STEPPS for Borderline Personality Disorder

Simone Hoermann, Ph.D. Updated: Oct 25th 2009

feet walking in sand leaving footprints The acronym STEPPS stands for Systems Training for Emotional Predictability and Problem Solving. STEPPS was developed by Donald Black and Nancee Blum and is a program that has shown to be helpful when provided in addition to other treatments for Borderline Personality Disorder, such as individual psychotherapy or medication treatment.

The program’s goal is to educate people with Borderline Personality Disorder about their diagnosis and to help them acquire skills to deal with different aspects of the disorder. The content is taught to people in a group format that is much like a seminar or workshop. The STEPPS program consists of a 20-week basic skills group program that meets once a week for 2 hours, and an additional program after that, which meets twice a month for about a year. The groups are typically lead by two trainers for about 6-10 participants.

The training begins with some basic information on Borderline Personality disorder. The main idea behind STEPPS is that people with Borderline Personality Disorder have difficulty in regulating their emotions and their behaviors, but that they can learn skills to do so. One goal is to de-stigmatize the disorder by helping people understand one of the main premises of STEPPS: Namely, that Borderline Personality Disorder stems from a certain biological sensitivity or disposition that meets with certain environmental factors. What makes STEPPS different from many other approaches is that people in the person’s environment, such as family members and friends are included in the training and are used as “reinforcers” of the skills, in other words, they are used as a resource for the person to support them in learning those skills.

Clients are asked to keep track and monitor their emotions and the intensity of their emotions, as well as their behaviors, on a daily basis. In addition, every week, clients are asked to fill out a self-report questionnaire to monitor their symptoms of Borderline Personality Disorder. This helps participant to monitor and measure how they are doing and how effectively they are using their new skills.

STEPPS participants learn how to identify and challenge automatic ways of interpreting events in their lives – called schemas- that can get in their way. Furthermore, some of the skills that are taught in STEPPS include self-care skills (such as sleep, exercise, or balanced eating), as well as problem solving, communication and relationship skills.

In addition to learning skills for dealing with intense emotions, anxiety, depression, anger, and the self-destructive impulses that often come along with these overwhelming feelings for people with Borderline Personality Disorder, the STEPPS participants are encouraged to share appropriate topics from their skills training with close friends and family members, and also with their therapists. This sharing of information can be helpful for family members to gain a better understanding of what the person is going through, and how to respond in emotionally charged situations. Furthermore, sharing the information can help the participant and the family to develop a shared language and terminology for what is going on and what skills to use.

There is some research that shows that when STEPPS is added to treatment for Borderline Personality Disorder as a supplemental intervention, it can improve treatment outcome. For more information, go to the University of Iowa Hospital and Clinics website.

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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