Schema Cards Tutorial

Three Boxes of Bear in Mind Schema Therapy Cards are laid out side by side. These are the Core Childhood Needs, Schemas, and Complete Modes Packs. The Schema Formulation Aid worksheet is visible below with some of the Schema Cards on it. It has been partially completed and an uncapped pen is resting on it as if it is in progress.

People frequently ask me how to use the Bear in Mind Schema Therapy Cards, and the truth is, you can use them however you like!  They’re intended to be flexible.  But to get you started, here are some of the ways I use them.  

Please feel free to email me if you have any questions!

Starting Therapy:
A very good place to start.

A diagram shows how the elements of Schema Therapy Interact. It shows that Core Childhood needs are needs all children have, and that if unmet or met excessively, they can cause problems. One of the problems they can cause is the development of maladaptive Schemas. Schemas are beliefs about the self, others, or the world which cause distressing and suffering. When a schema is activated, modes come into play. Maladaptive coping modes also cause problems by preventing the underlying needs from being met.

At the beginning of therapy, I usually start by explaining the different elements of Schema Therapy and how they interact.  I begin by arranging my piles of Core Childhood Needs (CCNs), Schemas, and Modes as above, with the CCNs at the bottom, Schemas just above them on the table, and Modes at the top.  I then explain that unmet Core Childhood Needs can lead to the development of Schemas, which when activated, invite unhealthy Coping Modes to manage them.  

I usually then suggest we choose a pack to start with and return to the others later.  For clients who are likely to find it hard to get started, or to want me to understand their history first, I begin with the Core Childhood Needs.

Introducing the Core Childhood Needs

The Core Childhood Needs cards come in pairs, with one card representing a need being met, and one representing it being unmet.  I explain this to clients, along with the idea that needs being excessively met can also be problematic.  Safety is a good example of this as clients can easily understand that if their parents were overprotective they might be anxious about their safety as adults.

I then pick up a pair and read it aloud to the client, asking them to tell me if they think the “met” or “unmet” card better represents their experience.  Whichever they choose is put into a pile and noted on my Schema Therapy Formulation Aid worksheet and the other card is returned to the box.  

A pair of Bear in Mind Core Childhood Needs cards. These represent Nurturance being met and unmet. On the Met card, a Black, heterosexual couple are gazing lovingly at their baby. On the Unmet card, a Caucasian baby is crying at the feet of their mother. They are not being attended to and have sick on their babygrow.

I ask the client to tell me why they think the card they have chosen applies to them, and make notes that will later support the Case Conceptualisation or be added to their timeline.  I find this really helpful when I need to help them make connections later on, or when validating the Vulnerable Child and challenging the Punitive Critic.  It also generally generates useful information about relationships which I add to their genogram.

Once we have our list of unmet Core Childhood Needs, I explain how these can contribute to the formation of Schemas, and we move on to looking at those.

Maladaptive Schemas

A Bear in Mind Schema Card depicting the Mistrust/Abuse Schema. A woman is shown looking mistrustfully at a wolf wearing a lamb costume. The wolf is holding the lamb mask in its hand. The woman has her arms crossed defensively.

I introduce the idea of Schemas, explaining that these are big beliefs about ourselves, others, and the world, which often originate in our early experiences.  I describe how these beliefs served us once, but are now a poor fit for our current lives and cause harm and suffering.

I read through each Schema card with the client and ask them to tell me whether the Schema is relevant to them or not.  If it isn’t, we put it away in the box.  If it is, I want to hear more about why.

I use my Schema Formulation Aid worksheet as before to record what my client has identified, and write down details of the Schema for my Case Conceptualisation.  I also notice if the client says anything about the origin of the Schema, and help them tie it to what I already know about their unmet CCNs.  

I tell clients that some Schemas seem to be buddies, and often pop up together or seem to have some sort of relationship.  If they are able to make these links, we make a note of these too for future work.

I explain that when Schemas are triggered, we are likely to feel vulnerable and find ourselves in a Child Mode, which may trigger all sorts of other Modes.  And with that, we move on to understanding Modes!

Modes

Because I understand the Modes as behaving in a hierarchical way, I tend to lay them out as below on the table.  I explain that all our very painful feelings are located in the Vulnerable Child and its subtypes, and that the Angry and Impulsive/Undisciplined Child subtypes tend to arise in response to the VC’s needs being unmet or unrecognised.  These are very unskilful, raw reactions, hence them also being Child modes.

Beyond this, are the Coping Modes.  These are our attempts at protecting or hiding the Vulnerable Child from the outside world and from the problematic internalised parents/critics.  They appeared for a good reason and served a purpose once, but now they cause more trouble than they are worth and prevent our needs from truly being recognised and met.

The Schema Mode cards are laid out hierarchically, with the child modes at the bottom, the coping modes in the middle, and the critical parents plus the healthy modes at the top.

I then explain how the Critical/Parent Modes can cause distress, and how Schema Therapy intends to turn the volume down on these and reduce or remove the Coping Modes so the Healthy parts of us can be in touch with and address the unmet needs.  We speak about how the Healthy parts will be bolstered through our work together, and about how we might not notice VC activation because we might avoid it by quickly flipping into other modes.

I explain that the Vulnerable Child Mode is an “umbrella mode” with other “flavours” and introduce these.  I then explain how the Angry Child Mode might appear to demand to be heard (and sometimes throw a tantrum myself to demonstrate!).  I shift focus to the Impulsive and Undisciplined Child Modes and explain how these are a childlike attempt to soothe oneself, but have little regards for the consequences.

And then we move on to the Coping Modes.  I explain the three categories of these: Surrender, Overcompensate, and Avoid, and relate these to Fight, Flight, and Freeze.  Clients often notice at this point that they have a preferred coping style, and I acknowledge this.

A close up image of the Eating Disorder Overcontroller Mode card

Once the client has a good understanding of the Modes and their functions, we look through them all together, putting any that are’t relevant away in the box, and making a pile of those that are.  I add them to our worksheet and ask them to tell me about what these look like so I can include this in the Case Conceptualisation.  I also check whether they recognise any patterns or can see how any Modes relate to their Schemas.

And then we’re pretty much done with Getting Started!  Any information we have gathered is tidied into useful documents and clients are provided with copies of these.  These are dynamic and may change as our understanding develops, but it’s a pretty good start!

Use in Subsequent Sessions

After the initial phase I continue to make very good use of the cards.  I always have them available to clients, mostly on the table in front of them, and ask them to pick out Schemas, Modes, and CCNs as they recognise them.  If they are struggling to understand a situation, I might do this for them, laying out the cards as you would in a DBT Chain Analysis or CBT hot cross bun to help them see what was happening.  As clients become more familiar with the concepts, I usually respond to them being stuck by picking several similar or possible cards and asking them to tell me which is relevant.  This is all good practice for clients and helps them complete the Circle of Awareness at home as they are increasingly good at reflecting and identifying schemas and modes.  This also enables us to recognise points when a Coping Mode interfered and to think about what a Healthy option would have been at this point.

For clients who are reluctant to do Chair Work, I sometimes put the card in a chair and we use this to represent the Mode.  This seems to be less cringey for some so has been helpful in transitioning them into doing the role play themselves.

There are plenty of other ways to use the cards, but these are just a few to get you started.  I really hope they’re useful and you get a lot out of them!

Have fun being creative with them!

Sapphire xXx