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Schema Focused Therapy for Borderline Personality Disorder

Is Schema Focused Therapy Right For You?

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Updated July 21, 2008

Schema focused therapy for borderline personality disorder (BPD) is a type of psychotherapy that focuses on identifying and changing specific unhealthy ways of thinking. Schema focused therapy includes some elements that are traditional parts of cognitive-behavioral therapy (CBT), but also includes some elements of other types of psychotherapy.

Childhood Needs and Maladaptive Schemas

The theory underlying schema focused therapy presumes that when our basic childhood needs (such as needs for safety, acceptance, love) are met inadequately, we develop unhealthy ways of interpreting and interacting with the world, which are called maladaptive early schemas.

Schemas are broad and pervasive patterns of thinking and behavior. These are more than just beliefs; schemas are deeply held patterns that are closely related to our sense of self and view of the world. Schema theory proposes that schemas are triggered when events happening in our current life resemble those from our past that were related to the formation of the schema. If we have developed unhealthy schemas because of difficult experiences in our childhood, we will resort to unhealthy ways of thinking and behaving in response to this new situation.

Schema theory proposes that many of the symptoms of BPD are caused by difficult childhood experiences (such as maltreament, or early separation from caregivers), which lead to the formation of maladaptive early schemas.

Goals of Schema Focused Therapy

The initial goals of schema focused therapy for BPD are to identify the patient’s relevant schemas and to link these schemas to past events and current symptoms. The therapist and patient then work on ways of processing emotions related to the schemas and altering unhealthy coping styles that are the result of maladaptive schemas. For example, the therapist and client may conduct exercises focused on venting anger, breaking unhealthy patterns of behavior, and changing unhelpful ways of thinking.

Research Support for Schema Focused Therapy

While there has not yet been extensive research on schema focused therapy, one study has been published to date which suggests that patients randomly assigned to receive schema focused therapy had significantly larger reductions in BPD symptoms than those assigned to receive psychodynamic therapy. While this is preliminary evidence of the effectiveness of schema focused therapy, it suggests that this therapy shows promise in treating BPD.

Sources:

Giesen-Bloo J, van Dyck R, Spinhoven P, van Tilburg W, Dirksen C, van Asselt T, et al. “Outpatient Psychotherapy for Borderline Personality Disorder: Randomized Trial of Schema-Focused Therapy vs Transference-Focused Psychotherapy.” Archives of General Psychiatry, 63:649-658, 2006.

Young JE. Cognitive Therapy for Personality Disorders: A Schema-Focused Approach, Sarasota, FL, US: Professional Resource Press/Professional Resource Exchange; 1999.

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