COPYRIGHTED MATERIAL. Table of Contents. About the Authors. Acknowledgements. Introduction 1

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1 Table of Contents About the Authors Preface Acknowledgements xi xiii xv Introduction 1 1. Borderline Personality Disorder 3 What is Borderline Personality Disorder? 3 Prevalence and Comorbidity 4 Development of BPD 5 2. Schema Therapy for Borderline Personality Disorder 7 The Development of Schema Therapy for Borderline Personality Disorder 7 Research Results 8 (Contra-) Indications 9 Rationale of Treatment/Theories Supporting Treatment 10 Schema Modes 11 The detached protector 14 The abandoned/abused child 16 The angry/impulsive child 17 The punitive parent 18 The healthy adult 19 Summary 20 COPYRIGHTED MATERIAL 3. Treatment 21 Structure of Treatment 22 Phases in Treatment 24

2 vi Table of Contents Starting Phase and Case Conceptualization 24 Developing a relationship and gathering information 25 Measurements 26 Explaining the treatment rationale 27 Treating Axis-I Symptoms 27 Crisis Management 28 Therapeutic Interventions with Schema Modes 28 Treating Childhood Traumas 28 Changing Behavioural Patterns 29 Ending Therapy The Therapeutic Relationship 31 Limited Reparenting 31 Good care 33 Giving direction 33 Empathic confrontation 35 Role playing and role reversal 36 Setting limits 37 Therapists Schemas and Self-Disclosure 41 Cognitive Techniques and the Therapeutic Relationship 44 Behavioural Techniques and the Therapeutic Relationship 46 Summary Experiential Techniques 49 Imagery 49 Applications and aims of imagery 49 Imagery of a safe place 51 Imagery Rescripting 54 Basic model for imagery rescripting during the first part of the therapy 55 Phase 1: Imagining the original situation 55 Phase 2: Rescripting by the therapist 57 Imagery Rescripting in the Second Part of Treatment 61 Phase 2: Rescripting by the patient as a healthy adult 62 Variations with a patient only partially capable of being in the healthy adult mode 63 Phase 3: Rescripting experienced by the child 63 Imagery Rescripting: Changing Behaviour Patterns 65 Problems with Using Imagery Rescripting 67

3 Table of Contents vii Role Play 70 Historical role play 71 Phase 1: The original situation 72 Phase 2: Role switching 73 Phase 3: Rescripting 75 Common problems with historical role play 77 Role play of a current situation 78 Two-or-more-chair Technique 79 Two-chair technique for the punitive parent 79 Problems with using the two-chair technique with the punitive parent 83 The two-chair technique with the detached protector 84 Problems with using the two-chair technique with the detached protector 85 Multiple-chair technique 86 Two-or-more-chair technique with changing schemas and coping strategies 87 Experiencing and Expressing Emotions 87 Anger 88 Experiencing and expressing other emotions 90 Letter writing Cognitive Techniques 93 The Socratic Dialogue 97 Evaluation on a Visual Analogue Scale 97 Multidimensional Evaluation 100 Two-Dimensional Reproductions of Supposed Connections 102 Pie Chart 103 Courthouse Method 104 Historical Testing 105 Flashcards 105 Positive Logbook Behavioural Techniques 109 Experiments 110 Skills Training and Role Play 110 Problem Solving 111 Discussing Dangerous Behaviours 111 Discussing New Behaviours 112

4 viii Table of Contents 8. Specific Methods and Techniques 115 Homework 115 Pharmacological Therapy 117 Crisis 118 Suicide and Self-Injury 120 Self-injury and other self-destructive behaviours 120 Suicide 121 Trauma Processing 122 Problems with processing traumas Methods per Mode 125 Treatment Methods for the Detached Protector 126 Therapeutic relationship 126 Feeling 126 Thinking 127 Doing 127 Pharmacotherapy 128 Obstacles 129 Treatment Methods for the Abandoned and Abused Child 130 Therapeutic relationship 130 Feeling 130 Thinking 131 Doing 131 Obstacles 132 Treatment Methods for the Angry/Impulsive Child 133 Therapeutic relationship 133 Feeling 134 Thinking 134 Doing 134 Pharmacotherapy 135 Obstacles 135 Treatment Methods for the Punitive Parent 136 Therapeutic relationship 136 Feeling 136 Thinking 137 Doing 138 Obstacles 138 Treatment Methods for the Healthy Adult 139 Therapeutic relationship 139

5 Table of Contents ix Feeling 140 Thinking 140 Doing 140 Obstacles 141 A Simultaneous Chess Play in a Pinball Machine Final Phase of Therapy 145 Behavioural Pattern-Breaking 145 Ending Therapy Conclusion 147 Appendix A Brochure for Patients: Schema Therapy for People with Borderline Personality Disorder 149 Appendix B Cognitive Logbook for Modes 155 Appendix C Positive Logbook 157 Appendix D Historical Testing 159 Appendix E Experiments 161 Appendix F Homework Form 165 Appendix G Problem Solving 167 Appendix H Changing Behavioural Patterns 169 Appendix I Eighteen Schemas (Young et al., 2003) 171 Appendix J Coping Strategies 179 References 181 Further Reading 185 Index 191

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