Steps to take
Here are the steps to take, practically, to assist with healing the client who is struggling with borderline personality disorder (BPD):
- Identify the client’s parts of self.
- Explain to the client that the parts of self were created by the client as protectors in childhood. Help the client to be non-judgmental of these parts, but to honor them for their protection.
- Empathize with and protect the abandoned child part of self.
- Teach the abandoned child persona give and receive love.
- Help the client learn to be more loyal to the self than to the inner punitive parent. (Note, the punitive parent is most likely an introject of a critical parent or other critical adult from the client’s childhood.)
- Set limits on the behavior of the angry and impulsive child part and help the client while in this mode to express emotions and needs appropriately.
- Reassure, and gradually replace, the detached protector with the healthy adult parts-of-self.
The following four stages explain the process of schema therapy as a tool to heal BPD (Young, Klosko, Weishaar, 2003):
- Stage 1: Bonding with your client. Learn to bypass the detached protector and other indifferent parts-of-self within the client and become a stable, nurturing base for your client. Work at forming a secure emotional attachment with the client. This is the beginning step of re-parenting the client’s abandoned child sub-self, by providing safety and emotional holding. Try to connect with the client in the abandoned child mode. Ask questions about his feelings and problems. Help him learn how to bond and to endure the unpleasant modes (angry and detached modes).
- Stage 2: Schema mode change. The therapist models how to be a healthy adult by re-parenting the patient. The goal of therapy is to lead the client in the direction of developing healthy parts of self (nurturing, strong, compassionate inner healthy adult parts.) This is baffling for a person with a poor childhood because he did not have a healthy role model to internalize. The client’s healthy adult inner self acts to soothe and protect the abandoned child and to set limits on the angry child; the healthy adult must also replace the detached protector The therapist helps the client learn how to parent himself. Slowly the client internalizes the modeling of the therapist. In addition, the therapist should focus on weakening the borderline client’s internal punitive parent. The internal punitive parent is most likely an introject from childhood; tends to be a “bully,” and is difficult to eliminate.
- Stage 3: Autonomy. The therapist advises the client about appropriate partner choices and helps generalize changes within their relationship (therapist and client) to other relationships. The focus at this stage is on teaching the client how to let go of destructive relationships and how to develop healthy intimate relationships. In addition to this, the therapist teaches the client proper emotional expression. It is also important for the therapist to teach the client how to self-soothe and not look to others in destructive ways in order to find fulfillment. The therapist needs to educate the client about the limits of what any relationship will be capable of providing.
Research has been conducted on the effectiveness of schema therapy for the treatment of BPD, which shows that the treatment is a very effective intervention for people struggling with the disorder. In fact, schema therapy was found to be more than twice as effective of various psychodynamic approaches, including transference focused psychotherapy. (Giesen-Bloo, et al, 2006).
According to the outcome research, schema therapy leads to complete recovery in approximately 50% of clients, and significant improvement in two-thirds. It was found that the effectiveness of the therapy strongly correlates to length of therapy and intensity of process (two sessions every week for 3 years) This is very encouraging news for those with the disorder and also for their loved ones (Giesen-Bloo, et al, 2006).
American Psychiatric Association (2014). 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.