Hi all,
What an interesting topic and one I am willing to answer with regards to my experience but I am still on a journey with this myself. I am not an expert. But sharing an be helpful I hope...
I have BPD and have been in therapy for this for some months. With my psychologist, we decided to opt for a Schema therapy approach first rather than DBT. I believe Schema is more focussed on meeting the needs that I missed out on as a child, that manifest as self-hate and low self-esteem today. So I would say Schema treats the cause, DBT treats the effect. DBT papers over the cracks, Schema tries to fill them in as much as possible.
Part of Schema is about providing 5 categories of needs that were missed in childhood and these needs are met in therapy, to the best of my psychologist's ability. The 5 categories are: 1) Connection (like love, attachment and belonging) 2) Freedom of expression 3) Autonomy (individual identity) 4) Playfulness (creativity and spontaneity) 5) limits and boundaries.
So my psychologist provides me with care, attention and attachment to help me with 1. She encourages me to talk about my needs and to express my feelings, even when they are demanding or rude for 2 (she doesn't always agree with me but I get unconditional positive regard). Then I am learning how to self soothe for 3 - to look after myself with self-compassion. I am being encouraged to create, joke, play, write in therapy for 4 - being silly and goofy. Then we discuss limits like appropriate behaviour etc in therapy for 5 (we don't do hugging or touching in our sessions but we do say nice things to each other for example, like "I care about you").
In Schema we also go back and deal with painful memories by rescripting them. It's kind of like changing the ending to painful memories. My psychologist might jump into the memory and defend me. I might defend myself by telling the person who did me wrong, what I think of them. Sounds goofy and it is but it changes how you subconsciously feel about yourself and increases self-worth because your subconscious now believes you've been defended during those difficult moments.
The culmination of this stuff helps my self esteem a lot. Before therapy I had no deep connecting relationships, now I am confident enough to connect to people and not be afraid they will hurt me or not I will rage. I now have a secure attachment so feel confident in socialising, when I was avoidant before. I couldn't even text people bfore without worrying about if they will reply or feeling rejected if they didn't.
I still have bad days. The other day someone did something I perceived as a rejection. I started self loathing and feeling negative about myself. It took me a day or so to come out of it but I didn't rage, didn't split that person or rely on drinking to soothe myself. I managed to pull out of it by self soothing by repeating that the person who I thought rejected me, in fact just set a boundary which is something I value and need, and that really they did that because they care about our relationship. It took a while to be effective but I also tell myself when i feel bad that "I have been here before and this is temporary and I will get out of it".
Schema is not a 100% cure type therapy but evidence suggests it improves BPD by on average 50% or so, which is enough for many people to no longer meet DMS 5 criteria for BPD.
Hope this helps. Pato.
