Schema Therapy for Borderline Personality Disorder

As personality disorders go, borderline personality disorder (BPD) sufferers arguably experience some of the most painful symptoms – an unstable sense of self; a pattern of unstable and intense interpersonal relationships; emotional instability; impulsivity; suicidal tendencies; intense, inappropriate anger; chronic feelings of emptiness; and paranoid thoughts. And yet, this disorder is also looked at as the “good prognosis diagnosis” because it stands the greatest chance of recovery, depending on the commitment of the sufferer. Now, people suffering BPD only have more good news to celebrate.

A recent study released by the American Journal of Psychiatry reveals what some people, particularly in the U.K. have known for a while – that there is a treatment for BPD that is proving to be even more effective for many BPD sufferers and in less the time and less the cost than perhaps any other treatment available today.

This integrative treatment is called Schema Therapy and was created by Dr. Jeffery E. Young for the treatment of personality disorders. It takes from other therapies and modalities and includes those treatment models that seem to work best from across a spectrum. The study reported in the American Journal of Psychiatry showed how Schema Therapy was not just successful in treating BPD, but was also effective across the board in treating personality disorders including the hard-to-treat narcissistic personality disorder. Schema Therapy resulted in a higher rate of recovery, greater declines in depression, greater increases in general and social functioning and had a lower drop out rate. The results indicated that Schema Therapy is also more cost-effective.

How Is Schema Therapy Different?

First, it’s important to note that if you are being treated for BPD with another therapy such as Dialectical Behavioral Therapy (DBT), you should not panic. Other treatments for BPD, particularly DBT, have been proven effective, because, as already said, BPD is the “good prognosis diagnosis.” DBT offers direct coping skills for in-the-moment emotions and cognitions that you need to turn around, and those are very positive, life-changing tools to have. What Schema Therapy does differently than a treatment like DBT is analogous to a difference of forest versus trees; it extends to you the ability to see the big picture of your life and how you’ve been reacting to people and situations in a kind of “mode” or crisis pattern. And then, it gives you the tools, similar to DBT, to examine yourself and decide if those patterns or modes are working for you.

So what are some of the common modes or “life traps” BPD sufferers experience?

Schema Modes Common to BPD Sufferers

Schema modes represent aspects of the self. We all have many different internal aspects. It’s important to understand that virtually everyone, whether they suffer from a personality disorder or not, can operate from within these schema modes at different times. Many marriage and family therapists use the schema modes to help couples understand themselves and one another, so when you read them, try not to see something “wrong” with yourself because you have BPD. Again, everyone operates within these different modes at varying times – even so called “normal” or healthy adults. It’s not just you! The important thing to focus on is nurturing the parts of yourself, or modes, that need nurturing, and standing up to parts of yourself, or modes, that need to be called out or quieted.

The Abandoned/Abused Child Mode

When a person is operating out of the Abandoned/Abused Child mode, she’s feeling victimized and abandoned. She’s afraid. She’s probably feeling isolated and emotional, needy and frantic for someone to help her feel calm again. Her reactions to current situations are based in the past – to some time in childhood when she felt abandoned, rejected or frightened.

The Angry/Impulsive Child Mode

The Angry/Impulsive Child Mode is a reaction to the internal child who did not have her needs met. She rages at past mistreatment and unmet emotional needs. She reacts in the present to real or perceived instances of mistreatment, rejection or abandonment. Paradoxically, the Angry/Impulsive Child mode ensures with these dramatic reactions that her needs will continue not to be met (by making others frightened or angry and thereby pushing them away).

The Detached Protector Mode

People with BPD have a reputation for behaving impulsively and chaotically, but the majority of the time, they operate in what is called the Detached Protector Mode. This mode is a “style of emotional withdrawal, disconnection, isolation, and behavioral avoidance.” The Detached Protector mode leaves a person somewhat cynical and aloof, but protected from the emotional extremes of Angry/Impulsive Child and Abandoned/Abused Child. In this mode, an individual is more likely to engage in social withdrawal, excessive self-reliance, addiction, fantasizing and stimulation seeking. This mode also blocks the therapeutic process by keeping the child modes from interacting with the therapist in order that their needs be met and that they may finally be healed.

The Punitive Parent Mode

The Punitive Parent mode is the internal aspect of a person that reflects the criticism and harsh words of parents or other authority figures from her past. This mode steps in as the inner critic, either to punish her for reacting out of other modes, or to condemn others for not meeting her needs. The Punitive Parent is a continuation of inner abuse that may have occurred in the individual’s early life, through the form of rejection, abandonment, devaluation, invalidation and criticism.

The Healthy Adult Mode

We all have within us a capacity for the Healthy Adult, even many teenagers and some children. The Healthy Adult nurtures, validates and protects the vulnerable inner child, sets boundaries for the Angry/Impulsive Child, helps the Detached Protector put her guard down, and encourages the Punitive Parent to quiet the criticism and rejecting voice. The Healthy Adult voice is responsible and loving while maintaining healthy boundaries.

A therapist works with a BPD individual through Schema Therapy by first helping her to identify these modes and then to build a relationship of trust so that ultimately the therapist can help to “reparent” the Abandoned/Abused child with a bond of nurturing, reassurance and trust. The therapist works to meet the previously unmet emotional needs of the individual so that she can begin to feel stronger, and ultimately, can begin to meet these inner needs herself. The goal is to get the BPD patient operating out of Healthy Adult most of the time, and when that happens, the symptoms of BPD are quieted or changed.

Schema Therapy is proving to be quite effective in this regard and as stated, the drop out rate for this therapy is quite low. Check out more about Schema Therapy for yourself or your loved ones.