Schema Therapy for Trauma (3/5): Limited Reparenting

Schema therapy is a relational, attachment-based approach. We can clearly see the integration of psychodynamic psychotherapy here – when developing his model, Jeffrey Young knew that 10-20 sessions of CBT would not work for more complex clients. Instead, they needed a slower-paced, long-term ‘corrective emotional experience’. Young mined the rich theoretical seam of attachment theory, especially John Bowlby’s concepts of the ‘secure base’ and ‘safe haven’, to emphasise that schema therapists need to embody these vital aspects of a secure attachment figure for our clients – many of whom have never experienced a safe, nurturing caregiver in their lives.

And when working with any client, whether suffering from trauma or other psychological difficulties, the core therapeutic stance of the schema therapist is ‘limited reparenting’. This means that, as far as possible, we strive to meet the key developmental needs that were not met in our client’s childhood. And understanding that person’s history, as well as their schemas, tells us which needs are most pressing.

For example, if someone had a clinically depressed mother, who (through no fault of her own) was too unwell to maintain a consistent, loving attunement with her baby, that person may well have felt abandoned and been insecurely attached from infancy onwards. They could then develop an Abandonment/Instability schema, which would make all of their intimate (especially romantic) relationships painful and problematic. So my limited reparenting with that person would focus on being consistently warm, compassionate and highly attuned to them, so they were able to form a strong bond with me. This would help heal that schema, as well as gradually changing their attachment style from anxious to secure.

Reparenting the Vulnerable Child

It’s also important to remember that anyone who has experienced complex trauma – especially at a young age – will have a traumatised child inside them. This idea of the ‘inner child’ is common to many therapy modalities, but is given unique importance in schema therapy. All of my reparenting efforts will be focused on the Vulnerable Child mode (as well as any other dissociated or traumatised child modes, such as the Angry Child or Mistrustful Child). Clients seem to find this profoundly healing, especially if their childhood was blighted by trauma, abuse or neglect.

Emma’s Vulnerable Child was highly sensitive to perceived signs of rejection or abandonment. At times, she would get angry with me for taking holidays, as these breaks would trigger her Abandonment schema and she would panic that I was leaving her. To calm and soothe her, I would speak directly to Little Emma, saying, “I know you are really scared right now and worry that I am leaving you. But I promise that’s not happening. I need to take a break sometimes, so I can recharge my batteries and be better able to help you, but I will see you in two weeks”.

To help her through the break, I would record voice messages on her phone, reminding her that I was still there, still cared about her and was not going anywhere. I also gave her a small, polished stone to keep in her pocket – a ‘think of Dan’ stone. Whenever Little Emma got anxious about being abandoned, Emma could hold the stone and conjure up an image of my face, imagine my voice and what I would say to calm her. These ‘transitional objects’ are a key part of the limited-reparenting process. They also helped Emma to internalise me as a secure attachment figure.

Between-session contact

When I am teaching schema therapy to mental health professionals, the idea of encouraging between-session phone, email and text contact with their clients often triggers some anxiety! This may be frowned upon in their modality; they might also fear being overwhelmed or flooded with messages by overly demanding clients. In this, as in many other ways, schema therapists push the psychotherapeutic boundaries to provide a truly deep, relational experience for our clients. But this is always within the normal ethical parameters and it’s helpful to set limits, saying you will only respond in office hours, unless it’s an emergency.

In my experience, just sending me the odd message reassures and soothes clients like Emma. It helped Little Emma believe that I was still there for her, even when physically I was not. And if the messages got too much, I gently worked with that to reduce them to a level that was manageable for us both. As Young often says, ‘Therapists have needs too!’ So if you are looking to incorporate some of these ideas into your practice, remember to take care of yourself and recognise your own limits – burning out helps neither you nor your clients.