The Schema concept of “limited reparenting” means that the therapist provides the support that the parents failed to provide, enabling patients to internalize the therapist and eventually provide their own support.
The process of limited reparenting is the heart of the treatment in schema therapy and is one of its most unique and defining elements. Through treatment the therapist uses the relationship built in therapy as a partial antidote to the patient’s schemas. This limited reparenting provides something of a corrective emotional experience specifically designed to counteract the patient’s Early Maladaptive Schemas. Limited reparenting flows directly from schema therapies assumption that early maladaptive schemas and modes arise when core needs are not met. Schema therapy’s aim is to meet these needs by helping the patient find the experiences that were missed in early childhood that will serve as an antidote to the damaging experiences that led to maladaptive schemas and modes. Limited reparenting, paralleling healthy parenting, involves the establishment of a secure attachment through the therapist, within the bounds of a professional relationship, doing what she can to meet these needs.
In order to do this the therapist will use childhood history, reports of interpersonal difficulties, questionnaires, imagery exercises… pretty much anything that gives insight into what the person with BPD was missing early in life. It takes the form of simultaneous tenderness and firmness through what is called “empathic confrontation”.
The more I learn about Schematherapy the more I believe that it takes a special kind of person to be this kind of therapist. Since this type of depends entirely on the individual with BPD the therapist has to be very flexible to adjust to their patients unique history. It’s the goal of the therapist to become something of a ‘good parent’. Now that does not mean they’re going to become a substitute parent. But within the reasonable limits of therapy a therapist will try to meet those basic emotional needs: (1) Secure attachment; (2) autonomy and competence; (3) genuine self-expression of needs and emotions; (4) spontaneity and play; and (5) realistic limits.
This technique works because treatment parallels child development in some ways. Think of it as the person with BPD growing up in therapy. The patient begins anew (as an infant or very young child) and under the influene of the therapist’s reparenting, can gradually mature into a healthy adult. This is also one of the reasons why therapy for someone with a Borderline Personality Disorder cannot be short. It takes a long time to grow up and mature. These things can’t be rushed and require putting in real effort to grow into a healthier person.
For this to be truly effective the relationship with the therapist has to be one of mutual respect and genuineness. The therapist should genuinely care about the patient. A lot of people with BPD are hypersensitive which makes them very aware of how other people interact with them. If the therapist doesn’t genuinely care that falseness isn’t hard to pick up on and it makes it really difficult to form a trusting therapeutic bond. It’s funny. My therapist often reminds and reassures me of this. That she cares. I don’t understand why she cares though. I don’t believe she has reason to because I’m essentially a random person in her life with no cause for an emotional bond. This is probably my failing though, not hers. Like I said, it takes a special kind of person to care about people like this. Or maybe I’m just so detached and dissociated from my own emotions that this only feels like a foreign concept to me. Maybe for an emotionally healthy person it’s not that difficult.
The overall goal of therapeutic treatment is to help incorporate that Healthy Adult mode, modeled after the therapist. Relating to all those modes we’ve been talking about the therapist tries to:
1. Empathize with and protect the Abandoned Child
2. Help the Abandoned Child to give and receive love.
3. Fight against, and expunge, the Punitive Parent.
4. Set limits on the behavior of the Angy and Impulsive Child and help patients in this mode to express emotions and needs appropriately.
5. Reassure, and gradually replace, the Detached Protector with the Healthy Adult.
Limited reparenting involves reaching the Vulnerable Child Mode and reassuring, being firm with or setting limits on the avoidant and compensatory modes or coping styles that block access to the Vulnerable Child Modes or schemas. In the midst of this, the therapist helps to provide constructive outlets for the Angry Child Mode. In addition, it often requires that the therapist help the patient fight punitive, demanding, or subjugating parent modes or schemas. These steps are usually facilitated by the use of guided imagery; an experiential technique that allows the therapist to establish more direct contact with the various modes and schemas.
People with BPD often expect other people to treat them the same way their parents treated them (or whomever it was that most affected them most growing up). It seems completely natural that everyone else would take on the worst aspects of the person you internalized most. This is part of the Punitive Parent schema. It’s necessary to go through a process of understanding why the parent mistreated the patient. Once patients are able to understand the parent’s reasons for mistreating them, they are more likely to break the emotional tie between their parent’s treatment of them and their self-esteem. It’s possible to learn that, even though their parent mistreated them, they were worthy of love and respect. By becoming a stable, nurturing base, the therapist provides stability, enabling us to let go of or stand up to the dysfunctional parent figure and eventually all the dysfunctional schemas we embody. In being able to do this a level of autonomy and independence is achieved. Essentially the therapist is trying to lead by example; by demonstrating what a healthy adult thinks, acts, and feels, eventually, in time, that will become what seems normal as old habits and ways of living become things of the past.
It’s not an overt thing though. I can definitely see how my therapist does this, but it’s not like she sets out to ‘be a parent’. It’s really not like that at all. She does what (I assume) most therapists do, she listens, and works through my issues with me, but while doing this she also puts an emphasis on creating a safe place and building the relationship between us. Limited reparenting isn’t one large overlying program. It’s all the little encouragements, positive affirmations, repeated reminders, subtle guidance, and appropriate corrections in addition to your standard therapy. Like I said, it takes a special kind of person to be good at this.
Thinking about it, I get down on therapist for being so positive and telling me I’m a good person when I don’t feel like I am. I’ve heard my entire life that I’m not good enough and can always be better, so when she tells me that I am a good person and I don’t need to be so hard on myself this just seems contrary to what deep down I know because it’s what I’ve always been told. Just because I’ve always been told that, doesn’t make it true though. Geezus her patience is outstanding because no matter how much I fight her some days, she holds steady with the reality that she sees in me. Some days I even believe her too.