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How to Treat Borderline Personality Disorder (Part 1)

Research has been conducted on the effectiveness of schema therapy for the treatment of borderline personality disorder (BPD), which shows that the treatment is a very effective intervention for people struggling with the disorder. (Giesen-Bloo, et al, 2006).

A schema is a deep seated, felt and internalized belief about the self in relation to others. You know you are experiencing a maladaptive schema (no longer functional in current relationships) when you feel “triggered” to the point that your reaction is not in line with the preceding event.

All people have schemas.

Early maladaptive schemas are the memories, emotions, bodily sensations and cognitions associated with the destructive aspects of the individual’s childhood experiences, organized into patterns that repeat throughout life.

Schemas of People with BPD

The core schemas experienced by the borderline person include abandonment, abuse, emotional deprivation, defectiveness, and subjugation.

These are defined below (Young, Klosko, Weishaar, 2003):

  • Abandonment: Involves the sense that significant others will not be able to continue providing emotional support, connection, strength or protection.
  • Abuse: The expectations that others will hurt, abuse, humiliate, cheat, lie, manipulate or take advantage.
  • Emotional Deprivation: The expectation that one’s desire for a normal degree of emotional support will not be adequately met by others.
  • Defectiveness: The feeling that one is defective, bad, unwanted, inferior or invalid to such a degree that one is unlovable to significant others.
  • Subjugation: Excessive surrendering to others because one feels coerced – for instance, submitting in order to avoid anger, retaliation, or abandonment.

People with BPD are often misdiagnosed as having bipolar disorder. The key marker for BPD is fear of abandonment.

Underlying Theory of Schema Therapy

While schemas are deeply ingrained systems of belief that are activated when “triggered,” modes are the personification the person takes on as a self-defense mechanism. In essence, a mode is a self-protective, dissociated state of personality that “comes to the rescue” in order to protect the fragile psyche (the vulnerable child) from facing the deep pain associated with the triggered schema.

The borderline person has five common modes (Young, Klosko, Weishaar, 2003):

  1. Abandoned child– this mode is the suffering inner child. It is the part that feels the pain and terror associated with most of the trauma experienced by the person. This child lives in an eternal present state, without clear concepts of past or future; this leads to a sense of urgency and impulsivity. They believe that what is happening now is all there is, was, or ever will be. This mode is largely preverbal; emotions are expressed through actions; the emotions expressed are unmodulated and pure. This mode “carries” the patient’s core schemas.
  2. Angry and impulsive child – this is the predominant mode experienced when the person is enraged or behaves impulsively. This mode is what most professionals tend to associate with the BPD patient. It tends to be their “default” mode of self-protection. This mode is where they vent their fury and impulsively act out in order to get their needs met.
  3. Punitive parent – refers to the internalized voice of the punitive or angry and unaccepting parent. When the punitive parent mode is activated, the person usually becomes a cruel persecutor, usually of himself. This mode is very destructive – particularly self-destructive. It needs to be eliminated as much as possible.
  4. Detached protector – this behavior refers to when the person shuts off all emotions, disconnects from others and seems to function in a robotic manner. Borderline individuals tend to spend a lot of time in this mode. The function of this mode is to cut off emotional needs, disconnect from others, and behave submissively in order to avoid punishment. They may even appear “normal” while in this mode. They may do everything they are “supposed” to do and act appropriately. Be careful not to reinforce this mode because the BPD person is cut off from his own needs and feelings while in this mode. They may be doing what the therapist wants them to do in this mode, but they are not connecting to the therapist. The patient does not make significant progress while in this mode.
  5. Healthy adult – although the healthiest mode, it tends to be extremely weak in the borderline personality. As adults, they lack the internal resources to sustain themselves and when faced with challenging emotional situations, they find themselves with no healthy internalized working models from which to draw. This mode needs to be developed in therapy.

There is one more mode which must be discussed; this is the vulnerable child mode. This is the mode  that is being protected by the other, more destructive modes. The vulnerable child is the inner child that was not nurtured or protected in childhood.

The therapist must help the patient find this vulnerable inner child and help him heal by limited reparenting. The therapist must, to some degree, take on the parental role with this patient. Patients with BPD, usually lack object permanence. They cannot summon a soothing mental image of a caretaker unless the caretaker is present.

The most constructive way to view patients with BPD is as vulnerable children. They may look like adults, but psychologically they are abandoned children searching for their parents.

They behave inappropriately because they are desperate, not because they are selfish. They are “needy not greedy.” They are doing what all young children do when they have no one who takes care of them or makes sure they are safe.

Most borderline patients were lonely and mistreated as children; they had no one to turn to except the people who were hurting them. They lack a healthy adult to internalize.

To help a person overcome reactive and unhealthy modes, the goal is for the therapist to help the patient experience the vulnerable child mode and nurture the self with the healthy adult mode.

The therapist must role-model to the patient what a healthy adult looks and acts like. The goal of therapy is to help the borderline patient reside in his healthier modes – the vulnerable child and the healthy adult.

It is important for those working with borderline patients to realize that underneath the anger, detachment, punitive behavior, and other intense reactions is an abandoned child.

How to Treat Borderline Personality Disorder (Part 1)

Sharie Stines, Psy.D

Sharie Stines, Psy.D. is a recovery expert specializing in personality disorders, complex trauma and helping people overcome damage caused to their lives by addictions, abuse, trauma and dysfunctional relationships. Sharie is a counselor at LIfeline Counseling & Education Inc., in Southern California (www.lifelinecounselingservices.org). Lifeline Counseling is a non-profit organization 501(c)(3) corporation. Sharie is also an abusive relationship recovery coach - therecoveryexpert.com

 

APA Reference
Stines, S. (2015). How to Treat Borderline Personality Disorder (Part 1). Psych Central. Retrieved on November 11, 2018, from https://pro.psychcentral.com/how-to-treat-borderline-personality-disorder-part-1/

 

Scientifically Reviewed
Last updated: 21 Oct 2015
Last reviewed: By John M. Grohol, Psy.D. on 21 Oct 2015
Published on PsychCentral.com. All rights reserved.