Therapy

How to Talk Yourself Into Therapeutic Change

Find different modes in your character and get the conversation started.

Posted Jul 28, 2020

 Emmanuel Bior/Unsplash
Source: Emmanuel Bior/Unsplash

Over 100 years ago, therapy was referred to as “the talking cure,” which implies a patient is cured by talking … to a therapist. Certainly, an effective element of therapy is when we are vulnerable enough to share our feelings with a relative stranger. But so often in my practice, I’ve witnessed how my clients gain deep insight when they are surprised by what they hear themselves saying aloud. In that way, you could say that sometimes therapeutic action happens when you talk to yourself.

The schema therapy concept of modes deeply expands this moment of “hearing oneself” into a broader concept of how complicated our identity really is. When we hear ourselves say something aloud which surprises us, it’s coming from somewhere, right? Schema therapy says this surprising thought or voice comes from a self who may be different from who we are on the surface. According to schema therapy, modes make up different parts of the personality, and they originally formed as a way of helping us adapt to our environment growing up. Think about how you may be a bit of a different self when you’re at work, or with your parents, at home, or with friends. It’s the same concept.

Now, if you’re well-versed in schema therapy theory, you may think I’m really talking about schemas, and not modes. So what’s the difference between a schema and a mode? You may recall that a schema is a very particular mindset, something like “you can always do better,” which leads to perfectionism and creative frustration. Or “I’m really defective, which is why no one likes me.” Again, a schema is a simple thought or mindset that is persistent and can do a lot of damage to your self-esteem. A mode, on the other hand, is what happens when a group of schemas come together into one voice. For example, a mode may be made up of thoughts of defectiveness, as well as the strong feeling that your pain is insurmountable, and a negativity that says it will always be this way.  These three schemas form into a mode that we could call the “vulnerable child.” For example, a rejection of some kind may throw someone into vulnerable child mode as a reaction, which involves these thoughts and feelings. (You can find a list of common modes here.)

Modes are ways we have of organizing our experience during child development and follow a kind of story of growing up, and how we hold onto selves that we leave behind as we mature. The story goes something like this. First, we hold onto our deepest emotions as child modes. Think about when you have simple joy, or intense sadness: these emotions are childlike. Next, we internalize our parents and caregivers into our minds as critical voices—parent or critic modes—that are formative in our senses of conscience, guilt, and self-esteem. You can imagine how a stern or withholding caregiver would lead to a punitive or demanding critic mode. Next, we develop coping modes to handle adversity, which are influenced by the core stress reactions in our body: fight, flight, and freeze. Think about when a sudden crisis happens. Are you someone who tends to freeze up? Or do you stay detached and react? Or do you anger quickly? These may be your coping styles, happening at a more intuitive level. For example, overcompensation for fear leads to overly aggressive reactions. And finally, we have joyous, assertive, curious, and caring modes making up our happy and healthy modes.

So what happens when we say something aloud in therapy and it surprises us, to therapeutic effect? A mode that hasn’t had much of a chance to be heard finally gets some attention, and it’s a huge relief. Schema therapy suggests—and my clinical experience backs this up—that strife and discord happen when our modes don’t get a chance to talk to each other and feel heard. I would say that the actual goal of therapy is to help a client pay attention to their modes. In this sense, each mode is like a person with feelings who needs to be heard. And as with anyone, being ignored can cause anxiety and depression.

For example, let’s consider a combination of anxiety and depression—so common among people who come to therapy. In schema therapy, we arrive at a place where we can listen to the anxiety and hear the mode which causes it. There may be a demanding parent mode, severe and possibly angry that we aren’t perfect, saying we always have to be better and until we are, no one will want us. This mode can feel like constriction, stress, tension, and anger at the self, simmering in anxiety. Depression comes from being on the receiving end of all these endless demands and demeaning thoughts. The mode leaves us feeling rejected, worthless, unlovable.

Schema therapy helps by strengthening a very important mode called the “healthy adult” but what I prefer to call the “healthy caring adult.” (I see “healthy adult” as misleading since people often take it to mean someone who acts maturely, is well organized, and emotionally detached. I prefer a term that describes a mode as mature, but also compassionate, patient, and caring, like a good, loving parent.) The healthy caring adult mode acts as a kind of stage manager or caretaker of the other modes, helping moderate and calm the urgency and even destructiveness of them, as a voice of calm reassurance, care, and love. In other therapy contexts, particularly the treatment of attention deficit disorder, this mode may play a role called "executive function."

Everyone has a healthy caring adult mode to one degree or another, starting very simply with the desire to stop suffering. "I just want to feel better." Therapy helps nurture and cultivate that inclination into a fully developed healthy caring adult. It takes practice, having the courage to be open and vulnerable, and being open to trusting a therapist to help. It may start with saying to ourselves one day, “I’m not going to talk to myself that way right now, I deserve better," and building from there. Sometimes the therapist will help model things a healthy caring adult would say.

Later in therapy, we may even have mode dialogues, where the healthy caring adult intervenes between a vulnerable child who may be wounded, and a demanding critic mode who won’t let up. In this case, the healthy caring adult would address both modes, and sound something like this: “I know that when you were a child and vulnerable, you were really hurt by people you trust. And you had no one to turn to but yourself, so you had to be really tough on yourself in order to survive. The problem is that no one ever comforts or consoles your vulnerable child, so he keeps feeling hurt and as a result, you keep being demanding to cover the pain. But the past is over, and you don’t have to do it this way anymore. You can take care of yourself and you don’t have to be so demanding. Why don't we try comforting and healing the pain of your vulnerable child?”

At first this may sound like a lot, but the mode approach is founded on the idea that we use talking to work through emotional difficulties, and it actually comes very naturally. We connect with the voices of child selves, parent/critic identified selves, and other modes so that they are really heard, often for the first time. This feels incredibly validating. The job of therapy is to help clients develop a self who listens and get the conversation going.

To find a therapist, please visit the Psychology Today Therapy Directory