (12, 13). ST is characterized by a combination of typical CBT techniques with
a special focus on experiential techniques (especially chair
dialogues and imagery rescripting) and a specific conceptualization of the therapeutic relationship as „limited reparenting“. The mode model gives a highly structured
frame. It helps both the patient and the therapist to understand current symptoms and interpersonal problems and
guides the treatment.
The main advantages of working with the mode model
are:
Focus on essentials: The mode model summarizes all
problems and symptoms even in patients with very
complex problems and high comorbidity in one clear,
plausible model. This way therapists and patients do
not get lost and rapidly reach a meta-understanding of
essential problems and can directly address them.
Individual case conceptualization: At the start of treatment an idiosyncratic case concept is worked out with
every patient. The individual mode model explains the
patient’s problems and symptoms and puts them into
context with pathogenic childhood experiences. In the
further course of therapy all problems and symptoms
are linked to this mode model. If necessary the model
can be easily adapted to incorporate issues that were
not clear at the beginning.
Transparent guide to mode specific interventions:
Treatment goals are derived from the mode model,
transparent for patients. Each mode is linked with specific goals, resulting in a „roadmap“ for the whole therapy. This „roadmap“ guides therapeutic interventions
and can be transferred to everyday life by the patient.
Validation and change: Current emotions, cognitions,
and behaviours can be conceptualized in the mode
model and thus be validated. At the same time patients
can be empathetically confronted with problematic
consequences of their behaviour and with the need to
change.
•
•
•
•
Die Psychiatrie 2/2014
pathology, but also healthy emotions, cognitions and
behaviours. The idea that everyone has maladaptive and
adaptive modes is a relief for most patients and can be
fostered through skillful self-disclosure by the therapist.
Corrective emotional and interpersonal experiences:
The intensive use of experiential techniques in the
safety of the therapeutic relationship is a special focus
of ST and leads to corrective experiences with regard to
emotions, needs and interpersonal relationships and
has the potential to break through dysfunctional,
chronic patterns.
Schemas, coping styles, needs and the
development of the mode model
ST states that everyone develops schemas during childhood. Schemas are defined as broad patterns of information processing comprising thoughts, emotions, memories
and attention preferences (12, 13). Healthy schemas develop when core emotional needs are met in childhood. This
enables children to develop positive views about themselves, relation to others and the world as a whole.
The basic needs of children include (3, 4, 12, 13):
Safety (secure attachment, stability, care)
Connection to others, social inclusion
Autonomy, competence, identity
Expression of needs, emotions, and opinions
Acceptance and praise
Realistic limits
Love and attention
Spontaneity, play
•
•
•
•
•
•
•
•
When these needs are not met, maladaptive schemas may
develop. Young described 18 maladaptive schemas, e.g.
abandonment, mistrust or emotional deprivation (12, 13).
When a maladaptive schema gets activated, it provokes
aversive emotions such as fear, sadness, shame, or anger.
People cope with these emotions by three major coping
strategies: overcompensation, avoidance, or surrender.
The plurality of schemas and coping strategies (18
schemas x 3 coping styles = 54 different possibilities)
leads to an inappropriate complexity, overwhelming both
patient and therapist. Young discovered especially for patients with BPD, that it is hard to keep an overview as
many different schemas and coping reactions are present.
Thus, Young developed the mode approach first for patients with BPD, later for narcissistic PD (12, 13). Arntz et
al. completed and empirically tested the mode model with
other modes and with specific mode models for most PDs
(1, 2, 14, 15).
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Theme Article
What is a mode?
A mode is a combination of activated schemas and coping
and describes the current emotional-cognitive-behavioral
state. It is therefore transient, while a schema is enduring
(schema = trait, mode = state) (12, 13).
Modes are typically triggered by specific stimuli, and
influence emotions, cognitions, behaviors and the attentional focus in the respective situation. Similar to the
mind-set construct a mode could be explained with the
metaphor of a DVD: If a DVD is loaded in a DVD-player,
the screen automatically shows a specific sequence of pictures and music. The loading of the „mode DVD“ is triggered by specific external conditions or internal stimuli
like thoughts, feelings or bodily sensations („emotional
buttons“). Once loaded a mode-typical pattern of feelings,
thoughts, bodily reactions and behavior is processed. The
attention focusses on mode-congruent information and all
information is processed in the light of the mode. Everyone has adaptive and maladaptive modes. Adaptive modes
are flexible and help to process information in a healthy
way. Maladaptive modes are inflexible, reinforce dysfunctional schemas and lead to enduring intra- and interpersonal problems. Mostly people are not aware of their active mode („the loaded DVD“). In therapy this automatic
process is interrupted. Thus patients learn to recognize
their current „mode DVD“ (mode-awareness) and its biographical backgrounds. Thus, they gain a better understanding of their cognitions, emotions and behaviors. If
the mode is problematic, patients learn in the next step
how to change the mode („insert a new mode DVD“), so
that they get their needs met in a healthier way (16).
Modes are divided into 4 broad clusters (Fig. 1):
1. Dysfunctional child modes develop when major needs,
particularly attachment needs were not adequately met
in childhood. Child modes are associated with intense
negative emotions, e.g. fear or abandonment, helplessness, sadness (vulnerable child modes), anger, or impulsivity (angry/impulsive child modes).
2. Dysfunctional parent modes (punitive or demanding)
are characterized by self-devaluation, self-hatred, or
extremely high standards. We regard them as internalizations of dysfunctional parental responses to the
child. They reflect internalized negative beliefs about
the self, which the patient has acquired in childhood
due to the behaviour and reactions of significant others
(e.g. parents, teachers, peers).
3. Dysfunctional coping modes serve to mitigate the
emotional pain of child and parent modes and describe
the excessive use of the coping strategies surrender,
avoidance, or overcompensation. These modes are
usually acquired early in childhood to protect the child
from harm, devaluation and make the emotional pain
more bearable („survival strategies“).
4. The healthy modes include the healthy adult mode and
the happy child mode. In the healthy adult mode,
people can deal with emotions, solve problems and create healthy relationship. They are aware of their needs,
possibilities and limitations and act in accordance with
their values, needs and goals. The happy child mode is
associated with joy, fun, play, and spontaneity. The
healthy modes are usually weak at the beginning of
therapy.
Healthy modes
Parent modes
Punitive/ Demanding
Coping modes
Overcompensation
Avoidance
Surrender
Child modes
angry/impulsive/
vulnerable
Figure 1
The mode model – basic structure
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81
Theme Article
Give safety,
review pros and
cons, replace by
healthy strategies
Healthy modes
Fight & Reduce
Strengthen
Parent modes
Punitive/ Demanding
Coping modes
Overcompensation
Avoidance
Surrender
Get aware of needs,
soothe & comfort, set
limits if required
Child modes
angry/impulsive/
vulnerable
Figure 2
Mode-specific goals of the therapy
For a detailed description of all schema modes see Arntz &
Jacob (17, 18). Modes can be assessed by self-report with
the Schema Mode Inventory (SMI), though there are limitations in the degree to which people can report their
modes (15).
The development and maintenance of
modes
Unmet basic needs, traumatic experiences, educational
factors, and vicarious learning in combination with biological factors lead to the development of dysfunctional
schemas and coping styles, hence to parent and child
modes. To mitigate the resulting emotional pain, coping
modes develop early and are applied also in later life.
Later in life the coping modes protect the person from
painful activation of the vulnerable child modes, but on
the other hand they also block access to emotions and
needs and hinder the development of healthy relationships. This way the coping modes often cause further suffering and interpersonal problems. Moreover, corrective
emotional experiences are not possible. No alternative to
deal with emotions and interpersonal difficulties can be
learned. Thus, even in adult life needs are not met, leading
to a life of low quality and lack of self-fulfillment.
Therapy goals
For every mode there are specific goals, resulting in a
„roadmap“ for the whole therapy: For the child modes it is
Die Psychiatrie 2/2014
important to find out unmet needs, and get aware of needs
in the here and now. Child modes are supported and comforted in therapy; thus frustrated needs are met and new
healthier schemas can be learned. Dysfunctional parent
modes are reduced, we even „fight“ against punitive parent modes. Coping modes are questioned and replaced
with healthier strategies. An important goal is to
strengthen the healthy adult mode in every possible way.
Figure 2 shows the goals of treatment.
To achieve these goals, mode-specific cognitive, experiential, and behavioural interventions are used. In addition,
the therapy relationship is conceptualized as „limited reparenting“. Within the professional boundaries the therapist
behaves towards the patient like a good parent and fulfills
some of the needs the patient missed in childhood. This
serves as an antidote to traumatic experiences and leads to
corrective interpersonal experiences. Limited reparenting
includes warmth, care, protection and empathy. However,
it can also mean to set limits or to encourage more autonomous behaviour.
Structure of the therapy
There are three overlapping phases in therapy:
1. In the first phase (mode awareness) we work on the
therapeutic alliance, investigate current problems and
the biography of the patient, and educate about modes
and needs. A major aim of this phase is the development of the individual case conceptualization.
2. The second phase (mode change) starts when the mode
model is well established. All arising problems and be-
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82
Theme Article
haviours are classified in the model mode and mainly
processed by experiential techniques. Usually coping
modes have to be addressed first to get access to the
underlying child modes. The therapist helps the patient
to identify coping modes and discusses pro and cons as
well as the way they initially developed in childhood.
Only when there is sufficient safety in the therapy relationship the patient can usually reduce his coping
modes. When the child modes are activated, they
should be supported in particular with imagery exercises, through the therapeutic relationship and the development of other useful relationships, e.g. in group
therapy. After that the dysfunctional parent modes are
antagonized and reduced.
3. Over the entire treatment process the healthy adult
mode is strengthened, so that patients themselves can
take on these tasks and finally can pass into the third
phase, the autonomy phase. Here the patient has to take
more and more responsibility and develops other helpful, healthy relationships outside the therapy relationship. Therapy contacts are gradually reduced, a contact
after the end of the treatment is possible, but not
required.
Disorder specific and transdiagnostic
approach
The mode model includes both a transdiagnostic and a
disorder-specific approach. Within the transdiagnostic approach, all symptoms, problems and problematic interper-
sonal patterns, as well as healthy behaviours and attitudes
are conceptualized within the framework of applicable
modes. In the disorder-specific mode models the typical
modes of a particular diagnosis are summarized. Disorder
specific mode concepts are available for most PD and
forensic patients (1, 2). However, these disorder-specific
models can only be viewed as a rough frame. An individual mode model always needs to be adapted to the patient’s
individual problems and history. It can be extended with
additional modes if necessary. As stated above we aim to
present the mode model of histrionic PD, since it is one of
the mode models that were less well described so far. For
examples and further explanation of all other mode models we refer to Arntz & Jacob (17, 18) or Fassbinder et al.
(16).
Mode model of histrionic PD
Figure 3 gives an overview of the typical mode model of
histrionic PD: In the vulnerable child modes patients with
histrionic PD feel unloved, lonely, abandoned, helpless,
and needy. As in childhood major needs were not satisfied
they crave for attention, appreciation and praise and
would do anything to get it. Moreover they have a very
low tolerance to frustration and difficulties with discipline. In the impulsive, undisciplined child modes, they
therefore often act impulsively, without thinking, if they
feel unseen or a task is boring. In the punitive parent
mode patients with histrionic PD devalue themselves
sharply, e.g. to be inadequate, unattractive, worthless, stu-
Healthy modes
Punitive parent
mode
Coping modes
Overcompensation:
Seeking Attention
Impulsive/ undisciplined
child
Vulnerable child
Die Psychiatrie 2/2014
Figure 3
Mode model of histrionic personality
disorder
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Healthy adult mode
„Grown up Conny”
Comes to therapy
Girlfriend
Completed
education as
secrtary
Coping strategy to
receive attention, and
not to be alone,
observational learning
from the mother
Messages from father
and mother
Punitive mode





„You are not lovable“
„You screwed it up“
„Loser“
„Nobody will ever put up
with you”
„You are lying”
Chaotic circumstances,
emotional needs of safety,
attention, love and
guidance are not met
Attention seeking mode
„Drama Queen“
dramatic behaviour (e.g.
nervous breakdown)
 exaggerated expression
of emotion
 flirting, going out
 dress provocatively,
heavy make-up
 having affairs

Impulsive/ undisciplined
child
 Problems to be
punctual
Vulnerable child mode
„Little Conny”
 Feels unloved,
lonely, unseen
 Need for attention
and love
Figure 4
Conny’s mode model
pid, or lazy. The main coping mode of people with histrionic PD is the overcompensating attention-seeking
mode, in which they do anything to get attention for their
lost and emotional deprivated child mode. This includes
typical histrionic behaviour such as flirting, being very
extroverted, loud and charming, overly sexualized behaviour, or exaggerated expression of emotion. The healthy
adult mode is mostly week at the start of therapy.
Bamelis et al. only found significant associations between histrionic PD and the attention-seeking mode. None
of the above mentioned child or parent modes was significantly associated with histrionic PD. One explanation is
the core function of overcompensating modes is to keep
up the appearance that the opposite of the schema is true
and to keep painful modes out of awareness. Thus, people
with strong overcompensating modes might be unaware
of, deny, or be unwilling to report vulnerable experiences.
Similar patterns are seen in antisocial, narcissistic or even
obsessive-compulsive PD (1).
Die Psychiatrie 2/2014
Case example: Histrionic PD
Conny, a 41-year-old secretary, is 10 minutes late for her
first appointment. She is provocatively dressed and
wears a lot of make-up. She complains: „I need your help
very urgently. Something has to happen immediately.
I’ve had several nervous breakdowns at work and have a
terrible stomach when I think of tomorrow. I had an affair with my boss and now he does not want to meet me
anymore. He just used me and wanted to have sex, like
all the men before. They are all the same. But with this
man, I will not survive it. I cannot understand …. Why he
doesn’t love me … (sobbing, crying) … I tried to get an
answer from him, but he did not react. Even not, when I
had this awful breakdown in the office and just could not
stop crying. He did nothing, as if I was not there. Do I
need to jump from a bridge to show him, that he has destroyed me? … I tried to forget him and I cannot stand
being alone, so I went out with my girlfriend to meet
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other men. But it always ends up the same way … I just
want somebody to love me, but all they want is sex … I
am already 41, my best years are over … How can I ever
find someone? ... I screwed it up … nothing in my life has
worked out … I am a loser and nobody will ever put up
with me … that is exactly what my father said …“ With
regard to her childhood she reports: „Oh, this was very
chaotic. My father drank a lot of alcohol, he was in jail
several times. My mother worked as a secretary, too, so
she did not have too much time for me and my younger
brothers. Only if we messed something up, we got at least
some attention, even when it was a slap on the face. She
had lots of affairs and there were always new men in our
flat. Some of them were nice, but it was not worthwhile
to get used to them, as they were only there a short time.
Other men were very aggressive and one was sexually
abusing me. I told my mother, but she did not believe
me.“
Conny’s mode model is shown in Figure 4. The case concept is developed in interaction with the patient on a flip
chart. If possible, individual names for the respective
modes are chosen. A name like „Drama Queen“ for the attention-seeking mode in this example should only be selected, if the patient herself mentioned it. Otherwise it
would be invalidating.
A limitation of four to seven problematic modes is recommended, as the human working memory is limited to a
maximum of seven items. The therapist has the task to select the relevant modes for the patient. With the increasing
number of modes, disorder-specific concepts and an exploratory survey with the SMI (15) may be helpful.
Table 1
Pros and Cons of the Seeking Attention Mode
Pros of „Drama Queen“
attention
• II get
do not feel so lonely and empty
• Others
• to me have to look for me, listen
am in the focus
• IExiting,
• Men findnotmeboring
attractive
• Flirting feels good
• At least I have some connection
• I can express my emotions
•
Con’s of „Drama Queen“
feel lonely
• IOften
ashamed afterwards
• I get onI feel
other’s
nerves and they
• withdraw from me,
than I feel
•
•
•
•
•
even more not seen and lonely
(vicious circle!)
I do not have the chance to find
a nice man or at least a good
friend
I have sex with too many men
I feel used afterwards
Others do not take me serious,
and I feel misunderstood
I do not have good contact with
myself, my emotions and needs
Die Psychiatrie 2/2014
Therapeutic Techniques
Cognitive techniques
Cognitive techniques are used to educate patients about
their modes and why they developed. For each mode,
identifying features like emotions, thoughts, bodily reactions, memories, behaviour impulses, and situational
triggers are worked out to foster mode awareness. Psychoeducation on basic needs of children, normal development, and emotions also plays an important role. In this
context, all CBT techniques can be used, such as focusing
on long-term consequences, analysis of selective attention
processes or behavioural analyses. Especially for coping
modes, discussing pros and cons is a major issue in therapy. Various suggestions for the use of cognitive techniques such as mode cards, mode diary or mode analysis,
and materials for psychoeducation can be found in Fassbinder et al. (16).
For Conny the pros and cons list displayed in Table 1
has been worked out.
Experiential techniques
Experiential techniques and emotional processing of aversive childhood memories are an important focus of ST and
aim at validating and healing the child modes. At any time
patients are encouraged to express emotions, such as sadness or anger. The main techniques are chair dialogues
and imagery techniques, primarily imagery rescripting.
In chair dialogues different modes are placed on different chairs and dialogues between them are performed. The
goal is to get more distance from modes, to illustrate different perspectives, and to activate emotions. Moreover,
the therapist or the healthy adult mode can address every
mode. Content, tone and action are adapted to the specific
mode by following the above explained mode-specific objectives (see Figure 2), e.g. fight the punitive parent mode
or soothe the vulnerable child mode.
An example of a chair-dialogue with Conny: After the
pros and cons of the „Drama queen“ have been discussed,
Conny comes in the attention seeking mode to the therapy
session again. The therapist proposes a chair dialogue to
better understand the „Drama Queen“. He asks Conny to
take place in a chair, provided for the „Drama Queen“, and
take over the perspective of the mode and answer to all
questions out of the modes’ view. He says: „You’re extremely important for Conny, I’d like to better understand
you. Can you tell me, why you are here today?“ He asks for
the development of the mode (e.g. „Do you know, when you
first came in Conny’s life? Why did Conny need you?“). If
Conny answers, the therapist validates her: “Oh yes, I can
imagine, Conny told me, that she often felt lonely and not
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85
Theme Article
seen. And that the only way to get attention, was to act extremely. So, it makes pretty much sense, that you came to
help her to get at least some attention. And that is what you
still do now, don’t you?“ After that the therapist aims to
work out disadvantages of the ‘Drama queen’ mode by
using self-disclosure in the therapeutic relationship „I have
the impression that something happened to little Conny,
and that she feels lonely, but at the moment I cannot see
what it is, because of that dramatic behavior. To be honest it
overwhelms me and pushes me away. And I think this is absolutely not, what little Conny needs. What do you think?“
The patient switches to the vulnerable child mode and is
placed on another chair for „little Conny“. She tells that she
had birthday last week, but that nobody called her, even her
girlfriend forgot about it, and that she feels very lonely and
sad. The therapist soothes and comforts her. A popping up
of a punitive parent mode („You are just not lovable“) is
fought by the symbolic action of placing the chair of the
dysfunctional parent mode out of the therapy room.
In imagery rescripting exercises (19), a stressful childhood memory is imagined and modified in a way, that the
needs of the child are satisfied. For this purpose, a helper
can be introduced into the image, for example the therapist, other helpful persons, or the patient himself in his
healthy adult mode.
An example in Conny’s case is imagery rescripting of
the situation after the sexual abuse by one of the mother’s
boyfriends, when the mother did not believe her. In the rescripting part the therapist comes into the image, protects
Conny and rebukes the mother. After that the boyfriend is
brought to jail, so that he cannot harm Conny anymore.
Finally, the therapist takes Conny and, at her request, also
her brothers to the house of her best friend’s family. This
was the only secure place in Conny’s childhood. At the
end of the image they play all together with the families’
dog and Conny feels safe and connected. The patient feels
strengthened by this exercise and gets the homework, to
repeatedly listen to an audio recording of the exercise.
For Conny it was important to learn, how her ‘Drama
queen’ mode affects others. Together with her therapist she
worked out, how to change her behaviour in a way, that
she is not primarily seen as a sexual object any more. On
the other side they developed a list of criteria, how Conny
can recognize that a man has serious long-standing interest in her. The therapist and she agreed on a ‘No Sex before
the third date’-rule, which was very helpful for Conny.
After one year of therapy Conny had a relationship for
already four months. About her partner she said: „I would
never have felt attracted by this man before, but now I
really do feel comfortable with him.“ She has found a new
job and is busy in getting adjusted with her new colleagues, but feels much better as she did in the job before.
For further information to work with the mode model
we refer to the detailed manuals, specifically for BPD (3,
4), general application (17, 18), and for ST in group therapy (20, 21).
Behavioural Techniques
Our studies on ST are supported by the Else-Kröner-Fresenius-Stiftung in Germany, and by ZonMW, the Netherlands Organization for Health Research and Development
in the Netherlands. Eva Fassbinder is supported by a grant
from the University of Lübeck.
It is important for therapists to consider, that behavior
does not change automatically in most patients. Patients
need support to translate emotional and cognitive insights
into behaviour and their everyday life. All techniques
known from behavioural therapy can be used to develop
and strengthen new healthy behaviours. These include role
plays, homework, exposure exercises, behavioural experiments, skill training, behavioural activation, or relaxation
techniques. These techniques are always set in relation to
the mode model. The main goal is spending more time in
the mode of healthy adult.
Die Psychiatrie 2/2014
Conclusions for clinical practice
ST with the mode model is a new therapeutic technique
particularly for patients with PD or complex chronic emotional problems. However, this model is also well applicable to other patient groups or therapists in self-therapy.
The mode model gives a clear structure for the development of an individual case conceptualization and guides
the treatment. Clear treatment goals can be derived from
the mode model. Special attention is paid to experiential
interventions and the specific design of the therapy relationship as ‘limited reparenting’. Previous studies show
very good efficacy in patients with borderline personality
disorder in individual (7, 8) and group therapy settings (5,
6) and for other PDs (9). Good results are also reported for
chronic depression (22). Studies for forensic patients and
chronic Axis I disorders are currently underway.
Acknowledgements
Conflict of interest
The authors report no conflict of interest.
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Correspondence to
Dr. Eva Faßbinder
Klinik für Psychiatrie und Psychotherapie
Universität zu Lübeck
Ratzeburger Allee 160
23538 Lübeck
Tel. 0451/500–2465
E-Mail: [email protected]
© Schattauer GmbH
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For personal or educational use only. No other uses without permission. All rights reserved.