‘All of It Was Hard. And All of It Was Necessary’: A Reflexive Thematic Analysis of Service User Experience of Group Schema Therapy for Borderline Personality Disorder

Background Group Schema Therapy is supported by a good evidence base as an effective treatment for Borderline Personality Disorder. Though we are continuing to learn about its mechanisms of change and how it is experienced, published research has not yet explored the experiences of service users in UK Tier 3 mental health services. Aim To explore service users' experiences of GST for BPD in a naturalistic Tier 3 Personality Disorder service in the United Kingdom. Method Dyadic and triadic interviews were held with participants who had a primary diagnosis of BPD and had completed at least a year of GST. Transcripts were analysed using reflexive thematic analysis. Results Safety and trust were central in the experiences of GST for BPD. Safety was tied to consistency and cohesion in the group, and when present, the group became a tool for self‐exploration. With safety, a journey in developing trust was possible, making experiential learning exercises accessible, including exploration of the Happy Child mode. The role of therapists in supporting the development of safety and trust was related to GST's stance of ‘limited reparenting’. Conclusion Quality of service user experience hinged on abilities to feel safe and develop trust. Supporting these abilities should therefore be prioritised in the implementation of GST. Further research is needed to understand how different populations develop these abilities in GST.