Understanding the "Healthy Adult" in Schema Therapy

Here, I aim to explain the nature and function of the "healthy adult" (HA), a concept that comes from the schema therapy (ST) model (Young, 1994) and is becoming an increasingly popular approach for working with a variety of personality and mental health issues (Masley et al., 2012).

The HA represents the state of mind that embodies psychological health and maturity. Its function is to provide capacity and guidance to make informed, realistic, and accurate decisions in everyday life, as opposed to simplistic, distorted, unrealistic expectations or choices (Salicru, 2023).

Modes or Self-States

In addition to 18 early maladaptive schemas (self-defeating, core themes or dysfunctional patterns that some individuals keep repeating throughout their lives), the ST model includes the concept of schema modes or self-states. Modes are momentary emotional, thinking, behavioral, and neurobiological states that we experience in response to the activation of schemas—when our needs are not met (the HA mode being an exception). There are four mode categories:

1. Child modes
2. Dysfunctional coping modes
3. Dysfunctional parent modes
4. Healthy adult mode

1. Child modes

These are moment-to-moment mental and emotional states, and behavioral responses, from which we learn in childhood to operate and adapt. There are four main child modes:

1. The vulnerable child experiences fear, pain, sadness, and anxiety due to schema activation of unmet emotional needs.
2. The angry child expresses by protesting or acting out anger due to schema activation of unmet emotional needs.
3. The impulsive/undisciplined child acts impulsively and has difficulty delaying gratification or considering others.
4. The contented/happy child feels joy, love, connection, and contentment because emotional needs are being adequately met; there is no schema activation.

2. Dysfunctional coping modes

These represent dysfunctional or maladaptive coping ways that we learned during childhood, when we were developing, to adapt to situations to help us survive. As adults, we are likely to continue to use these coping modes during moments that evoke or elicit past emotions in the present and remind us of these situations, even though we no longer need them to survive the current situation. There are three main types of dysfunctional coping modes:

1. The detached/avoidant protector copes by withdrawing, disconnecting, and avoiding schema activation. Cuts off own needs and feelings; detaches emotionally; rejects help; and can engage in self-soothing, or self-stimulating activities in a compulsive or excessive way (e.g., alcohol, drugs, porn addiction).
2. The compliant surrenderer copes with schema activation by being compliant or dependent on others. Acts in passive, subservient, submissive, approval-seeking, or self-deprecating ways around others to avoid the fear of rejection or conflict; and tolerates abuse and/or bad treatment (e.g., being a people pleaser or a pushover).
3. The over-compensator attempts to prevent schema activation by being over-controlling, dominating, or acting in ways that are opposite to what has been activated. Feels and behaves in an attention-seeking or status-seeking way. Displays grandiosity, controlling behavior, manipulation, and aggressiveness (e.g., being a bully). These feelings and behaviors developed originally to compensate for, or gratify, unmet core needs during childhood.

These three coping modes correspond to three coping styles that parallel the basic organismic responses to threat: flight, fight, or freeze.

3. Dysfunctional parent modes

These are referred to as internalized dysfunctional parental modes and relate to the way in which, as children—through the process of introjection—we internalized (unconsciously incorporated into ourselves) the way our parents treated us (e.g., dysfunctional parenting). According to research, for the good or the bad, we treat ourselves and others as we have been treated.

There are two prototypical forms of internalized parent mode:

1. The demanding/critical parent pressures themself to achieve excessively by meeting unrealistically high expectations and standards, and criticising oneself if they are not met.
2. The punitive parent shames, criticises, or punishes oneself. Feels that oneself or others deserve punishment or blame, and acts on these feelings by being blaming, punishing, or abusive towards self.

Internalized parent modes represent the various ways in which we may become our own worst enemies.

4. The healthy adult mode

Based on the above, this section explains why the healthy adult (HA) mode is so critical for mental health. The HA helps us to compensate or correct what we missed from parents or caregivers in childhood.

The HA helps us to free ourselves from the above-described self-destructive patterns, and to functionally satisfy our basic needs as independent, mature, and responsible individuals, as well as to positively relate to others.

Hence, the HA is the part of ourselves that is confident, capable, strong, and well-functioning. It is always able to answer the question: “How would a mature, compassionate, and psychologically minded person think, feel and act in this situation?” (Edwards, 2022, p. 4).

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From this perspective, the HA is equivalent to what Carl Rogers called a “fully functioning person,” Maslow’s “self-actualization” and “self-transcendence,” and the pragmatism of the traditional concept of “wisdom” and the “wise self.”

Source: Vladimir Wrangel/Shutterstock

Given the multiplicity of roles and tasks the HA needs to perform at any given time, a recent paper proposes using the metaphor of the octopus to represent the HA. The octopus is a highly intelligent creature that:

• Senses and learns the complexity of its surroundings swiftly;
• Solves problems idiosyncratically and creatively;
• With a large brain, elaborate sense organs, and eight highly flexible arms, can reach and grasp, swim, walk, dig, and groom;
• With large eyes can actively scan its environment to discriminate objects easily;
• Given its soft body, comprising a hydrostatic and articulated skeleton, its arms have large degrees of freedom to execute any given action;
• With its large nervous system, which contests that of many mammals, displays advanced cognitive abilities.

All this enables the octopus to generate amazingly efficient adaptive behaviors with elegance and ease—a capability that has been referred to as “embodied intelligence.”

In sum, the octopus metaphor offers a simple, pictorial, creative, powerful, and memorable metaphor that individuals can use to develop and strengthen their healthy adult mode as a positive psychological intervention to achieve their goals.