Borderline Personality Disorder Consulting & Family Support

For over 20 years I have worked primarily with clients who have Borderline Personality Disorders. I began this work when, as a newly minted therapist working at a county mental health agency, I found myself with a caseload of clients whom, I discovered, had BPD, often undiagnosed or misdiagnosed as some other disorder. Seeing the similarities in the struggles my clients were experiencing, I started a BPD treatment group. I researched treatment protocols and discovered the STEPPS Program (Systematic Treatment for Emotional Predictability and Problem Solving), a group therapy program designed specifically to treat clients with BPD that had been developed by researchers and clinicians at the University of Iowa.​ 

 

As I worked with clients in both group and individual therapy using the STEPPS protocols, I found the program to be remarkably helpful in reducing the problematic symptoms of BPD. While I found the skills that were incorporated in the program (skills drawn from Cognitive Behavioral Therapy and Dialectical Behavioral Therapy) useful in managing the symptoms, what most excited my clients was what was called, in the STEPPS Program, the Filter’s Questionnaire. This questionnaire identified many of the core, maladaptive ways that my clients viewed themselves, other people, and the world, ways of thinking that created feelings of fear, self-hatred, and emotional reactivity, and that caused the behavioral symptoms that they were learning skills to manage.

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I realized that as my clients were able to challenge and change these unhealthy core beliefs, the behavioral symptoms decreased and dropped away.​I began looking deeper into the Filters Questionnaire and discovered that it had been drawn from the Schema Questionnaire developed by Jeffery Young, the founder of what is known as Schema Therapy. Dr. Young was a colleague of Dr. Aaron Beck, the founder of Cognitive Behavioral Therapy (CBT), who realized that CBT, while useful, was not particularly effective in treating personality disorders. He called the deeply held beliefs about ones self, schemas. Dr, Young and his colleagues defined schemas as: A schema is an extremely stable and enduring pattern that develops during childhood and is elaborated throughout an individual’s life. We view the world through our schemas. Schemas are important beliefs and feelings about oneself and the environment the individual accepts without question. They are self-perpetuating and are very resistant to change. For instance, children who develop a schema that they are incompetent rarely challenge this belief, even as adults. The schema usually does not go away without therapy. Overwhelming success in people’s lives is often insufficient to change the schema. The schema fights for its own survival and, usually, is quite successful. Even though schemas persist once they are formed, they are not always in our awareness. Usually, they operate in subtle ways, out of our awareness. However, when a schema erupts or is triggered by events, these schemas dominate our thoughts and feelings. People tend to experience extremely negative emotions and have dysfunctional thoughts at these moments.  ​David C. Bricker, PhD, and Jeffrey E. Young, PhD. Modified by Ozgur Yalcin, PhD

 

​In my work with my clients in group, it was learning to identify and change the schema-based ways of thinking that brought about the most powerful change. Schema Therapy has become one of the therapeutic modalities that has been proven to be effective in treating personality disorders, and specifically Borderline Personality Disorder.​As I moved into a private practice I continued offering my Borderline Personality Disorder treatment group to my clients, and expanded on the STEPPS program with techniques from Schema Therapy. I spent more than a year becoming a Certified Individual Schema Therapist through the International Society for Schema Therapy.  ​I also began offering a BPD Family Support Group, a 10 week group for the family members and significant others of my clients with BPD. This was a very well received addition to my clients treatment, helping family members understand BPD, and learn to respond to the clients in ways that supported their progress in treatment.​ 

 

I have also worked with family members in individual and family therapy, with the goals of enhancing their understanding of Borderline Personality Disorder, taking the stigma and misunderstandings away from the diagnosis, and strengthening family relationships that were often stretched to the breaking point by the behaviors of my clients.​  I am offering this service both to family members who wish to better support their loved one who is dealing with BPD, and to clinicians who would like to increase their understanding of and ability to treat their clients with BPD.