The Dutch care standard gives schema therapy a route past borderline personality disorder
- The revised Dutch care standard for personality disorders, authorised on 4 March 2025, names psychotherapy, where possible, the first choice of treatment, usually within a course of 1 or 2 years.
- For the most complex problems and the most severe personality disorders, one of four psychotherapies is preferred: DBT, MBT, schema therapy or TFP. CAT, VERS, supportive psychotherapy and GIT-PD can also be recommended.
- Schema therapy is described for a range of personality disorders, in particular borderline personality disorder and cluster C disorders such as avoidant personality disorder. For older adults the standard lists short-term group schema therapy, intensive group schema therapy and adaptations of intensive individual schema therapy.
- An estimated half (20 to 80%) of patients referred to Dutch mental health care meet the criteria for a personality disorder. The most frequent classification, at 50% of the target group, is unspecified or other specified personality disorder.
The Netherlands has revised its national care standard for personality disorders, replacing the 2017 version. A zorgstandaard describes the patient pathway across the care system; this one was brought into line with the 2022 multidisciplinary guideline and was asked to give extra attention to the life course.
Four methods at the top
Psychotherapy is "waar mogelijk, de eerste keuze" ("where possible, the first choice"). For the most severe cases the standard prefers DBT, MBT, schema therapy or TFP, with CAT, VERS, supportive psychotherapy and GIT-PD in a second group. All of these are preferred over psychotherapy without a specific view of personality pathology, provided they are delivered "zoals ze beschreven en onderzocht zijn" ("as they have been described and studied"). The targeted treatments, the text says, differ little in effectiveness and differ in the training and certification they require.
Cluster C and later life
Section 7.3.4 presents schema therapy as several schools integrated within a cognitive framework, built on the mode concept, offered outpatient or in a (day) clinic, individually or in a group. Its use is "met name" ("in particular") in borderline personality disorder and in cluster C, with avoidant personality disorder as the example. TFP and affect phobia therapy also carry a cluster C mention. In the section on older adults, schema therapy has three adapted formats, more than any other method listed there.
Reading it from the consulting room
In my reading, this is where the document departs from the usual pattern. Clinical texts on personality disorders tend to stop at borderline. Here the avoidant client and the older client both have a named schema therapy route. That matters for caseloads: if half of classifications are unspecified or other specified, much of the work is not borderline at all. For an avoidant or older client, check whether a certified schema therapist or group programme is available, and do not count scattered schema techniques inside routine CBT as the treatment the standard names.
In the Dutch standard, the avoidant client and the older client each have a named schema therapy route.
The standard is written for the Dutch mental health system and its training and certification routes, and is published in Dutch only. The supporting evidence and its weighting sit in the 2022 multidisciplinary guideline.