Getting a grip on personality disorder; 'Re-parenting' therapy is proving helpful

Sheralyn Taysheralyn@mediacorp.com.sg
07 December 2007
TODAY (Singapore)
English
(c) 2007. MediaCorp Press Ltd.

LIFE can be an emotional minefield for people with borderline personality disorder (BPD), who suffer moodswings from heart-rending sorrow to uncontrollable rage or blank withdrawal.

Until recently, there has been no effective way to treat BPD, which affects 1 to 2 per cent of people.

According to American psychologist Jeffrey Young, BPD patients have an extremely poor sense of self-worth and tend to have unhappy or tumultuous relationships. More worryingly, 10 to 15 per cent of them commit suicide.

"They are the unhappiest people and are in psychological pain all the time," he said, adding that BPD treatment can be an "enormous" burden to the healthcare system because patients seek constant medical help for other problems and often harm themselves by cutting themselves or attempting suicide.

Now, a form of therapy for BPD sufferers called schema therapy, developed by Dr Young, is gaining recognition, although it has drawn flak for its radical departure from conventional psychological treatment.

Schema therapy is based on the identification of 18 maladjusted personality types called schemas, explained Dr Young. "While most people have three to six moderate schemas," he said, "those with BPD have up to 16 of them".

Unlike other mental illnesses that can be treated with medication, BPD stems from poorly formed personality traits that are inherent, said Dr Young. Therefore, it is much harder to treat.

However, an independent three-year Dutch study of schema therapy - addressing these maladjusted personalities - is showing good results. An encouraging 52 per cent of patients on schema therapy were deemed to have recovered, compared to 29 per cent on transference-focused psychotherapy, which has been in use for a longer time.

Dr Young, the director of the Schema Therapy Institute and Cognitive Therapy Centre in New York, was recently in Singapore for a schema therapy workshop with mental health professionals at the Institute of Mental Health (IMH), teaching basic diagnosis and therapy skills.

Dr Clare Yeo, IMH head and principal psychologist, said the seminars raised awareness of the therapy. "Very few" mental health practitioners are fully trained in schema therapy, she added. The diagnosis of BPD here is relatively low, she noted, because conditions such as depression can mask BPD. But "we are finding out that those with chronic mental illness are responding to schema therapy", said Dr Yeo.

Dr Young is vindicated by the success of schema therapy, which departs from conventional treatment. Instead of keeping a neutral stance, the therapist bonds with the patient within session limits, in a method called "limited re-parenting".

"(BPD patients) are very mistrustful, frightened and detached, and are very afraid of abandonment," said Dr Young. He noted that up to 70 per cent of the patients were abused or neglected as children and likened their emotional age to a two-year-old.

By playing a supportive parental role, therapists support patients through their fears, reassure them and reinforce the belief that they are worthy people.

It is a long process that takes at least two years and frequent sessions - as many as two a week during initial treatment. Eventually, emotional upheavals taper off and the patients are better equipped to deal with their emotions, he said.

The IMH said it may sending interested psychologists for training