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Section 1
Principles and Clinical Application of Schema Therapy
for Patients with Borderline Personality Disorder

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In this section, we will examine the various steps inherent to treating a client diagnosed with Borderline Personality Disorder through Schema Therapy: 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 and Acknowledgement
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
To help 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 unlovitability schema. 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
Over 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 Root
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 way.

♦ Exercise: Remembrance
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 early moment in her life that might have had a direct effect on her schema.

♦ 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
2. Unwanted
3. Inadequate
4. Frustrated
5. Small

After 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 chores.

"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.

In this section, 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.
Reviewed 2023

Peer-Reviewed Journal Article References:
Boterhoven de Haan, K. L., Fassbinder, E., Hayes, C., & Lee, C. W. (2019). A schema therapy approach to the treatment of posttraumatic stress disorder. Journal of Psychotherapy Integration, 29(1), 54–64.

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.

 Jacobs, I., Lenz, L., Dörner, S., & Wegener, B. (2019). How do schema modes and mode factors align with defense styles and personality disorder symptoms? Personality Disorders: Theory, Research, and Treatment, 10(5), 427–437.

Ng, C. (2021). Mathematics self-schema, motivation, and subject choice intention: A multiphase investigation. Journal of Educational Psychology, 113(6), 1143–1163.

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.

QUESTION 1
What are the various steps to treating a Borderline Personality through Schema Therapy? To select and enter your answer go to Test.

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