EFFECT OF SCHEMA THERAPY IN BORDERLINE VIRTUAL
Borderline Personality Disorder is a very difficult disorder to treat. It was first started to be treated with Analytical Therapies, then Cognitive Behavioral Therapy was tried. However, no therapy system has been as effective as Schema Therapy developed by Jeffrey Young. According to the researches; In psychoanalytic therapy, quitting therapy (46-67%) and suicide attempts were found to be quite high. In a study conducted in Norway, 50% of the percentage of schema therapy treating borderline patients were no longer diagnosed as borderline; It was observed that 80% benefited greatly from the treatment.
What is Borderline Personality Disorder? (There must be at least 5 items from DSM 5 diagnostic criteria)
1. Making intense efforts to avoid real or mental abandonment(except suicide and self-harm attempts to avoid abandonment) ( abandoned child scheme – hurt child mod)
2. To have a two-pronged interpersonal relationship cycle, such as raising the other person to the sky at once, glorifying them and putting them down at the same time. (Inconsistency in emotional responses due to rapid transitions between modes.)
3. Experiencing identity confusion. Having a distinctive and consistently inconsistent, bumpy identity (identity confusion due to fast transitions between modes)
4. Impulsivity in at least 2 areas that are self-destructive(ex: spending a lot, promiscuous sexual relations, substance abuse, dangerous driving, binge eating…) (suicide and self-mutilation behaviors) ( impulsive- angry kid mode)
5. Repetitive suicidal behaviors, attempts, threats, or self-mutilation(eg razor…) (punishing kid mode)
6. Inconsistency in affect due to impulsivity in mood(eg: intense periodic dysphoria, irritability, or a cycle of boredom that usually lasts longer than a few days) (mod loop)
7. Persistent sense of emptiness (disconnected mode)
8. Inappropriate intense anger or difficulty controlling anger(frequent anger, constant anger, frequent fights) (angry- impulsive kid mod)
9. Temporary suspicious thoughts or severe dissociative symptoms related to the strain ( disjointed mode)
So what are Borderline’s triggered schemes and mods?
Active schemas of people with borderline personality:
“- abandonment scheme
-skepticism- abuse scheme
-emotional deprivation scheme
– scheme of vulnerability to disease or damage
-insufficient self-control- self-discipline scheme
-emotion suppression scheme
-the punitive scheme” (Arnoud Arntz and Hannie van Genderen “borderline personality disorder” p.30)
J. Young has developed ‘Mod Therapy’ since these transitions between schemas and mood changes, which are active in the borderline, are very fast. The concept we call mode is the momentary mood that occurs when schemas are triggered. In order not to complicate the already complex structure of Borderline, mod therapy is applied.
Borderline’s Mod Loop:
Individuals with Borderline Personality Disorder do not consistently exhibit angry, angry, impulsive and self-harming behaviors in the DSM 5 diagnostic criteria. Generally in detached sheltered mode, they live by withdrawing into themselves in order to preserve their spiritual integrity. In this process, they try to stay away from emotionality and engage in activities that console them, eg excessive sexuality, substance use, excessive eating, excessive reading, overwork, etc.
When the person perceives any real or imagined threat of abandonment by other people in a relationship in abandoned-hurt child mode experiences intense pain. Afterwards, he feeds anger on those who hurt him so much. The intense anger and impulsiveness she has experienced causes her behaviors that she does not want to do. (angry- impulsive kid mod).An inner voice that questions how he did these things after the anger he has caused him to punish himself ( punishing parent mode). The person may want to commit suicide in the extreme to punish himself. It can then revert back to its detached sheltered mode. And the cycle continues. In order for the person to break this cycle, the 5th mode is healthy adult modestrengthening is necessary.
With schema therapy, therapists help the person to strengthen their healthy side, express their emotional needs, discover different ways to meet their own emotional needs and integrate them into their life.