At Secure Nest we want to support users to integrate our eHealth tool into the therapy process based on the schema mode model. This may be a relatively new concept for some therapists and we will be developing session-by-session guides to offer assistance each step of the way. We encourage you to share any questions, feedback or creative ways that you have used Secure Nest to enhance your therapeutic work as this information will be valuable to our Secure Nest community and will assist in making positive changes to the lives of individuals receiving Schema Therapy. User feedback including inquiries will guide the topics and content of our journal entries.
My client has created an account and can now access the tool but where should we start?
Firstly, we are excited to share that the protocol we are basing our session-by-session guides on is being used in an international randomised controlled trial and therefore we can reassure you that the Schema Therapy techniques, activities and resources have been developed in collaboration with Schema Therapy experts around the world, ensuring the use of the platform stays true to the Schema Therapy conceptual model, is evidence-based and can be applied to clients from different cultures.
In general for all therapy sessions therapists should try to look into the client’s ‘Notes/Events’ page to see what they have tried before the client comes in for his or her individual face-to-face session. Each session it could be helpful to ask the client how he or she perceived using Secure Nest during the week, answer any questions, help with difficulties, recommend personalised exercises based on schemas and basic core needs, and encourage further usage. Throughout Secure Nest our clients have reported that they like it best if the language fits their own personal experience of the modes.
Session 1 and Session 2:
Identifying modes and personalising the mode model is the first step when using Secure Nest. This involves adding your client’s modes in ‘My Modes,’ within the workshop menu. If you have already developed an individual schema mode model together with your client you may decide to add this information to Secure Nest between sessions or you can use Secure Nest on any internet-connected device in session and update ‘My Modes’ as you continue to further develop the case conceptualisation.
Clients are encouraged to visit the ‘Identify My Modes’ page when they log in to Secure Nest in order to build awareness of which schemas and modes are triggered and to connect with thought processes. After identifying which mode is active, clients can then access strategies linked to that particular mode. Try to fill in the behaviour field first in ‘My Modes’ as this field is visible on the ‘Identify My Modes’ page. In this field consider writing what this mode is telling the client to do, and if it is a coping style acknowledge that this way of coping feels like the clients’ only option.
In ‘Identify My Modes’ the top text box allows therapists to write down key questions for each client, to encourage the client to re-connect with their Healthy Adult or to connect with the therapist.
Consider developing goals together which are linked to the core emotional needs of the client/positive qualities that they long and add his or her goals to ‘Goals.’
Homework for Session 1 and Session 2 could involve:
• Choosing images for modes on Secure Nest based on their experiences, needs and schemas
• Practicing “mode spotting” by watching their modes to encourage them to identify modes and adding an entry into ‘My Journal’ if they can notice any signs of the modes during the week (e.g. a Healthy side or a Demanding/Self-Critical side)
• Logging in to Secure Nest, seeing the therapist’s image and trying to feel connected between sessions, providing an opportunity to develop object permanence and enhance connection.
* Descriptions, explanations and case examples of modes will be available on Secure Nest soon and you can encourage your client to become more familiar with their schemas and modes by reading this content.
Following an experiential exercise in session (e.g., imagery, role-play, historical role play or a chair technique) consider uploading an audio flashcard based on your client’s schemas and core emotional needs in ‘Managing My Mode’ on the ‘My Modes’ page for the particular mode (e.g. Vulnerable Child mode, Little …) Alternatively you could consider:
• Uploading an imagery exercise in ‘Managing My Mode’ on the ‘My Modes’ page for the Vulnerable Child mode where you encourage the client to get in contact with their Vulnerable Child in their safe place once each day.
• Write a note in ‘My Journal’ each day to notice when they are in touch with their Vulnerable Child mode and if possible check in to see what she or he needs.
• Do a drawing of their Vulnerable Child mode and upload to the image of the Vulnerable Child or ‘My Journal.’
Following an experiential exercise in session consider adding Healthy Adult messages in ‘Managing My Mode’ on the ‘My Modes’ page for the particular mode. You could pre-prepare Healthy Adult messages with your client and consider uploading your reparenting recording so your client can take in some of the messages too as if your client is really stuck in a mode he or she may need a stronger persuasion to change their behaviour than only the Healthy Adult messages.
Consider adding a ‘Homework’ exercise based on your client’s childhood experiences. Your client could make a list of which needs he or she mostly missed in childhood, and which they miss out on now. This may provide an opportunity for your client to link the present situation to deeper messages they have received from different people in their life about their sense of self and their emotional needs. Perhaps consider encouraging your client to change the colour of the title bar that sits behind their name at this stage in order to give the platform growth over time.
We hope our guide for introducing Secure Nest into Schema Therapy has been helpful and we look forward to writing the next part of this current series.
The Secure Nest Team