It helps you recognise the patterns you are trapped in that keep you behaving in certain ways, and also gives you an opportunity to try fully trusting someone.
At the heart of schema therapy is the idea that we all live out certain themes in life, called ‘schemas‘. These are patterns of behaviour we choose when we are children, and then repeat throughout our lives. For example, the ‘abandonment schema’ means you believe whoever gets close to you will eventually leave you, and that you must overreact or sabotage each relationship to protect yourself.
Schema therapy is unique in that it offers something called ‘limited reparenting’. Your therapist ‘stands in’ as the reliable parent you didn’t have. They commit to being there for you no matter what you do, say, or think, just like a good parent would.
focus is on noticing and changing unhelpful patterns
involves ‘reparenting’ where therapist stands in for parent you didn’t had
Its goal is to help you find balance and acceptance in your life, and to help you create a life that you actually like being in.
It does this by focussing on four areas. These are regulating your emotions (how to change what you feel), mindfulness (accepting the present moment), distress tolerance (how to navigate emotional upset), and interpersonal effectiveness (how to relate your needs and boundaries without upsetting both yourself and others).
A highly structured therapy, DBT therapy involves homework. This might include trying out your new skills and reporting how it went. In its original form it involves both group therapy and one-to-one work.
highly structured and involves homework
focussed on present day issues and behaviours
often a group therapy with extra support between sessions
can be done one-on-one
Mentalisation based therapy (MBT)
Mentalisation based therapy comes from the psychodynamic school of thought, and is again a therapy specifically designed for those with borderline personality disorder.
“Mentalising” is the art of understanding how other people think and feel, and it’s a skill you can learn.
So mentalisation based therapy is all about helping you understanding the difference between the assumptions you make about others and the way others really are. You learn to understand people (and yourself) better.
The belief here is that the main issue for those with BPD is that they lack a natural tendency to understand the ways other people actually think and feel.
You might think you understand people perfectly, better than anyone, but you are not seeing them as they are. The world in your head is actually different than the world others are inhabiting. And you also don’t see yourself as others see you. This can obviously lead to a lot of confusion for you, and can mean you overreact and have problematic relationships.
You can get MBT on the NHS if you are diagnosed as borderline and they feel it might help you. You might start out with sessions in a group. Although MBT is used as a short-term therapy in some cases, when it comes to BPD it tends to be at least 18-24 months.
The focus of CAT therapy is, like schema therapy, on patterns. But CAT focuses exclusively on patterns of relating. What are your responses to other people, and how are they affecting your life?
Again like schema therapy, there is a focus on a strong relationship between you and your therapist. This relationship itself is seen as a tool of change, where you can see your problems with relating and then try new ways of communicating.
all about how you relate to others
does look to your past to see how your problems started
strong focus on your relationship with your therapist
time-limited, often 16-24 sessions.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy is currently the most popular form of therapy in the UK, often recommended by the NHS. And it has some evidence base for helping with BPD.
CBT focuses on the link between your thoughts, feelings, and actions. How do they ways you are thinking lead to the behaviours that cause you problems, and what can you do to troubleshoot that cycle?
Cognitive behavioural therapy can help you with borderline personality disorder because it trains you to automatically question if your thoughts are true or assumptions, slowing down your reaction time and helping you feel more balanced.
looks at the connection between your thoughts and behaviours
helps you retrain your brain to think in less negative, reactive ways
focuses on present issues
highly structured, involves homework
How soon will I get better if I try BPD treatment?
A personality disorder means that you see the world differently than others. So it isn’t like getting over the flu!
It’s a lifelong experience. Although of all the personality disorders, BPD is the one that does change with age. It’s found that most people find their symptoms lessen when they reach their 40s. Of course therapy means that you don’t have to wait. You can learn to manage your symptoms now.
Most people find that when they start borderline personality disorder treatment, things can feel worse before they feel better. You are having to really face up to yourself, and to learn entirely new ways of seeing yourself, which isn’t always a walk in the park.