The healthy adult mode – what is it really?
The healthy adult mode represents the healthiest part of a person. It’s the side that gets things done such as paying bills and making life work. It’s also the part that has compassion and kindness towards others and their own vulnerable child. As schema therapists, our ultimate aim is to strengthen the healthy adult so that the client can meet their needs and enjoy improved functioning and wellbeing. We achieve this through reparenting the client and in turn they internalise this over time to strengthen their own healthy adult mode.
Why, when and how to introduce and build the healthy adult in imagery rescripting
A common question that schema therapists have is why, when and how to introduce the healthy adult mode in imagery over time.
This may seem obvious but the reason to invite the healthy adult mode in imagery is to meet the vulnerable child’s core needs and to help the client develop their HA.
How do you introduce and build the HA?
I find the best way to introduce the healthy adult mode into imagery is to follow the principles of graded exposure and gradually increase the role of the healthy adult in imagery.
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You can have it all, just not at the same time
Early therapy strategies – ask the healthy adult to witness the imagery and seek their feedback during the imagery. For example, after meeting (or attempting) a core need for the vulnerable child (VC) ask the healthy adult if what you said landed with the VC. Alternatively, when you are debriefing with the client ask them to sit in the healthy adult chair and ask them what they will take with them or what message they can reinforce through the week (e.g. I am worthy just for being human).
Middle therapy strategies – Once the client is displaying a reasonable amount of healthy adult mode, I generally invite their healthy adult mode to enter the imagery after I have reparented and ask if there’s anything they would like to say or do? You could also plan the imagery (e.g. plan how the HA can support the VC) prior to commencing it.
Later therapy strategies – Once the client has a well-developed healthy adult mode, encourage them to support the vulnerable child in imagery. In this stage, the therapist steps back and allows space for the client to do the majority of the reparenting in imagery. The therapist acts a proud parent by acknowledging the HA’s strength and role with the VC. If the client experiences any stuck points during the imagery the therapist can ask the client for permission to enter the image and support the HA. Alternatively, the imagery could be paused and the client and therapist can conference together around how to best support the VC.
Q & A - trouble shooting
But what if they have a lot of healthy adult to begin with? Should I just skip to later therapy strategies?
Not necessarily. The first step is to really assess if they have a very strong healthy adult mode. It can be easy to confuse a high functioning person with a healthy adult (and the healthy adult mode with a perfectionistic over-controller mode).
The healthy adult mode is not just about being high functioning and getting things done. It’s also about the client’s capacity for self-compassionate. Effectively this is the difference between being vs doing. High functioning clients in my experience are better at doing than they are at being. Therefore, their healthy adult mode may struggle to meet the psychological needs of the VC in imagery, early in therapy.
If a client has developed enough healthy adult mode early in therapy, I would move through the stages a bit faster. My other reason for leading the reparenting initially is also to build my relationship by meeting needs and nourishing the vulnerable child. This meets an important attachment need for the client and bolsters the strength of the relationship between the client and the therapist. This is particularly important for clients with emotional deprivation schemas who may never have experience sufficient nourishment, empathy and emotional care.
What if the healthy adult attacks the vulnerable child mode in imagery?
If it seems that the HA is attacking the VC, then what may well be happening is that the critic mode has entered the image. When this happens, I call it out quickly (e.g. hold on, the critic has entered this image) and protect the VC from the critic (e.g. critic, you are not welcome here, I will not let you speak to little X like that, I am going to ask you to leave…is the critic leaving?). From there, I will either take over the reparenting to ensure safety for the VC and invite the HA if appropriate.
Tena Davies is a Clinical Psychologist and Advanced Certified Schema Therapist/Supervisor. She works with adults in Melbourne, Australia and enjoys teaching and supervising for schema therapy accreditation and general schema therapy supervision. She is the current chair of the bulletin committee, which is the ISST’s publication for members.
Tena runs group supervision here: https://www.tenadavies.com/supervision
