Schema-focused Therapy : New Hope for Treatment of Personality Disorder Patients. Joan Farrell, Ph.D. Program Director, Center for Borderline Personality DisorderTreatment & Research Indiana University School of Medicine Larue Carter Hospital. WHAT IS A PERSONALITY DISORDER?.
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Joan Farrell, Ph.D.
Center for Borderline Personality DisorderTreatment & Research
Indiana University School of Medicine
Larue Carter Hospital
paranoid episodes, dissociation.
Any combination of 5 symptoms earns a BPD diagnosis.
Negative attentional bias
Biology? Genetics? Temperament?
Emotional Awareness Deficits
Emotional Regulation Deficits
Maladaptive Core SchemasHYPOTHESIZED ETIOLOGYPerson with BPD
Overactive Amygdala (the engine)
Other areas of dysfunction
Person w/BPD can have a faulty engine, or brakes, or both.
Findings like these led to NAMI including BPD as area of interest
Schema Therapy was developed to Improve the Effectiveness of
Cognitive Therapy with
Personality Disorder patients
CT for MDD - Beck’s Studies
60% Success rate
30% relapse at 1 year
object relations approaches
emotions & cognitions
Mistrust & Abuse
Jeffrey YoungMALADAPTIVE SCHEMAS
develop when specific
are not met.
can play a role
They erupt when
related to the schema.
They may not “fit”
what is needed in
one’s adult life.
To help patients get their core needs met
in an adaptive manner
through changing their maladaptive schemas and coping styles
We are trying to create a healthy healing, reparenting environment so they can finish the steps in childhood development that they missed
We must find ways to validate their feelings and needs—
While setting limits on and challenging their unhealthy behaviors.
TO TAKE ON THE OUTSIDE WORLD
This is where our role is critical – our responses will either reinforce negative core beliefs or challenge them.
In contrast to CBT , SFT includes childhood
give her back
Axis I – MDD, PTSD, hx ED
Axis II BPD
Abandonment, Emotional Deprivation, Defectiveness
Subjugation of needs, self-sacrifice, approval seeking
Unrelenting standards, Punitiveness
schemas & coping styles
are not in
But can be recognized
when pointed out to
Not just a belief that she is “bad”, but feelings of shame and memories of rejection.
Origin in bio. Parents abandonment & adoptive parents rejection
Triggered whenever she does not get unconditional acceptance from significant others
= I am “Bad” & I Deserve Punishment
my situation is hopeless.
No memory file folders exist to store
the info that contradicts core beliefs in so,
Don’t expect them to remember getting a positive response from you until it has happened many times.
e.g., “Are you mad at me?”
Until a new positive belief forms they will keep testing.
Childhood survival strategies
can recur when Schema Issues
but they use them
most of the time
I’ve decided to quit my job, drop out
Of society, and wear live animals as hats.
OFSCHEMA THERAPY TECHNIQUE
Counter schema modes:
“I know in my head
that I am not evil,
but I feel evil”
“Empty Chair” Dialogues
Example: reduce the hold
of the Punitive Parent.
Arntz, et al.,
Arch Gen Psychiatry June, 2006
Schema issues kept them from using the healthy coping skills they learned
E.g., the beliefs that they are bad,
helpless or hopeless
Borderline Syndrome Index Pre Treatment
% patients meeting diagnosis criteria
Borderline Syndrome Index
Clinical & Statistical Significance
mean = 57.51, SD = 5.91
Paired Sample t-test
t = -17.55(36), p< .01
mean = 28.16, SD = 10.70
One Year before
One Year After