Read content below or click FREE Audio Download to listen
Right click to save mp3
On the last track we addressed various maladaptive schemas that characterize many BPD diagnosed clients: selective perception; overgeneralization;
and jumping to conclusions.
On this track, we will examine
the various steps inherent to treating a client diagnosed with Borderline Personality
Disorder through SchemaTherapy: recognition and acknowledgement; finding the
root; and challenging the schema. Also, we will include a schema log I believe
are helpful in facilitating these steps in Schema Therapy
3 Steps in Using Schema Therapy
Step # 1 - Recognition
The first step in treating Borderline Personality disorder
is the recognition and acknowledgement of the destructive schema. By pinpointing
the source of the impulsivity, I believe it is much easier to treat it.
Exercise: Schema Log
my thirty year old client Susan, diagnosed with BPD, better monitor her behavior,
I had her keep a "Schema Log". In the log, I asked Susan to write down
an incident that she believed was the result of her unlovitabilityschema. In
this schema log, I made four concepts that Susan needed to keep in mind when writing
her entry: 1. Emotion before reaction: 2. Your Reaction: 3. Reaction of other
people: 4. Emotion After Reaction:
Susan's First Schema Log
The first situation that
Susan recalled was with her husband Dan, "I was coming back from the kitchen,
and Dan told me that the Reuben sandwich I had made him for lunch was crap, and
that he had to throw it away and eat something out of the vending machine. The
first emotion to hit me was panic. I didn't want him to be mad at me, so I made
him his favorite dinner, even though I had to throw away the dish I had been making
the entire day. Dan was happy, but under my breath, I was whispering, 'I hope
you choke, jackass.' He made me feel ashamed, but I never told him that."
I asked Susan why she didn't express her needs to Dan, and she said, "He's
the best I could get. No one else is going to look my way, so I might as well
be with him. I made such a mess of my life, I guess I had it coming."
Susan's Second Schema Log
the course of the next several weeks, a similar pattern arose in Susan's household
in which Dan would become angry and harsh with her. In turn, Susan tried her best
to appease him, even if his demands were unreasonable.
Susan related in one of
her last schema logs, "Dan told me that he needed his blue shirt for work
that day. I told him that it hadn't made it into the laundry. He told me to wash
it anyway. I said, 'No, Dan. I have other things to do and my world does not revolve
around you.' He couldn't believe that he wasn't controlling me anymore."
As you can see, by keeping track of her schema behavior, Susan was able to acknowledge
her problem and eventually step out of her schema's influence.
Step # 2 - Finding
The second step in Schema Therapy is finding the root of the schema.
This involves examining the client's past and analyzing the exact situation that
taught the client's mind to adapt to a certain set of emotions in a particular
To help Susan accomplish this, I used the "Remembrance" exercise.
I asked Susan to think back to the earliest time she remembers someone making
her feel the emotion of unworthiness, associated with her schema of unlovability.
I asked her to make three columns on a sheet of paper: 1. For the person's name; 2. For what he or she did; 3. For how it affected her.
Susan wrote, "Dad left
me when I was five; he was always telling me I needed to keep my room clean. From
that point on, my room was a sterile environment. I think I was hoping that if
I did this, he would come back and be proud of me again. I hated him for it. I
felt angry, manipulated, and unwanted."
As you can see, Susan has successfully
discovered an earlymoment in her life that might have had a direct effect on
Step # 3 - Challenging the Behavior
In addition to acknowledgement and past behavior recognition,
the third step in treating a schema is challenging the behavior. While this depends
largely on the will power of the client, I believe that the "Familiar Emotions"
exercise is helpful.
Exercise: "Familiar Emotions"
I asked Susan to make a list of all the emotions she feels
when her unlovability schema is starting to take control. Then, after she made
the list, I asked that when she started to feel these emotions again, to stop
and analyze these familiar emotions and to decide whether or not the trigger had
anything to do with her unlovability schema.
Susan's 'Familiar Emotions' List
Susan made this list: 1. Angry
a several months of using this technique, I asked Susan to tell me how the exercise
had helped her. She stated, "As soon as Dan said that my hair looked like
a rat's nest, I felt the usual inadequacy surface, and that's when I stopped and
thought that there is no reason that a little comment like that should ruin my
day. I said to Dan that my hair looked like this because I had spent the entire
cleaning our house. Ha! You should have seen the look on that pig's face! I had
never referred to anything as 'ours' before, it was always 'his' house or 'his'
car, but I had made the same contribution as he had. I have a job and I do house
"We got into a huge fight that night and I told him that he was an awful
husband and that if he wanted to continue this marriage then he was going to have
to make some changes. He said he wasn't going to change for any bitch, so I left
that night and went to my mother's. That happened about two days ago, and I haven't
heard from him since. I can't say that I don't miss him, but I know I'm better
off now. My mom is even looking for a lawyer to help me with the divorce papers,
if I felt like that was necessary."
As you can see, Susan had taken a large
step in overcoming her schema and challenging it in her everyday life.
this track, we discussed the various steps inherent to treating Borderline Personality
Disorder through Schema Therapy: recognition and acknowledgement; finding the
root; and challenging the schema. Also, we included a schema log I believe are
helpful in facilitating these steps in Schema Therapy.
Feasibility of Group Schema Therapy for Outpatients with
Severe Borderline Personality Disorder in Germany:
A Pilot Study with Three Year Follow-Up
- Fassbinder E, Schuetze M, Kranich A, Sipos V, Hohagen F, Shaw I, Farrell J, Arntz A, and Schweiger U. (2016). Feasibility ofGroup Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up.
Front. Psychol. 7:1851. doi: 10.3389/fpsyg.2016.01851
Peer-Reviewed Journal Article References:
Chakhssi, F., Kersten, T., de Ruiter, C., & Bernstein, D. P. (2014). Treating the untreatable: A single case study of a psychopathic inpatient treated with Schema Therapy.Psychotherapy, 51(3), 447–461.
Nysæter, T. E., & Nordahl, H. M. (2008). Principles and clinical application of schema therapy for patients with borderline personality disorder.Nordic Psychology, 60(3), 249–263.
Spinhoven, P., Giesen-Bloo, J., van Dyck, R., Kooiman, K., & Arntz, A. (2007). The therapeutic alliance in schema-focused therapy and transference-focused psychotherapy for borderline personality disorder.Journal of Consulting and Clinical Psychology, 75(1), 104–115.
Online Continuing Education QUESTION
2 What are the various steps to treating a Borderline Personality through
Schema Therapy? To select and enter your answer go to CE Test.