Schema Story: Borderline Personality Disorder

Shan is a professional client with a wealth of experience in psychotherapy, and I am now her third clinical psychologist as she has been seeking treatment on and off for nearly a decade. In the course of my work with her, she has disappeared and stopped therapy for short periods of time.

Many therapists are afraid of borderline personality disorder cases. They are unpredictable because of their inner insecurity about relationships, their moods go up and down, and they find it difficult to trust the therapist; some have experiences of self-harm, suicide, or addictions, and the therapist has to be constantly on the alert with them, as the case is likely to go through one crisis after another.

Shan came to us at an emotional low point. After a breakup, she scratched her arms and thighs. Because she had attempted suicide when she was younger, and her family forced her to come to psychotherapy because they were afraid she would do something stupid again.

‘Why didn't you go back and seek help from the clinical psychologist before you?’ I was curious.

‘After all, it would have saved me a lot of time not having to repeat my story. She's famous, but I don't think she can help me,’ said Shan. I read about you online and I think you can help.’

‘I can't say that I can help, but if you choose to work with me, I'll do my best to try,’ I said.

Shan shared with me the story of her breakup with her boyfriend. Her ex-boyfriend was a foreigner she met on a dating app and would go to discos with her. He not only took her drinking and dancing to meet new people, but also lured her into using marijuana and cocaine. Shan is 20 years old and the man is in his 30s.

Shan's friends warned her that he seemed unreliable, but Shan found him so exciting, so many new things to do, and so much that he opened her eyes to another world, that she became obsessed with him.

It was only a few months before Shan found out about her boyfriend's affairs, and they had a big fight.  Such a big fight that alerted the police, and her family was worried about Shan 's safety. However, Shan said, ‘I told the police that I was being abused by him because of my bruised hands and feet, and the police took him away!’ She was lying.

One minute she's so angry, the next she's bursting into tears. ‘What did I do wrong for him to do this to me? It's only been a few months and he's already given up on me? Why am I always the one who gets cheated ......,’ Shan burst into tears as she cried her heart out.

As I listened, offered her tissues, and empathised with her feelings of being cheated on, I wondered, ‘What would make this girl take such a risk to find excitement?’

Shan's parents were divorced and she grew up with her mother, who remarried and gave birth to a younger brother. Since then, Shan has always felt that she is the ‘extra one’ at home. Her step-father was not bad to her, but he wasn't very affectionate either, and she sighed, ‘I'm an outsider in every sense.’ She felt that her mother had less time to take care of her after she gave birth to her younger brother, and since she was always told that her younger brother was better than her, she had been neglected and wanted to win her mother's attention, but her grades were not impressive enough and she did not achieve much in the eyes of her mother.

‘So, when did your mum notice you the most in secondary school?’

‘When I got into trouble.’ Shan had a calm, almost smug look on her face.

‘Tell me more, please.’

Shan's mother was very strict with her, while her father was indifferent and only cared about her brother. As a teenager, Shan went to an international school, and once when she went to a bar with her foreign friends and came home smelling like cigarettes, her mum got angry and scolded her in vulgar language. She remembers that ever since then, whenever she went out to play, went on a night out, drank and smoked, she was scolded by her mum.

‘So you're saying that when mum gave you the most attention, that's when she scolded you.’ Shan nodded, looking almost amused.

Shan agreed that she fit the definition of Borderline Personality Disorder, so I asked her directly about her self-harm.

‘Did it ease your pain after you cut up your arms and thighs so badly?’

‘A little bit.’ She nodded.

‘But it will leave you with scars.’ I said softly, watching her reaction.

Shan smiled, as if she felt a little satisfied. ‘I don't know what I want to do. All my friends say I am stupid.’

‘Shan, why are you smiling when you're saying that you're lost, that you don't know what to do, and that your friends don't sympathise with you?’ I looked into her eyes and wondered. Shan suddenly looked dumbfounded for a moment and awkwardly averted her eyes while keeping her smile on her face.

‘What would you say if I suggested that in the future you try to relieve my emotions without hurting yourself?’ Shan shrugged and said, ‘Okay.’

At the end of the first session, as she stood up, she said, ‘I think you're going to help me.’

I smiled and said, ‘I hope so.’

How do you feel?

We agreed to meet weekly, and for the next few sessions, Shan was very engaged, answering questions, but at the same time bringing up topics.

‘You didn't seem very interested in the mood record I invited you to do, did you? You haven't done it for two weeks in a row. What makes it difficult to remember please?’ I asked Shan.

‘I'm busy.’

‘So, I'm going to give you this list of adjectives to describe your mood today.’ I said.

Shan looked annoyed. ‘I'd like to talk about ......,’ I interrupted, ’Wait, can you stop for a second, feel it, and tell me how you feel when I give you this list and ask you to tell me how you're feeling today?’

‘Nothing.’

‘I don't know if I'm right, but I seem to sense that you're a little bothered, aren't you?’

Shan shrugged her shoulders, a little helplessly.

‘I'm probably more interested in your moods than you are in your own, don't you think?’ I didn't stop there, and continued to drill on about her moods at the moment.

‘I don't know what to answer you.’ Shan shrugged again, shaking her head.

‘You say that from time to time you find life too boring, too empty, and that you need something new and exciting, but when I try to find out what you're like on a regular basis, when you're bored, when you're stuffy, you're just not interested. I wonder if there are times when you don't want to know how you feel at all, and that's what you've shown me today.’

Shan paused, and then she laughed as she said, ‘I do find you annoying, I don't know what you want me to say about my feelings, what do you want me to say to you when nothing is happening?’

I looked at her and said, ‘Good, at least now I understand that you're annoyed, and you don't feel anything, do you? Because life is so dull, you can't remember feeling anything at all, right?’

Shan looked away while maintaining her hard smile, ‘I feel bad for talking like this, but I really do feel annoyed with you, why do you always have to ask me how I feel?’

‘It's like there's a part of you that doesn't want to feel about yourself, and that's why you find this question so annoying.’ I took out a chair and pointed to another chair and said, ‘I'd like to invite you to sit here and be the part that doesn't feel anything, is it okay?’

Shan shook her head and laughed as she ruffled her hair, ‘I'm not sitting out.’

I looked at her for two seconds and said, ‘Well, how about I sit down and play this part of you?’

She shrugged again. I sat down on one of the chairs.

Chairwork

‘I'm the Shan who doesn't want to feel anything, and so is the other Shan, so I'm going to demonstrate how to tell the other Shan why I don't think it's important to feel anything. If I'm right, nod your head; if I'm wrong, shake your head, okay?’

Again, Shan shrugged her shoulders, expressionless.

I began, facing the empty chair in front of me, acting as Shan 's ‘detached protector’: ‘Shan, you don't have to feel, the more you feel, the worse it gets, and no one wants to know how you're doing, and the more you feel, the more you're going to lose your temper, and the more Mom and Dad are going to think you're not as good as your brother. I'm here to help you out, so calm down, or I'm afraid you'll lose your temper or get into trouble, and then no one will want you.’

I turned to Shan and asked her, ‘Is that right? Am I wrong?’

Shan was a bit moved, her face was flushed, her eyes seemed a bit moist, and she stammered, ‘That's a bit right ......’.

‘So what's wrong with it? Please correct it.’ I looked at her sincerely.

Tears were streaming down her face as she said, ‘I don't know!

‘It's okay, you can think about it first, and you can tell me later when I come back to see if my understanding is wrong.’

My heart ached for this girl who could only cry but not speak.  I adjusted my position and sat on the opposite chair to be her ‘angry child’ and said to my original chair, ‘I know you're right, but I'm having a really hard time, I want someone to feel my hard time, I want to lose my temper, and you're blocking me and I'm all alone. ...... In the past, if I hadn't acted like a madman, nobody would have cared about me, nobody would have wanted to care about me, nobody would have wanted to care about me. No one wanted to talk to me!’

I spoke louder and louder, and when I stopped, it was almost as if the room echoed. I turned to look at Shan again, and she was in tears.

Without asking her how she felt, I sat back in my original therapist's chair and said to the ‘detached protector’, ‘Thank you for protecting angry Shan, especially when she was little and wanted attention, but was badly rejected and considered too much trouble. She felt that her parents loved her younger brother more, and she felt lonely like an extra one, (I pointed to the ‘angry child’ across the room) She was frustrated and angry, and it was you who protected her to continue to be Mum’s good girl ...... until she exploded, and she was so frustrated that she deliberately did all those things that Mum hated the most, such as smoking cigarettes and going to nightclubs. You see? You have been trying to protect her, meanwhile she finally can't hold back, her emotions are about to explode.’

I stopped and looked back at Shan. She had calmed down and her tears had stopped. I asked her gently, ‘What do you think? If you have any thoughts, you can share with me.’

Shan was silent for a long time, but she finally spoke, ‘I'm so angry with Mum for always being mad at me, for always thinking my brother is better, and for not maintaining a good relationship with Dad....... Why doesn't anyone know what I like...... I remember that on my twelfth birthday, I wanted to go horse riding as my birthday present, but they wouldn't let me, so we ended up going to eat hot pot. I know mum loves hot pot, but I wanted to go horse riding......’ Shan said in one breath. I empathised with her anger, the anger that comes from not being seen or understood or valued for so long. She began to calm down.

The Angry Child and the Vulnerable Child

After seeing me for a few months, Shan started to sit in the chair and talk. She would sit in the chair of the angry child and curse at the empty chair that represented her mother, and then the ‘vulnerable child’ part of her began to emerge, and I would let her sit in the chair of the vulnerable child to express her sadness at the lack of care, affirmation and attention.

In the past few months, she stopped doing any self-harming behaviours. I set a new therapeutic goal with her: ‘To learn to better perceive and regulate her emotions without going to the extremes and without doing things that she would regret.’ She agreed.

Despite the progress in sensing vulnerable feelings, Shan still cried a lot during the sessions, not knowing what she was crying about, let alone what she needed.

She rarely completes the homework I give her and often ‘thinks I'm bored’ and will tell me so without hesitation. I need her to see ‘her as I see her’: living as a “detached protector’ has led to a sense of security, but also to a perpetual feeling of emptiness, of not understanding herself, of being lost. ...... She needs to be able to see herself well, without judgement, and then to learn about herself through life, through discovery, and then she will have a direction. However, even though she is now more in touch with her inner feelings and is willing to do experiential interventions such as ‘chairwork’. I still have to face a problem: how can I make her feel that the therapy room is a safe enough place?

I needed to confront her properly, and empathetic confrontation is one of the most important interventions in Schema Therapy.

When Shan came in, she sat down relaxed and easy. I asked her, ‘Did you listen to the recording I gave you last week? It's the dialogue we had during the chairwork exercise.’ She smiled and shook her head. She answered as she always does, ‘I've been too busy.’

‘Well, why don't we listen to it together now that we have time?’ I decided not to let her go.

She shrugged her shoulders in reluctant acceptance, trying to hold back the look on her face that made her want to look the other way. I turned on the recording and cranked up the volume.

When I was done, she looked blank. ‘What do you think?’ I asked.

She said, ‘I don't feel anything.’

As usual, the ‘detached protector’ sat down in front of me and listened to the recording with me. I said, ‘I know that the detached protector is here, and I'd like you to sit here ......’ When I got the chair out, she suddenly said in a loud voice, ‘What do you want from me?’

I paused and looked at her for a few seconds and saw how angry she looked, ‘You're not here to satisfy me, you're here to do therapy. But you always seem to resist doing the homework I give you, as if by doing the homework I tell you to do, you will be controlled by me. Is that what you are feeling somehow?’

She looked more relaxed, but she still said stiffly, ‘I don't know what you want from me.’

‘I don't want anything from you. I'm just doing my job. Can you tell me how you felt when I took the chair out? Did you feel annoyed, or what?’

‘Annoyed.’

‘Yes, ......  ‘annoyed’ seems like a generalization of all the negative feelings you have. What I feel is that you feel annoyed that you have to do what I want you to do again, and that part of you that's just a problem that makes Mum angry, that ‘angry child’ seems to have reappeared, and she's angry with me, isn't she?’

Shan 's expression moved, and there was a bit of a vulnerable, hurt look in her eyes. I knew that when the ‘angry child’ was discovered, the ‘vulnerable kid’ would appear right after. I softened my voice, ‘I'm here to help you, not to control you. You are not obliged to satisfy me in any way. I want to help you not go to the extremes of your emotions. That's the goal of therapy, isn't it? However, with the ‘detached protector’ always dominating your life, you will be left without feelings for a long time, and feeling lonely and empty, you will seek excitement. You say your one-night stands happen out of this need, and sometimes you regret it.’

I pause and look at her, her lips are tightly closed but her eyes are filled with tears. ‘Controlling you is the last thing I want to do. Because I want you to be free, to find your own freedom in your life, not to keep responding to the feelings of the moment.’

‘What part do you want me to do?’ She said as she walked over to the chair and sat down with tears streaming down her face.

‘How do you feel now?’ I wanted to know which mode she was closest to at the moment.

She said she didn't know, so I asked her in a different way, ‘Feel the tears as they slide down your face, and then pay attention to how your body feels right now... Is there any part of your body that feels particularly strong?

Shan slowed down, closed her eyes, and said, ‘There's a heavy feeling of pressure in my heart.’

‘Good. Now, if it's appropriate, please press your hand against the heaviness in your heart and connect to it, letting the heaviness led you to see what memories, images and situations from the past come to mind. You don't have to think, jus let connect this heavy feeling in your heart, and let the images appear naturally. ...... If you don't have any images, its ok too.’

I sat beside her and put my hand on my heart, imagining the heaviness she might feel, and closed my eyes.

‘I see myself as a child, standing on the balcony of my home.’

‘How old did you see yourself?’

‘I don't know, maybe eight or ten. ......’

‘Why is she standing there? How does she look?’

‘She's just been scolded by her mum, I don't know why. Anyway, she was so mad, she locked her out of the balcony and wouldn't let her in the house.’

‘How's Little Shan feeling? What was she doing on the balcony?’

‘She's just standing there, not knowing what to do. It seems to be raining soon, and mum won't answer the door. She's so helpless, she wants to cry.’

‘Well, can I go into the picture?’ Shan nodded.

I continued, ‘I walked over to Little Shan and told her, ’I'm your future clinical psychologist, I'm coming back for you, you must be very sad and scared, I think it's going to rain soon, I'm going to go to the door to find your mum, okay? Or would it be better if an adult talked to her?’

What is Little Shan's reaction to that?’

‘She nodded her head. ...... She wasn't sure if this was a good idea.’ She said as she shed tears.

‘I knelt down, gently stroked her head, and comforted Shan by saying, ‘No matter what you have done, it's not good to be locked up outside the balcony like this, and Mum is too strict. This will make Shan feel like an abandoned child. ...... Besides, it's going to rain soon, so it's time for Mum to let you in.'’

Shan suddenly cried bitterly, ‘I remember, I stood there for a long time that time ...... because I teased my brother, and Mum was very angry!

I said, ‘I'll tell Little Shan, you must think Mum is too biased, that's why you want to tease your brother more, and then Mum punishes you as if it proves that she loves your brother more! Come on, let me talk to Mum. What does Little Shan say?

‘She cried out in sadness. Finally, someone understood her. She's sad that Mum locked her out for so long. She thinks Mum doesn't want her anymore.’

‘Let me tell Mum to open the door. I knocked on the door (I knocked on the table to make a sound) and introduced myself to Little Shan's mum, ‘I'm Little Shan's future clinical psychologist, I'm here to see you, please open the door and let us in to talk to you, OK?’

‘Mum heard that, what does mum do?’ I closed my eyes and continued with this imagery.

‘She comes to the door, looking at you with a suspicious, surprised look on her face.’

‘Shan 's mum, it's going to rain soon. Can we come in first?’ ‘What does Mum say?’

‘She nodded, and seeing that you seemed more polite, she eased up a bit and stepped back to open the door.’

‘I walked in with Little Shan, holding her hand. I said to Mum, ‘I have something I want to say to you, can we talk about it in your room please?  Little Shan please go back to the living room, and you don’t have to be afraid anymore.’

Shan spoke as if that’s mum replying, ‘Mum told me that she thought Little Shan was too naughty, bullying her brother all day long, and that she really regretted having her. She also said that if she hadn't had Shan, she would have turned a new page in her life, but now she still has to be in touch with her ex-husband ......’.

I was saddened by the fact that Little Shan heard such words of abandonment, so it was no wonder that she has ‘abandoned schema’ and was full of insecurity about relationships. I said, ‘I immediately said to Mum in the image, ’Stop, Mum, you can't talk like that, you're hurting your daughter, do you know that? Come with me to ......’ and then I took Mum to the kitchen so that Little Shan would not have to listen to those hurtful words. (Shan was in tears.) ‘Shan's mum, I know your first marriage was a disappointment, but you can't take it out on your daughter, you brought her into this world, you can't say things like that to her! You can complain to your friends or to me, but not to your daughter! If you do that to her, she'll think she's unwanted.’ I paused. ‘What happened to Mum after I told her?’

‘She is a little embarrassed, I guess. ...... Anyway, she is speechless.’ Shan continued to wipe her tears, holding a box of tissue paper in her hand.

‘I went out to Little Shan and said, ‘Little Shan, it's not your fault that you were born. You know, I know Big Shan, she's a very pretty girl who knows how to knit. You'll find the life you want in the future. ......’ I said, my voice shaking a little.

When the rewriting of the imagery was over and Shan opened her eyes again, she looked at me with a sense of awkward intimacy. I knew that I was one step closer to taking care of that ‘vulnerable child mode’ and showing her how ‘healthy adult mode’ (Big Shan) can learn to take good care of her vulnerable child mode.

Treating borderline personality disorder is a process of allowing the ‘healthy adult mode’ to grow and mature, the ‘detached protector mode’ to become smaller and smaller, and the other parts of the child (e.g., the angry child, the vulnerable child) to be seen, reconciled, fulfilled, and loved. Often, when the ‘healthy adult mode’ is strong enough, the case will have a deeper connection with the ‘vulnerable child mode’, and he/she will better understand his/her own feelings and needs, so that he/she will have more energy and direction in his/her exploration of life, and will gradually be able to build up a sense of inner security. When the ‘detached protector mode’ becomes smaller and smaller, the feeling of emptiness is not as strong, and the impulse to seek external stimulation naturally diminishes. When the ‘healthy adult mode’ knows how to take care of the ‘vulnerable child mode’, the incidents where the emotions go to the extremes also diminishes, and not only is there no need to resort to self-harm to relieve the emotions, but also improves their interpersonal relationships.

It is a translated version, extracted from the book ‘Schema Therapy’ in Chinese, which is scheduled to be published in Sept 2025 in HK.

Beatrice Ng-Kessler

Registered Clinical Psychologist (HK and UK)

Advance Certified Schema Therapist and Supervisor (ISST)

Certified Mindfulness Trainer from Canada