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How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 2)

Please see previous article for introduction:  How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 1).

Note: The terms modes, personas, parts-of-self, and sub-selves, are all used interchangeably in this article.

 

Common Modes, Personas, Sub-Selves of the Borderline Personality

According to the Schema Therapy Model, the person struggling with BPD has five common sub-selves or modes (Young, Klosko, Weishaar, 2003):

  1. Abandoned child– this sub-self 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.  He believes that what is happening now is all there is, was, or ever will be.  This mode is largely pre-verbal; emotions are expressed through actions; the emotions expressed are uncensored and pure.  This mode “carries” the client’s core schemas.
  2. Angry and impulsive child – this is the predominant or “bully” part-of-self experienced when the person is enraged or behaves impulsively. This is the mode that most mental health professionals tend to associate with the BPD client.  This tends to be his “default” mode of self-protection.  This is the mode where he vents his rage and impulsively acts out in order to get his needs met.
  3. Punitive parent – this is 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 is a very destructive mode – particularly self-destructive.  This mode needs to be eliminated as much as possible.
  4. Detached protector – this is when the person shuts off all emotions, disconnects from others, and seems to function in a robotic manner. Many clients with BPD 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.  He may even appear “normal” while in this mode.  He may do everything he is “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.  He may be doing what the therapist wants him to do in this mode, but in the process, he is not connecting to the therapist.  The client usually cannot make significant progress while in this mode.
  5. Healthy adult – this is the healthiest mode and tends to be extremely weak in the borderline personality. As an adult he may find himself 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 part-of-self that is being protected by the other, more destructive parts.  The vulnerable child is the inner child that was not nurtured or protected in childhood.  The therapist’s goal is to help the client find this vulnerable inner child and help him heal by limited re-parenting. The therapist takes on the parental role with this client.  Clients with BPD usually lack object permanence.  This means they cannot summon a soothing mental image of a caretaker unless the caretaker is present. 

The most constructive way to view clients 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 clients were lonely and mistreated as children; they had no one to turn to except the people who were hurting them.  They lacked a healthy adult to internalize.

I have heard it stated that the child with reactive attachment disorder grows up to have borderline personality disorder. Does that description fit? What do you think? Research does support the notion that fragmented personalities are a result of early childhood attachment trauma and child abuse.

To help a person overcome reactive and unhealthy modes, the goal is for the therapist to help the client experience the vulnerable child mode and nurture the self with the healthy adult mode.  An additional approach that a therapist could take is to help the client develop not just one healthy adult mode, but two – an inner strong parent and an inner nurturing parent.

The therapist can help the client identify healthy role models in his life; or, the therapist can help the client imagine a healthy adult; and the therapist can role-model to the client what a healthy adult looks and acts like.

The goal of therapy is to help the client with BPD reside in his healthier modes – the vulnerable child and the healthy adult.  It is important for those working with these clients to realize that underneath the anger, detachment, punitive behavior, and other intense reactions, is an abandoned child.

Continued: How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 3)

 

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth  Edition:  DSM-V.  Arlington, VA: American Psychiatric Association.

Giesen-Bloo, J., van Dyck, R. Spinhoven P.; van Tilburg, W. Dirksen, C.; Thea van Asselt, T., Kremers, I., Nadort,& Arntz, A. (2006).  Outpatient Psychotherapy for Borderline Personality Disorder: a randomized trial of Schema focused therapy versus Transference focused therapy.  Archives of General Psychiatry (63)6.  pp. 649-658.

Schmidt, S.J. (n.d.) The Developmental Needs Meeting Strategy: What It Is and How It Works. Published by The DNMS Institute, LLC. Retrieved from: http://www.dnmsinstitute.com/therapy/wp-content/docs/aboutdnms.pdf

Young, J.E.; Klosko, J.S.; Weishaar, M.E. (2003). Schema Therapy: New York, NY. Guilford Press.

 

 

How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 2)

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

 


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APA Reference
Stines, S. (2018). How to treat Borderline Personality Disorder: A Schema Therapy Approach (Part 2). Psych Central. Retrieved on December 13, 2018, from https://pro.psychcentral.com/recovery-expert/2018/12/how-to-treat-borderline-personality-disorder-a-schema-therapy-approach-part-2/