STEPPS Group Treatment Programme:  Introduction to Training

Welcome to STEPPS
In this cognitive-behavioural, skills training approach, Borderline Personality Disorder (BPD) is characterised
as a disorder of emotion and behaviour regulation. The goal is to provide the person with BPD, other
professionals treating them, and closely allied friends and family members with a common language to
communicate clearly about the disorder and the skills used to manage it. Clients (service users) learn specific
emotion and behaviour management skills.  Clients identify key professionals, friends, and family members as
part of their “reinforcement team,” and these individuals learn to reinforce and support the newly learned
skills. This helps avoid the phenomenon of “splitting,” a process in which the person with BPD may
externalise their internal conflict by appearing to draw others around them into taking sides against each other
and arguing about the merits of differing perspectives and behaviours.  Splitting, like other behaviours
common in BPD, is viewed not as an intentional act of aggression, but as an automatic response to the
emotional intensity and deregulation that the client can learn to anticipate and replace with more effective
behaviour.

Underlying this training approach is the assumption that at the core of BPD is an actual clinical entity, a
disorder that might be characterised as a defect in the individual’s internal ability to regulate emotional
intensity. As a result, the person with BPD is periodically overwhelmed by abnormally intense emotional
upheavals that drive him or her to seek relief. Family studies suggest an underlying biological vulnerability. The
childhood history of the person with BPD often includes inconsistent emotional support or even abuse by
important caregivers.  In most cases there is a complex interplay between underlying vulnerability and the
social environment.  Identifying someone to “blame” for the disorder is usually counterproductive.  We believe
that individuals with BPD do not consciously choose to have this disorder and, with rare exceptions, parents
and other important caregivers do not consciously choose to create an inconsistent and unsupportive
childhood environment.

Early in treatment, many clients view the term personality disorder as a code for, “it’s all your own fault.”  The
term borderline seems to imply that it is only a matter of time before they fall completely “over the edge.” For
these reasons, clients often resist the label of BPD, even though they may readily acknowledge the
behaviours. Bartels and Crotty suggested the name Emotional Intensity Disorder as a more accurate
description that clients may find easier to understand and accept.   We use both terms interchangeably.
Regardless of the terminology there are significant advantages to reframing one’s understanding of BPD as a
disorder. Rather than viewing themselves as someone who is attempting to manipulate, is attention-seeking, or
is sabotaging treatment, the STEPPS participants learn to view themselves as driven by the disorder to seek
relief from a painful illness through desperate behaviours which are reinforced by negative and distorted
thinking.

The training is composed of three steps:

Step 1 - Awareness Of Illness

The first step is to replace misconceptions about the BPD label with an awareness of the behaviours and
feelings that define the disorder.   Behaviours can be changed and feelings can be managed.  Clients often
begin with the belief that they are fatally flawed (for which they may alternately blame themselves or others)
and that they deserve to suffer.  The ability to entertain the notion that this is a legitimate disorder and that the
individual can learn specific skills to manage it, is an important precursor to developing the capacity for
change.

Group members are provided with a printed handout listing the DSM-IV criteria for BPD and time is
provided to acknowledge examples of the criteria in their own behaviour (“owning” the illness). A second
component is the concept of cognitive filters.  Therapists may recognise the similarity to the concept of
schemas described by Jeffrey Young (1999) in Cognitive Therapy for Personality Disorders – A Schema-
Focused Approach.  A questionnaire has been developed to allow trainees to identify their early maladaptive
filters and to see the relationship between these filters, the DSM-IV criteria, and their subsequent patterns of
feelings, thoughts, and behaviours.

Step 2 - Emotion Management Skills Training

We describe the five basic skills that aid the person with BPD in managing the cognitive and emotional effects
of the illness. Combined with an understanding of how the illness works, and recognizing the filters that have
been triggered in a given situation, the skills assist the person with BPD in predicting the course of an episode,
anticipating stressful situations in which the illness is intensified, and building confidence in their ability to
manage the illness.

Step 3 - Behaviour Management Skills Training

There are eight behavioural skills the person with BPD must work at mastering. As the BPD syndrome
progresses through the disruptive interplay between the emotionally intense episodes and a social environment
that becomes increasingly unempathic and unresponsive, many functional areas may begin to break down.
Learning or relearning patterns of managing these functional areas helps to keep these areas under control
during episodes.

STEPPS Basic Skills Group Programme

The Basic Skills Programme consists of 20 weekly meetings of two hours each.  This includes a short break
between the first and second hour. Each lesson is organised around a skill that is the focus of the session.  
Some skills require more than one weekly session to teach. The skills include:

















For those groups whose meetings occur during the Festive Season, we have included an
optional unit (See Appendix) for managing emotional intensity during this time of the year.

Continued...
  • ·        Distancing
  • ·        Communicating
  • ·        Challenging
  • ·        Distracting
  • ·        Managing Problems
  • ·        Setting Goals
  • ·        Eating
  • ·        Sleeping
  • ·        Exercise
  • ·        Leisure
  • ·        Physical Health
  • ·        Abuse Avoidance
  • ·        Relationship Behaviours