Healthcare Training Institute - Quality Education since 1979
Psychologist, Social Worker, Counselor, & MFT!!

Section 3
Track #3 - Schemas and BPD

Question 3 found at the bottom of this page
Answer Booklet | Table of Contents
Get Audio Track: Open a new window with Ctrl N,
Left click audio track to Listen, Right click to "Save..." mp3
Get PRINTABLE format of this page

On the last track, we discussed definitions, symptoms, and treatment challenges regarding your client who has a Borderline Personality Disorder.

On this track, we will examine how schemas affect everyday lives: as a way to view the world; and a stored response to an emotional trauma. Also, we will address various maladaptive schemas that characterize many BPD diagnosed clients: selective perception; overgeneralization; and jumping to conclusions.

Schemas
As you may know, schemas refer to the way your client views the world. Many times, these schemas are beliefs instilled during an early developmental stage. They give a single way of seeing and thinking about the world. However, they also inhibit clients from flexing their creativity by confining thoughts along arbitrary lines. Louisa, 32, diagnosed with Borderline Personality Disorder, developed her own schema of not belonging while growing up. She stated, "I grew up on a small town in Iowa, about two thousand people. The luckiest girls lived in town. They could go to the drugstore together after school and get a soda. I couldn't do that; my mother made me stay in my room most of the time. God, even when I was a little kid, like eight years old, she was afraid some guy was going to knock me up. I've always felt outside of things. Apart from everyone. I don't trust anybody, including you."

As you can see, Louisa's early experience of being isolated instilled in her the schema of exclusion, which as you know is typical of BPD diagnosed clients. Louisa continued, "It boiled down to my belief that those other girls were thinking, 'You're not like us, and we don't like you. I hate those bitches!'"

Amygdala
Now let's look at the way in which a schema first takes hold for the BPD diagnosed client. The region of the brain responsible for inherent schemas is the amygdala . When a client experiences a trauma, such as abandonment, early in life, and reacts in a certain way, the amygdala registers the emotions felt during the trauma and the reaction. Therefore, when, later in life, a client experiences a feeling of abandonment again, the amygdala reacts in a split second and favors the primary reaction it learned early in development. Because the amygdala reacts much faster than the neocortex, or the reasoning portion of the brain, the client, if their primary response was anger acts angrily without the information having been sorted through yet. However, once the information has reached the reasoning portion of the brain, the client looks back on the incident and many times regrets their decision.

I like to think of the client diagnosed with BPD that I see in terms of schemas and how it relates to the functioning of the amygdala, because it depersonalizes the attacks I receive from this type of client as you will see. Rather than thinking of the client as having selective perceptions and being perfectionist, the concept of schemas helps to keep me from burning out with this client population by thinking of their remarks, behaviors, and backslides in the construct of brain patterns. Would thinking of your client diagnosed with BPD in the construct of brain patterns assist in decreasing your BPD burn out.

Three Schemas
In my practice, I have found the client diagnosed with BPD exhibits three maladaptive schemas which cause the most social havoc for them. The first maladaptive schema is selective perception. This occurs when the client sees things in only one way, while discounting evidence to the contrary. This schema was exhibited by Trisha, age 23, diagnosed with BPD. Trisha was attempting to be a competitive ice skater and practiced for countless hours to perfect her moves. During the most important competition of her career, Trisha lost her footing and fell. Even though the rest of Trisha's routine was perfect, that one flaw was what she focused on and so did the rest of the audience. Trisha said, "They expected perfection from me and I let them down." I pointed out to Trisha that the majority of her performance was flawless and she responded, "It doesn't matter. I am just no good. That one bullshit mistake was all that the judge, the announcer, and the whole stadium saw. I was so ashamed, but then I hate them for judging me. All my work, every single bit of it just down the toilet." As you can see, Trisha was suffering from selective perception, viewing only her one flaw and interpreting it as complete and utter failure. Such thinking caused Trisha to go into a loop of self-criticism, refusing to give herself credit for any other accomplishments because she had made a mistake. This loop leads to overgeneralization, another maladaptive schema that the client diagnosed with BPD has. This schema is characterized by a single event being interpreted as a perpetual pattern. Trisha would say, "I can never get this right" and "I'll never be good enough".

A third schema that clients diagnosed with BPD exhibit is known as jumping to conclusions. As you know, this occurs when a client concludes their worst beliefs are valid despite the lack of evidence. Alicia, for example, related this story to me. "I once had a boyfriend I had met when we both worked for the same company. After several months, we broke up. Two weeks after our breakup, I saw him pull into the parking lot and there was a woman in the car with him. I was hurt and furious. I thought, 'God damnit, They've slept together. He's done this to me already!' I felt completely betrayed, even though I had already started dating another man. I stormed right in front of his car, seething, yelled everything in the book at the top of my lungs at them, gave them the finger, and made sure he could see me. Then I stalked into the building and slammed as many doors as I could find. I later found out that he and the woman weren't together at all. He had just given her a lift because her car broke down on the way to work." Alicia's reaction, as you can see, jumped to the conclusion that her ex had already replaced and this drove her into a rage, even though she had done the same thing to him.

"Reaction Analysis" Technique
To help Trisha and Alicia better understand their maladaptive schemas of selective perceptions, overgeneralizations, and jumping to conclusions, I found the "Reaction Analysis" technique beneficial. In this exercise, I asked Trisha and Alicia to recognize their ingrained schemas. Then, when they felt they had enacted a schema, I asked them to answer several questions that evaluated their reaction. These questions included:

1. Ask your client if there reaction was beneficial to facilitate them meeting their goal For example, the goal for Trisha and Alicia they stated, was enjoying ice skating or maintaining relationships. I tactfully asked Trisha and Alicia Did the resulting interaction work out well, or did their thoughts, intense feelings, or reactions leave them feeling upset?
2. Each schema, such as selective perceptions, overgeneralizations, and jumping to conclusions, // has it's unique triggers, so the situation that sets a client diagnosed with BPD off is another clue to which schema might be involved. In short, find the schema, find the trigger. What was your client's schemas and triggers?
3. Each schema has its own distinctive emotional flavor. You can identify whatever schema may be at play by identifying your client's visceral or primitive reactions. What was your client feeling?
4. What did your client do?

As a response to this exercise, for Alicia's overreaction to her ex-boyfriend, she stated, "I let myself become overpowered with rage. I felt betrayed and angry. Afterwards, I felt so ashamed and rash. I felt like I had reacted like an adolescent school girl whose crush rejected her. That's not the level of maturity I want. I think I may be suffering from a jump-to-conclusions schema."

By analyzing her reaction, Alicia began to identify her schema of jumping to conclusions and to better address when again when it struggled to surface.

On this track, we have discussed how schemas affect everyday lives: as a way to view the world; and a stored response to an emotional trauma. Also, we addressed various maladaptive schemas that characterize many clients diagnosed with BPD: selective perception; overgeneralization; and jumping to conclusions.

On the next track, we will discuss pattern schemas and BPD.

QUESTION 3
What are three maladaptive schemas prevalent in Borderline Personality disorder clients? To select and enter your answer go to Answer Booklet.