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Strengthening the Healthy Adult Mode

by Rosi Reubsaet, Sally Skewes, Jenny Broersen, and Anne-Marie Claassen 


In this case presentation, we want to focus on the clinical issue of strengthening the Healthy Adult mode. For this, we want to present three ways to accomplish this. Each angle adds some ideas and techniques from adjacent psychological fields to enrich schematherapeutic interventions. The first angle is the use of technology to help the patient enhance the experience of therapy outside the therapy-sessions. The second contribution focuses on using interventions and concepts from positive psychology and states that the Healthy Adult part can be seen as a human being. The third presentation states that using phases, stemming from developmental psychology, helps the patient and therapist in strengthening the Healthy Adult mode even from the start of the therapy.

Each presentation will take 20 minutes in which the ideas are introduced. Also, each presentation comprises an example of a typical exercise or feature. The last 30 minutes are left for discussion among the presenters and the audience.
The first presentation will state the following: A core goal of Schema Therapy is to strengthen the Healthy Adult part of the patient by validating core emotional needs.

The patient is often coached to practice being in the Healthy Adult themselves in the last stage of therapy. However, even in this stage of therapy it can be difficult to translate changes in the treatment room to the patient’s day to day life. How can we bring the Healthy Adult into the patient’s world, which is often a very different setting to the treatment room? The introduction of technology in Schema Therapy provides new ways to strengthen the Healthy Adult. If therapists and patients could bring the Healthy Adult into the patient’s world from the start of therapy via accessing a therapy companion, such as Secure Nest between sessions this could enhance the experience of therapy and assist with the important needs-meeting work in Schema Therapy. Creative ways to introduce the Healthy Adult, help patients to understand the Healthy Adult, and learn Healthy Adult behaviour will be illustrated across different stages of therapy using Secure Nest.

The second states that Schema Therapy puts the Healthy Adult mode against the vulnerable and dysfunctional parts of the patient. The presenters think that the Healthy Adult can be targeted more directly. For this purpose, we developed interventions specific for enlarging and strengthening the Healthy Adult side. These interventions stem from Schema Therapy and from positive psychology. Positive psychology is becoming more popular and uses inspiring techniques and concepts such as wellbeing, gratitude and compassion. We think that Schema Therapy can be more effective if these ideas are integrated. In working with the Healthy Adult mode, this means that this mode is seen as a human being, who is strong in dealing with the complex challenges of life. Interventions also comprise psycho- education on stress-systems, using personal values and future-directed imagery work.

The third contribution also focuses on the fact that one of the main goals in Schema Therapy is to strengthen the Healthy Adult part. Traditionally, the idea is that this mainly takes place in the last part of the therapy. In this part, the patient is stimulated to practice outside the therapy room. However, when using a phase-oriented approach, strengthening the Healthy Adult can be an explicit, on- going process during the entire therapy. The phase-oriented approach states that the therapy process in Schema Therapy shows similarities to the upbringing of a child. This means that normal developmental stages and tasks can be used as a girder for limited reparenting. Following this, several exercises have been developed to help a patient develop his Healthy Adult mode. This work begins in the first sessions of the therapy and evolves over time. For example, at first a patient practices acknowledging his emotions. When he is able to do this, he takes the next step in trying to manage his emotions. At the end of the therapy, he is capable of acknowledging, managing and using his emotions in a constructive, Healthy Adult way.

Expected Points of Discussion:
  1.   It is important to stimulate the Healthy Adult in different ways; the three angles can amplify each other.

  2.   Strengthening the Healthy Adult mode starts early on in therapy and can be trained.

  3.   Using technology and positive psychology enriches schema therapy

  4.   Developmental phases structure and guide limited reparenting and the therapeutic process

Discussant 1

Name: Rosi Reubsaet

Discussant 2

Name: Sally Skewes

Discussant 3

Name: Jenny Broersen and Anne-Marie Claassen

It is one thing to get rid of dysfunctional modes and schemas, but another to build on the healthy ones. During the course of therapy, the schema therapist is aware of building on things like healthy standards, flexibility, self-compassion, perseverance, strength, etc. Especially during the (phase of) behavioral change, the patient is challenged to keep self-confidence and faith in their possibilities. Here the patient, more than ever, needs the therapists’ support in strengthening the Healthy Adult (HA). Even at the end of treatment things can get shaky in sessions How can we keep track of letting the HA grow? How can we stay with the patient, but simultaneously give the patient confidence in their possibilities? How can we "withdraw" and stimulate autonomy, without patients are feeling neglected? 

This skill class provides a clear guideline for the needed therapist attitude and how to act in challenging situations in the last phase of (group) therapy. There will be demonstrations how to use experiential techniques to strengthen the HA in group and individual sessions. After the demonstration, the participants will work in small groups to practice these skills. 

Level of Experience Required for Participants: 

All participants

About the Presenters:

Rosi Reubsaet: 

Rosi Reubsaet:Rosi Reubsaet is a registered clinical psychologist/psychotherapist, trainer/supervisor Schema Therapy ISST and supervisor CBT. She started working with (group)Schema Therapy in 2006 and has been trained by Arnoud Arntz, Hannie van Genderen, Joan Farrell and Ida Shaw. She is boardmember of the personality-disorder section of the Dutch CBT-association. Momentarily, she works at a large mental health care organization in the Netherlands, where she treats PD-patients with individual and group schema therapy, in an outpatient and day treatment setting. She trains and supervises Schema Therapy and CBT in the Netherlands and in Germany, since 2012. She is author of the book “Schematherapie. Werken met fases in de klinische praktijk” (2018; title translated: “Schema Therapy. A phase-oriented approach in clinical practice”

Sally Skewes: 

Sally Skewes is a Clinical Psychologist based in Australia, certified as a Schema Therapist and Supervisor with the International Society of Schema Therapy (ISST). She is also the co-founder of Secure Nest, an innovative eHealth tool designed specifically for Schema Therapy. Sally has been using Secure Nest with clients for four years to enhance the limited reparenting aspects of Schema Therapy. She has experienced that Secure Nest functions as a transitional object for clients between session

Jenny Broersen: 

Jenny Broersen is a certified clinical psychologist/psychotherapist and site director at G-Kracht Mental Health Care Institute in Amsterdam, and is active with GGZ Delfland (Mental Health Care Institute) in Delft. She is a certified supervisor/trainer and personal therapist in schema therapy (ISST, Dutch society of Schema Therapy and cognitive behavioral therapy (VGCt). She works with personality disorders for more than 15 years mainly in an outpatient setting and for a few years in a day treatment setting. She gives regularly schema therapy workshops/ supervision/ personal therapy in the Netherlands.She has published various books, chapters, and articles on the subject of Schema Therapy e.g. (for example: Van Vreeswijk, M. F., van, Broersen, J., & Nadort, M. (2012). The Wiley-Blackwell Handbook of Schema Therapy, Theory, Research, and Practice.Oxford, Wiley-Blackwell. 9780470975619). The last publication is about the Healthy adult mode and is written with co-author Anne-Marie Claassen: module schematherapie en de Gezonde volwassene, 2019 (translation: module Schema Therapy and the Healthy adult, 2019)

Anne-Marie Claassen: 

Anne-Marie Claassenis a psychotherapist and head of Clinic for inpatients with personality disorders and head of the Schema Therapy department of de Boerhaven, Mediant; a mental health institute in the Netherlands. She is chief editor of PsyXpert; a leading Dutch journal with publications on psychotherapy, offering e-learnings and other articles for psychiatrists, clinical (neuro-) psychologists, and psychotherapists. She is a registered supervisor Schema Therapy and psychotherapy. She trains teams and gives training in Schema Therapy. She is author and editor of two books about Schema Therapy and the healthy adult. (Schematherapie en de Gezonde volwassene, 2015 en de module Schematherapie en de Gezonde volwassene with Jenny Broersen). She has published several articles aboutSchema Therapy and the healthy adult

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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