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.

Examples

In order to understand how schema therapy works, it is helpful to look at some of the unhealthy early schemas people may have and the issues they may later cause.

A few examples of maladaptive schemas include:

  • Defectiveness / Shame: People who believe that they are fundamentally unloveable may sabotage their relationships because they are afraid of being abandoned. 
  • Emotional Deprivation: People who believe that other people will not meet their needs may end up in relationships with people who are emotionally neglectful.
  • Social Isolation: People who hold a schema that they are separate or unaccepted in the world may isolate themselves from others.
  • Enmeshment: People who hold a schema that they cannot be happy or successful without the support of other people, often family members, may become overly dependent on their loved ones. They may lack a sense of direction, autonomy, and individuality.

Not everyone responds to early schemas in the same ways. Schema therapy suggests that there are three primary coping styles that people use to deal with these beliefs.

  • Surrender causes people to engage in behaviors that reinforce their existing beliefs.
  • Avoidance leads people to try to avoid any situation that triggers feelings of fear or vulnerability.
  • Overcompensation involves engaging in behaviors that act in opposition to the belief, often to an extreme degree. 

Goals

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.

How to Find a Schema Therapist

Finding a qualified professional who has experience with schema therapy can be a challenge, but there are resources that can help. You might start by looking for therapists in your area who specialize in cognitive-behavioral therapy (CBT). Because schema therapy uses many of the same techniques as CBT, these therapists may also have experience with both approaches.

The International Society of Schema Therapy also provides a directory of therapists, or you can utilize the American Psychological Association's therapist finder to look for providers in your area.

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  1. Tan YM, Lee CW, Averbeck LE, et al. Schema therapy for borderline personality disorder: A qualitative study of patients' perceptions. PLoS ONE. 2018;13(11):e0206039. doi:10.1371/journal.pone.0206039

  2. Schema-focused therapy appears effective for BPD treatment. American Psychological Association. March 2007, Vol 38, No. 3.

  3. Stoffers JM, Völlm BA, Rücker G, Timmer A, Huband N, Lieb K. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2012;(8):CD005652. doi:10.1002/14651858.CD005652.pub2

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