The Change Phase
Liz Lacy, LCSW
www.elizabethlacy.com
Advanced Schema Therapist, Certified Trainer/Supervisor
243 Main St. New Paltz, NY
633 Gidney Ave. Newburgh, NY
Case Conceptualization
• Big Picture is Critical: needs, schemas, modes
• After very thorough Assessment
• Drives the case and can be modified
• Do Share with Client
Broad Strategies for Change

Cognitive: Restructure thinking related to schemas; develop
healthy voice to create distance (not detachment)

Emotion-Focused: Practice emotive exercises to vent anger &
grieve for early pain, to empower patient

Therapy Relationship: Focus on therapy relationship to
provide limited reparenting, and to heal schemas & coping
styles triggered in sessions

Behavioral Pattern-Breaking: Rehearse behavioral and
interpersonal changes related to presenting problem; break
dysfunctional life patterns
Column 1: List Evidence Supporting the Early Schema
A. From Childhood & Adolescence
B. From Adult Life
Column 2: Reattribution
A. Was it my fault?
B. Are there other explanations? Special circumstances?
Am I overgeneralizing?
C. Can I change?
Column 1: List Evidence Against the Early Schema
A. From Childhood & Adolescence
B. From Adult Life
Column 2: How I Discount the Evidence?
Column 3: Reclaiming the Positive Evidence
Dialogues between
Schema Mode
And Healthy Adult Mode
 Therapist
dictates flashcards, using
template or free-style
 Write (or audio record) separate
flashcards for most recurring life
situations or modes
 Later in therapy, assign Schema Diary
Schema-Driven Behavior in
the Therapy Relationship
Point out when patient’s schemas/modes seem to
be triggered in a session
 Ask patient for trigger event, emotions &
cognitions; label schemas & coping styles
 Are the therapist’s schemas/modes being
triggered?
 Distinguish the patient’s accurate and adaptive
reactions from schema-driven reactions
 Link events in the session with situations outside
therapy

The therapist tries to fulfill those emotional
needs for a patient that were not adequately
met in childhood, while respecting the healthy
limits of a therapy relationship

Therapist’s behavior serves as an antidote to patient’s
childhood experiences; tailor style to patient’s schemas

Therapist fulfills needs that were never adequately met,
within appropriate boundaries of therapy relationship
(“corrective emotional experience”)

Patient internalizes therapist’s Healthy Adult mode
 Convey high degree of warmth, nurturance
& caring
 Be a real person, don’t play the role of a therapist;
be honest, direct, & genuine; avoid neutrality
 Empathize with & validate the patient’s feelings,
more than correcting distorted interpretations
 Ask about positive & negative reactions to you as a
person, not just as a therapist
Confidence-building
through direct praise
Incorporate appropriate self-disclosure
whenever possible
“What would a healthy, “good parent” do
for a young child?”
 Reparenting through imagery
 Continual therapist supervision to work with
therapists’ own schemas
 Guidelines for appropriate self-disclosure
 Limits on contact outside of sessions to protect
the therapists’ & patients’ boundaries, while
still providing extra therapy time

Imagery & dialogues for empowerment

Patient expresses anger and asserts rights
appropriately in imagery and role-playing

Patient grieves for losses; faces & overcomes
trauma

Clarify self-defeating behaviors that are part of the life
pattern; review negative consequences & link to presenting
problem

Patient keeps detailed, “verbatim” reports of current
situations that are part of cycle

Therapist models, then patient practices new behaviors to
break cycle in imagery and role-plays

Therapist assigns homework; uses schema imagery to
overcome avoidance and obstacles to change
 Therapist’s
Posture: “Sensing the Story” –
Differentiating the Past from the Present.
 Linking and Labeling Maladaptive
Reactions and Self-Defeating Patterns.
 To Understand and Hold Accountable
Schema Modes
Complex Trauma and BPD
Common Schema Modes
Abandoned
Detached
Angry
& Abused Child
Protector
& Impulsive Child
Punitive
Parent
Healthy Adult
Three Stages of Treatment
 Bonding
and Stabilization

Schema Mode Change

Autonomy
Common Mode Strategies
for Complex Trauma

Limited Reparenting

Schema Mode Dialogues

Mode Imagery

Cognitive reattribution

Limit-Setting for Anger & Impulsivity

Overcoming Detachment to Evoke Affect

Behavior Rehearsal & Practice
The Process of
Limited Reparenting

Patients with Complex Trauma and BPD need to begin the
process of meeting core needs within the therapy
relationship.

In BPD their maladaptive schema modes are usually too
destructive initially for them to develop gratifying
relationships outside of sessions.

Over time, limited reparenting directly heals many of the
maladaptive modes of BPD patients, so that they can later
get their core needs met outside of the therapy
relationship
Using Empathic Confrontation
to address Avoidance,
including…Defiant Avoidance!
Avoiding Schema Activation AND Identifying the
Defiantly Detached/Angry Protector Mode
 Linking the mode to childhood and the presence
of Parent Modes
 Refocusing on the Child Mode
 Reparenting the Vulnerable Child
 Debrief

Using Empathic Confrontation:
A “high road” Approach
Frustrated
and Enraged Child
 Rebellious /Bullying Adolescent
 Overcompensating Adult
Empathic Confrontation: to Access
the Vulnerable Child and to Set Limits
Identifying our own “Triggers”
(With a Challenging Client)
Harnessing “Realness”
Label schemas and modes; create dialogue
with modes to measure relative strengths
 Discuss importance of allowing Lonely
Child to be cared for and connected with
therapist and with someone in patient’s
life
 Negotiate with maladaptive modes to
overcome blocks to vulnerability
 Generalize changes in session and in
imagery to relationships outside therapy

Therapist’s Schemas
short list of examples
Emotional Deprivation: misunderstood
Defectiveness: unlovable, unworthy, inadequate
Abandonment: rejected
Mistrust/Abuse: attacked or manipulated
Failure: defeated, incompetent
Self-Sacrifice: guilty or resentful
Unrelenting Standards: didn’t try hard enough

Examine schemas of parents and other significant
others who hurt the patient

Parenting is difficult; most do the best they can, given
their life circumstances and psychological limitations

“Legacy of schemas”

Concepts of acceptance & forgiveness to achieve
peace and closure, if possible
To Purchase/Use Inventories
http://www.schematherapysociety.org
Schema Therapy: A Practitioner’s Guide
Jeffrey Young, PhD and Janet Klosko, PhD
Disarming the Narcissist, Wendy Behary, LCSW
Schema Therapy in Practice, Arnoud Arntz, PhD
Question/Answers
• Cases
• Clarification