THE BORDERLINE PERSONALITY CLIENT
BY SHARI SCHREIBER, M.A.
The material you'll be reading here has been over two decades in the making, as looking back over the many years of my career, I'd always used a core trauma approach with my acutely depressed clients as a Marriage and Family Therapy intern in private practice, long before I'd learned anything about Borderline pathology.
Miraculously enough, my schooling never touched on this pervasive disorder, yet my understanding of it cumulatively expanded through assisting clients who'd never forged healthy, enduring attachments, nor been able to tolerate or endure darker emotions without compulsively analyzing them. If you're wanting to help emotionally underdeveloped people grow and recover, it can feel much like navigating a very complex and challenging labyrinth, until you've become so familiar with their defenses and patterns of behavior in direct relation to these, it's like taking a road trip to a place you've visited thousands of times before.
A few clinicians have contacted me seeking guidance with particularly challenging patients, after reading some of my articles. Invariably, the core of their difficulties in those sessions, was they wrestled with a significant amount of counter-transference in relation to their client. With a little digging, it became clear the therapist had very similar feelings as a child in response to a volatile, yet fragile parent. The unique struggle this can present to clinicians is monumental, as their natural priority is to be gentle with the patient/client, but this might entail dangerous disregard of the Self, to where a professional can feel like a deer in the headlights while treating some of these people. Until the therapist seeks qualified help to deal with their own unresolved childhood issues, they should probably avoid accepting people with BPD into their practice.
Whether you're a Borderline or a clinician who's attempting to help one, this literature may give you deeper insights into BPD, and perhaps assist you with revising some long-standing beliefs and/or assumptions you've held about this disorder. That at least, is my hope for you.
Let me be perfectly clear; I have not 'treated' Borderline Personality Disorder. I've merely helped clients resolve underlying difficulties like disconnection from emotions/senses and poor self-worth, which in my opinion, have spawned and perpetuated this very destructive and debilitating personal obstacle, and made it impossible for them to build and maintain mutually loving, harmonious relationship dynamics.
Borderlines are not "bad people." Their lifelong struggle with fear and anguish have made it necessary to develop a self-protective, tough outer shell or armor that's helped them avert further harm to themselves during a time when they were very young and defenseless, and had to survive. Unfortunately, learned survival instincts and defenses prompt disruptive acting-out episodes and distancing behaviors in even potentially close relationships.
In truth, when core damaged individuals are helped to resolve their self-worth issues, and connect with their emotions without compulsively analyzing or judging them, personality disorder features can be eliminated. It's surely not 'rocket science,' but it definitely requires an unconventional and unique type of approach that falls outside the realm of standard or traditional therapies.
Resolving Borderline Personality Disorder isn't a head issue, and there is absolutely nothing wrong with a Borderline's mind. In my view, BPD is a heart issue, which seems to be why psychotherapeutic treatment has for many, remained a disappointing, unrewarding endeavor.
BPD MYTHS, MISCONCEPTIONS AND FANTASIES
Borderline 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, such as ADD/ADHD, Bipolar Disorder, Anxiety Disorder, etc., that have nothing whatsoever to do with mental illness or incapacity! Borderline pathology is never caused by a genetic or biological abnormality, and it cannot be "inherited." BPD is solely an environmentally induced 'nurture' issue, which is passed along through a diffuse, inadequate maternal connection from each generation to the next. In short, if we've never been able to receive nourishing love, warmth and affection within a stable, trusted bond, we never get to learn what the experience of real love actually feels like, and we're not equipped to give it, either.
The Borderline personality is constructed from a cumulative, complex group of emotional injuries to one's sense of Self. The first year of life is a critical time for an infant, but core injury begins in the first weeks of life outside of the womb, due to deficits in affection, holding, nurturing and emotional attunement with the birth mother that inhibit/derail a baby's ability to retain the nourishing attachment bond we forged with Mom during our gestation period.
We form an intimate bond of oneness with our mothers in-utero. We hear her breathing and her constant heartbeat (which often lull us to sleep), and share her oxygen and blood supply. We hear the tone of her voice, and grow very familiar with her language style, the cadence of her speech and how she uniquely enunciates her words. In addition, we co-experience her emotions, so when Mother is sad, so are we. If she's anxious, angry or upset we feel those emotions at the very same time she does. We can acquire what I've coined, "womb anxiety" if we're born to a woman who often felt worried or unsafe during our gestation period, for this was the predominant sensation we experienced in-utero.
By the time we are born, we're already in-love with this woman. 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 is 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. Many Borderlines who've contacted me for help have named this painful inner craving, "Love Addiction." Such an "addiction" does not exist.
The 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.
Adoption 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."
This child will go through his or her entire life with a troubling question that subconsciously inserts itself into all relationship endeavors: "If my own mom can't love me, who the hell can??"
Any 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 inexplicable SIDS (Sudden Infant Death Syndrome). I think of this all too common "phenomenon" as an infant's fatal heart attack.
A 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 mother.
THE BORDERLINE'S CRUCIBLE - DEEP DENIAL
Borderlines beget Borderlines. Anyone who grew up with a BPD mother cannot help but acquire survival defenses during 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 trauma. 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.
Even the slightest sense of distance from a lover or spouse can catalyze profound abandonment terror in Borderlines, because he/she assumes it's their fault. They scan their inner terrain to determine what they might have done wrong to bring about this painful outcome, and imagine all sorts of scenarios to codify the wild stories they're making up about themselves, and You~ their "Abandoner."
Because 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??
Trust issues have serious ramifications within a potentially solid and meaningful therapeutic endeavor. A Borderline will resist helpful intervention, especially when it interferes with their need to 'change the channel' on what they're feeling during episodes of duress. The characteristic of BPD impulsivity can make working with a Borderline feel considerably more challenging. You're put in a position of having to reign them in, and all you can do at these times is damage control and crisis intervention, which are antithetical to growth work.
Even when acting-out behaviors self-destructively catalyze excruciating pain beyond that with which they're already struggling, the temptation for someone with BPD features is, at least they've orchestrated those changes~ and there's a subtle sense of relief and power in this. Now, their familiar life-long agony envelops them like a familiar old blanket that's oddly comforting.
The 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 for people with 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.
It's 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.
Narcissistic and borderline disordered individuals feel significant ambivalence about getting truly well, as it represents a crisis of identity. Their resistance to surrendering a malfunctioning sense of Self 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 new one. You might think of this element of resistance in the Borderline as a "devil you know" kind of issue.
Some 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.
A 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 is 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 if you have these people in your practice.
DIAGNOSIS IS JUST THE BEGINNING.
Most 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 accepted the layman's very narrow and stereotypical notion of how BPD presents in impaired individuals, and what Borderline Personality Disorder actually looks like or entails! Because of their lack of independent research and/or experience working successfully with core trauma issues, their very limited, biased and stigmatic view of people with borderline traits renders many professional caregivers afraid to accept them as clients.
Sadly, 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 authentic wellness.
The 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 abrasive and abusive~ and while you might tolerate or encourage their rage, you should not agree to be their whipping post. Ever.
Promising never to leave a Borderline does not mitigate their abandonment trauma, and it's foolish to presume it will. I did this at the very start of my career as an MFT intern, as I thought it would be helpful. It wasn't. No matter how patient, tender and warm a 'surrogate mother' I was to these clients, they made some strides, but didn't actually recover.
Be certain to keep your counter-transference in check while working with a BPD client, for he/she can easily trigger your own unresolved core trauma issues. My book, DO YOU LOVE TO BE NEEDED, OR NEED TO BE LOVED (linked to on this website's main page) was written for psychotherapists who have difficulty establishing healthy boundaries, and putting their own needs first.
While 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.
The 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 at least be present for your other clients the rest of your work day.
Because Borderlines have such terribly diminished 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.
Frankly, the Borderlines I've assisted have been some of my favorite clients, even though the work can be 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. Some may have navigated years or 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.
I 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.
Crisis and chaos addiction is typical among borderline disordered clients, so as you help them begin to surmount immediate struggles and their pain lessens, they lose impetus/motivation to continue with and complete their emotional development work, and progress is effectively derailed.
Non-compliance with treatment is common for Borderlines. Aside from their fear of change which feels frighteningly destabilizing, they tend to rebel against useful, meaningful intervention~ especially if there are BPD Waif features present. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted.
Unfortunately, very little in undergraduate and graduate course work prepares future clinicians for working with this type of client, or 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've called on this cumulative wisdom to help people grow, and together we have worked to repair and restore the Self.
THE SEEDS OF AN INTRICATE GARDEN
As stated earlier, Borderline Personality Disorder begins within the first year of life, and if you want to get even more specific, the first weeks of an infant's life outside his mother's womb critically shape and mold how he views and relates to himself lifelong. 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.
A 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 gifted practitioner.
A 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 no exceptions.
These 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.
You 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 Recovery Methods with psychotherapy~ and there is virtually no similarity between the two.
A 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 represents emotional betrayal and neglect.
I've 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 (typically, the mother). These views are mostly 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.
It's 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).
Borderline 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.
Perhaps 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.
Significant 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.
Many 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.
The 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, in order to discover, accept and finally embrace the whole Self.
The 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 or disciplines set forth by a church, synagogue, yoga or Buddhist practice.
The 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.
BETWEEN A ROCK AND A HARD PLACE
Psychotherapists 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.
The 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.
Therapeutic practitioners who treat Borderlines or anyone who's suffering from core trauma issues for that matter, must constantly remind themselves that they're dealing with someone who is 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 therapeutic burn-out.
Effective treatment of clients with BPD might be very similar to doing child psychology, and requires just as much mindfulness and patience.
I 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.
A 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.
I'd 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.
The 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.
Core 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 be otherwise??
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AN ANCIENT, BUT FAMILIAR AND COMFORTING AGONY
Many 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.
As 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 to their initial outreach.
The Borderline Waif 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.
BPD 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.
Childhood 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 a Borderline's self-defeating compulsions.
Like 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!
For this Borderline to begin tolerating love, success and a real sense of joy, there has to be a paradigm shift. This takes hard core (and 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 and more comfortable to keep circling the drain, than to climb out of the sink.
Pain 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.
BLACK, WHITE OR SHADES OF GREY?
Working with a borderline disordered client who's coupled means you'll frequently 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.
All 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 shortsightedness. 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 this.
Feeling work can help Borderlines connect with both intense and subtle emotions. In truth, if we can teach a BPD individual to say what they're feeling, like "whenever I feel really close to you, it triggers fear and dread in me" it diffuses those sensations, and makes it unnecessary for them to act-out by picking a fight with you, or retreating. Your only job is to listen, and not try to fix or change it.
The same holds true, when they're feeling destabilized, sad or in need of holding and comfort. Learning to ask you for a hug or have you spoon them in bed ameliorates the shame they feel about having any needs. It gives you a way to respond to them instead of frantically trying to know what to do when they speak about wanting to die (or "kill" themselves), and you're feeling totally impotent to help them or ease their pain.
These effective strategies can be taught to a Borderline, making it possible for them to construct more harmonious relationships. This is no easy task of course, because the Borderline's been in his/her head lifelong, mentally analyzing all their feelings (like you have) since they were about two years old, and gained vocabulary.
BEYOND THE YELLOW BRICK ROAD
My passionate dedication to each of my clients, was to help them recover, heal and grow emotionally, whether they were borderline disordered or not. There exist 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~ and the core of Healing work is Feeling work, designed to reintegrate all emotions that constitute a balanced adult's complete feeling repertoire.
A Borderline tries to gain a sense of Self through engagement with others. Their seduction routines are reflexive, predatory and highly perfected, but this strategy is merely symptomatic of deeper pathology related to sensations of insecurity and unworthiness.
Even 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 is catalyzed.
This 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.
"I THINK I LOVE YOU."
Throughout 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.
Throughout 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 and 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.
Borderlines 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 transference issue is very natural/normal within context of doing meaningful, growth-oriented work with all clients, whether borderline disordered or not. When handled correctly and without evoking shame in the client for their intense feelings of attachment, they can successfully navigate this delicate phase of treatment, and resolve their infatuation.
SELF-HARM AND CIRCLING THE DRAIN
The 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 either 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 orchestrate their own setbacks, at least they can feel in-charge/in-control, and it gives them a semblance of comfort.
Interestingly 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.
The BPD client craves a sense of intimacy, and yearns to be fully understood and known during treatment. Unfortunately, this can generate a sense of being too emotionally naked or vulnerable, which triggers 'out of control' feelings, and prompts their 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.
Every BPD client who commits to effective 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.
For 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 issues, anxiety disorders, OCD (Obsessive-Compulsive Disorder) traits, and their need to argue or distance, after especially enjoyable episodes with you.
Life 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 it.
Old 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 do not.
I've 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:
Neither 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??
Casanova 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 thus ameliorated.
Sadly, 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.
If 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.
Codependency 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.
If 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.
Solid 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.
It 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 and implacable.
This 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.
For 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.
THE NATURE OF THE BEAST
Borderlines are passive-aggressive, 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 arrest).
Helping 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.
Without 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.
Due 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.
A 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).
Unfortunately, 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.
Realistically, 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.
The 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 purgatory' 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 Healing, helps them navigate this difficult but necessary adjustment period.
I 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. My understanding of BPD is an unintended consequence of working with a core damaged population (which includes Borderlines and Narcissists) since I was an intern, just out of school. You might think of it as on-the-job training. It's been my only form of "research" into this issue for well over twenty years.
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