In Brief

Nearly half of the participants in a Netherlands-based study testing schema-focused therapy's effectiveness for borderline personality disorder (BPD) showed so few symptoms that they were evaluated as recovered after completing three years of treatment, according to a recent study in the Archives of General Psychiatry (Vol. 63, No. 6, pages 649–658).

And one year after the therapy ended, 70 percent of the schema therapy patients had achieved "clinically significant and relevant improvement" in symptom reduction-working, attending school, thinking less frequently about suicide and more successfully regulating their emotions.

The study demonstrates for the first time that schema therapy can help people with BPD live more stable lives and make deep personality changes, says Jeffrey Young, PhD, a New York City-based psychologist who developed the therapy in the mid-1980s.

Young says he developed schema therapy because other therapies weren't serving his most difficult patients, particularly their need to develop a deep bond of trust with a therapist.

Drawing from cognitive-behavioral therapy, attachment theory and Gestalt techniques, the schema approach helps a therapist and client confront severe emotional damage, usually stemming from abuse in childhood, using an approach Young describes as "limited re-parenting."

Within firm limits, an attachment between therapist and client is allowed to develop-an approach different from other therapies' more neutral stances, Young says.

For the study, Dutch researchers divided 86 BPD patients from four mental health treatment centers into two groups. The first received schema therapy, and the second transference-focused psychotherapy, which seeks to help a client change from seeing themselves, and other people, in split-off extremes of "good" and "bad" to a more integrated mix of good qualities and bad qualities. Both groups received 50-minute, twice-weekly sessions of therapy for three years.

One year after completing treatment, 52 percent of the schema therapy participants reached full recovery-evaluated as such if their Borderline Personality Disorder Severity Index score fell below a cutoff point for a BPD diagnosis, and if other quality-of-life measures, such as improved social relationships and fewer incidents of self-mutilation, demonstrated a fundamental shift in how they viewed themselves and other people, says project leader Arnoud Arntz, PhD, a Maastricht University psychology professor.

By comparison, 29 percent of the transference-focused psychotherapy participants reached full recovery.

The schema therapy dropout rate was 27 percent, while half the transference group dropped out.

In fact, schema therapy limits societal costs as well as bolsters quality of life, Arntz says. The researchers estimated that per BPD participant who received schema therapy, Dutch society saved an average of $5,700 per year in medical costs and more stable employment, Arntz says.

Arntz hopes follow-up studies replicate the results and determine if group therapy based on schema therapy is possible.

-C. Munsey