Organizing Awareness and Increasing Emotion Regulation: Revising Chair Work in Emotion-Focused Therapy for Borderline Personality Disorder

Abstract

Emotion-focused therapy (EFT) is an empirically supported treatment that may have potential as a stage-two treatment for borderline personality disorder (BPD). Specific aspects of BPD--the tendency to experience fluctuating self-states; weakness in meta-cognitive or reflective functioning; and the tendency for self-states to be organized by presently occurring interpersonal processes--present challenges to applying some EFT interventions with this population. In particular, even within a highly attuned, validating and accepting empathic relationship, clients with BPD may have difficulty with the usual manualizations of chair work interventions. This is because these interventions often employ polarization and intensification of experience in order to activate adaptive alternate emotional resources and self organizations. For the client with borderline personality disorder, these interventions may be counter-productive, emotionally dysregulating and disorganizing. EFT chair work, however, also has the potential to provide structure to the borderline clients experience of self, to stimulate metacognitive awareness, provide an alive experience of the process of polarization, attenuate emotional activation, and increase the experience of self-coherence. This article describes the development of stepwise approximations of EFT two-chair intervention for self-critical splits. It outlines potential stages of two-chair work as well as intervention principles important for productive chair work with this population. The EFT change principles of awareness, expression regulation, reflection, transformation, and corrective experience still centrally apply. However, several additional strategies are discussed to scaffold clients' capacity to both experience and regulate emotion.