How Schema-Focused Therapy Works for BPD

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Schema-focused therapy for borderline personality disorder (BPD) is a type of psychotherapy that focuses on identifying and changing specific unhealthy ways of thinking. The 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, and love) are met inadequately, we develop unhealthy ways of interpreting and interacting with the world, which is 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 behave in response to this new situation.

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


The initial goals of schema-focused therapy for borderline personality disorder are to identify the patient’s relevant schemas and to link these schemas to past events and current symptoms.

Following this initial work, 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 (unhealthy schemas that could be causing symptoms in BPD). 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

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 borderline personality disorder 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.

In addition, an analysis of multiple research studies on psychological therapy for borderline personality disorder also concluded that schema-focused therapy appears effective, but the authors also said more research is needed.

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Article Sources

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  • Giesen-Bloo J 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.
  • Stoffers JM et al. Psychological therapies for people with borderline personality disorder. The Cochrane Database of Systematic Reviews. 2012 Aug 15;8:CD005652.
  • Young JE. Cognitive Therapy for Personality Disorders: A Schema-Focused Approach, Sarasota, FL, US: Professional Resource Press/Professional Resource Exchange; 1999.