Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions

Abstract

Schema therapy (ST) has been found to be effective in the treatment of borderline personality disorder (BPD). However very little is known about how the therapy is experienced by individuals with BPD including which specific elements of ST are helpful or unhelpful from their perspectives. The aim of this study is to explore BPD patients’ experiences of receiving ST, in intensive group or combined group-individual format. Qualitative data were collected through semi-structured interviews with 36 individuals with a primary diagnosis of BPD (78% females) who received ST for at least 12 months. Participants were recruited as part of an international, multicenter randomized controlled trial (RCT). Interview data (11 Australian, 12 Dutch, 13 German) were analyzed following the procedures of qualitative content analysis. Patients’ perceptions of the benefits gained in ST included improved self-understanding, and better awareness and management of their own emotional processes. While some aspects of ST, such as experiential techniques were perceived as emotionally confronting, patient narratives informed that this was necessary. Some recommendations for improved implementation of ST include the necessary adjunct of individual sessions to group ST and early discussion of therapy termination. Implications of the findings are also discussed, in particular the avenues for assessing the suitability of patients for group ST; management of group conflict and the optimal format for delivering treatment in the intensive group versus combined group-individual formats.

Experiences of Patients With Borderline Personality Disorder With Imagery Rescripting in the Context of Schema Therapy—A Qualitative Study

“…Other effects included an improvement in problem solving skills and physical well-being. In the study by Tan et al ( 17 ), patients with BPD receiving ST also reported broad therapeutic gains in various areas of life, while perceiving IR and other experiential techniques as emotionally confronting. The majority of the participants in our trial estimated the benefits of IR to be higher than the costs.…”

“…De Klerk et al ( 15 ) interviewed patients with PDs (BPD excluded) about their experiences with ST in general, and Ten Napel-Schutz et al ( 16 ) interviewed patients with PDs (BPD excluded) about their experiences with imagery (“safe place” and “diagnostic imagery”). There is one study that interviewed patients with BPD about their experiences with ST ( 17 ), finding that these patients experienced the experiential techniques (including IR) used during ST as confronting, but important. However, detailed information on how BPD patients perceived IR is limited.…”

The Good Enough Parenting early intervention schema therapy based program: Participant experience

“…Early intervention programs are effective [ 4 ] and cost saving versus the later financial impact of the psychopathology of the individuals who could have been helped by the program [ 5 ]. Schema therapy is a well-established cognitive behavioral approach with a firm evidence base for both theory and practice [ 104 ] with acceptability of specific techniques from the perspective of patients [ 105 , 106 ] and therapists [ 107 ]. This large-scale qualitative study showed that Good Enough Parenting, the schema therapy early intervention and parenting program, has considerable acceptability to the end user participants.…”

Effects of Schema Therapy for Children and Adolescents on the Externalizing Behaviors of the Adolescents Referred to the Counseling Centers in Ahvaz, Iran

“…The method allows therapists to help adolescents move on from difficult incidents and choose newer and healthier ways of doing activities. As adolescents focus on their peers and accept their responses more than those of their parents' or healthcare specialists', they could benefit from group therapy better than adults (19,20).…”