BORDERLINE PERSONALITY CLIENT
By Shari Schreiber,
material you'll be reading here has been over two decades in the
making, as looking back over my career, I'd always used a core
trauma approach with my severely depressed clients as a Marriage
and Family Therapy intern, before I'd learned anything salient
about Borderline pathology. I'm still using these methods in my
practice, because they've proven very effective.
you're a Borderline or a clinician who's attempting to help one,
this literature may help you gain deeper insights into BPD, and
perhaps assist you with revising some long-standing beliefs or
assumptions you've held about this disorder.
me be clear; I do not 'treat' Borderline Personality Disorder.
I help clients resolve underlying issues, like poor self-worth
and disconnection/dissociation from emotions that have spawned
and perpetuated this very destructive and debilitating core issue.
are not "bad people." Their lifelong
struggle with fear and anguish made it necessary to develop self-protective
defenses, much like a tough outer shell that helped them avert
further harm to themselves. It's these defenses that prompt disruptive
acting-out episodes and distancing behaviors in even potentially
truth, when individuals are helped to heal and resolve their core
trauma, personality disorder features are eliminated. It's certainly
not 'rocket science,' but it definitely requires a unique and
unconventional type of assistance, that's outside the realm of
standard or traditional therapies.
Borderline Personality Disorder is not a head issue, as there's
nothing wrong with a Borderline's mind. BPD is a heart
issue, which is why psychotherapeutic treatment has for many,
remained disappointing and ineffectual.
MYTHS, MISCONCEPTIONS AND FANTASIES
Personality Disorder is not a "mental illness."
Yes, it's listed in the DSM-IV and V~ but so are a lot of other
clinical issues (ADD/ADHD,
etc.) that have nothing to do with mental illness or incapacity!
Borderline pathology isn't caused by a genetic or biological abnormality,
and it can't be inherited. It's purely an environmentally induced
'nurture' issue, which is passed along from each generation to
personality is constructed from a cumulative, complex group of
emotional injuries to one's sense of Self. These begin within
the first year of life, due to deficits in affection, holding,
warmth and emotional attunement with the birth mother that inhibit/derail
a baby's ability to retain a nourishing attachment bond
form an intimate bond of oneness with our mothers in-utero. We
hear her breathing and her constant heartbeat, and share her oxygen
and blood supply. We hear her voice, and learn and become familiar
with her language style, the cadence of her speech and how she
uniquely enunciates her words. In addition, we co-experience her
emotions; when she's sad, so are we. If she's anxious, angry or
upset we feel those emotions at the very same time she does. By
the time we are born, we're already in-love with this woman, as
from our point of view as a fetus, there is no separation
between us~ she is us, and we are her. It's after we leave her
womb that our trouble often begins, if she's not emotionally sound
and whole. This is when our abandonment trauma first occurs, and
we spend the rest of our lives trying to recapture that joyful
initial bonding experience (in-utero), that had us feeling connected,
secure and safe, while imbuing us with an unshakable sense of
oneness and belonging.
initial Honeymoon phase in a new romance with a BPD lover replicates
the initial bonding period we had with our mothers in-utero.
When he/she starts pushing away or finding fault with us, we begin
to re-experience the core shame and despair we felt after birth
when this bond was broken, and we feared it was our
fault that we couldn't get our love for Mother reciprocated.
or being handed over to someone else to raise or care for us after
we're born, magnifies infancy core abandonment trauma and solidifies
one's sense of shame; "I'm not lovable or good enough for
my mommy to have wanted me close to her, or kept me."
child will go through his or her entire life with a troubling
question that subconsciously inserts itself into all relationship
endeavors: "If my own mother can't love
me, who the hell can??"
separation during this very early part of a baby's life greatly
impacts his sense of lovability. Even well meaning parents who
have prepared a beautiful nursery for their newborn and leave
him to sleep alone in a separate room, have undermined their infant's
sense of connection, security and well-being. A newborn hasn't
developed a sense of object
constancy, that takes months to acquire. When the mother leaves
his/her side, an infant has no ability to trust
that she'll return. No wonder, so many babies succumb to unexplainable
Sudden Infant Death Syndrome (or SIDS)!
lot of core injured people presume there was some sort of "major
trauma" that occurred during childhood that left them impaired,
but what's far more accurate is that there were dozens, maybe
hundreds of little emotional betrayals and disappointments that
cumulatively derailed this child's capacity to trust someone with
their care. "Death by a thousand cuts," is how one of
my clients aptly described his experiences as a child with his
BORDERLINE'S CRUCIBLE - DEEP DENIAL
beget Borderlines. Anyone who grew up with a BPD mother cannot
help but acquire survival defenses in infancy and early childhood,
which leave them with abandonment fears and attachment difficulties.
You might think of these defenses as a suit of armor, which protects
the Borderline from incurring more harm. This outer protection
is very stiff and cumbersome, and it keeps them upright when they're
feeling a bit vulnerable or fragile. The problem with a suit of
armor though, is it also keeps others from getting really close.
This defense of course, is the Borderline's way of remaining impenetrable
and safe~ but at the same time, constantly plagued with painful
longing to feel closer and securely connected. This is literally
the root of their come here/go away dance.
of inadequate/defective primal experiences that kept the Borderline
from retaining a solid bond of attachment during his/her earliest
years, he/she was never able to forge real trust in Mother. As
a result, learning to trust oneself has been elusive,
at best. If you've never been able to rely on your own senses
to discern who's trust-worthy, how can you ever trust
anyone not to hurt you??
issue has serious ramifications within a potentially solid and
meaningful therapeutic endeavor. A Borderline will resist helpful
intervention, especially if it interferes with their need to 'change
the channel' on what they're feeling during episodes of duress.
Even when acting-out self-destructively catalyzes excruciating
pain beyond that with which they're already struggling, at least
they've orchistrated those changes~ and there's a sense
of relief and power in this. Now, their familiar life-long agony
envelops them like a familiar old blanket, and it's oddly comforting.
Borderline client has learned to avoid, distract and run from
vital and important feelings since the first few years of life,
in order to survive intense pain. This has left them emotionally
underdeveloped, which is always at the baseline of personality
disorders. They must be taught how to experience and
tolerate all their emotions (even light, good
ones), so that growth can be accomplished. Only then, are they
equipped to surrender their acting-out behaviors and BPD features.
not at all uncommon to see pathological levels of borderline disorder
and codependency within the same individual~ in fact, this combination
is way too prevalent among psychotherapeutic professionals.
and borderline disordered individuals have significant ambivalence
about getting truly well, as it represents a crisis of identity,
and their resistance is palpable to the trained clinician. A dysfunctional
identity feels familiar to the NPD/BPD client, and it's far more
comfortable to retain, than exploring a healthy and wholesome
Borderlines cling to the ideation that they've fallen victim to
a "mental illness," but if that were true, BPD would
only be treatable, not curable~ and I have assisted Borderlines
who've worked hard at growing and healing, and fully recovered.
solid therapeutic dynamic allows that the Borderline client's
interpersonal struggles will manifest within their clinical dyad
as well. In a sense, there exists a permeable membrane between
a Borderline's private life, and the relationship he/she shares
with any practitioner who's dedicated to doing healing and growth
work with them. In short, how they've behaved with others, is
precisely how they'll eventually behave with their therapist.
This is inevitable, and should be anticipated.
IS JUST THE BEGINNING.
BPD individuals are never diagnosed, and there are myriad reasons
for this unfortunate reality~ but here are just a few: 1)
The clinician has not recognized their own borderline
personality traits. 2) He or she is afraid of
the emotional fallout that might occur during their client's session,
if they reveal this diagnostic impression. 3)
Psychotherapeutic professionals are afraid they'll lose
a client, if they confront them with this information. 4)
Too many psychotherapists/psychologists have formed a narrow and
stereotypical notion of how BPD presents in impaired
individuals, and what Borderline Personality Disorder actually
looks like or entails. Because of this very limited and mostly
negative view, many are understandably afraid to accept them as
many clinicians are under-informed about the etiology of this
disorder, intimidated about how to work with it effectively, and
have no idea what a Borderline client needs from them,
in order to embark on their journey toward Wellness.
Borderline's core abandonment wounds make it difficult for them
to trust a clinician with their care, but it's a mistake to tell
someone with BPD that you will never abandon
them. The BPD Waif inspires these assurances from you, but they'll
test you at every turn, and keep acting-out their ambivalence
surrounding this attachment, just as they do with their
lovers. Some can be abusive, and while you might tolerate or encourage
their rage, you should not agree to be their whipping post. Ever.
never to leave a Borderline does not
mitigate their abandonment trauma, and it's foolish to presume
it will. I tried this at the very start of my career as an MFT
intern, as I thought it might be helpful. It wasn't.
Keep your countertransference in check while you're working with
a BPD client, for they will surely trigger your own unresolved
core trauma issues.
you may fear you're replicating their childhood trauma by even
hinting at separation, the Borderline knows no limits or boundaries,
and you must be willing to end treatment, if they're not willing
to be compliant. In short, don't make promises you may not be
able to keep, for this is more injurious to them, and
imprisoning both professionally and personally, to you.
BPD client might alternate between being seductive and abusive
or diminishing during treatment, with a Dr. Jekyll and Mr. Hyde
temperament. Some weeks, the therapist is "brilliant,"
and he's ecstatic he has found him or her. Other sessions,
he's petulant, argumentative, devaluing, etc. This all good/all
bad reflex is central to borderline pathology, and is referred
to as splitting.
You could feel as though you need a shower after those
sessions, to wash off the toxic residue that's left in his/her
wake. Burning a scented candle during their visits can be helpful
for diffusing some of that intrusive, negative energy and helping
you be present for your other clients the rest of your
Borderlines have such terrible self-worth, they cannot fathom
that their therapist actually cares about them; it
simply doesn't show up on their radar. This issue contributes
to abrupt departures even from long term treatment, as if the
therapeutic bond never existed. Emotional cut-off is very common
within their interpersonal world as well, which of course has
made for a catastrophic romantic history. The BPD patient enters
therapy feeling ashamed and unlovable, so it's difficult to imagine
that anyone might view him/her more favorably.
the Borderlines I've assisted have been some of my favorite clients,
even though the work is very demanding at times. They are bright,
engaging and affable. Most are extremely talented, and you can't
help but like them~ but at the start of contact or during treatment,
they may come across as combative and belligerent. Many have navigated
years, or even decades of psychotherapy and a litany of recovery
programs which have all proven disappointing. Their anger about
these tragic outcomes is palpable and quite understandable, as
I'm seen as just another person who'll let them down.
do not view anger as a 'bad' emotion, and I encourage
it during this work. It never dissuades me from accepting somebody
into my practice, unless I sense we'll have a continuous power
struggle, which will deter him/her from making substantial gains
here. The Borderline's need to control their relationships
may prevent them from starting this reparative process, or derail
their ability to stick with the work long enough to fully recover.
and chaos addiction is typical among borderline disordered clients,
so as you help them begin to sumount immediate struggles and their
pain lessens, they lose impetus/motivation to continue with and
complete their emotional development work, and progress is effectively
with treatment is common for Borderlines. Aside from their fear
of change which feels destabilizing, they tend to rebel against
useful, meaningful intervention~ especially if there are BPD
Waif features present.
very little in undergraduate and graduate course work prepares
future clinicians for working with this type of client, nor understanding
how pervasive a problem BPD is within societies all over the globe.
My own life experiences brought me a rich, working knowledge about
core pain associated with poor self-worth, entitlement issues,
and a litany of other obstacles caused by defective parenting.
I call on this cumulative wisdom to help people grow, and together
we work to repair and restore the Self.
SEEDS OF AN INTRICATE GARDEN
stated earlier, Borderline Personality Disorder begins within
the first year of life. Any psychic and/or emotional wounds incurred
thereafter, reinforce one's sense that he/she isn't lovable, or
worthy of genuine affection, protection and care. This faulty
assumption must be corrected within the framework of a steady
and solidly nourishing, but firmly boundaried therapeutic
relationship~ or the client remains unwell.
client with borderline or narcissistic traits can enter treatment
with a "fix me" demand, but never comprehends the need
and importance for an interactive experience within a process
that must allow for the gradual growth of trust. Their impatience
is palpable, and they're always speeding ahead of themselves and
the work, due to the daily anguish they have to endure. This type
of client seldom stays in treatment long enough to achieve their
wellness goal, and typically blames this failure on even the most
great number of females who contact me for help, say: "I've
done a lot of work on myself!" Their statement
instantly alerts me that they've been tireless seekers of healing
that has always eluded them. For me, it's become a dead giveaway
that they're borderline disordered~ and thus far, I have seen
people often try to control what happens during their time with
you, by filling it up with chatter about themselves that you do
not require and haven't solicited, which wastes their precious
time and money (if you've allowed it) within effective, solution-focused
treatment. It's mostly this client's manipulation tactic~ so try
to resist indulging them by giving into it.
cannot allow the BPD client to gain the upper hand in your therapeutic
dynamic. If he/she did not require sound, reliable adult
guidance and sensible, concrete direction, they would not be struggling
with this disorder! In short, there are times you'll have to play
The Heavy. It's called 'tough love,' and it's often the only way
you'll get their attention and keep them on track with the progress
you're wanting to help them make. Their tendency is to confuse
with psychotherapy~ and there is virtually no similarity between
common misconception is that all Borderlines were molested
or incested as children. Sexual abuse does not cause BPD!
The Borderline may try to elicit your sympathy by telling you
stories about rape or sexual abuse, but that doesn't mean
it happened. Even if abuse by a father, family friend or
relative did occur, the mother's failure to guard/protect
her child from such atrocities or believe his/her reporting of
these incidents, is a much deeper wound, because it signifies
emotional betrayal and neglect.
seen tremendous defenses in these clients, as to idealization
of one parent and devaluation of the other, based on which one
they've come to believe inflicted the least or
most emotional or psychic injury, but their perceptions are usually
heavily biased by stories and accounts they've heard from one
resentful parent. These evaluations are typically inaccurate,
which tends to foster and perpetuate poor partner selection, while
setting them up for for the same type of relational strife they
frequently observed as kids, between their parents.
not unusual for the
offspring of this type of coupling to have been brainwashed/coerced
into sympathizing with and relating to the passive/victim parent,
while despising and rejecting the other parent's dark or "negative"
traits from their own emotional repertoire. We then have discarded
or split-off facets of the Self which results in a fragmented
or partial personality structure, instead of a whole
one (fertile soil for BPD seeds to grow).
clients often pedestalize their mother and see her as "perfect."
They identify their relationship with her as sacred/holy and vehemently
want to defend her, regardless of how neglectful or noxious that
maternal connection was or is for them.
Mom always appeared to be a long-suffering "victim"
of their father's abuse or neglect and she's regarded as 'the
good parent,' in sharp contrast to the other's monstrous volatility
or irresponsibility. I always challenge this stance, for there
are two sides to every coin, and children seldom get to see who's
holding the flame that has ignited their father's fuse.
lapses in childhood memory are silent clues as to how much abuse,
neglect and emotional betrayal the Borderline had to endure and
dissociate from as a child, in order to survive. Kids who
cannot develop defenses and coping strategies to ameliorate their
anguish, often orchestrate their own exit plan, and suicide by
traffic incident or catastrophic fall is not uncommon among these
tragically unhappy children.
survivors have enlisted psychotherapy, which has spanned decades
of their life and/or tried numerous other "healing"
modalities, self-help venues, DBT, etc., in an effort to ease
their pain, but none of these have brought about significant or
lasting change. Still, they continue to hope that a 'magical cure'
will one day relieve their lifelong anguish, and cling to the
ideation that they are essentially well.
Borderline lives with such a profound level of core shame, they're
compelled to regard themselves as perfectly
brilliant, skilled, talented, beautiful, successful, etc. Their
'affirmations' may episodically override self-loathing, but these
grandiose defensive strategies are purely compensatory, which
keeps the false-self actively refuting/rejecting the type
of help they really need to discover, accept and finally embrace
the whole Self.
Borderline may develop 'roles' they've come to use within their
everyday life, which allow them to navigate on 'auto-pilot' and
perform spousal, parental or professional tasks, while being disconnected
from any genuine emotions and needs. In a sense they're sleepwalking,
but their role-play gives them a much needed sense of containment,
and helps them adhere to socially acceptable limits and boundaries,
so they can maintain some semblance of order and functionality.
I've noticed this trait most prominently among hyper-religious
clients who appear to need rigid parameters set forth by a church,
synagogue or Buddhist practice.
Borderline in treatment could be 'A Lifer' in long-term care,
particularly if he or she has tried to get their needs met with
standard therapy or analysis. They're heavily armored and their
defenses are thick, and often impenetrable.
A ROCK AND A HARD PLACE
with BPD features are especially challenging
to treat. Most have been over-therapized or have undergone
no useful treatment whatsoever, and they want to run the show.
borderline disordered therapist hyper-analyzes every single feeling,
rather than learning how to experience it in the body. It's a
shame that their cerebral brilliance works against them
during true recovery work, and they fall (or jump) off the grid.
Healing work is very different from psychotherapy.
Some just can't make the bridge from thinking to feeling
their way along~ and the mind is antithetical to one's journey
toward emotional wholeness and wellness.
practitioners who treat Borderlines or anyone
who's suffering from core
trauma issues for that matter, must constantly remember that
they're dealing with someone who's emotionally underdeveloped--in
essence, a very young child in an adult body. If this isn't routinely
on the forefront of a healing professional's mind, helping
this individual will feel daunting and extremely frustrating.
In short, you'll regularly experience burn-out.
treatment of BPD is realistically on par with doing child psychology,
and requires just as much mindfulness and patience.
don't believe in withholding diagnostic impressions from my clients.
Issues of core shame ("I'm not good enough")
make it difficult to accept personality disorder features, but
how can we effectively work with a problem, unless we understand
what it is? If you went to a physician complaining that you were
hurting, wouldn't he/she need to discern where you felt pain and
the nature of that discomfort, to assist you? Learning we have
BPD traits is a hard pill to swallow, but it's not a death sentence~
and it is possible to recover with the right
kind of help, and one's serious dedication to getting Well.
dual diagnosis must always be considered, as a fair number of
Borderlines also struggle with chronic depression or Bipolar
Disorder, and balancing brain chemistry with medication is
often a crucial adjunct to helping them hold the work,
and make good use of it. Untreated ADD
issues can inhibit solid BPD recovery outcomes as well.
say the primary issue with the Borderline in treatment, is their
resistance to trusting someone/anyone with their care, due to
painful disappointments and setbacks throughout childhood, that
undermined their ability to feel protected and emotionally safe
with their parental units. Many of these people have been physically
beaten as kids, but most were emotionally brutalized.
tragic outcome of this type of upbringing, is the child grows
up with the ideation they deserve this brutality, and
perpetuate the parents' abuse by beating up on themselves every
day, and attaching to lovers who echo/mirror how badly they truly
feel about themselves. Their self-defeating narratives have become
reflexive and automated, and they're the toughest to dismantle,
while trying to help the Borderline client move toward healthier
self-care and positive self-regard.
traumatized people are programmed to accept that it's far easier
to expect disappointment, than be disappointed.
This feels less risky and anxiety provoking~ but outcomes due
to retaining these faulty attitudes and thought patterns
block their capacity to achieve genuine happiness. How could it
ANCIENT, BUT FAMILIAR AND COMFORTING AGONY
Borderlines fantasized throughout childhood about killing themselves,
or at least contemplated how to harm themselves seriously enough
to try and elicit a parent's tender concern, so they could finally
gain a sense that they really mattered to Mom or Dad.
Often, the only attention they got, was during occasions of grave
injury or illness. Any non-abusive touch from a parent
was experienced as nourishing or loving, even if it came by way
of perfunctory or obligatory care.
this was the only way for many BPD'ers to receive a modicum of
nurturant attention, their tendency to solicit help by inspiring
another's sympathy, became an automatic and strategic survival
defense. Borderline Waifs (female and male) usually begin their
requests for therapeutic assistance by informing you of their
financial hardship prior to any inquiries about your
fee structure, and may use histrionics to secure your timely response.
instantly triggers your sympathy, and you'll wanna bend over backwards
to help him/her untangle the mess they're in, unless you've become
a seasoned professional who can spot these folks within seconds
of meeting them. These are Survivors, who are
much tougher than they come across, but you'll have to stay on
your toes to avoid getting pulled into their drama, and feeling
an urgency to protect and repair them. BPD Waifs seldom get
well. Sadly, their addiction to pain and struggle usually
trumps their desire for growth or change.
Waif-types don't just fall prey to feeling traumatized by elements
outside themselves, many of them routinely victimize themselves.
Their dissociative (out of body) episodes generally lead to carelessness,
which can result in injury or illness. Waifs are notorious for
painting themselves into corners personally, professionally or
legally. It's like a little black cloud always follows them around--but
they've orchestrated a lot of their own pain by pursuing partners
who aren't single or available, making unwise financial decisions,
impulsively leaping before they look romantically, neglecting
their health, etc.
neglect and abuse has left the Borderline with severe entitlement
issues, so she continually feels undeserving of love, abundance
and/or prosperity. The enlivening challenge of having had to repeatedly
surmount setbacks as a child by pulling herself 'up by the bootstraps,'
gave her a false sense of empowerment~ which is key
to her self-defeating compulsions.
Houdini, both male and female BPD clients are compelled to keep
creating and surviving perilous conditions, just to prove
to themselves they can~ but even the great Houdini
eventually succumbed to one of his death-defying performances!
this Borderline to begin tolerating love, success and
a real sense of joy, there has to be a paradigm shift. This takes
hard core trauma work, which challenges everything she grew up
believing about herself. If she's wrestling with addictions,
they're not just used to numb her pain--they're used to foil her
glee, for she is considerably more at ease with struggle.
She's the Eternal Martyr~ it's simpler to keep circling the drain,
than to climb out of the sink.
has a way of grounding us, which is no exception for the BPD client.
If you've always had to maneuver around like your feet were encased
in heavy concrete blocks, you will feel destabilized when
they're set free. An absence of anguish makes the Borderline
feel uneasy, as it triggers intimidating brand new sensations
to which he/she must learn to adapt. Some will, some won't.
WHITE OR SHADES OF GREY?
with a borderline disordered client who's coupled means
you'll be taking a roller-coaster ride with them. They'll typically
come in vilifying their partner or lover, and making them sound
like monsters. Just when you're pretty certain this client's in
an abusive relationship, they'll show up singing their paramour's
praises about how loving and considerate they've been. A young
therapist (someone new to the business) is taken in by this, and
never questions the issue of projection
on the Borderline's part. Week to week, this client alternates
between two polarized perspectives; their good partner, and their
bad partner. If you confront them about their emotional see-saw,
they brush aside or trivialize any details you've retained
from their latest session.
that matters to the Borderline is that their immediate world is
either calm or in chaos. Chaos in their outer world mimics the
chaos they experience internally, so it's much easier to tolerate.
They're incapable of managing any sense of peaceful continuity,
or appreciating the bigger life picture, due to childlike myopathy
or short-sightedness. One's capacity for abstract thinking and
circumspection belongs to an adult's emotional development,
not a child's~ and no amount of reasoning with them can alter
THE YELLOW BRICK ROAD
passionate dedication to each of my clients, is to help them recover,
heal and grow emotionally, whether they are borderline disordered
or not. There are striking similarities
between borderlines and their partners, as both suffered trauma
to their emerging sense of Self during infancy, which caused important
feelings to be discarded. Disconnection/dissociation from difficult
emotions throughout infancy and childhood, results in arrested
emotional development in adults~ and the core of Healing work
is Feeling work.
Borderline tries to gain a sense of Self through engagement with
others. Their seduction routines are reflexive, predatory and
highly perfected, but this is only a symptom of deeper pathology
related to sensations of insecurity and unworthiness.
brief absences of contact with another, can make the Borderline
feel non-existent, undesirable, invisible, unlovable and worthless.
These shameful feelings prompt inner narratives and thoughts like,
"If I'm this messed-up or defective, I have no right to be
here~ and what's the point of going on?" and suicidal ideation
client often wrestles with feelings of emptiness/deadness, and
their need to distract from these sensations with dating,
sex and attaching to others, is driven by deep anxiety and pain.
The trouble is, they've never been able to trust real
intimacy and closeness, for those responsible for their care in
the earliest stages of life, weren't equipped to provide solid,
nourishing attachment experiences. As these supplies were unavailable,
the Borderline struggles to accommodate relational bonds that
are more than fleeting or transient. These types
of attachments feel unnatural, anxiety provoking and suffocating
to them. Hence the paradox;
as you love them more, they love you less.
THINK I LOVE YOU."
their entire life, the Borderline client has confused sensations
of painful longing and yearning to have their love returned/reciprocated,
with the emotion of love itself. Their in-utero attachment
to a mother with BPD features is maintained as a deep, unrequited
craving that begins in the first week after their birth. Deeply
distorted perceptions of "love" follow them for a lifetime,
unless highly specialized assistance is engaged to help them begin
to form an alternate feeling frame of reference for this
normally nourishing and satisfying emotion.
various phases of treatment, the Borderline client both longs
for and resents their practitioner. Solid recovery work anchors
a client, which helps them start to feel stronger/safer~ but it
also stirs dependency and abandonment fears, which trigger their
need to push away. This issue may take the form of skipping weekly
appointments, canceling/rescheduling at the last minute, taking
out of town (or out of reach) business trips or vacations, lying,
etc. These distancing tactics ease sensations of dreaded vulnerability,
which arise out of their feelings of need for the therapist,
once the therapeutic bond has become more established, comfortable
and important to them.
may develop a 'crush' on their clinician as this relationship
solidifies. Real closeness is foreign to a Borderline's love experiences,
so it's automatically converted into a more familiar/known sensation
consisting of sexual or romantic ideation and fantasy. This therapeutic
issue is very natural/normal within context of doing meaningful,
growth-oriented work with all clients, whether
borderline disordered or not. When handled correctly, the client
can successfully navigate this delicate phase of treatment, and
resolve their infatuation.
AND CIRCLING THE DRAIN
most disconcerting and tragic personality aspect in BPD individuals,
is their entrenched need to self-sabotage. I've worked with some
who've gotten very close to joy and wellness, but they've left
treatment just short of it--or done something to undermine their
progress professionally or personally. It's literally heartbreaking
to witness this happening over and over again, and there's no
other way to view this phenomenon, than as Abandonment of
the Self~ which is a learned response to having
endured a litany of psychic and emotional setbacks during childhood,
over which they had no control. If they can orchistrate their
own setbacks, at least they can feel in-charge/in-control,
and it gives them a semblance of comfort.
enough, it's this singular feature which prevents the Borderline
from engaging or maintaining a suitable and gratifying relationship
experience, whether it be personal or therapeutic~ and
traps them in their own private hell.
BPD client craves a sense of intimacy, and yearns to be fully
understood and known during treatment. Unfortunately,
this can generate 'out of control' feelings, and prompt one's
need to distance or retreat. Some sturdy parameters must be in
place, to help the Borderline understand the archaic basis for
these uncomfortable, conflicting feelings, learn how to tolerate
them, and continue to build and solidify trust.
BPD client who commits to Integrated
Recovery methods reaches a transitional plateau in their wellness
journey. They'll recognize the strides they're making, but are
fearful/ambivalent about going further. I've coined this, The
Life Raft segment of treatment: If you've stayed afloat on
a huge chunk of driftwood in the middle of the ocean your entire
life, and it's kept you from drowning every time a large wave
hits, you're not gonna easily surrender that life raft~ even though
it's steadily taking on more and more water each week! Even if
a bigger/sturdier plank floats by, you can't see beneath the water's
surface to determine if it will support your weight, so fear
of the unknown keeps you from leaving the one you're on.
the Borderline, pain is easier to tolerate than pleasure. This
is due to an old 'superstition' which was acquired during their
childhood; "If I feel too good, something really
bad's gonna happen!" In essence, whenever this kid felt any
stable or happy feelings, the emotional rug was yanked out from
under him. Steady repetition of that type of event is incredibly
destabilizing for a child, and teaches him to anticipate
disaster the minute he feels any sense of comfort or calm. Sadly,
this reflex becomes habituated, for it eases his fear of impending
disappointment and ensuing devastation from any/all unforeseen
disasters that 'might' lay ahead, but it also spawns serious control
disorders, OCD (Obsessive-Compulsive Disorder) traits, and
their need to argue or distance, after especially enjoyable episodes
has been painful, and that's all the Borderline knows. It's their
only frame of reference, and they're comforted by believing they
can survive, no matter what. When life starts
feeling good, they're filled with anxiety, as good feelings
(whether in personal or professional realms) are totally foreign
to their experience, and must be gotten rid of. The upshot? Thriving
is completely out of the question! Nothing about this faulty mechanism
is held on a conscious level, so it's compulsively repeated
until solid, specialized help is engaged to dismantle and eliminate
habits die hard. With some Borderline clients, their self-sabotaging
reflexes can be terminated, but it's surely not the case with
all. Many cling tenaciously to it, for a defective identity is
familiar, and less threatening/scary than forging a wholesome
new one. This is actually the defining difference between those
who get well, and those who don't.
discussed this aspect fairly thoroughly within my BPD
male piece, and a bit of illumination can go a long way toward
understanding the Borderline's need to self-destruct--even within
an exemplary treatment protocol:
Borderlines nor Narcissists can tolerate therapeutic misattunements.
Their desire to distance or cut off therapy (especially
when it's getting close to a nerve or breakthrough), is pretty
common. Some of these individuals try to flood themselves with
numerous other modalities that help diffuse their
reliance on any single source for help (I call this The Buckshot
Method); such is the extent of their attachment concerns and abandonment
terror. A sound, meaningful therapeutic endeavor helps
one experience corrective, authentic interplay leading to conflict
resolution, which involves two beings. The client ideally
takes this newfound ability into his private world, having learned
the critical distinction between two hands clapping,
rather than just one--which his narcissism had halted earlier.
Naturally, the question begs to be asked: Where else
would he learn intimacy skills??
often plays musical chairs with therapists. His needs are profound,
but given his inherent trust issues, there's less threat if he
spreads himself thin--and has a stable to choose from,
the minute he's in crisis. He's a serial patient, who's unlikely
to spend any more than two years (consecutively) in treatment.
There's a separation/individuation issue that's stirred before
this two year juncture, which activates subtle anxiety involving
real dependency and the risk of abandonment~ tragic remnants of
developmental struggles with Mother as a toddler. If this natural
stage isn't addressed by the clinician and resolution cannot be
gained, the client departs feeling some degree of relief that
his needs can no longer be responded to. Dependency fears are
Casanova's difficulties are characterological, meaning intrinsic
or core to how he has choreographed his life
and relationships. Inevitably, the same issues resurface in his
next romantic catastrophe, and he begins anew with another
therapist. Why won't he resume with the last one who helped? His
shame at being back in this hole in the road prevents it--and
his fragile ego can't handle being that vulnerable or exposed.
this male's mother had BPD
Waif features, he grew up having to meet her needs
for attention, mirroring, flattery, emotional soothing, etc. She
could have made him her confidant in adult matters--especially
concerning issues with his dad. A small child is overburdened
by these complaints, and doesn't relish this role--but at the
same time, all this special attention from Mother imbues him with
a sense of value/importance, which forms the crux
of his self-worth. Her awareness of his needs is painfully
limited, so he welcomes this 'surrogate husband' job, which (at
least) provides vicarious satisfaction. This sets him up to form
codependent relationships in his adult world, for being
needed is his only way of bolstering and replenishing
a very tenuous self-image.
and engulfment concerns resulting from this boyhood dynamic are
then transferred onto all subsequent attachments. There's an automatic
reflex that comes into play with a mother-enmeshed man. Sensations
of closeness are entwined with loss of Self.
Thus, his inner narrative becomes; "if I get too close
to you, I'll have to relinquish too much of me." Commitment
has gotten confused with engulfment,
which means having to give up important needs and freedoms. Hence,
profound control issues have evolved, and he'll only choose females
with whom he thinks he can maintain the upper hand. A
needy, BPD female perfectly fits this paradigm--at least at the
onset. Any male who persistently gets involved with borderline
personality women, has severe attachment fears of his own.
his therapist is especially nurturing/caring, the borderline disordered
male's engulfment concerns are often triggered~ particularly if
he'd felt responsible for a parent's happiness/well-being as a
boy. He has little frame of reference for someone being responsive
to his needs, and his grandiosity can't tolerate it.
He must remain in the one-up position with all his relationships,
and destroy any type of connection that doesn't afford
him this opportunity. This issue is especially common
in BPD patients/clients who are psychotherapists.
inner work can invoke feelings of needing the therapist,
which instantly produce anxiety. This catalyzes his impulse to
sabotage that relationship with 'tests'
he suspects may result in abandonment. If this occurs, his entrenched
belief that anyone who could have value/importance to him will
let him down or leave, becomes prophesy fulfillment.
Sadly, this reflex keeps real love at bay--and he'll
continue to dabble with Borderlines (and clinicians), who have
no real capacity to meet his intrinsic needs.
isn't that Casanova can't be helped--it's that he won't
be. He sets up all his relationships in such a manner that they
have no choice, but to abandon him. He'll act-out by confounding
and undermining any nourishing/supportive presence that comes
his way. Even after decades of focused, psychodynamic treatment,
childhood issues of unworthiness and shame can remain entrenched
male's mother was easily overwhelmed and incapable of
adequately responding to his needs during infancy and boyhood.
From this, he concluded that meaningful, helpful attention, care
and assistance were not available to him. These clients often
feel compelled to reconstitute the early frustrations
and deficits that prompted their intense need for control.
This control shows up within their therapeutic dyad, as resistance
to healing and growth.
the Borderline, winning takes precedence over
getting well. Thus ensues an endless power struggle with the clinician.
His narcissism resents anyone's expertise or wisdom eclipsing
his, so he's prone to selecting therapists who aren't equipped
to meet his needs. The ones who have the capacity to
help, jostle his defenses, and heighten his competitive reflexes.
The one element that can actually assist him in healing, is the
thing he dreads most--which is surrendering to someone's care.
Even the loss of a dysfunctional identity (en route to
becoming sound and whole), is too frightening to ponder.
NATURE OF THE BEAST
and prone to leaving you abruptly. This is a very common pattern
within personal attachments, and therapeutic ones as well. The
Borderline's narcissism prevents him/her from regarding their
clinician as a viable and whole entity who's capable of experiencing
human emotions. He or she is merely 'an object' to the BPD client
who is trying to obtain essential supplies to survive,
much like a newly born infant. No capacity for empathy is possible
at this stage in life~ and in fact, is not acquired until between
the ages of nine to twelve (with any luck, and barring developmental
Borderlines heal, means teaching them how to tolerate their
own difficult feelings, so they can begin to identify with
and relate to another's. Only then,
can empathy be acquired.
provocation, BPD clients may disappear or send a brief note conveying
their decision to terminate treatment, regardless of how effective
their time with you has been. Others won't cancel standing appointments,
even at considerable monetary sacrifice. So deeply ingrained are
their childhood fears of confrontation and/or reprisal,
most will avoid direct contact at any cost. This passivity issue
continues to play-out in all their adult attachments, and invites
ongoing conflictual dynamics or stagnancy
and deadness in their romantic life, which prompts Borderlines
to blame 'boredom' on a partner, and leave in search of greater
stimulation. A lover who is distant/abusive is more likely to
hold their attention, because painful and dramatic yearning
for love has been equated with the emotion itself, since infancy.
to this client's monumental issues with confrontation, they may
quit their job if there's ongoing discord/friction with a co-worker
or boss, even if it's a position they really love
rather than taking a stand for their needs, and commanding the
other's respect. Passivity in the work-place but volatility
and depression at home, is usually how this story goes. A new
job means starting with a clean slate~ but some end up jumping
from the frying pan into the fire in their next position, due
to their frantic (and often shortsighted) needs to flee the former
one. This rebound issue is typical in their romantic
endeavors as well.
Borderline's profound need for intensity to break through
their dissociation and non-feeling bubble, keeps them addicted
to crisis and chaos. When they begin to make gains in treatment
and their painful inner drama quiets down, they typically want
to leave therapy. Anguish is far easier to live with, than the
absence of it for a BPD individual. If there's no tidal
wave that threatens to capsize their boat and drown them, nothingness
can be felt, and performance anxiety within treatment
may emerge. They sometimes presume that their therapist will lose
interest in them, if there are no disasters present "to fix."
This is projection
by the patient, which involves their shame-based inner void, and
the sense they're unlovable just for being (not doing).
this same issue usually determines a BPD client's term or length
of treatment. Borderlines seldom seek help until they're
in crisis. This may take the form of professional or health setbacks,
but it's frequently tied to having gotten involved with another,
whose confusing/painful (borderline) pathology
is either on par with, or surpasses their own~ and it turns their
world upside-down. The need to control their torment within this
dyad is reminiscent of a childhood fraught with instability and
agony, but ignites false hope that they can 'get it right' (this
time). Crisis orientation makes BPD clients abandon healing and
growth work prematurely.
if we're always having to do crisis intervention and damage control,
there's no opportunity to accomplish emotional development
work, which is central to helping the Borderline
relinquish personality disorder traits, and heal. If treatment
is ended/curtailed without ample emotional growth, this client
typically resumes faulty entrenched behaviors, and recreates
their trauma over and over again, indefinitely.
borderline disordered client has a particularly difficult time
making the shift from feeling daily pain, to experiencing the
lack of it. This part of their journey into wellness/wholeness
makes them feel uneasy, and it's when their self-defeating behaviors
tend to flare up most. Without acute anguish, they might feel
emptiness or numbness, and it scares them. This 'emotional pergatory'
phase of treatment is every client's pit-stop along their route
from Hell to Heaven, but it feels uncomfortable for awhile. Learning
to trust that these feelings are temporary and an essential part
of their Healing, helps them navigate this very difficult but
necessary adjustment period.
am not a psychotherapist, although having returned
to school at forty-one, this was originally the path I was pursuing.
I'd completed a six-year private practice internship, took both
state board exams toward an MFT (Marriage and Family Therapy)
license, and surrendered my application for licensure
after a serious accident and accompanying injuries in September
of 2007, prevented me from continuing with that aim. These facts
are well documented with The Board of Behavioral Sciences, if
you've any need for confirmation.
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