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Borderline Personality Impulse Control with Schema Therapy
Borderline & Schema Therapy continuing education addiction counselor CEUs

Section 5
Track #5 - Exclusion, Vulnerability, Failure, and Entitlement

CEU Question 5 | CEU Answer Booklet | Table of Contents | Borderline
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On this track, we will examine more maladaptive schemas that relate the wider world to a client diagnosed with Borderline Personality Disorder's sense of reality: exclusion; vulnerability; failure; and entitlement.buckle up Diagnosis & Treatment of Borderline Impulse social work continuing education

4 Maladaptive Schemas

Share on Facebook Schema # 1. Exclusion
The first of these types of maladaptive schema is known as exclusion. This occurs when, obviously, the Borderline Personality diagnosed client experiences a great sense of isolation from a central social group or family. The effects of this can range to reclusion from other activities, feelings of anxiety especially in larger groups, and a deep sadness from being lonely.

Sonia age 23, one of the clients I treated for BPD, experienced this while being raised by her single father. Sonia related to me, "My dad didn't know how to deal with women. It was almost like he was afraid of me. My brother was the favorite, and it was so obvious; he didn't even try to hide it. Whenever a big game was on TV, he and my brother would ensconce themselves in the sofa the entire day and just yell like damn maniacs at the screen. When I came into the room to join them, the only time my father addressed me was when he needed his chips bowl filled. My brother was the kid, I was the bowl filler. Even during the holidays, I wasn't really a part of the family. For my 18th birthday, my dad bought me a Barbie doll. 'Thanks dad, I'm 18, I'm gonna go buy a pack of cigs now." A Barbie doll. Jesus. And then he bought my brother a Nintendo, what the hell?"

Sonia's conflict and alienation from her father soon crept into her relationship. "I was never in an active relationship. I never really took part. I expected my boyfriend to do all the reaching out. I guess I was just so sick of trying to connect with someone, I just gave up." Sonia's feelings of isolation incorporated an exclusion schema that resulted in the ingrained belief that despite her efforts, a warm, affectionate relationship was not achievable.

Share on Facebook Schema # 2. Vulnerability
The second type of a wider world maladaptive schema is called vulnerability. At the core of this schema lies a sense of loss of control. A BPD diagnosed client suffering from the vulnerability schema generally has an almost paranoid belief that something awful could happen at any moment and that they are powerless to prevent it. Ordinary fears escalate out of control into what's called catastrophizing.

Thirty-four year old Todd, a vulnerable BPD diagnosed client of mine, related this story to me, "When I was fourteen, my father had a near-fatal heart attack. As he was recuperating, he told me, "You're the only reason I'm trying to live". I began to fear that his very life depended on me. I worry about everyone in my life. Like, anything could happen to anyone I'm close to. My mother used to do the same. When I went out, she'd ask, "Do you have your keys? Your money? Don't forget to buckle up!" I always got the hidden message that something bad might happen. Now I do the same thing. I got into a huge fight with my girlfriend when she came to pick me up from work because her really old car didn't have seatbelts. I wouldn't get in. I knew that if I got in, we would crash and I would break my neck. I told her that she didn't care about me and we broke up two days later."

Todd's overwhelming sense of vulnerability leaves him incapable of feeling safe and soon his fear developed into an almost phobia.

Share on Facebook Schema # 3. Failure
In addition to exclusion and vulnerability, the third type of wider world maladaptive schemas is failure. This type of schema leads a client diagnosed with BPD to fervently believe that no matter their success, they just are not worthy. This can stem from early taunting by siblings or classmates or a constant comparison with very successful parents.

Forty-three year old Julie, a BPD diagnosed client who maintained an intense failure schema, harshly criticized herself, even though she had become a partner in her law firm. Julie stated, "Kids can be cruel to each other. Someone has to put someone else down to make themselves feel better and that happened to me with certain family members. Or at school, the teacher would pick on you and make you feel incredibly stupid in front of the entire class. And then if you come home and someone else makes you feel the same way, you can begin to see how you feel less-than not worthy: fraudulent. I just think that I got the promotion because I'm good at fooling people."

As you can see, the idea of unworthiness was so instilled by those Julie was close to, that she soon became certain of her inability to succeed. Think of your Julie. Does he or she feel an overwhelming sense of failure? What do you think is the cause of this?

Share on Facebook Schema # 4. Entitlement
The fourth type of schema that affects the way a BPD diagnosed client relates to the wider world is entitlement. Unlike those with a failure schema, this type of client feels an exaggerated sense of importance. They view life through a distorting lens that places them above everyone else.

Sixteen year old Angelina was a client diagnosed with Borderline Personality Disorder who maintained an entitled schema. Angelina was an exceptional student, but her confidence in her intelligence soon led her to become egotistical. She stated, "My mom always told me that I didn't have to take shit from anybody, because I know more than they do, and I'll be more successful than them some day. I don't need to study. It comes naturally to me. I hate it when people try to make a connection with me and their level is miles below me."

Angelina's mother had a large effect on her entitlement schema, implanting the view that a higher intelligence results in special privilege. Angelina assimilated this into her everyday life and took her beliefs to an extreme.

Share on Facebook Technique: Anecdote
Because BPD diagnosed clients are not aware that they are under the sway of a maladaptive schema, I believe that the "Anecdote" exercise helped Sonia, Todd, Julie, and Angelina recognize the various ways they react to certain situations.
First, I asked each of them to invent a scenario and a conflict.
Then, I asked them to tell how they would react to that situation and what the outcome might be.

Julie wrote, "Luanne's boyfriend, Samuel, had planned a home cooked dinner for them on the night of their two year anniversary. It had taken him three months to set the occasion in motion, and he had high hopes of giving his girl a wonderful night. However, when it came time for Luanne to show up at his door, she wasn't there. He waited an hour and a half, until, after his twenty third phone call, Luanne picked up and told him "She didn't feel like it tonight". Broken and dejected, Samuel blew out the candles that had burned to the nibs and put away the engagement ring he had taped to the bottom of her chair."

I asked Julie why Luanne didn't go to the dinner and she responded, "She was afraid. She knew about his proposal and didn't think she could make him happy like he made her happy." I then asked, "Do you think she's depriving herself of something?" Julie slowly replied, "Yes. She's depriving herself of happiness she feels she might spoil."

By having Luanne react in way similar to Julie's mode of reaction, Julie could step outside of her own schema and recognize the harm it was doing to her social and career life.

On this track, we discussed exclusion; vulnerability; failure; and entitlement.

On the next track, we will discuss Schema Clustering.

Online Continuing Education QUESTION 5
What are four maladaptive schemas that affect a BPD client's relationship to the wider world? To select and enter your answer go to CEU Answer Booklet.

 
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