Schema therapy for borderline personality disorder: A qualitative study of patients' perceptions

PLoS One. 2018 Nov 21;13(11):e0206039. doi: 10.1371/journal.pone.0206039. eCollection 2018.


Schema therapy (ST) has been found to be effective in the treatment of borderline personality disorder (BPD). However very little is known about how the therapy is experienced by individuals with BPD including which specific elements of ST are helpful or unhelpful from their perspectives. The aim of this study is to explore BPD patients' experiences of receiving ST, in intensive group or combined group-individual format. Qualitative data were collected through semi-structured interviews with 36 individuals with a primary diagnosis of BPD (78% females) who received ST for at least 12 months. Participants were recruited as part of an international, multicenter randomized controlled trial (RCT). Interview data (11 Australian, 12 Dutch, 13 German) were analyzed following the procedures of qualitative content analysis. Patients' perceptions of the benefits gained in ST included improved self-understanding, and better awareness and management of their own emotional processes. While some aspects of ST, such as experiential techniques were perceived as emotionally confronting, patient narratives informed that this was necessary. Some recommendations for improved implementation of ST include the necessary adjunct of individual sessions to group ST and early discussion of therapy termination. Implications of the findings are also discussed, in particular the avenues for assessing the suitability of patients for group ST; management of group conflict and the optimal format for delivering treatment in the intensive group versus combined group-individual formats.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Borderline Personality Disorder / psychology
  • Borderline Personality Disorder / therapy*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Perception
  • Psychotherapy*

Grants and funding

AA obtained funding for the Dutch sites of this study from the Netherlands Organization for Health Research and Development (ZonMW; 80-82310-97-12142) and Netherlands Foundation for Mental Health (2008 6350), GAJ obtained funding from Else Kröner-Fresenius-Stiftung for the German sites, and CWL obtained funding from Australian Rotary Health for the Australian site. The Greek site is supported by the Greek Society of Schema Therapy and the 1st Department of Psychiatry of the Medical School of the University of Athens. The funders played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.