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