Transcript - Dr Lars Madsen

Jess Leondiou (04:59.918)

I just wanted to say thank you so much for your time. And I'm very excited to have you on the podcast because obviously your work is exploring something very interesting, which is schema therapy. And then you've explored it in such an interesting way in terms of like the forensic space and the kinds of people that you're helping and serving. So the point of this podcast is to understand how people's minds work. 

Lars Madsen (05:35.269)

I'm delighted to be here. Thank you very much for the invitation, Jess. Yeah, I'm fascinated by people and I think schema therapy, we'll talk about it today, is I think a model of therapy that can assist with sort of understanding sort of quite complicated behavior and behavior that on the face of it sometimes can look or can appear quite difficult to understand.

Jess Leondiou (06:08.791)

Thanks. Well, actually, maybe we can start there if you want to give a bit of a breakdown of like, what is, is schema therapy?

Lars Madsen (06:14.437)

Yeah, that's a good schema therapy is sort of a way to understand and heal deep emotional patterns that have shaped how we think, feel and act. So these patterns often start in childhood and can keep us stuck in unhealthy habits or relationships as adults. Think of it like this. When we're children, our experiences with our family, our friends and the world around us often create sort of a blueprints in our mind about who we are and how the world works, how life works. And these blueprints, we'd call them schemas, might tell us for instance, that we're no good. Or they might tell us that people will leave you, will leave us, or that we can't trust anyone. So they're like invisible lenses that color how we see ourselves and also other people. So for example, if you grow up feeling sort of ignored, you might develop what we would call an emotional deprivation schema, which makes you feel like no one will ever really truly care about you, see you or understand you. And this can lead to perhaps picking partners who aren't emotionally available or feeling lonely, even when you're not actually alone. Schemas are powerful because they feel true even when they're not and they can drive us to repeat the same kinds of mistakes like avoiding closeness or getting angry to protect ourselves with other people. Schema therapy, what it is, is sort of about trying to identify these blueprints and then, you know, it uses a mixture of talking, imagining, and even creative exercises to try to rewire them. For instance, you might imagine in a schema therapy session, for instance,

You might imagine talking to your younger self, giving them the love or the safety that they needed back then that they didn't get. This isn't just about thinking differently. It's about feeling inside different and healing those old wounds. So our goal in schema therapy, our longer term goal is to sort of build what we call the healthy adult part of you. And that's the part of you that can sort of challenge the negative beliefs.

Lars Madsen (08:37.1)

Soothe yourself when you're sort of activated or triggered and make better choices. So it's a long-term therapy. There's no quick fix. It's not sort of 10, sessions or 10 sessions and then you've done your schema therapy. If we're truly working with schemas, these blueprints that we see the world in, they've been around for pretty much most of our lives. And it takes a long time sometimes to sort of really identify them and also start to become conscious of the impact that it has on us. So we're kind of looking at the roots as to why we get stuck and whether it's trouble in relationships, self criticism, feeling empty, schema therapy kind of helps you understand your story and it tries to rewrite it with compassion. It's like being a hero on your own journey, facing your own fears and kind of coming out stronger.

Jess Leondiou (09:36.674)

I love that. And could you explain what's the difference between something like schema therapy and then cognitive behavioral therapy and perhaps for someone who's not listening, just to explain what cognitive behavioral therapy and how schema, I guess, attacks the stories in a different way?

Lars Madsen (09:53.72)

Okay, yeah, sure. Good question. So, cognitive therapy, so schema therapy sort of came out of cognitive therapy. Schema therapy sort of was a reaction to the observation that when cognitive therapy works with some people, there are some people that really, really struggle with being able to benefit from cognitive therapy. And they're usually individuals who we would describe have these long entrenched patterns of sort of problematic, unhelpful ways of seeing or experiencing the world.

So schema therapy uses cognitive therapy a lot of the time in what we do. And let me explain what cognitive therapy is. So cognitive therapy sort of at the very core sort of will say that when we feel depressed or when we feel anxious or when we are experiencing a strong negative emotional reaction, the reason for that is because we're thinking a particular kind of thought.

And then that's sort of activating a strong negative emotion. Now, when people are depressed or anxious, they're often thinking depressogenic thoughts. So thoughts that kinda tilt us towards feeling depressed. So for instance, someone wakes up in the morning and it might be the weekend for instance, and they might sort of go out and it's raining, it's a bit cold, and they might have, like a depressogenic thought that says, well, nothing ever works out for me. It's always raining. My life is pretty miserable. And then the feeling is, you know, maybe depression or sadness. Another person might sort of be, you know, out walking their dog, for instance, and they might pass some people and they might have the thought, well, you know, I'm sure that those people look negatively at me or they were judging me in some way. They were judging me negatively. They were looking at me, right?

They have that thought and then they feel some anxiety. So that's how we kind of make sense in cognitive therapy, cognitive behavioral therapy, that's how we kind of make sense of, well, you if people are struggling with their emotional states, we start to explore what are they thinking about and how they interpret it in the world. And the therapy then involves trying to help the person become better at sort of managing and thinking through their own thinking processes.

Lars Madsen (12:17.582)

because typically the thoughts that we have that make us really anxious or depressed are what we would call slightly distorted, right? So for instance, the, you know, waking up in the morning and it's raining and I'm cold and it feels all pretty miserable and my life's terrible. Well, your life probably isn't really terrible. What's the evidence for it? What's the evidence against it? What's a different way of looking at this? What's another way of, you know, what could we do that would actually be a positive thing? So we go through.

Cognitive therapy is about helping folks then kind of think through and analyze their thinking and then challenge it in ways that are helpful for them to lift their mood. And it usually works. Now schema therapy, we do those kinds of things as well. But the difficulty with a lot of schemas is that there's a real kind of, it's more than just a fleeting thought. For a lot of folks who have very entrenched schemas,

They have this experience, lived experience within their body in many cases of what a schema is. So when schemas are activated, there's this sort of very strong sort of emotional physical response that also gets activated. And what we try to do, what we found and what the research shows is that when we try to just challenge the surface level thoughts that might kind of get activated from that it doesn't really hit the mark in terms of changing how we feel about ourselves. So someone, for instance, who might have what we'd call a defectiveness schema. So defectiveness schema is this sense that I'm broken, I'm toxic, I'm fundamentally flawed no matter what. Being able to kind of challenge that as in, look at all the good things that I've done and look at all the, just doesn't really hit the mark.

And so what we do in schema therapy, we use much more what we describe as experiential exercises. So experiential exercises involve things like kind of, through our imagination, we call it imagery rescripting. We will sort of connect with memories and experiences that link to the formation of the schema that

Lars Madsen (14:35.524)

that we might have. So for instance, if someone comes in and has a defective schema as we're talking about, we might try to go, okay, well, let's try to explore the roots of this experience for you. And what we might, and we'll sort of try to sort of ask, well, how can we make sense of this? What happened to you when you were younger? What messages did you get? And then we might do an imagery float back, which is where we ask the person to get in touch with the feelings in their body.

And then we asked them to sort of float back in time to a time when they had this kind of feeling perhaps for the very first time and to recall a memory of that. People will, and this is what the experience is, for a lot of folks is that they will come back to memories that they will have forgotten or they wouldn't have thought about before. And then they will kind of have this sort of almost sort of epiphany moment where they'll go, yeah, know, like this.

This experience, I'm a 40 year old person right now and I'm standing in the queue and I'm feeling defective because I didn't get all the things that I wanted to get from when I went shopping and I'm feeling really terrible. I'm feeling really bad about myself because I'm broken. But when we kind of float back to a memory, we are at home as a child, as a six year old.

And mom or dad or someone is sort of telling us that we're useless and we're stupid and you're not worth anything. So suddenly you kind of, we make these links. We suddenly go, all right, so this experience that you're having now actually kind of at an emotional level takes you back to this experience when you were very, very young. And it feels very, very fit, very, very similar. Now we would say that that's a schema, you know? And that's the blueprint, remember going that.

That's the blueprint we carry through life in terms of making sense of how we see ourselves, how we see other people, what we should do in relationships, what we expect from other people. And, you know, so once we discover these things, what we try to do is do a process where, we, what we describe is we start to try to heal the schema. And it sounds a little bit kind of, you know,

Lars Madsen (17:00.764)

I don't know, like wooly perhaps, but really we will go back to imagery and imagination again and often sort of replay these experiences, but we changed the experience slightly where we all have a more corrective emotional experience for the person. So for instance, in a scenario where someone goes back to a memory of them as a child, where they're being put down or belittled by someone, we might go back to that kind of memory and stop that. We'll stop that in the memory and we will do what should have happened back then, right? So that's often the therapist's approach is that we try to do what should have happened in that moment that didn't happen, right? And the experience for clients when they have that,

Lars Madsen (17:59.032)

who have these very strong schemas. The experience for clients is that it shifts them slightly. And it doesn't cure them straight away. Like you need to do this sort of multiple times. And there are other interventions that we also do, but it has the effect where, you know, the burden of this trauma kind of lifts slightly, right? And that's what we describe when we hit the mark, of course, when we say, you know, clients will often be really, really attuned to the fact that actually, you when you hit the mark in terms of what should have happened back when they were six or eight or whenever, then it has a sort of like a relieving effect within their body. And it kind of lifts some of that, the trauma of that slightly. And suddenly we would say that schema sort of gets healed slightly. It gets a little bit smaller in the person and little less to get activated, little less prone to sort of, you know, become, you know, something that just sort of hums along in the background of someone's experience.

Jess Leondiou (19:06.867)

That's so interesting. So cognitive behavioral therapy would be if somebody's walking down the street. They look at the person and they think that those people are perhaps thinking something negative about them. And it would be about breaking down, you know, what is the logic behind that thought in the present? But then Schemer is asking the question, why would we be having that thought in the first place? And how can we trace back to that moment so we can change that fundamental blueprint?

Lars Madsen (19:33.55)

Yeah, yeah. Meaning, we look at schema therapy, a lot of the time, what we're looking at themes are sort of long-term themes that are problematic for someone. So typically it's, so someone for instance, you know, would have the, you know, would be able to recognize that they struggle with feeling safe with people, or they struggle with feeling good enough about themselves in certain situations that it's the same repetitive pattern that keeps getting activated for them. So it doesn't matter, know, it happened last year, it happened last week, it happened 10 years ago. So what we try to do is sort of, when we start to think we're dealing with, you know, an actual schema, we've identified that moment that we just talked about, this person walking past and feeling anxious that they're being judged.

We would kind of link that, okay, so this feels like this is something that has been happening for some time. It feels like that this is not just you having a bad day or a bad month or something like that. It's something that feels very repetitive. It's the same experience for them. it's the same, in many cases, the same outcome because people will often try to cope with that in ways that doesn't actually heal it.nor change it for the future.

And that's so interesting. And so what is the role of going back and imagining yourself in the past? In what way does that help the person to re-encode the memory?

Lars Madsen (21:11.588)

Well, what we would say is that we go back to the trauma memory. This is, the schema has been formed on the basis of multiple, multiple experiences in many cases throughout their childhood where they've had this experience perhaps of being of no value or being belittled or being humiliated or something like that. And what we try to do, what we do is that when we when we go back into the memory, the person will describe the feeling that they've returned to, they feel like a child, sort of emotionally. They're not, no one's sort of saying that people are going back in time and that kind of stuff, but they emotionally will feel like they're back there. And what the intervention does is it kind of meets an emotional need that wasn't met in that memory. And in that trauma memory, if we think about it as a trauma memory, what it does is it exposes us to us and then it gives the client a corrective experience of this memory. And what it seems to do is it assists with just sort of reducing the saliency and the trauma of that memory.

Other kinds of trauma memories like exposure, for instance, is a very common intervention, a very well validated sort of intervention for trauma experiences. So exposure typically works like this where if there's been a traumatic experience that people have had and it's traumatized them, you know, and people will

Typically in response to trauma, they will try to sort of not remember it. They'll try to push it out of their mind. They'll try to avoid it. And that kind of manifests in behavior and also in the way we might try not to think about things. We block it out, we disassociate. With exposure therapy, what we try to do is to go through a process where we allow ourselves to sort of remember what might have been traumatic.

Lars Madsen (23:39.254)

and in a sense sit with the distress of it in the moment until that passes because the process of at a neurological level, we process the memory and then the memory feels less scary and less traumatic and we kinda, it feels like it's happened in the past. a similar kind of process. So this process of going back to trauma memories and then having a different kind of experience is one that is sort of well recognized within psychology as a way of addressing and treating trauma.

Jess Leondiou (24:16.936)

Yeah, that makes so much sense. I wanted to ask you something, but something else has just popped into my mind.

Jess Leondiou (24:23.95)

I've read a lot of James Penbecker's research around journaling and writing and how writing about traumas that have happened in the past can help reduce, I guess, the emotional current that's associated with them. What's your lens on writing as a tool to help people in that space? I know that you obviously need a professional and that there's something unique to a relational healing experience that writing can't provide, but what is your lens on writing as a way to help someone process?

Lars Madsen (24:51.108)

It's fantastic. Absolutely. encourage all my clients who are willing to do it to write about their experiences and difficult experiences. And I've found consistently over time that folks who do it and do it, who are able to sort of articulate and explain it over time that there is a shift in the way. There's a shift. What I observed is there's a shift in a number of different ways. One is they report the memory or the thing that they're writing about becomes less traumatic, but that doesn't mean that it becomes a good memory or becomes something that they like or wanted or whatever. It just means that they're less bothered by it. It's like being able to have the experience of, you know, that happened to me and I didn't like it. It was awful, but I'm kind of, you know, like it feels like a long way away from me now, like within myself, you know? Because the experience people often have with trauma is that, when you kind of activate it, even though it might've happened 10 years ago, five years ago, 20 years ago, even 40 years ago, people, when you ask them, how long ago did this trauma happen? Like when they're activated emotionally by thinking about the trauma, people will say, it feels like it happened yesterday. It feels like, I know it happened 40 years ago, it's like, remember, everything clearly, feel it clearly, like it's so awful, it's so overwhelming. And so when they do things like this, when trauma clients are able to write about things or we do the float back imagery, re-scripting, do the exposure, then people sort of describe something to the effect of, well, it feels a little bit further away from me, sort of within myself, like from a time perspective. It feels like, now I know that it happened and I don't like it, but I kind of feel like it's behind me now. Yeah, so people have those experiences. It becomes less triggering and it becomes something that feels processed, if we can call it that, feels in the past.

Jess Leondiou (27:09.655)

In the space of people processing things and integrating their past traumas, what are the other kinds of changes that you've seen your patients experience in the time that you've worked with them? What does healing look like in that space?

Lars Madsen (27:26.808)

Yeah, look, mean, so typically what we try to do is to help the person be more functional in terms of being able to kind of exist in life, in their relationships, know, wherever their schemas kind of showed up, we want to be able to kind of help them be able to make healthy decisions about what they want, right? So in terms of relationships, some clients, for instance, may constantly find themselves in relationships that they're unsatisfied and unfulfilling. Clients who have emotional deprivation schemas, so this is a schema where they felt throughout their childhood, maybe they felt ignored, they felt invisible, they felt no one really got them or talked to them or showed a great interest. Then they can have the blueprint when they grow up as you don't really get that much from relationships, right? You can't really expect that much from other people.

So they tend to then, perhaps choose people not because it's the one, not because they feel a great affinity or connection with that person, but more because they're just convenient. You're there and you're single, I'm single, well, let's... So there's no kind of perhaps reflection on, are we compatible?.

Do you understand who I am? I understand you? Are we interested in each other's inner world? So it becomes very unsatisfying, it becomes perhaps a relationship of convenience. I'm using just the example with emotional deprivation here. It becomes a relationship of convenience. There isn't much thought to whether we might be truly matched.

Lars Madsen (29:19.952)

And those relationships after a while just feel very, very empty. And people will end up saying, well, you know, I'm in this relationship and I feel lonely and I feel unhappy, but I don't really know why because, you know, I'm in a relationship and, you know, we're doing all the right things. And then when we, you know, and often these relationships kind of break up or people leave or people, you know, and no one really knows why because it's like, you know, there wasn't any strong connection there anyway.

So these kinds of themes or patterns in a person's life would be schema driven. And with the healing of the schema, we start to recognize, well, okay, so really what we need to heal is to be able to corner, have the experience where you are with people where you feel understood and cared about and you open up and you start to understand what it's like to be understood and loved and empathize with them and listen to and take them seriously and all this kind of stuff. So healing for that person is around helping them to figure this stuff out in their relationships. Now people will typically then have an experience of feeling, well, wow, you know, like I never, I grew up my whole life, not expecting that people would ever care about me or, you know, truly understand me or be helpful in my life.

But that people can have these relationships just seems amazing. So they start to kind of have a new sort of experience. So what healing looks like is very much sort of linked to the theme or the problematic patterns, the scheme is kind of driving their life. Whether it's about not being vulnerable in relationships because you can't trust people, it's about learning how to pick people to trust and then be more vulnerable.

Lars Madsen (31:17.604)

whether it's about feeling like you're a failure and therefore why bother, why bother doing anything, like I'm gonna fail at this or gonna fail at that, then it's about figuring out, let's look at what you could achieve and work towards what you would like to achieve if you didn't have this perception that you were gonna fail. So it depends on those kinds of things. Typically clients will come in, also with a problem that might be very specific and it's schema linked, but healing looks like figuring out what the problematic maladaptive theme is and then sort of helping them be able to change it in a way that's sustainable going forward.

Jess Leondiou (32:07.662)

Yeah, that makes perfect sense. And what about something like borderline personality disorder or ADHD? So my understanding is there's a lot of conversation around how trauma can, I guess, create maladaptive schemas that might present like some of those personality disorders, if that's the right term. What's the difference between those two things? Or do I think that those two things come bundled together? Is it biology? Is it upbringing? How do you break those concepts down in relation schema.

Lars Madsen (32:38.894)

Yeah, okay. Yeah, look, mean, temperament definitely has a part and we know that people, some people are temperamentally predisposed in different ways, and we're all predisposed in different ways. I mean, within Schema Therapy, mean, Schema Therapy was designed as a treatment for personality disorder.

Lars Madsen (33:02.704)

And what that really speaks to is the chronic and enduring problematic patterns that extend over a person's life that don't change. So when we think of personality disorder, we typically think of problematic and maladaptive thoughts, feelings, and behaviors that sort of are chronic and enduring. So they persist over time and don't seem to change very much. Within schema therapy, we don't necessarily, I mean, I certainly don't really get too bogged down into the diagnosis of personality disorders. Normally it's about trying to understand it like, schema therapy provides a way of trying to make sense of an individual's struggle, whether they have a diagnosis of BPD, borderline personality disorder or narcissistic personality disorder. We don't really get kind of hooked up in those things because it's more about trying to understand the person's, you know, presentation.

Lars Madsen (34:00.9)

Going back to your question, I would say that we know now that there's some people that have a temperamental predisposition to perhaps be more prone to experience negative emotions. And there's some folks who have less. If you have those traits and you're in an environment that is warm, loving, and supportive, then that's probably okay. They don't become problematic. exist and function without, they just become their personality, their quirks. But if you grow up in an environment where perhaps you have that vulnerability and you have trauma, now trauma might be emotional neglect, absence of people who, like we're talking about emotional deprivation today, might be growing up in an environment where there wasn't a lot of love, but there was a lot of practical stuff. Like there was a roof over your head, food on the table, you know, we weren't living in the streets, right? So it's practical, but there's, you know, emotional trauma in the fact that, you know, there's no warmth and love and connection and safety and, you know, understanding between each other, perhaps expressing strong emotions and being understood that kind of stuff. If you're in that kind of environment, with that kind of temperament, it can create challenges. If you grow up in environments where there's physical abuse like violence and that kind of thing, we know that that's also very much implicated in creating sort of, certainly schemas and personality related issues. And if there's sexual abuse as well, that's also very much related. Sexual abuse in particular is much more related to of borderline personality characteristics. One or all of them can, and I think, you know, I think that if we think that things exist on a continuum, like I think that, you know, people can have sort of not a predisposition to develop sort of, not a predisposition to be prone to have negative emotions, be anxious or neurotic.

Lars Madsen (36:26.48)

and experience those things and still end up having trauma. Of course, it's not just all temperament. It's a bit of both. And typically the trauma, the experiences in childhood have been more severe, more neglectful, then you can almost see that sometimes there's a corresponding sort of more rigidity and complexity in terms of how

Lars Madsen (36:55.836)

They struggle with managing their life as they become adults. Now, of course, I work a lot within the forensic space, so I have a lot of experience working with people who have come from extraordinarily traumatizing, difficult backgrounds, and where they, from day one, have had very little opportunity to be able to, I think grow up to become adults where they are sort of functional and healthy and capable of meeting their own needs in terms of existing in life and attaching and connecting with others as well.

Jess Leondiou (37:38.652)

The context that someone's been through is perhaps what's brought them to a particular kind of behavior. And if anyone had experienced that, there's a very good chance that they might be behaving in a similar way. And I feel like that's often forgotten when people are looking at, I guess, people that are considered to be criminals. There's like a lack of empathy in and around the context that created that circumstance.

Jess Leondiou (38:06.86)

And to what degree have you seen somebody change through therapy? How much do you think that it can help people change and guess rewire their schemas?

Lars Madsen (38:20.558)

Look, think that, I think, certainly in my experience with clients, think that clients have come to therapy and engaged in therapy for a period of time and ended up understanding their schemas and being able to heal them enough so that they don't impact on their life in the way that they used to do previously. Schemas though, you know,

Lars Madsen (38:46.786)

Like we still have those triggers. If you think about schemas, they are sort of like emotional landmines that we step on and then generate powerful negative emotions that are linked to it. They never really go away, but once they get healed, they become much more muted. So the experience might be for clients who have been successful in schema therapy is to say, well, you know, I noticed that what's getting activated now is my failure schema, and I know that when that gets activated, I feel like just withdrawing and avoiding and just, you know, like not giving it a go. But, you know, I know that this is not the helpful way of doing it. And I know where this comes from and I'm able to kind of make different choices in this particular moment. And then what happens is that the intensity of that distress just kind of, you know, fades off pretty, you know, a lot quicker than what it ordinarily would have. So I've seen clients say they've progressed and they've moved on in their lives and they've been able to pursue goals that they didn't think they could because their scheme has held them back and also have relationships with people that they didn't think that they could either. Be able to trust in relationships, be able to make better choices about the kinds of partners that they might have relationships with. And life of course is stressful and hard for all of us.

Jess Leondiou (40:24.816)

Yeah, that makes sense. So there's a level of being able to observe the schema at play rather than responding in a way that's more automated.

Jess Leondiou (40:36.258)

That makes sense. I'm thinking too, as we're speaking about this, if somebody's having a conversation with a friend and they get the sense that their friend is talking about something that's traumatic, hearing you speak about this gives me the sense that it's really important that we create the space just to sit back and listen and allow that person to be heard if they are in a moment of vulnerability. What can people integrate from this therapeutic process? If they are having vulnerable conversations with people, what would you say are some good, I guess, rules of thumb for people who are having these tricky conversations with friends.

Lars Madsen (41:20.176)

Yeah, no, it's perhaps a nuanced response. Look, I think a lot of... Look, I'm just going to give some generic thoughts on this, right? Okay. Like I think a lot of people sometimes struggle with talking about vulnerable stuff because we worry about saying the wrong thing or we worry about whether this person really wants to talk to me about this or maybe this isn't appropriate or we have some kind of thoughts like that maybe. I think that these kinds of thoughts can lead us to sort of shut down conversations and perhaps not ask or give advice, you know, don't worry about it or, you know, it'll be fine, that kind of thing. And I think that those experiences, I'm not really sure that those, that kind of response is helpful for folks. I would say that allowing people to talk without trying to rush in with a judgment or perhaps reassurance, you know, is sometimes just what's needed, and allowing people to kind of sometimes talk through things, know, with, me, know, like for instance, sort of saying, well, tell me about how this affects you, you know, or tell me more about, you know, what you're thinking here or how you experienced this, you know, that must've been really hard. So, try to allow, give people space to be able to talk about it and then see if you can kind of just reflect back, what their experience must have been. So sort of, you're practicing some empathic, you know, listening, you know, where you say, well, that sounds like it would have been really hard or that sounds like it would have been really awful. Well, this must be really difficult for you. The experience for someone who's talking about this is one of feeling validated and perhaps also understood and perhaps also cared about.

Lars Madsen (43:44.28)

Yeah. I think also, I don't think that you're necessarily rushing in if someone's had a difficult experience and then say, you know, tell me all about it. And you know, what happened and you know, it's really important for you to talk about it. And you know, that's what the psychologist said. Like I don't know whether it sometimes is, it varies from person to person. Some people need to talk about it. Some people need to think about it and just.

Lars Madsen (44:13.744)

make sense of it themselves before they feel they can talk about it. Some people, we certainly know with critical stress debriefing, this was the, if there's been a traumatic thing at work. A long time ago when I used to work in institutions, we used to have this protocol where, like if there was an incident that happened, like a fight, like in a prison or a hospital. Then all the people that were involved had to get in there to talk about their experiences. You have to share it. Tell me how you're feeling, what's going on straight away. And we now know that that actually can have the effect of just re-traumatizing people. You know, assume that most people don't do this anymore. It's more to do with the fact, well, what do you need and what works? And the reason why that is in terms of the critical stress debriefing thing is that. Many people have ways of being resilient and coping. And sometimes those ways are just like, look, I'm fine. I can move on with this. This is part of the job. you know, I'm, know, I, I feel boundaried and okay with this. I'm not affected. And then when you're kind of diving in and forcing people to talk about this stuff, you're kind of, you know, breaking up their natural sort of ways of coping with this stuff and sort of forcing this thing that they're trying, that they don't need to do and they don't feel they need to do, but forcing it upon them in the hope that it will relieve distress that you presume they might be experiencing when they may not.

Jess Leondiou (45:55.476)

That makes so much sense. Yeah, it is almost impossible to give an answer because in one instance, it might be the type of circumstance where someone would like to open up, but in the other, they've maybe just brushed over something that's happened with logic and that is a perfectly fine way for them to move forward. The asking is inappropriate because they've made peace with it that needs to be respected.

Lars Madsen (46:19.982)

or the insisting of it like, you got to talk about, got to do this. Yeah, no, I don't think so. I don't think that's the case for everybody. Yeah.

Jess Leondiou (46:27.182)

I'll give you the context for why I'm curious. I've been asking myself what might be the slip-slop-slap of better communication.

Jess Leondiou (46:38.382)

So I've been trying to work that out just because I feel like there is a space for people broadly to improve the way that we're communicating. Of course we can't get to levels that are anything close to professional, but to me, there's simple cornerstones of coaching and listening and therapy that exist around the space of listening. I keep asking myself, how can we make that knowledge more widely available? Because I feel like so often we do misstep.

Jess Leondiou (47:06.104)

For example, as you said, like we're trying to help someone solve a problem. So we jump in rather than give them the space. So how can we clarify what good communication looks like in a way that people can, yeah, remember so we can help each other heal a bit more effectively.

Lars Madsen (47:22.764)

Yeah, I think in circumstances like this sometimes you might ask people, what do you think you need? You know, what do you need right now? Do you want to talk about it? Do you want to kind of go for a walk? You know, I think, I think asking people, you know, and we get anxious, I think about asking for that because we worry that it's gonna upset people or we worry that this is gonna traumatize them that you ask them. But I think that's probably a good, with this kind of stuff, a good place to start. I think also when people are talking about it and it sometimes is helpful to try to sort of, as a response,is to sort of reflect back what you think the person might have been experiencing or feeling. Sort of like predicting saying, as I've said before, that sounds like it was really difficult for you. It sounds like you would have felt quite lonely. It sounds like you would have felt quite scared. It sounds like you feel quite sad about this. And that, I think that even if you get it right, if you get it right, I think that the experience of the person is one of feeling understood and cared about. I think if you get it wrong I think that they'll let you know so you know like so in a sense but I don't think people are going to say well you don't understand me you know blah blah blah. People aren't going to get angry if you get it wrong they'll clarify it and then it's like oh okay yeah so you feel this yeah got it. You know so I think that those kinds of inquiries is a

Jess Leondiou (49:13.454)

No, those are really good pieces of advice and I love that too. Especially what you were just saying around asking them which way they'd like the conversation to go. It's such a good point because then you're not making the assumption, should we dig in or not? You're just asking which would you prefer.

Lars Madsen (49:40.944)

Yeah, yeah, what do you need right now? What do you need? In schema therapy, we often ask folks what they need because at the core of it is about trying to meet those needs, those emotional needs, you know,

Jess Leondiou (49:51.534)

Yeah, that's interesting. Could you share more too in and around? I can't remember the term that you used about, was it imagining or? Yeah, I can't remember. Could you share some more of the techniques that you use, not with the idea that other people should use them. Explicitly not with that intention, but just more to give us a lens on, yeah, what the conversation looks like when you're having with one of your clients.

Lars Madsen (50:13.792)

Okay, so there's a couple of experiential techniques that we use. So one is the imagery rescripting and imagery, which is what we've described before, where you kind of connect to an emotional feeling and then we kind of link a memory or an experience that kind of resonates with that feeling. So it's usually a feeling of anxiety or distress of some kind of schema reaction, right? And then we go back and we might sort of imagine to the clients their eyes closed.

We'll try to give a correct experience in that memory for that client at that moment. The other techniques that we use, so obviously, we use cognitive techniques and act kind of techniques as well. So mindfulness and being able to let go and cognitive and diffusion. So these are techniques where, now, they're kind of sophisticated cognitive ways of being able to deal with strength feelings and emotional states. So we use those kinds of techniques as well. We use chair work. Now what is a chair? Empty chair work where we will, this is slightly different to sort of the imagery we're scripting in that sometimes we will for instance say for instance that a client has a coping mode, so this is an internal sort of experience of themselves that is very critical and negative of themselves, so very punitive. So we can probably all relate to that. We probably have a side of ourselves that sometimes can be very, if you're not doing a good enough job, or, you know, this, you know, like that's pretty stupid, like can be pretty unhelpful in some of the dialogue that can get activated for you. We know that with some clients, these modes, these sides of them within themselves can get very, very dominant and very, very big, right? And they'll have this experience that there's a part of them that's just really giving themselves a hard time, just saying that the worst thing ever and they're awful and horrible. And then there's another part of them that kind of feels defective and useless and awful and things like that. So we have this experience within ourselves that we're having.

Lars Madsen (52:35.194)

sort of multiple, not multiple personalities, but we're having different experiences in a particular moment. Yeah, you can relate to that. I think most people can probably relate to that. So then schema therapy, what we try to do with these sorts of parts of ourselves or these sides of ourselves, we will try to dialogue with them and sometimes set limits on them. So using chair work, we would perhaps put this coping mode, right? So it's not the, but it's the side that gives them a really hard time, we'd put that in a chair and we would have a conversation with it. So how would that work? Well, sometimes that would work by the client just going into the chair and then speaking out loud from that side of them. So they would say, well, I think Lars is just so stupid, he's lazy, never does things on time. Like, this is just another example of just how awful he is about doing all these kinds of things.

So this would be the reflection of the inner dialogue, right? So we have a conversation with this part of ourselves. We then might start to kind of, you know, challenge it. So we might start to put, you know, limits on it, but we would say things like, well, you know, I know you feel this way, sort of demanding and punitive part of Lars, but you know, he's actually doing his best and I think you're being unreasonable.

And I think that actually, you're actually not really helping here at all. You're just actually making things worse. So we start to kind of have this dialogue with this empty chair where we have this critical or negative or punitive part in it, where the client is sort of like involved in, they're involved initially, certainly early in therapy, this is mainly driven by the therapist because clients a lot of the time don't have the template or someone sticking up for them sometimes, right? So they almost need to see it to be able to believe that this can happen. So in that moment, you know, we're having this experience with an empty chair where I'm, you know, as a therapist, you know, talking to it, saying, you know, this is not okay, and I'm not gonna allow you to talk to, well, Lars, in this way. And then I'll sort of say, well, you know, to my client who's, you know, like, how does this side respond?

Lars Madsen (55:01.04)

And often you'll get this dialogue going backwards and forwards. Now, in this particular case, this punitive demanding part is typically the internalized voices and messages that someone has received from their child growing up from one parent figure or multiple players and figures. It's normally when you kind of trace it back and go, well, where does this kind of come from? Who does this sound like? And there's usually one or two people that feel very familiar. So it's like,

As children, we've kind of internalized this inner dialogue, right, from someone else. And then now it gets played out every time we feel like we mess up. So this experiential technique then brings it out in the open and we challenge it in the chair. And sometimes we'll do things like we negotiate with the parts saying, okay, well, you can't be in the room here when we're doing therapy, you have to get out, you know?

A client will sometimes get up and move the empty chair outside reflecting this sort of shift. And these kinds of sort of techniques, they sound like, this is crazy. Why would anyone do this, right? But they actually are very powerful because when you're doing them, people become very powerfully emotionally reactivated. And then what you're doing here, when you kick the punitive part of this person out the door, right? You know, they describe God, that feels good. Or they all say to you, no one's ever talked back to that like that. You know, like that just feels amazing. And what happens over time is, you know, people understand they're in a world a lot better, but what happens also is that they start to internalize some of how you as a therapist deal with these unhelpful parts or modes the client might have, in my experience. And they start to themselves be able to push back on that voice when it gets activated. They start to go, okay, no, no, no, you're not. I know where you're from. I'm not listening to you. You just be, you know, and, and, and they can put limits on it and they can reduce it. And suddenly it doesn't become so sort of overwhelming. So chair work is something that we do quite a bit of.

Lars Madsen (57:27.824)

And we use it in many, many different ways. So you can have, you know, you can have, for instance, people's abusers, you know, perpetrators that come in and sit in the empty chair, and then you as a therapist can sort of berate them and put responsibility back on them if that's appropriate, right? Or parents that have been neglectful and they'll come in and you can sort of use, you can have conversations with parts or experiences that they've had.

Jess Leondiou (57:55.822)

That is so interesting and it makes sense because I guess you're giving them, as you said, that new language to talk to themselves.

Lars Madsen (58:13.658)

Yep, yeah, absolutely. And what you would do over time, you would, over time you sort of would invite the client in. Like if the client is able to sort of be able to talk back or they have enough healthy adults, we would say, then, you know, like there's no need for the therapist necessarily to step in, in that way. But for clients who don't have a lot of that stuff or when that mode is activated, they don't have a very big part of them that can stand up. They sort of retreat back to being a nine-year-old girl or an eight-year-old boy, and they feel helpless and trapped and scared, it's so powerful to be able to see, for them to kind of hear and see that, because then the part of them that is healthy and is functional and adaptive in their lives can start to sort of learn from it and step in as well.

I think it really crystallizes to how therapy works in terms of taking someone and doing an action with someone in the room and how that then flows on to their day to day thinking and how that you can build up in terms of an evolution over time if people are willing to step into the space.

Lars Madsen (59:30.424)

Absolutely, yeah, yeah, absolutely. And I mean, we often, you know, in the therapy, we try to integrate those experiential exercises into their regular day-to-day as well. So asking folks when this comes up, remember what I said, remember, you know, how would I respond to this? And then sort of maybe you have a go at trying to do this as well.

Jess Leondiou (59:54.505)

Yeah, that's brilliant. Thank you so much Lars for that insightful breakdown and just that deep understanding that you've learned that in terms of yeah, what is schema therapy? How does it work? And yeah, all of the different ways that it can support somebody. I really appreciate it.

Jess Leondiou (01:00:15.412)

That's brilliant. Thank you. and I wanted to ask you too, if somebody wanted to start exploring the schemas that have been occurring in their own lives, is there a particular question that you think people should ask themselves? Say if they were going to start journaling or just thinking about this concept more broadly?

Lars Madsen (01:00:33.168)

Yeah, okay. um, so this is the thing that I would suggest listeners try, right? Think of one reoccurring struggle in your life, maybe a fear of rejection or always putting others first. Ask yourself what old belief or need might be driving this. And then you can try to write down small ways you could, you could meet that need, but I would encourage folks to start to see, what are the reoccurring patterns in my life?

Lars Madsen (01:01:03.436)

that feel like they've been there for a very long time. And journaling about it, like typically I think when people journal about those types of things, you'll see them pretty clearly. I think they come out pretty clearly because they're so repetitive. They can be so repetitive. I should say some people have bigger schemas than others, but we all generally have them.

But the repetitive ones are the ones that we want to pay attention to. And journaling about them, I think, is an excellent way of being able to start to identify them and recognize them. And there's lots of really good literature on some of these things, on schemas, and they're very easily accessible on the internet. There's a book that was written by Jeffrey Young, who was one of the founders, who is the founder of schema therapy, called Reinventing Your Life.

It's out of print, it's, you know, I'm sure you can find it on Amazon. That's an excellent, easy to read book that's very accessible to the lay person in terms of explaining it. They call them life traps in there, but they're really talking about schemas, which is not a term for it, isn't it?

Jess Leondiou (01:02:20.0)

That's brilliant. cool. Well, thank you again so much, Lars. Yeah, it's been really nice having you on and I'll put all of the links to your podcast and your work in the show notes below.

Lars Madsen (01:02:29.36)

Thank you very much Jess and it's been lovely to be here, lovely to chat with you and yeah, thank you very much.