Disclaimer: The following material was written for therapists to identify and manage clients with Borderline Personality Disorder (BPD) while illustrating some consequences that could occur during clinical practice. Clinical terminology will be interspersed with colloquial storytelling for accessibility. Attempting to conduct therapy with an undiagnosed or misdiagnosed mental health patient suffering from Borderline Personality Disorder can be like walking into the Australian Outback without a compass—clinical confusion, navigational errors, and emotional dehydration are virtually guaranteed. In essence, you won’t just be lost, you’re likely to become a part of the BPD landscape. The journey of a thousand mistakes begins with a stroll into the unknown. Furthermore, the following hypothetical situation in no way suggests that all patients suffering from BPD are similar regarding presentation, cognition, or behavioral responses. Therapists, like others, should avoid endorsing the No True Borderline fallacy. This essay is not intended as a support resource or treatment recommendation for those suffering from Borderline Personality Disorder; it represents an experiential and educational guide to inform and protect therapists from becoming professionally upended. Despite some of the behavioral depictions, occasional humor, and provocative vernacular, there is no motivation by the author to show prejudice or discriminate against this controversial, and often misunderstood, mental health population. Contempt is reserved for the disorder (the legacy of trauma), but not for the person. However, without proper diagnosis and treatment, the person and their pathology are indelibly intertwined. Similarly, compassion is reserved for the person’s suffering, but not for their destructive behavior. Having what is considered an externalizing disorder, people with BPD search for external sources of stimulation, validation, safety, and emotional regulation. They also search for external sources of blame to avoid feelings of shame. Loved ones often describe relationships with Borderlines as “hostage situations,” but those who suffer from BPD are also held hostage by their own unresolved internal conflicts, insecurity, fear, impulses, and highly unstable emotions. Borderline Personality Disorder is a serious mental illness that negatively affects the person suffering from it, in most cases, more than it affects those who interact with them (10% percent of Borderlines commit suicide). Overwhelmed by their emotions, BPDs can also overwhelm healthcare providers who try to treat them. Borderline behavior is simply a maladaptive means of survival, but therapists must learn how to recognize and manage the onslaught of such behaviors in a clinical setting. Therapists are professionally identified as caregivers, and many clients suffering from BPD obtain their sense of identity by being taken care of. This perilous juxtaposition creates the potential for a clinician’s version of Murphy’s Law. Therapists should have compassion for those who suffer from the disorder, and for those who suffer by association. Borderline Personality Disorder creates a momentous ripple effect through personal, professional, family, and social realms. We all pay a price in the end. *The term Borderline (BPD) will be used for purposes of descriptive brevity, but this is not meant to imply that a human being is reducible to their disorder (correctly identified as pwBPD).
Chaos is the score upon which reality is written. — Henry Miller
Although therapists may have the necessary academic background to assess Borderline Personality Disorder (BPD) from a vignette, list of traits, anecdote, or comprehensive case study, they may not have worked with enough varieties of Borderline experience in a clinical setting to identify the full range of behavioral manifestations. For example, therapists can learn to recognize common strains of the BPD “psychovirus,” but other strains may go completely unnoticed (i.e., not recognizing a melody because it’s being played backwards). The DSM-IV and DSM-5, with their checklists of infamous Borderline traits and diagnostic features, cannot begin to capture the experiential dynamics of being in a more direct relationship with a Borderline individual (the World Health Organization’s ICD-10 defines BPD as Emotionally Unstable Personality Disorder). The complexity of this disorder sometimes goes undetected by even the most seasoned clinicians until a specific behavioral pattern over time suggests a definitive pathology. The danger of normalization and misdiagnosis is common with Borderlines because of the protean nature of this biosocial disorder and its wide array of individualized features. According to the article Subtypes of borderline personality disorder patients; a cluster-analytic approach from the journal Borderline Personality Disorder and Emotion Dysregulation, 2017: “The BPD population is notably heterogeneous from a descriptive and theoretical perspective. Two hundred fifty-six possible combinations of criteria may yield the same diagnosis. Hence, two patients with a diagnosis of BPD may have only one diagnostic criterion in common.” Correspondingly, a dimensional-based severity scale for BPD should include categories for mildly disturbed, moderately disturbed, and severely disturbed—in addition to Theodore Millon’s 4 BPD subtypes: Discouraged, Impulsive, Petulant, and Self-Destructive. Regarding functionality, some Borderlines are highly self-sufficient, whereas others can be completely dependent, yet they’re all emotionally dependent. BPD is considered to be the great masquerader of mental health disorders. As a characterological disorder, the symptoms of BPD are often camouflaged by the client’s mysterious presentation, myriad symptoms, and interpersonal conundrums, thereby making the prospects of a conclusive diagnosis even more troublesome. There’s also considerable overlap among all Cluster B disorders (narcissistic, borderline, histrionic, and antisocial). Approximately 90% of persons with BPD have co-occurring dependent, obsessive compulsive, or antisocial personality disorders. Overall, Borderline Personality Disorder should be considered on a broad psychiatric spectrum rather than relying on common caricatures, clinical stereotypes, or hyperbolized Hollywood depictions. BPD represents approximately 2% of the general population with roughly 75% of cases being diagnosed among females. A large percentage of BPDs report a history of abuse in childhood (physical, emotional, and sexual), but yet 20% claim to have no memory of such encounters (possibly repressed, or not recognizing neglect as a form of abuse). In addition, we cannot underestimate the role of genetics as a primary factor in the development of the Borderline condition. As the late psychiatrist John Gunderson pointed out, “Our understanding of the disorder itself is in the process of dramatic change. Where its etiology was once thought to be exclusively environmental, we now know it is heavily genetic.” But even with all of these stipulations and appraisals taken into consideration, to creatively paraphrase Richard Feynman: If you think you understand Borderline Personality Disorder, you don’t understand Borderline Personality Disorder; just ask a Borderline. It’s Heisenberg’s uncertainty principle; it’s Schrodinger’s cat; it’s believing in two diametrically opposed ideas at the same time. As a system of trauma incognito, BPD passes the Turing test and takes therapists through a jungle of deception until they unwittingly arrive in the uncanny valley. Considering the vast catalog of mental illnesses, Borderline Personality Disorder stands out as an ontological contradiction that never fails to generate confusion among family members, loved ones, acquaintances, and caregivers. Most tragically, it deeply confuses the person who is suffering from it.
In terms of an accessible two-tier classification system, BPD “first impressions” could be recognized as either Authoritarian or Vulnerable.
Authoritarian BPD Interpersonal disposition: Compulsively self-sufficient, domineering, mesmerizing, intrusive, anxious, dysphoric, demanding, passionate, presumptive, judgmental, perfectionistic, fearful, competitive, impatient, pessimistic, combative, easily angered, petulant, stubborn, critical, paranoid, and envious. Attachment style: Fearful/Disorganized. Intimacy style: Erotophobic. Rationale: “I have needs for stability, predictability, and approval that were not met during childhood; therefore, I must be in charge to survive.” Valence: Aggressive, flamboyant, anxious, intense, and irritable. Parenting style: Over-involved. Objective: Control of self-image, others, and their environment (overtly expressed).
Vulnerable BPD Interpersonal disposition: Dependent, charming, captivating, coercive, desperate, mercurial, seductive, playful, hapless, passionate, anxious, perfectionistic, dysphoric, duplicitous, suspicious, solipsistic, fearful, affectionate, labile, docile, hypersensitive, desultory, fantasy-prone, childlike, vindictive, and jealous. Attachment style: Anxious/Preoccupied. Intimacy style: Erotophilic. Rationale: “I have needs for safety, validation, love, and nurturing that were not met during childhood; therefore, I must be taken care of to survive.” Valence: Coy, mischievous, needy, desperate, and enigmatic. Parenting style: Under-involved. Objective: Control of self-image, others, and their environment (covertly expressed).
It should be understood that these rudimentary classifications are not mutually exclusive. For example, a Vulnerable BPD could easily switch into an authoritarian mode of expression, given the volatility of their internal barometer during stressful circumstances. However, general appearances indicate a default tendency towards either one disposition or the other, and both classifications maintain fantasies of omnipotence to offset deep feelings of insecurity. For purposes of this essay, the author will focus on clinical encounters with the Vulnerable BPD on the severe side of the spectrum. A more descriptive archetypal rubric is supplied by Christine Ann Lawson in her popular book Understanding the Borderline Mother.
In addition to the DSM’s notorious 9-point diagnostic criteria, here’s a 10-point list of the more “unspoken” aspects of Borderline Personality Disorder:
- Perfectionism. Excessive attention to details with hypervigilance.
- A pervasive need for control in multiple contexts. Hyper-competitive, uncompromising, jealous, anxious, defensive, irritable, dysphoric, bitter, and mistrusting (assuming malicious intent where none exists).
- Relying on a victim identity (learned helplessness) for obtaining sympathy, affection, and resources.
- Situational transmogrification. Shape-shifting according to interpersonal circumstances. Presenting and behaving differently around different people (i.e., social image versus private persona).
- Automatically viewing others in terms of object relations and unconsciously reenacting childhood trauma during every intimate encounter. Confusing internal objects with external objects (i.e., feelings become facts). Resorting to aversion and aggression during periods of frustration.
- Projective identification. Coercing intimate others to “become” an avowed or disavowed representational object without the other person realizing that it’s happening (i.e., emotionally transforming others to act as a container for fear and frustration; a source of stability; a “good” or “bad” mother; a “dumping ground” for destructive impulses, behaviors, and intolerable feelings; or an object of blame).
- Emotional reasoning, all-or-nothing thinking, and having personal definitions for universal language (sometimes harboring ideas of reference and magical thinking). Overreacting to any sudden change in plans and low in agreeableness.
- Seeking intimacy as a form of compensatory nurturing that provides safety, comfort, soothing, reassurance, stability, and validation. Using transitional objects (material items) as surrogates for absent others.
- Subconsciously evaluating others for their potential as need-gratifying objects (i.e., “good” enablers or “bad” obstacles). Socially anxious, suspicious, tense, and pathologically self-absorbed as a relational style.
- Compromised listening, comprehension, and communication skills due to overwhelming emotional preoccupations. Borderlines may appear as if they understand the viewpoints of others, but they often don’t due to deficits in cognitive processing, alterity, and mentalization. Paying attention to the content of conversations becomes difficult if the subject matter deviates from their immediate interests or needs. The BPD’s attention to detail is greater than their attentiveness.
A useful image for Borderline Personality Disorder interpretation is to picture a 3-layer cake. On the surface of the cake is the BPD’s survival-based persona, a “false self” (coping self) that allows them to function in the world and feel accepted while avoiding the agony of criticism or rejection. In essence, the false self is an idealized form of identity that the Borderline wants to present to others as their authentic self. The middle section of the cake represents a large arsenal of primitive defense mechanisms, irrational thoughts, and impulsive behaviors that generate the bulk of Borderline traits. The bottom layer of the cake symbolizes the BPD’s traumatized and psychologically arrested inner child who is buried underneath a complicated mix of ingredients that include denial, fear, and dissociation. In therapy, clinicians must become the equivalent of psychoanalytical archaeologists willing to get messy in a mixing bowl of toxic cake batter to unearth the Borderline’s traumatized self. Staying on the surface of the cake is what the BPD wants everyone to do, and they will fight like hell to maintain their protective exterior. But focusing on the frosting and its permutations only enables this evasive disorder to flourish with impunity. Basically, the “bright side” is the BPD’s manifest image, and the “dark side” is their pathological behavior. Side A is a hit song, but side B should have never made it into the studio. As a result of such confusion, therapists and other providers often take an à la carte approach to symptom evaluation and treatment before getting to the center of the Borderline tootsie pop. But wait, there’s more! The therapist may assume that he or she is interacting with the BPD’s “true self,” but this is an illusion. In reality, the therapist is interacting with the BPD’s mask of normality (detached protector). However, the therapist will eventually be judged according to the Borderline’s impossible-to-please persona (angry-impulsive child). In fact, the BPD’s core self is conflicted because they never developed trust, healthy independence, or self-acceptance. From an article in the UK entitled Two different presentations with Borderline Personality Disorder by Liz Fawkes and Val Fretten: “The earliest experiences for these patients were abusive. There were no good objects. Others either abused, tormented and persecuted them or ignored, hated and derided them. The child was helpless to have any effect on such a world; nothing they could do enlisted anyone to meet their needs for safety, security and containment. From the viewpoint of the child, it was as if they truly must have been so bad that others, who should have cared for them, apparently had to punish them. It is important to understand that the patient cannot see the therapist as separate or as benign—as a therapist you are an Other to them. These patients often elicit a very warm caring response. However the sense of connection feels very fragile, because their core feeling is that they cannot affect the world around them and therefore that they do not exist to others. Their existence is invested in the other, but the Other is not a real object for them, merely a repository for their projections.” In recent clinical literature, Borderline Personality Disorder is considered a subtype of Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) with multiple self-states (emotional states) in perpetual conflict with one another. BPD uses a polarization form of splitting (polarization of self, object, and relationship), whereas MPD/DID uses ego splitting or identity division. Borderline dissociation results in feeling completely different from moment to moment, but this also means that their feelings about others will alternate in an equally disorganized manner. BPDs are the croupiers of emotional roulette, spinning their wheels of tribulation on an unstable table. In therapy, the Borderline will believe that the therapist is either an indifferent (aka cruel) professional or an unencumbered caregiver who has the power to magically rescue and nurture their damaged inner child. However, all therapists endorse a “situational self” by assuming the role of a caregiver as an occupational identity. In reality, the therapist is a human being with faults, problems, vulnerabilities, stressors, and limitations, just like everyone else. Last but not least, most interactions in therapy rely on neurotypical standards of reasoning and interrelating, but Borderlines have no reliable baseline for congruent communication because of their fractured identity, cognitive deficits, emotional instability, abandonment anxiety, paranoia, dissociative amnesia, developmental immaturity, and lack of insight. To make matters worse, BPDs are extremely sensitive to how others are affecting their emotions, but they have no idea how they’re affecting the emotions of others. Introspection is replaced by deflection. What could possibly go wrong?
It is certainly abnormal to crave so much to be loved and understood. — Anaïs Nin
A conceptual view of BPD is noted by Robert B. Shulman: “The characteristics of the borderline personality include a marked and persistent identity disturbance, chronic feelings of emptiness and boredom, and intense unstable personal relationships. The borderline tends to have difficulty tolerating being alone, and will fear abandonment. They are highly impulsive, and may engage in self-mutilating behavior, have recurring suicidal threats, and manipulate others to meet their immediate needs. The borderline also tends toward having an intense affect; unstable mood; displays of inappropriate anger; perceptual distortions; and under great stress may depersonalize. They see the self as justified; since they feel intolerably bad, they are entitled to go by impulse instead of common sense, and feel entitled to soothe themselves. Their fictitious goal is to do whatever they want as they cannot be happy by how others do it. Their methods are protean, and include splitting, primitive idealization, projective identification, denial, and devaluation. The borderline personality is not a cooperator. Their impairments include affective instability, anxiety and panic, and engaging in self-harmful behaviors. These impairments may cause significant interference in social or occupational functioning. Because the borderline uses others to meet their needs, they can often be the ‘problematic patient’ that medical offices dread.”
Another way to think about Borderline Personality Disorder is as a unique arrangement of C-PTSD (Complex Post-Traumatic Stress Disorder) that causes the sufferer to believe that some combination of affection, love, validation, control, and retributive justice is the cure. However, this view is limited because it does not take into account genetics, object inconstancy, psychotic transference, autophobia, and abandonment rage that creates an impaired character structure akin to a developmental syndrome with alloplastic defenses. What emerges is a pathological split-self, otherwise known as structural dissociation—multiple self-states that represent a highly unstable entity of its own, like uranium. The Borderline’s attachment issues are pervasive and owe as much to insufficient bonding during infancy and childhood as they do to trauma-induced hypervigilance (the unstable sense of self originates from the internalization of the child’s primary relationships). Perhaps most ironically, many individuals who become involved in a BPD relationship cycle are later diagnosed with some form of PTSD themselves due to being recipients of the Borderline’s self-justified reactivity (aka narcissistic/borderline abuse). Left to their own devices, Borderlines will not break the cycle of abuse, they will perpetuate it towards themselves and others.
Come on, babe on the round about; ride on the merry-go-round. — Robert Plant
The ways that Borderline Personality Disorder can present itself are sundry, but traits reliably surface whenever sufficient stressors are involved in the person’s life. The problem is that significant levels of stress may not emerge during casual therapy sessions as they would in a family context, romantic relationship, or adverse situation. In many cases, the BPD’s affable demeanor, charm, and energetic magnetism—as presented in a structured setting—can create the illusion of normalcy for extended periods of time before things begin to unravel. But, to be sure, this commonly misunderstood disorder is a far cry from the “worried well” going through a seasonal spell. BPD is a form of psychological pain that cannot be attenuated by methods of normal communication or reasoning. Individuals with personality disorders do not realize that their perceptions, emotions, and behaviors diverge considerably from quotidian human experiences. To be inappropriately blunt, Borderline “flare-ups” behave a bit like the herpes virus. There may be no visible outbreak of symptoms until the person with BPD encounters enough stress to end the remission period. In most cases, the crux of this disorder is environmentally triggered by interpersonal factors and exacerbated because the host has a skewed perceptual lens. This is why those suffering from BPD can “hide” their internal suffering when interpersonal situations are at a minimum threat level. However, it’s the stress of not getting their way that really brings out the creature features of this tumultuous disorder. BPDs want a normal and happy life, but they don’t know how to find that magical place; it’s like window shopping in the dark with cataract shades. The lights are out on the mean streets, and there’s no hope to be found. They’re on the run for restitution, but they’re running in circles. A Borderline’s inability to manage stress, or interact with others in a balanced way, creates an amusement park ride of rotating pandemonium. For many BPDs, life is just too difficult, or isn’t worth living. *It’s important to know that not all Borderlines engage in self-mutilation or suicide attempts, but they can be self-destructive in other ways that are less obvious (i.e., negative internal dialogue, eating disorders, and other self-sabotaging behaviors). Furthermore, self-injury and suicidality for a person suffering from BPD are more about taking control than letting go of a shitty situation. In fact, studies have shown that Borderlines are less sensitive to physical pain than they are to emotional pain. Physical pain distracts from, alleviates, or brings attention to their psychological pain. Regarding other counterintuitive revelations, a BPD’s risky behavior (i.e., promiscuity, substance use, spending sprees, etc.) is usually enacted for purposes of escapism, self-soothing, or to feel alive, but it’s often misinterpreted by others as recreational or adventurous. Since most humans have their vices when faced with adversity, the Borderline’s excuses for irresponsible, self-destructive, and hedonistic behaviors are often excused. As clinical misinterpretation progresses, the caregiver may end up pouring the equivalent of codependent jet fuel on the BPD’s emotional reasoning by gradually supporting their distorted views of reality, or by feeling compelled to gratify assorted requests and demands for special favors. Borderlines could be thought of as emotionally unstable individuals with maladaptive software programs—akin to a faulty GPS—when it comes to navigating interpersonal dynamics. As BPDs were often betrayed by their original caregivers, they anticipate betrayal from anyone who is supposed to care. Unfortunately, the Borderline condition is not amenable to standard forms of patient engagement. In fact, some forms of therapy can actually make BPD patients worse by trying to accelerate self-sufficiency. As a result, BPDs must be willing to submit to specialized treatment programs (i.e., DBT, MBT, IFS, TFP, STEPPS, and schema therapy) that sometimes require years of attendance before adequate insight is developed or meaningful change occurs. *Effectively mitigating the deleterious effects of this disorder to improve the client’s quality of life is more realistic than expecting a “cure.” However, due to chronic instability, crisis intervention may be the only treatment some Borderline patients receive. Longitudinal studies of patients with borderline personality disorder indicate that even though these patients may gradually attain functional roles several years after admission to psychiatric facilities, still only about one-half will have stable, full-time employment or stable marriages. Nonetheless, overall treatment prognosis is good for dedicated patients with low comorbidity, and there are reported cases of spontaneous symptom remission with age. Regardless of major improvements in treatment and outcomes, many Borderline behaviors persist indefinitely based on habituation. For others, their denial is too intransigent to accept diagnosis and commit to multi-modal treatment. To even suggest that something might be wrong with a BPD’s worldview is often considered a threat. It could also be argued that this population may be better managed by clinicians who have additional training in child psychology. Borderlines don’t know how to interact in relationships, and a relationship with their therapist is just another type of relationship.
“The clinician is challenged in many ways when caring for a patient with borderline personality disorder. The poor coping skills and tendency to form intense, unstable relationships associated with these patients often identifies them early on as difficult and problematic. Treatment compliance is poor, and their behavior is often demanding, although they reject help. They may often idealize the physician as the only person who offers help and understanding, yet return for a follow-up visit expressing anger and hatred. The behavior of “splitting,” or viewing one member of the healthcare team as all good while another is all bad, is common in these patients. It is important that all members of a medical staff or unit team have a consistent approach to avoid the manipulative behavior that splitting may cause,” states Dr. Melinda Lantz.
Things are not always what they seem. — Phaedrus
The challenge for clinicians is when an undiagnosed or misdiagnosed Borderline presents in multiple sessions without conspicuous traits or clear evidence of Cluster B psychopathology (misdiagnosis is a set up for iatrogenic harm). Likewise, the patient’s clinical record is sometimes contradictory or misleading. Furthermore, the elusiveness of this disorder will often escape the radar of previous clinicians because of the client’s ability to superficially present themselves as well-mannered and ostensibly reasonable during brief interactions. BPDs can also appear cognitively copacetic and highly functional (apparent competence) when engaged with specific activities that allow for structure, routine, affirmation, control, and unambiguous results. *Borderlines who are taciturn can be exceptionally difficult to assess because they tend to remain placid until provoked. In other cases, pressured speech is an early warning sign that may indicate ongoing hyperarousal and impulsivity. If internal dysregulation (ego-dystonia) is admitted by the client, it’s often misdiagnosed as Bipolar Disorder, atypical depression, or minimized as situational anxiety. Despite a plethora of comorbid considerations, a contradictory or confusing diagnostic history might well suggest that the client is suffering from pervasive patterns of psychological disturbance that transcend Axis I considerations. However, due to time constraints and other factors involved with high-maintenance clinical work, reliance on the assessments of previous caretakers often remains unquestioned. Likewise, it’s sometimes assumed that the client has been an innocent bystander of chaotic family circumstances—surrounded by other personality disordered individuals—rather than being a card-carrying member themselves. In other words, objectivity can be lost if a confirmation bias exists in thinking that the client is an unfortunate victim of bad luck instead of being a potential culprit (this bias does not dispute victimization from abuse in childhood). Whenever such misguided conclusions become diagnostically solidified, the lost-in-translation therapist becomes a detective chasing down the wrong suspects. The clinician might be in the right neighborhood, but they’re focusing on the wrong address. In these circumstances, understanding the multi-generational effects of trauma and the hereditary pervasiveness of Borderline Personality Disorder is of key importance (early diagnosis of BPD is crucial for a favorable treatment prognosis). Because of the public and mental health stigma surrounding Borderline Personality Disorder, medication management is often chosen as the sine qua non for treating symptoms rather than subjecting the client to a series of more intensive evaluations. However, psychotropic medication is only supplemental and not effective for addressing the nucleus of this multi-layered disorder. Unfortunately, most insurance companies do not cover payment for treatment of personality disorders. Revealing the disorder to the patient can also backfire because, in their mind, it suggests an inherent defectiveness that’s coupled with a social stigma. After all, how do you tell someone who is hypersensitive to criticism that they have a disorder that makes them hypersensitive to criticism? In essence, you’re insulting a Borderline’s essence.
An overarching rubric for the evaluation of Borderline character pathology is supplied by psychologist Joseph W. Shannon:
- Adaptive inflexibility – rigidity; reluctance to learn new ways of coping; neurotic adherence to old ways of coping which have long-ago outlived their usefulness.
- Tendency to foster vicious cycles – typically lack or have a poorly-defined observing ego; do not benefit from feedback; make same mistakes repeatedly.
- Tenuous stability – problems are extreme and date back to early childhood; “therapy junkies;” “thick file.”
- Cluelessness – are typically oblivious to the severity of their pathology; remarkable ability to project blame or otherwise not take responsibility for their behavior; oftentimes lack awareness regarding the impact of their behavior on others.
- Pathological problem solving – create “psychodramas” in lieu of dealing with problems in a more constructive fashion.
It’s the Hard Knock Life for us. — Annie
Borderlines are known for being resource and sympathy acquisition specialists—chameleons of expediency and masters of mimicry with lifestyles that are frequently in dramatic fluctuation. Their lives are in flux because their moods and emotions are in flux. Their stories are captivating, and their charismatic powers of persuasion are often unrivaled. The BPD’s voyage of hardship (unrelenting crises) and methods of retelling are irresistible bait for any caretaker who cares too much. In fact, Borderlines are some of the most emotionally convincing interlocutors on the planet. From a BPD’s point of view, they’re soldiers of misfortune struggling for survival in a hostile world filled with untrustworthy people (survival usurps self-awareness). Because many BPDs come from broken homes, they’ve learned to see people as potential allies or enemies—eat or be eaten in the land of dysfunction. The Borderline’s street-fighter style of resilience is impressive, but it’s a maladaptive form of resilience based on hypervigilance, persecutory beliefs, and fraught with jeopardy. Put out and put upon, but never in the wrong. Assessments taken at face value may have therapists believing the client’s victim identity, which can provoke a strong rescue response, thereby enabling an unwarranted and unsustainable advocacy position as the therapeutic alliance develops. After all, it’s considered rude for therapists to question the veracity of a self-proclaimed victim in the safe space of a treatment setting. But keep in mind, the client’s list of abusers often includes multiple offenders, in multiple contexts, to be blamed over an extended period of time. For example, BPDs can go from one personal or professional relationship to another while complaining about how they were grievously mistreated during their last encounter (aka “support surfers” and “professional victims”). BPDs will pull at your heartstrings, but there are definitely some strings attached. In addition, the Borderline’s penchant for gossip is highly effective for collecting negative advocates (e.g., concerned others, enablers, and “flying monkeys”). Welcome to the triangulation trap—endorsing the innocence project with someone who may not be so innocent. When this happens, therapists are caught in the crossfire of a divide-and-conquer melodrama with an inclination to side with the patient. However, a detailed history of the client’s former relationships will undoubtedly reveal significant contradictions while demonstrating evidence for repetition compulsion. Furthermore, these hard-luck stories are frequently incoherent and will shift over time. Skepticism and consultation is advised. Borderlines are notoriously involved with contentious divorces, custody battles, or complicated legal issues with former partners, family members, and professionals. BPD friendships are often perfunctory and run the gamut from confidants to “frenemies.” A Borderline’s opinions of other people can change quickly, and someone who is seen as a “best friend” one day may be considered a traitor the next. Their history of interpersonal conflict is usually quite extensive before they step foot in a therapist’s office; however, these battles will often be framed as being unfair, cruel, and imposed upon the Borderline. If there’s a dispute, BPDs will declare themselves as virtuous while creating an exaggerated narrative regarding their “adversaries”(Borderlines seem to be unfamiliar with the mathematical concept of a common denominator). Most of their relationships are inherently adversarial because BPDs feel that people are inherently untrustworthy. In many situations, Borderlines will provoke confrontations to reassert victimization, thereby eliciting caretaking responses from others. *It’s difficult to think of someone as potentially dangerous when they’re constantly claiming to be in danger, but this is a common form of misdirection with high-conflict people.
Having burned so many bridges, Borderlines are always looking for a new set of suspension cables. The BPD’s ongoing search for someone who “really cares” becomes a perpetual motion machine of dependency and disappointment. Upon closer examination, Borderlines inadvertently exploit others while maintaining a repeated position of victimhood—perpetuating a cycle of victim and rescuer. Consequently, this position abdicates personal responsibility while justifying the Borderline’s impulsive behavior, self-aggrandizement, rage, and mistrust of others. In other words, Borderlines are playing a game of emotional tennis without a net. Note to therapists: Never hand the ball to the worst player on the court. BPDs are crucibles of disturbance who are exceedingly proficient at persuading their sympathizers that everyone else is disturbed. But in the Cluster B interrogation room, accusations are often confessions in disguise. Projection results in misunderstandings and confusion that requires labor-intensive analysis and retrospective dismantling. Borderline paranoia is also bewildering and contagious if not understood for what it is. Paranoia is a projection of the BPD’s own aggression and perceptual distortions, but it also works to reinforce victimhood. A Borderline is generally imagining the worst about people and situations, and their imagination is unimaginably negativistic. Of course, their wild imagination consistently gets them and others into trouble when confabulation replaces realism. BPDs frequently fabricate events based on a combination of cognitive distortions, emotional convictions, and lapses in autobiographical memory (experienced by others as pathological lying). It’s also important to avoid misinterpreting Borderline defiance as a form of self-assurance or radical independence; it’s an expression of fear and frustration. Having a “cheeky attitude,” rebellious temperament, or a flair for sarcasm is a defensive cover-up for existential insecurity. To be sure, giving a Borderline the benefit of doubt will not benefit anyone, including themselves. Other diagnostic misinterpretations may include believing the BPD to be a scapegoat (identified patient) of other “crazy-makers,” rather than investigating the client’s contributions to their own psychosocial predicaments. To make matters more convoluted, Borderlines often expect professional relationships to be indistinguishable from personal relationships. Therapeutic relationships, in particular, are anticipated to become more intimate and time consuming because BPDs want to be convinced that their therapist’s empathy is unconditional. However, Borderlines will often interpret challenging clinical interactions to be a simulacrum of parental judgment by an authority figure with the potential for criticism and shame—even the therapist’s tone of voice can set off an adverse reaction in these uniquely hypersensitive patients. Subsequently, BPDs will work hard to undermine the power differential by controlling the therapeutic process to avoid anxiety in the face of uncertainty. The process of change equals an all-too-familiar source of stress and unpredictability that subconsciously reminds them of their childhood. Borderlines prefer power over uncertainty rather than working towards self-actualized empowerment. They must win rather than reflect. Furthermore, social ineptness and immaturity can be seen whenever reality interferes with the BPD’s need for validation, resulting in boredom and impulsive attempts to regain recognition, or whenever serious discussions require reciprocal engagement among adults. It’s more important for the Borderline to control the direction of conversations rather than centering in on the substance of conversations. Therapeutic relationships are meant to be collaborations, but building a therapeutic relationship with a BPD has a much greater likelihood of becoming contentious or codependent because of their distorted perception of trust. Trust, from the Borderline’s perspective, is based on the acceptance and availability of the therapist to meet their needs. A good diagnostic benchmark is to pay close attention to the client’s style of interaction. Excessive hostility or excessive congeniality are key indicators for ruling out Cluster B pathology. Borderline patients employ polarized attributions towards others (good object/bad object), and their affective presentations and beliefs about themselves are equally divided. Because BPDs cannot accurately identify the source of their suffering, which makes them feel alone, they need others to identify with their pain.
“Borderline patients seem to have the peculiar ability to inflict a specific form of ‘sweet suffering’ on their therapists. They themselves have suffered throughout their lives, and it is important to them to have their therapists suffer for them. They seem to demand that the therapist abandon the professional therapeutic role so that whoever attempts to treat them must share in their misery,” states Dr. Glen Gabbard.
Love is a battlefield. — Pat Benatar
The Borderline’s history of romantic relationships is characteristically unstable and stormy. Likewise, there’s often evidence of intermittent reinforcement relationships that are intense, turbulent, and ephemeral. BPDs are looking for someone to love and someone to blame to compensate for adverse childhood experiences with primary caregivers. As a result, BPD relationships are representational and transactional rather than egalitarian. Borderlines want the appearance of an adult relationship with the fulfillment of a parental relationship. In this sense, their concept of a relationship is pathologically immature. They’re unconsciously searching for an all-loving, all-caring, and all-giving surrogate parent. Consequently, the ambivalence they felt towards their parents will be projected onto their partner. This “hot and cold” relationship style is based on an extreme version of the approach-avoidance conflict (otherwise known as “I hate you, don’t leave me”). Borderline’s engage in paradoxical thinking that alternates within minutes, hours, or days. Confusing and contradictory in its push-and-pull nature, this self-defeating dynamic can bring fast connection, enthusiasm, and intensity to relationships, but it also creates a breeding ground for disappointment and hostility. It draws people in, but it eventually pushes people away. For Borderlines, their search for an idyllic version of love is a defense against feelings of fear, emptiness, contempt, and anger. Love becomes a clinging form of desperation beset by jealously. Frank Yeomans, a New York City psychiatrist, describes those with Borderline Personality Disorder as failed romantics. “They seek an ideal of perfect love and pursue it zealously. But as soon as the people they’re besotted with are a few minutes late, or can’t text during a busy work day, BPD sufferers go into a tailspin.” A friend or lover is either “just perfect or all hell breaks loose,” he says. “The borderline mind has not yet been able to integrate positive loving feelings with negative ones, such as frustration and anger. Since every relationship includes a whole range of emotions, you’ve got to deal with all of it to have the relationship work out.” BPDs exhibit a preoccupation with nurturing and reparenting—under the guise of an adult romantic relationship—as the solution to their problems. However, long-term pair bonding is extremely difficult with Borderlines because of their predisposition towards jealousy, irrationality, fear, self-sabotage, age regression, paranoia, and abandonment rage. More specifically, an inability to be emotionally subdued for any substantial period of time (object inconstancy) is a chronic feature in the BPD’s universe of fluctuating feelings. Bonding with a Borderline is fundamentally a sadomasochistic endeavor.
According to psychotherapist Ross Rosenberg, “Their [Borderlines] romantic relationships begin quickly, intensely, and with a great deal of excitement, euphoria, and sexual chemistry. Their volatile emotions move in one of two directions: love and adoration or hate and destruction. Because this person has had little-to-no experience with healthy relationships, the euphoric ‘perfect love’ feelings that occur in the beginning of the relationship are neither realistic nor lasting. The early euphoric love experience is transient as their psychological fragility leads them to an eventual emotional crash and burn. This black-and-white approach to their romances creates a teeter-totter effect of extreme behavior; they either shower their partner with love and kindness, or rage at them with disgust and violence. Their love/hate processing of relationships places an impossible burden on the partner. Often individuals diagnosed with BPD are preoccupied with real or imagined abandonment, which they frantically try to avoid. The perception of impending separation or rejection can lead to profound changes in the way they think about themselves and others, as well as in their emotional stability and behavior. Whether real or imagined, any reminder causes them to strike back at their romantic partner with rage and aggressive hostility. A mistaken comment, a benign disagreement, or an expression perceived as disappointing can quickly transform their loving feelings toward their ‘soulmate’ into a raging retribution against an enemy.” Borderlines are tortured souls who torture others by association.
Perhaps most unusual is the fact that a Borderline’s preoccupation with friendship, affection, love, and romance (features of bonding that everyone desires) are also characteristics of this disorder—amorous coping mechanisms (limerence) to attenuate anxiety, loneliness, emptiness, and the fear of abandonment. Many people who have been neglected do not know how to feel connected in a healthy way; consequently, the “love” they seek is obsessive love. For Borderlines, their capacity for love depends on the attachment and caregiving behavioral systems; it follows that either one or both of these is affected by secondary psychopathy. According to the Five Factor Model (OCEAN), individuals who are low in agreeableness, high in antagonism, and high in disinhibition tend to have insecure attachment, deficient caregiving, high neuroticism, high dominance, and unrestricted sociosexual orientation. Dominance in relationships, overtly or covertly expressed, ensures that the Borderline’s physical and psychological needs are met, regardless of their partner’s well-being. Caveat emptor: Deep in the woods of Borderlandia, hate eventually becomes a substitute for love, because love is an egocentric prelude to a much darker world. It’s all peace, love, and understanding until somebody gets hurt.
The brain is the organ of destiny. — Wilder Penfield
The neuroscience of Borderline Personality Disorder is both fascinating and unsettling. BPDs interpret their surroundings through a gallery of uncensored emotions that defy normal comprehension. It’s not rational because BPD is the preeminent domain of irrationality. Remember, BPD is not just a behavioral disorder; it’s a brain disorder. There are significant differences in both the structure and operational dynamics of the brain with people suffering from this disorder (early and chronic childhood trauma often interferes with neurocognitive development). It’s well known that the brain’s limbic system—more specifically, the amygdala—generates the bulk of human emotions, including feelings of love, sexual desire, fear, aggression, and hatred. However, these emotional states are normally regulated by the brain’s prefrontal cortex to ensure continuity of experience within the parameters of external reality. Without neurotypical filtering processes, an electrical storm of impulsive potential becomes as unpredictable as it is unmanageable. In some cases, the Borderline’s prefrontal cortex is structurally malformed with evidence of temporal lobe dysfunction. Hippocampal atrophy and anterior cingulate reduction are often identified with overactive limbic responses, which results in mood swings, panic, and dissociative amnesia. For BPDs, the fight-or-flight mode never takes a break due to their high index of suspicion. Excessive reactivity occurs when critical faculties are not functioning properly during periods of stress because Borderlines have weaker circuitry for inhibiting inappropriate reactions to negative emotions.. These “filters of reason” appear relatively absent or significantly diminished in Borderlines, thus resulting in a unique hyperarousal of the limbic network with unregulated feeling states. In addition, studies have shown that BPDs have an overactive hypothalamic-pituitary-adrenal area (HPA axis), which creates hypersensitivity as manifested through excessive anxiety. When Borderline Personality Disorder is misdiagnosed as Bipolar Disorder, it’s crucial to understand the difference between cycles of mood caused by neurochemical instability (Bipolar), and cycles of emotional instability arising from the influence of stressful interpersonal factors (Borderline). To put it mildly, Borderlines have a brain that reacts to stress differently than the rest of us. Subsequently, BPDs will create a world that makes sense to them as a way of overcoming or compensating for these cognitive impairments.
Because the Borderline’s feelings are not regulated by the brain’s usual gates and checkpoints, a wide range of competing emotions are experienced with incomparable intensity. For the non-borderline, witnessing these extremes of emotion can be both captivating and terrifying. The BPD’s feelings of joy and enthusiasm are as unrestrained as their feelings of fear, paranoia, anger, hatred, and resentment. For example, euphoric displays of idealization and affection are compelling because such emotional intensity is abnormally exciting. Upon introductions, some Borderlines have an almost otherworldly effect on others due to their dynamic energy and eagerness. On the downside, disproportionate expressions of hostility will be experienced by the non-borderline as unexpected, vicious, confusing, and unusually disturbing. Furthermore, the BPD’s emotional reactions during periods of extreme stress are not amenable to modulation or introspection. In fact, these feeling states (self-states) can erratically alternate without warning—as if the person is summoned by their urges. Periods of paranoia, increased tension, and interpersonal stressors often precede acute emotional discharges that will launch a Borderline into a different persona, but the moment when this occurs is relatively unpredictable. Not having a cohesive sense of self results in shifting moods, emotions, goals, plans, and values. Likewise, correctly interpreting the actions or motivations of others is next to impossible when the capacity for interpersonal integration is absent. As the Borderline’s mood runs amok, a backdrop of fear becomes omnipresent—like an invading force that permeates everything. The BPD’s manifest image is contingent on the precarious mechanisms of a reactionary mind, and this uncanny juxtaposition will surprise anyone who tries to make sense of such counterintuitive behaviors and cognition. Dysregulated minds are primarily self-serving minds, especially when reality threatens their defense mechanisms. Borderlines have a hyperaware form of affective (emotional) empathy, but they experience difficulty with cognitive empathy (understanding the perspective of others). Although they’re known for being good at “reading” people, a BPD’s emotional empathy is truncated because their perception of other people’s emotional states is restricted (gradation and complexity of expression within context is not understood). The feelings of a Borderline are intense and sincere in each moment, but they lack continuity and are subjectively biased towards catastrophizing. When the rubber hits the road, the BPD’s reactivity can become so merciless that it will burn down everything within their interpersonal radius. Empathy takes a back seat to fear and rejection sensitivity.
*Caveat for therapists to consider: Borderlines are more responsive to emotional and physical demonstrations of care (i.e., proximal reassurance, comforting voices, hugs, and positive eye contact) than they are to logical conversations about the importance of behavior management, introspection, and self-efficacy. BPDs sometimes believe that they can read people’s minds, or that others should be able to read their minds. In such situations, the client and therapist may feel like they are talking past one another, when, in fact, they’re speaking different languages. These gaps in communication require therapists to understand the Borderline’s dialect before attempting intervention.
Being a hero is about the shortest-lived profession on earth. — Will Rogers
Borderlines are like runaway trains searching for someone who will save them from emotional derailment. In their compulsive quest for control, they are literally out of control. BPDs can surreptitiously condition others to respond to their feelings of desperation through forced teaming, and conscientious therapists may feel compelled to go the extra mile—like a case manager on steroids—as a gesture of loyalty. However, these expectations place enormous pressure on therapists to compensate for the BPD’s desire for unconditional support. Unfortunately, the therapist’s rescue attempts will only reinforce the client’s dependence and further vindicate their assertions of distress (BPDs often claim to be mistreated by those who are supporting them either financially or emotionally). In short, the therapist may feel obligated to take care of the Borderline until the caretaking fuel runs out. But a clinical death trap of Faustian proportions awaits the therapist if they become the client’s go-to person (aka “favorite person”). The Borderline’s favorite person is based on a fabricated image (the “distorted other”) that places the therapist on a superhuman pedestal to serve the unfulfilled needs of the client. A subset of BPDs live in a fantasy world inhabited by heroes and villains to protect themselves from painful memories of childhood trauma. As a consequence of such unrealistic constructions, therapists will unknowingly be subjected to tests and confirmations that either prove or disprove their caretaking worth. The Borderline is “fishing” for responses that ensure trust and safety from the “good enough” mother who is now represented by the therapist. Subsequently, the personification of a mythological trope ensues: The therapist, like many before them, becomes the Borderline’s knight in shining armor. In this seemingly marvelous reconnaissance mission, the BPD’s need to feel protected and nurtured matches perfectly with the therapist’s need to be seen as a compassionate and competent caregiver. Unfortunately, the BPD’s performance evaluation of the therapist’s valiant rescue efforts will begin with effusive praise followed by devastating disappointment. There is no perfect caregiver, and Borderlines must reconcile with this fact. Meanwhile, therapists should refuse to accept the nomination.
Because the most significant goal of Borderlines is to gain the unequivocal concern of caretakers, this disorder may be the most challenging condition for clinicians to work with when it comes to maintaining professional boundaries. Borderline Personality Disorder represents a strange inversion of reasoning. BPDs are aggressive, and yet insecure. Demanding, and yet implacable. Needy, and yet suspicious. Helpless, and yet controlling. Competitive, and yet resistant to being challenged. Affectionate, and yet contentious. Fragmented, and yet solipsistic. Therapists have a job that depends on building trust with their clients, but BPDs live in a perpetual state of mistrust. Impossible standards of care will be expected before the Borderline feels comfortable enough to “trust” their caregiver. However, attending to these expectations is usually the beginning of a downward spiral. In the world of BPD communication, everything is upside down and contradictory; it’s a complicated game of surreal semantics that must be carefully unpacked and analyzed. Assumptions are dangerous. Words like trust, relationship, friendship, family, love, and care have entirely different meanings for Borderlines, and any deviation from their emotionally challenged dictionary spells trouble. No matter how synchronized you may feel when conversing with a Borderline, you’re not reading from the same page, chapter, or book. BPD speak is the coded language of trauma that passes as everyday vernacular. Borderlines are relationally illiterate, communicationally challenged, interpersonally mistrustful, and emotionally volatile. There is no intersubjective agreement, because Borderlines—being low in agreeableness—expect others to agree with their distorted views regarding the nature of reality. André Breton pointed out in the Surrealist Manifestos that the European tradition of enlightenment could not prevent the horrors of World War I. In a similar vein, Winston Churchill famously quipped, “You cannot reason with a tiger when your head is in its mouth.” Borderlines are the temperamental tigers of mental health patients; they have majestic stripes and a ferocious bite. When the purring stops, there’s no headroom for reason. The BPD’s reprisal-ready incisors are a custom fit for caregivers who will go from being heroes to zeros.
Givers need to set limits because takers rarely do. — Rachel Wolchin
“Setting limits with individuals with Borderline Personality Disorder often causes them to experience frustration which may be expressed as rage. Refusing them or restricting them in any way causes them to feel slighted, or worse, rejected. These feelings leave them feeling victimized, which then justifies lashing out behavior. This may take the form of challenges to the boundary, or possibly abusive behavior towards you for setting the boundary. Individuals with BPD not only feel the sense of helplessness that others associate with feeling like a victim, they also experience the boundary as an accusation of unworthiness,” says Dr. Daniel S. Lobel.
Borderlines crave the sensation of control, so therapists should expect to feel dominated at some point during the therapeutic alliance. Therapists may rationalize exceptions to treatment and loosen boundaries as a way of surrendering to the client’s increasing demands for validation, or to demonstrate solidarity within the therapeutic relationship. BPDs instinctively perceive boundaries as a form of rejection, so they will often ignore these inconvenient barriers to bonding. It’s a precarious predicament, because Borderlines think of themselves as being entitled to customized experiences that cater to their immediate emotional needs. Why shouldn’t they? After all, they feel numb, empty, bored, and worthless without a continuous supply of affirmation, consolation, support, and stimulation. Mental health patients who travel along the Cluster B bypass are no fans of delayed gratification. BPDs fail the Stanford marshmallow experiment because indulgence supersedes forward thinking. Borderlines often expect frequent contact with their caregivers via phone calls, email, texts, and emergency visits. However, not wanting to alienate or hurt the feelings of a BPD in the short-term may result in confusion and resentment for both parties when boundaries are no longer amenable to remediation. If therapy progresses from being professional to becoming more “friendly,” it’s only a matter of time before a BPD will initiate further efforts to decimate the remaining power differential. Shared decision making with a Borderline is treacherous territory. The BPD’s urgency to have their needs prioritized can lead to multiple role endorsements by caregivers, such as becoming an advocate, family interventionist, apologist, avenger, secretary, friend, parent, emotional support ambassador, babysitter, and emergency manager. It must be understood that Borderlines will elicit strong emotional responses from their caregivers, and these responses are commonly experienced as intensified concern (i.e., feelings of pity, outrage, helplessness, or moral panic). Being aware of your own emotions is just as important as being aware of your client’s emotions. Therapists must trust their professional instincts more than the emotionally driven impulses of a BPD, but patients in distress can be difficult to assess with neutrality. Precipitously, the dynamics of therapy will be governed by the client’s capricious emotional states instead of being effectively analyzed and redirected by the therapist. Borderlines are in the molding business as they search for those who are willing to become malleable acolytes in service of their “id without a grid.” According to psychologist Elinor Greenberg, the BPD’s basic message is: If you care for me, you will do something to make it better right now! The therapist’s protective instincts will automatically be innervated by such displays of desperation, because no caregiver wants to be seen as uncaring. For the love of god, will someone step up to the plate and help this poor soul? It’s a Catch-22 situation. Like the parable of Thales, therapists can fall into a bottomless well of boundary violations as they attend to the Borderline’s constellation of insurmountable needs. What was once an analytic space is now lost in space.
Psychotherapists face an unavoidable paradox. They must immerse themselves in the moment to empathize with patients and emotionally distance themselves to maintain boundaries, or offer perspectives to foster change (Bateman & Fonagy, 2006). Philosophically, therapists strive to adopt a dialectical stance in which they simultaneously accept the patient while facilitating change in the patient (Koerner, 2012). From a practical standpoint this means switching between validation and change during a session, often in the same intervention, and flexibly navigating this contradiction (Koerner, 2012). Gabbard & Wilkinson (1994) argued that therapists typically react by becoming either over-involved to “save” the patient or under-involved to emotionally distance themselves.
Controlling my environment was still a compelling need for me. I did everything I could to not be surprised by anything. Looking back, I think that my need to predict how my day was going to unfold was a direct response to the amount of chaos in my childhood. — Olga Trujillo
It’s important to be aware of the Borderline’s unrealistic expectations for validation, proximity, and reassurance. They cannot tolerate being alone (autophobia) and have great difficulty managing emotionally stressful situations. Without self-acceptance, BPDs rely on acceptance from their environment. Borderlines will identify characteristics in others, such as generosity or agreeableness, to get their emotional needs met (appearing retrospectively as premeditated manipulation). Incidentally, the longer a person with BPD has gone undiagnosed and untreated, the more refined their survival mechanisms will become. In layman’s terms, Borderlines are less interested in change than changing others to get what they need (alloplastic defenses). Other people (need-gratifying objects) are in a position to provide special services, but if those services fail to meet the Borderline’s expectations, calamity will ensue. Therapists, by definition, are trained to be of service to those in need; however, BPDs will take advantage of every accommodation offered while cataloging susceptibilities for future interactions. They will subjugate challenging interpersonal encounters because it makes them feel uncomfortable. For the Borderline, spatial distance may also be perceived as a sign of rejection. BPDs simultaneously seek and reject help, because accepting help that requires emotional labor, experiential honesty, and self-reflection makes them feel out of control. Notice the inherent contradiction: A helpless victim who needs to be in control. Perfectionism, a common Borderline attribute, is another manifestation of control that acts as a substitute for external validation (“when I’m perfect, then I’ll be loved”). Because Borderlines were often raised in families where survival was based on performance, they will try to prove to the world that they’re “perfect” by conveying an image of success. Many BPDs were expected to be perfect and compliant to win their parent’s approval, or to avoid punishment, so they’ll inevitably expect perfection and compliance from others (this is why Borderlines can be extremely judgmental and unforgiving). Counterintuitively, perfectionism also serves as a form of self-invalidation because these unrealistically high standards become self-imposed forms of torture. Borderlines live with an embedded sense of “badness” that is often caused by insufficient mother-infant attachment and neglect. It has been argued that BPD perfectionism symbolically represents a form of “emotional cutting.” In fact, many Borderlines experience various forms of somatic symptom disorders that are exacerbated by self-inflicted injuries meant to punish themselves, or to alleviate tension and feelings of emptiness. Inflexibility runs in tandem with perfectionism. Borderlines are perfectly content with letting the perfect be the enemy of the good. Things must go a certain way, and any sudden change in plans is anathema. The Borderline lives in fear, but control makes them feel safe. BPDs will try to obtain as much control and power as allowed in adulthood to compensate for the lack of control they experienced in childhood. Control of their image and their environment is the Borderline’s primary method for fear management. What other people think of them means more to a Borderline than what they think of themselves. Meanwhile, they’ll dispatch a decoy of ineptitude as they demand unreasonable levels of support from anyone who gets too close, thereby exposing their emotional dependency. As a result of appearing victimized, the BPD’s concerns are often misinterpreted as legitimate complaints rather than pathological patterns of learned helplessness. Monopolizing the compassion of others is a full-time job. With Borderlines, you cannot separate personal motivation from pathology; it’s a distinction without a difference. Consequently, therapists who accept assertions of helplessness at face value are headed for an imminent clinical disaster. The BPD’s victim identity provides an instant attachment to caregivers, but this attachment is unrealistic and unendurable. Subsequently, therapists will lose objectivity by allowing themselves to become emotionally invested in the BPD’s eternal quagmires. Welcome to the sunk cost fallacy for therapists. A therapist can offer sanctuary to a Borderline, but they cannot protect a Borderline from themselves. Safe is one thing, sound is another.
Listed below is the Borderline’s “Tyrannical Toolkit” for obtaining recognition, affection, resources, and allegiance from family members, friends, romantic partners, or caregivers. Commanding the will of others is the BPD’s primary goal to mitigate their insecurities, anxiety, and fear of abandonment. Weaponizing emotions is the wheelhouse of the emotionally unstable. These survival-based methods of control are strategically effective because they demand sympathetic responses from the Borderline’s “target” or intended audience.
- Anger/hostility: Anger evokes a sense of urgency and fear in others, which may result in attempts to de-escalate the BPD through appeasement and various efforts to soothe their rage. Although it usually has the opposite effect, hostility can sometimes induce deference and accommodation. Entitlement, intimidation, rage, and devaluation belong in this camp.
- Seduction/charm/flattery: Borderlines sometimes use seduction as a form of currency for gaining approval; to avoid separation anxiety; to evoke caretaking responses; or as a defense mechanism to avoid scrutiny. BPDs may flirt and flatter until others acquiesce to their requests and demands for validation. To acquire nurturing, Borderlines will become whatever they believe you desire, or they will tell you whatever they believe you want to hear about yourself (“grooming” through attribute mining). Either way, these approaches to “persuasion bonding” can be very effective. Furthermore, a BPD’s emotional seduction is usually as effective, or more effective, than their attempts at physical seduction. Idealization and “love bombing” fall into this category.
- Incentivizing: Gifts or financial obligations. Gifts can be used as a form of coercion under the guise of appreciation. Receiving gifts compels others to respond with gratitude while feeling obligated to reciprocate; it also establishes a false sense of harmony. Subsequently, others will feel valued and willing to do more for the Borderline. In a similar, but much more controlling way, financial dominance implies a position of ownership to ensure that all eyes are focused on the donor. BPD quid comes without realizing the nature of the pro quo.
- Pity: Portraying victimization to solicit support and affirmation of suffering. Appeals for sympathy can be extremely powerful because most people do not want to be seen as indifferent to the suffering of others. Threats of self-harm or suicide can engender compassion and compliance from loved ones. Martyrdom is another method for obtaining concern and attention, whereas malingering elicits caretaking responses and allows the Borderline to avoid responsibility altogether.
- Guilt: Shaming through guilt can make others feel negligent, cruel, inadequate, or incompetent. Apologies and offers of compensation will be made by those who succumb to blameworthiness. Criticism, blame, and disapproval causes others to feel self-conscious and question their own experiences, thereby becoming more amenable to BPD influence. The engine of gaslighting runs like a champ in the garage of guilt. Kafka traps are inescapable accusations often used by Borderlines.
- Emotional Blackmail: An effective way to intimidate others into compliance is by posing unmerciful ultimatums. Punishment often awaits those who disappoint the Borderline. The message is: “Do it or lose it!” This strategy reminds others that the BPD is always in control. Double binds, bullying, and suicidal threats belong in this category.
- Entrapment: Obligation through legal ties (e.g., marital, financial, children, or professional endeavors). BPDs will work quickly to secure contractual commitments from others to avoid abandonment, but this association may result in consequential involvement with the court system whenever such unsustainable commitments sour. More importantly, high-conflict personalities (HCPs) are typically litigious and will use the legal system as a way to create drama, obtain resources, garner sympathy for perceived injustices, or to seek revenge. *Not all Borderlines are considered high-conflict personalities.
When they discover the center of the universe, a lot of people will be disappointed to discover they are not it. — Bernard Bailey
Borderlines share many similarities with those suffering from attention-deficit disorders, but mostly because they believe that not enough people are paying attention to them. BPDs were not given enough validation in childhood due to parental neglect, so they’ll over-compensate for this lack of developmental stimulation in adulthood. In fact, emotional neglect and growing up in an invalidating environment may be the most influential traumatic variables in the development of BPD. Attachment theorists have suggested that the route of continuity from infancy to adulthood is through the individual’s internal working model or schema of the relationships between the self and others (Ainsworth, Blehar, Waters & Wall, 1978; Bowlby 1969/1982, 1973, 1980; Bretherton, 1985; Main, Kaplan, & Cassidy, 1988). Like an angry infant in its crib, the Borderline will aggravate others until they’re fed. The baryonic matter of the cosmos must revolve around the Borderline’s gravitational force, but the total mass-energy is no match for their negative energy. This is why BPDs are often described as selfish, bossy, theatrical, and impatient. BPDs are on an unconscious mission to course correct for childhood deprivation, and they expect others to be complicit with their needs for recognition, reassurance, security, and love. Borderlines try to fill their emptiness through a continuous reinforcement of narcissistic supply (a pathological or excessive need for attention or admiration from others, or such a need that does not take into account the feelings, opinions or preferences of other people). The BPD’s egocentric behavior is caused by fear, and sensation-seeking behaviors to “medicate” anxiety result in more self-centeredness. This need for centrality comes from a transactional message by the BPD’s original caregivers: Attention is provided when the child is sick, in pain, or miserable and additional attention is received for performance that reflects well on the parents. Subsequently, seeking recognition from others is how a Borderline regulates their self-esteem and circumvents loneliness. However, this chronic need for emotional fulfillment places extensive pressure on caregivers and is only made worse by appeasement. Therapists often report feeling as if they have no life outside of their most demanding Borderline clients—there’s no division between their professional and personal space. For example, there have been reports of BPD patients feeling abandoned if their therapist goes on vacation. It must be emphasized that Borderlines experience others in relation to how every interaction affects them. Because they’re interpersonally hypersensitive and paranoid, conflict from minor misunderstandings is often inevitable. Conflict is not created for purposes of effective problem solving, it’s created to keep the spotlight on the Borderline’s emotional pain. Although people suffering from BPD describe attention-seeking behavior as a coping mechanism, which is clinically accurate, the end result commands the attention of others in a way that resembles premeditated manipulation. As with all parsing of BPD semantics, it’s another clinical distinction without a practical difference. Validation is an addictive drug for Cluster Bs, but the side-effects are not limited to the user. “People with BPD often derive their sense of worth from how much other people are serving them,” says psychologist Daniel S. Lobel.
Harboring enormous levels of self-doubt, Borderlines experience a sort of “prosopagnosia of the soul” and rely on others to provide them with a sense of self and self-esteem. BPDs are perpetually simmering in a rice cooker of self-loathing, internal isolation, and despair. Otto Kernberg, a psychiatrist who pioneered a new understanding of Borderline Personality Disorder, believed that pervasive feelings of loneliness and the need to belong to something were the driving forces behind all of the other behaviors associated with BPD. For the Borderline, other people are props to help them achieve emotional stability while quenching their thirst for propinquity. Power through control over intimate others is their primary objective to avoid abandonment. Therapists learn that successful therapy requires patient engagement by developing a strong therapeutic alliance, but too much engagement with BPDs will create an avalanche of unrealistic expectations. A client with BPD is less likely to pay attention to the substance of therapeutic conversations, because they’re usually focusing on details related to the interaction (i.e., the therapist’s tone of voice, eye contact, the appearance of the therapist, and non-verbal cues). In other words, listening comprehension is secondary to the Borderline’s need to take inventory of their surroundings. Similarly, the BPD’s emotional preoccupations cloud their capacity for being fully present (by definition, they exist in a dissociative state). But to be sure, Borderlines are equal-opportunity seekers whenever emotional propitiation is on tap. If the therapist has been showered with attention, this is primarily because the Borderline is seeking validation for themselves. Compliance with the fanciful expectations of a BPD is expected, but don’t expect them to comply with the rules and expectations of others. Up is down and black is white. Over time, trying to navigate such duplicity will become overwhelming (this is a telltale sign that a client is hitting home runs in the Cluster B ballpark). A Borderline will rely on their therapist as an anchor, but the water below is deep, murky, and brimming with uncertainty. BPDs often assume that caregivers should be available on short notice to eliminate their feelings of desolation and to soothe their anxiety. However, the Borderline’s hypersensitivity to criticism and problems with trust makes therapy exceptionally challenging without triggering their inferiority/superiority complex. Everything is on a self-referential loop. Borderline pathology overlaps with covert narcissism (aka “shy” narcissists), and narcissism thrives on the allegiance of others to avoid narcissistic injury. Although Borderlines often present as warm and friendly, their fear of rejection can trigger a level of compensatory grandiosity akin to Narcissistic Personality Disorder (BPD and NPD frequently co-occur). However, there are important differences that must be recognized between BPD and NPD. NPD patients are more “solid” in their defensive projections, whereas BPD patients oscillate quickly in relation to feelings about themselves and others with a greater fear of abandonment. Borderlines are primarily dysregulated, and Narcissists are primarily grandiose. Borderlines are searching for stability, whereas Narcissists are searching for status. Borderlines fear abandonment, and Narcissists fear vulnerability. Therapists who aren’t suspecting Cluster B shenanigans will eventually be caught by surprise—like an off-duty police officer during happy hour—whenever they say or do something “wrong.”
It is the fool who thinks he cannot be fooled. — Joey Skaggs
The valence of Borderline Personality Disorder is perennial desperation, but the BPD’s ability to maintain composure while suppressing symptoms can prevent or postpone diagnosis. To act in desperation suggests a need for protection, although vulnerability among BPDs is seldom revealed as a form of subterfuge. Borderlines are not who they say they are, because they don’t know who they are. Narcissists, psychopaths, histrionics, and borderlines are often experts at disguising their pathologies. Borderlines, in particular, will modify their behavior, interests, and appearance to please others because they struggle with identity disturbance. The BPD’s shape-shifting capacity for presenting themselves in a carefully assembled manner is a survival-based façade (aka “false self”) that improves social acceptance while appearing “normal,” thereby distancing themselves from their traumatized core. Overall, BPDs are highly skilled performers in need of an audience to regulate their self-esteem. Borderlines can be captivating, energetic, seductive, and glamorous (especially predominant among BPDs with histrionic traits) with enough élan vital to entertain a colosseum. They’ve often been described as adventurous, “fun-loving,” and “free spirits” by those who encounter them under favorable circumstances. There’s never a dull moment in Bordertown. Many Borderlines are creative and intelligent with interests that can quickly become obsessive, but they also lose interest just as quickly due to their impulsive and unappeasable character. Carpe diem is the BPD’s modus operandi whenever elation reaches critical mass, but scorched-earth policies are not far behind whenever they feel disrespected or rejected. Borderlines are very passionate and affectionate people, but it’s a passion propelled by pathology and percolating with unease. Not being allowed to individuate or express themselves during childhood, Borderlines will work hard to become someone whom they believe others will admire. In fact, Borderlines will generally work hard at any activity that provides them with a sense of control, validation, and completion (BPD determination should be bottled and sold on the black market). Their goal is to avoid feeling flawed, invisible, or damaged by portraying an idealized version of themselves through appearance, material possessions, or externally validated accomplishments. When image is everything, you’re interacting with a person who has learned to survive through the art of single-mindedness, presentation management, and mirroring. Many Borderlines are know for their sultry sensibilities, sartorialism, and effortless ability to command the attention of others. Because a BPD’s inner experience is feeling like they don’t exist, extraordinary efforts are sometimes made to obtain positive affirmation from society. For example, BPD males may present with a hyper-masculine persona that exudes bravado, whereas BPD females often present with a hyper-feminine persona to offset their core insecurities. Borderlines want to be noticed, accepted, and thought of as desirable, but yet they resent being objectified. Ironically, their loved ones become need-fulfilling objects (object-representation other) by association. Therapists must learn to ignore the client’s window dressing (supernormal stimuli) and pay closer attention to how the furniture is arranged inside the building. In other words, therapists must be good at reading between the Borderlines. The false self is a protective form of misrepresentation; an eminence front; an empty vessel posing as a cathedral. Underneath the BPD’s veneer of well-crafted pageantry lies a cauldron of festering resentment, fear, insecurity, and hostility from unprocessed frustrations. For therapists, they must find a way to respect the person without respecting their defensive costume. Taking the BPD’s false self seriously encourages denial, but falsity of self is not always apparent (the bigger the trauma, the better the wrapping). Borderlines covet the relaxed confidence, happiness, and healthy autonomy of others; a source of endless curiosity and envy. Why can’t they feel like that? Pretending to be well-adjusted is an act that has a very short shelf life. Sadly, Borderlines rarely believe good qualities about themselves, no matter how much others believe in them. Occasional bursts of arrogance are quickly subsumed by fear, and their potential is often stifled by self-sabotage. According to psychoanalyst Donald Winnicott, there are five degrees of the false self. In the worst-case scenarios (extreme pathology), the true self is completely hidden. The false self is required to become so strong that it appears to be the true self. To be sure, BPDs are much easier to recognize when their suffering results in visible disability (i.e., overwhelmed with misery and unable to function). At the other end of the scale, the “nearly normal cases” still retain a false self but are able to meet ordinary social expectations. Basically, the Borderline’s suit of armor has expired, but they refuse to shed their skin. However, once the Borderline’s false self begins to crack under stress, an impressive display of defensive reactivity will light up the night sky. Keep your eyes on the powder keg; avoid being blinded by smoke; and beware of the fireworks.
*Borderlines often place themselves in double binds, and they may incorporate double binds to acquire unambiguous commitment from caregivers. These no-win situations are efforts to preemptively avoid abandonment by asserting dominance, but they’re usually presented as offers that caregivers would be a fool to refuse. Borderlines crave stability, like a live wire requires neutral sources for proper conduction, so they’ll poke and prod to find out what their therapist is made of. Some patients are pejoratively described by the psychiatric community as “med seekers,” but Borderlines could easily be described as “people seekers.” To avoid abandonment, Borderlines need people like diabetics need insulin. More specifically, exclusivity in relationships diminishes feelings of emptiness and aloneness. However, the BPD’s fragmented identity is a foreboding challenge for therapists who haven’t been trained in treating this pathology. The monumental task of core restoration through integration is difficult to address without producing anger or enmeshment. Too little engagement results in accusations of not caring, and too much engagement reinforces dependency. BPDs also have a preternatural antenna for spotting those who appear charitable and approachable, such as easy-going caregivers who are committed to making a difference. To reduce anxiety caused by ambiguity, Borderlines will sometimes work to create an atmosphere of casual friendship and merriment. As a result, the therapist’s temptation to become more amicable and accessible may allow an undiagnosed Borderline to avoid being confronted in ways that would reveal their pathology. Psychotherapy stirs up a lot of emotionally painful subject matter, and BPDs will find clever ways to shut it down by using whatever defense mechanisms they have at their disposal. Having the courage and energy to follow the Borderline’s evasive trail of denial will inevitably lead you to their unresolved emotional wounds.
Fool me once, shame on you. Fool me twice, shame on me. Fool me three times, and you’ve probably developed a characterological disorder that has been fooling everyone, including yourself.
Voices carry. — Amiee Mann
Too much self-disclosure is potentially dangerous when working with BPDs. The therapist’s efforts to relate to the client may result in revealing information that will be used against them later on. Transparency is a double-edged sword that will hang over the head of the therapist like a time-released guillotine. Most therapists do not have the power of prescription. What do they have? The power of conversation, encouragement, reassurance, relatedness, and emotional support. However, the very qualities that make therapists good at what they do (i.e., being attentive, compassionate, considerate, empathic, and accommodating) are the very qualities that can work against them when interacting with Borderlines. Therapeutic conversations that focus on shared experiences are necessary for establishing trust with BPDs, but they could also reinforce an abuser-victim-rescuer paradigm that becomes internalized by both participants. Traumatic bonding with people suffering from Borderline Personality Disorder is common because they need someone to punish as much as they need someone to care for them. The essence of trauma bonding is loyalty to someone who is destructive (i.e., sacrificing your autonomy for the sake of someone’s disorder). Although the therapist may feel like the Borderline’s “rescuing protector,” they unwittingly become the enticing, rejecting, and abusive mother. As the trauma bond is further entrenched, the therapist will alternate between being rewarded for becoming the “good” (available) parent, and being abused by the BPD who is symbolically seeking revenge towards the “bad” (neglectful) parent. This reflexive pattern continues because of the therapist’s emotional investment in meeting the demands of the Borderline, especially when the rewards of caregiving outweigh the headaches. Of course, the therapist will never be able to keep up the pace of appeasement and will lose their bearings if they try. In a bizarre plot twist, the BPD will declare victimization after devaluing the therapist’s “substandard” performance by temporarily seizing the role of the critical and punitive parent. When this occurs, the Borderline becomes the judge, jury, and executioner of the “inadequate child” who is now represented by the therapist. However, the inadequate child is a projection of the patient’s own feelings of inadequacy. After the therapist has been punished for their “inadequacy,” the BPD resumes the role of the abandoned-wounded child in need of a rescuing protector. Confused yet? In this mangled network of role-playing madness, the Borderline surreptitiously obtains power over authority, only to end up in the same place before they entered therapy. Cluster B chicanery is stranger than fiction.
Borderlines can be very open about personal information, sometimes to a graphic degree, but therapists must remain dispassionate. Do not get caught in the BPD’s tsunami of effusions or efforts to procure collusion through overidentification. Furthermore, avoiding discussions about the limitations of therapy with a Borderline only postpones the inevitability of future disappointment and abandonment rage. Talk is cheap, but the consequences of misguided communication are not. Borderlines take things personally, literally, and have difficulty understanding figurative speech. They need reassurances that are concrete, but absolute compliance with their expectations is futile. Volunteering to become a clinical marionette at a BPD’s disposal is nothing less than professional abnegation that gradually occurs as a consequence of trying to please the unpleasable (it’s common for Borderlines to think of therapy as a form of customer service). It’s better to speak cautiously and carry a big boundary. Therapists who are non-confrontational must find ways to engage in measured confrontation when necessary. It’s important for therapists to practice being assertive and comfortable with their own aggression. If the bargaining chip of self-sacrifice is enacted (masochistic surrender), the therapist is headed for an impossible task of perpetual mollification. For example, repeatedly soothing a cancerous outbreak with corticosteroids may temporarily reduce pain and inflammation, but it won’t remove the patient’s tumor. Borderline Personality Disorder is a form of emotional cancer. In some cases, it can metastasize beyond remediation (e.g., delayed diagnosis with poor prognosis). The compulsion to appease a person with BPD may also occur if the therapist is reminded of urgent demands imposed upon them by their own family of origin (i.e., having a Cluster B parent). However, Borderlines identify with suffering because being in pain was often the only way they received nurturing from a caregiver during childhood. Although BPDs may plead with others to resolve their suffering, they’re ultimately too afraid to let go of what they know best. Attempts to remove a Borderline’s agony through reparations only provides more attention to their suffering. In other words, the BPD’s subconscious motivation is to continue suffering rather than working to coordinate a successful relief program. The most terrifying prospect for a Borderline is to take away their emotional dependency through exposure, because emotional dependency minimizes abandonment anxiety. BPDs want to be saved from themselves, but yet they resent being rescued because they feel at home with their maladaptive version of self-determination. In addition, Borderlines will unconsciously use therapists to fulfill object-other roles that were denied in childhood (i.e., the “perfect” parent), or fantasies unattainable in adulthood (i.e., the all-giving partner). Likewise, therapists may capitulate for purposes of correcting former attachments gone awry in their own life, or to receive affirmations of caretaking competency. The chemistry of familiarity is a toxic brew, and it all starts with a conversation.
Lookin’ for love in too many faces. — Johnny Lee
Strong transference by the Borderline and countertransference reactions by the therapist will undoubtedly emerge as sessions progress. Countertransference occurs with all mental health patients, but it’s particularly problematic with BPDs. Masterson (1990) views countertransference as a prominent issue with borderline patients because the phenomenon “combines the intensity of the patient’s transference acted-out projections, and the human vulnerability of a therapist.” Additional therapist-client transference problems may occur because of age, shared interests, family of origin similarities, historical commonalities, and other forms of overidentification. Furthermore, Borderlines will engage in mirroring to create the illusion that they are “the same kind of person” as their therapist. In such circumstances, the therapist may feel like they’re interacting with a version of themselves. The reality is that BPDs are not masters of mirroring, it’s just that they’re imitating some of the therapist’s most obvious characteristics to attenuate their own anxiety. In the process, the therapist will naturally respond in a positive way (i.e., smiling) and they’ll hold onto that response as a way of creating an “unmovable stereotype.” Because Borderlines lack whole object relations, they’re stumbling around to “see what you’re made of.” The therapist is basically being essentialized and instrumentalized, even though it may feel to them like the client has really figured them out. By copying the therapist’s behavior, or by agreeing with his or her values, it gives the Borderline a false sense of security (downloading an identity for themselves in an attempt to stabilize their object inconstancy). The mirroring is often inaccurate and clumsy, but therapists may get caught up in the flattering effects of being emulated. However, BPDs don’t want others to deviate from their internalized caricature. As a result, their “essentialized” version of others is invariably inflexible and profoundly unrealistic. Whenever you start to move away from this absurdly rigid characterization, they panic and then immediately respond with devaluation. Borderlines have no idea who you are, because they have no idea who they are. A BPD’s fear of abandonment means they also fear the abandonment of their internalized representations. Similarly, the therapist may automatically internalize the BPD’s false self and become shocked when the client deviates from this image. Remember, the intimate nature of therapy is magnified whenever working with Borderlines because of their intense need for attachment (an infectious intensity). Borderlines like to be liked, and therapists like to be appreciated by their clients. However, communicating with BPDs is a bewildering lesson in psychological hermeneutics, and understanding what’s really being communicated requires a great deal of careful analysis. For example, idealization (aka “love bombing”) of the clinician is a splitting phenomenon with BPDs who become overly attached. Idealization is both a defense mechanism and a way to acquire positive mirroring, but it’s also a form of misrepresentation. Borderlines are very good at making others feel good about themselves (idealization is “cocaine for caregivers”). Being zapped by the stun gun of idealization can prevent therapists from seeing who their client really is, or what they’re capable of after the compliments fade. When a therapist is immobilized by encomiums, the Borderline patient is often seen as innocuous, friendly, alluring, or endearing. Not surprisingly, most therapists enjoy being admired for their efforts to provide support, comfort, advice, and reassurance, regardless of the BPD’s tendentious proclamations. After all, therapists are human beings who have their own needs for validation in an otherwise thankless and emotionally grueling profession. Nonetheless, this “admiration” can have a trapdoor that includes eroticized transference (an intense, vivid, irrational erotic preoccupation with the therapist characterized by overt, seemingly ego-syntonic demands for love and sexual fulfillment that goes beyond normally expected expressions of erotic transference). This transference dynamic can intensify because the therapist is literally paid to pay attention to their client through empathic attunement and unconditional positive regard. Idealization will make a therapist feel valued, but it has no intrinsic value. If, for example, the therapist misinterprets the Borderline’s idealization for genuine appreciation, a chain of events may result in the client’s desire to establish a corrective relationship. In such cases, the therapist may feel simultaneously drawn to the BPD’s desperate need for connection and express malignant eroticized countertransference, especially if the therapist is unable to displace their own feelings (a Borderline’s attachment needs can activate mirror neurons and release bonding hormones, such as oxytocin and vasopressin, during close encounters). Likewise, fantasies of “making up” for the client’s dismal past might happen if the therapist’s positive countertransference is not monitored with sufficient reality testing. The idea of heroically helping the “helpless” is seductive because it induces caregiver’s grandiosity (aka the Healing Complex). In this sense, the patient’s idealization of the therapist may result in reciprocal idealization of the patient, and this mutual admiration is often reflected in the clinical documentation. As therapeutic dialogue resumes, the Borderline’s intense need for attachment may become increasingly problematic for therapists who fail to identify or manage countertransference reactions. The power of this pathology can be difficult to resist once co-idealization has been solidified. Idealization transference is a clandestine invitation by the BPD to establish an uninterrupted symbiotic connection (“If you are good, I am good”). For the Borderline, caring is often conflated with physical demonstrations of intimacy, but their dynamic sexuality is infused with apprehension and rage. History shows that the human intellect is no match for the power of eros. It turns out that Freud was right after all.
“Because of the centrality of projective identification in the experience of treating borderline patients, therapists often feel invaded and transformed into someone other than who they are. Attempting to resist this transformative process can be a formidable problem. Firm boundaries and reasonable limits will eventually reduce the patient’s infantile demands. When the therapist refuses to be the idealized, perfect parent, patients will ultimately learn that they must become their own mothers—the wish to fuse and be fed must be turned inward,” says Dr. Glen Gabbard. As Masterson (1976) noted, “Probably the single most difficult skill to acquire in psychotherapy of borderline patients is the ability to recognize and control one’s own identification with their projections.”
From an article in the Clinical Social Work Journal entitled The trainee and the borderline client: countertransference pitfalls: “Countertransference will be broadly defined as distorted thoughts, feelings, and attitudes toward the client, either consciously or unconsciously held. For the borderline client, the definition should be expanded to state that the countertransference is a response to the transference inspired behavior of the client. Borderline transference will be defined as a manifestation of the borderline psychopathology, which involves relating to the therapist as a tantalizing omnipotent, but potentially abandoning, parental stereotype. It is based on primitive object representations that are largely unavailable to the therapist. The transference contains magical expectations of infantile wish fulfillment that, if unwittingly encouraged, cause numerous problems for the therapist.”
Rule of thumb: Never go full-transference gratification. The key to avoiding countertransference pitfalls is to recognize when countertransference is occurring. Getting lost in the drama of transference enactments happens when therapists lose themselves during the process of pacifying their patient. Enabling by accident can result in some very serious accidents.
We’re far from the shallows now. — Lady Gaga
Borderlines can pressure therapists into becoming “psychosocial saviors” if their purported tales of victimization and historical discrepancies are not thoroughly investigated. Fear and denial keep BPDs from doing any emotional heavy lifting, so they become experts at deflection by reorganizing factual accounts to avoid personal responsibility or feelings of shame (experiential avoidance). As a result, therapists might feel responsible for doing more than they should if they’re swept away by the BPD’s anecdotes of adversity. Therapists are trained to be of service to those in need (public servitude), and Borderlines survive by getting others to serve them. Unfortunately, much more will be expected than the therapist can provide because of the BPD’s lack of object constancy and inability to self-soothe in a healthy way. It could be argued that object inconstancy represents the core of this disorder. A Borderline’s identity diffusion and fear of abandonment are likely epiphenomena caused by the undeveloped mechanism of alterity that allows for object constancy. This would also explain the incessant trust issues endemic to this personality disorder. Genetics and insufficient maternal bonding during infancy are sufficient factors for incurring this deficiency, but additional trauma during early childhood only makes the problem worse. If this premise is correct, it would explain why a person with BPD has poor “psychosocial proprioception.” Everything is ridiculously ephemeral, and nothing is ever safe enough, good enough, reassuring enough, caring enough, etc. Meaningful change is intolerable because it’s a simulacrum of object inconstancy, hence active-passivity (if ever there was a contradiction). Other people are as perceptually inconsistent to the a Borderline as their emotions and moods, thus resulting in fear, paranoia, and all the fun stuff that follows. How can something (self or others) be trusted when it’s never in the same place twice? The world is pivoting on the BPD’s lack of object constancy and everything is disappearing (abandonment). In fact, the therapist could end up responding like everyone else in the Borderline’s life—attending to the never-ending needs of a desperate foundling in search of a supportive audience. When this occurs, the therapist will be baptized as the patient’s object-constancy generator. However, the more a therapist tries to “solve” these developmental deficits by becoming a taskmaster, the more unsolvable these deficits become (the tar-baby dilemma). The therapist may unknowingly represent the most recent target in heavy rotation on the Borderline’s take-care-of-me carousel.
From the American Addiction Centers: “People with BPD have relationship issues with nearly everyone in their lives, and significant relationship issues will often develop with therapists as a result of the therapeutic process of change. The patient may first idolize the therapist and then later totally demonized them (splitting), or may attempt to manipulate different therapists against each other in order to manipulate the overall treatment. Professionals who treat people diagnosed with BPD must be aware of these potentialities and even expect them to occur. Unstable personal relationships within treatment itself as well as outside treatment contribute to the difficulty of helping these individuals adjust.” However, the limited time frame of therapy is not equipped to withstand such relentless permutations of interpersonal stratagem. As a consequence, the therapist may begin entertaining taboo thoughts of attending to the client’s psychosocial “emergencies” outside of a clinical context. Without maintaining boundaries, the therapist will no longer be able to maintain objectivity; without maintaining objectivity, the therapist will forever be trying to extinguish the BPD’s peripheral complaints instead of addressing their core issues. Borderlines unconsciously manufacture their own misery, but they can make anyone who attempts to alleviate their misery even more miserable. Like a swift water first responder, the therapist will drift farther and farther down the gauntlet of BPD appeasement until the rescue raft of good intentions finally capsizes. The helping profession of psychotherapy encourages the development of a strong relationship to help the client, but it’s the professional aspect of the relationship that must be prioritized whenever working with Borderlines. In the BPD motorcade, the wheels of impulsivity are always out of brake fluid—it’s like having a hyperactive limbic system for an engine without access to a steering mechanism. If the therapist mistakenly hands over the car keys, the Borderline will drive everyone off the nearest cliff with their busload of needs. Meanwhile, the therapist should prepare to be thrown under the bus whenever those “needs” are no longer being gratified. It’s the parable of the scorpion and the frog writ large.
Dr. Thomas Gutheil describes the “you’ve gone this far” rationalization for boundary crossings, in which the patient points out that some boundaries have already been crossed and thus further transgressions are required or demanded: “Therapist guilt about past boundary transgressions may be the driving force behind agreeing to continue. Conversely, threats of complaint about early boundary issues may frighten or coerce the treater into continuing or expanding the crossings.”
Change begets change as much as repetition reinforces repetition. — Bill Drayton
Addressing the continuous demands of a Borderline is like experiencing The Myth of Sisyphus on methamphetamines; it’s utterly exhausting. There’s not enough coffee in the galaxy to keep up with a Borderline’s level of impulsive energy. BPDs will make six impossible demands before breakfast, but any effort to fulfill these demands will result in six more demands before lunch and dinner. BPDs are mental health patients without patience; they must win the war of acquisition through attrition. Adrenaline prevents boredom, because boredom breeds dysphoria. The problem is that Borderlines largely identify with the drama of their problems, so any attempt at remediation threatens their victim identity. Lacking in object constancy, there’s never enough words of reassurance or altruistic gestures to placate a BPD’s need for consolation—you might as well be sweeping a dirt road. In such circumstances, the therapist may find themselves making promises equivalent to the demands of the Borderline in an effort to reduce emotional reactivity; attenuate impatience; soothe anxiety; or to continue receiving accolades as an intrepid caretaker. As this temerarious gambit commences, the BPD will invariably become more dependent on the therapist’s attempts to stabilize their moods. Meanwhile, therapists may become “addicted” to eliciting positive changes in the BPD’s emotional state. The Borderline’s ability to reshape the therapist into becoming a more responsive caretaker provides an insurance policy for maintaining centrality. Predictably, a therapist will feel professionally authenticated by the BPD’s compliments and gestures of lavish appreciation—willing to risk more and more for the sake of accommodating their client. Therapists who allow clients to take advantage of their generosity often have people-pleasing tendencies (therapy sometimes encourages dependency with clients who lack self-efficacy as a consequence of the power differential—implicit in the medical community is the suggestion that you’ll be taken care of when you’re suffering). It’s easy in these situations for therapists to feel revitalized by offering levels of emotional support, comfort, and advice that are supposedly unavailable to their client in other contexts. After all, if positive psychology teaches us that finding a sense of meaning and engagement is curative, nothing could feel more meaningful for a caregiver than assisting someone who appears helpless and unambiguously appreciative. However, the BPD’s veneration of the therapist is always contingent on a continuation of appeasement within the therapist-client validation pyramid scheme. No matter how intoxicating reciprocal validation feels during the ascending honeymoon period with a Borderline, the end result will invariably lead to emotional bankruptcy, disappointment, and rage. Although idealization is a potent dopamine generator, therapists should take immediate precautions if they become the subject of excessive pedestalization. Adulation by BPDs is followed by animosity; the cling comes before the sting. Borderlines and caretakers can become lock-and-key participants in a swamp of creeping codependence, and this indelicate union involves countless caveats. BPDs will use luminol to expose the bleeding hearts of anyone who is willing to be subservient to their emotional needs. Once the lifeblood of caregiving capitulation is located, Borderlines become merger-hungry hemovores of opportunism.
I went down, down, down and the flames went higher. — June Carter Cash
The therapist might regrettably believe that professional boundaries aren’t going to be effective in addressing this client’s needs. In fact, the therapist may have never encountered a patient who is so oblivious to standard rules of engagement in a clinical setting (BPDs were often raised in households without personal boundaries). Lacking in alterity, the separate identity of the therapist is not recognized by a Borderline; it’s internalized, “reformulated,” and instrumentalized when idealized and externalized and repudiated when devalued. In fact, the therapist is unknowingly fulfilling designated roles based on the needs, fears, and fantasies of the patient. The word inappropriate is commonly used to describe BPD behavior, because Borderlines cannot relate to others in age-appropriate ways. Borderlines encourage regression and discourage differentiation. Conversely, therapist must encourage differentiation and discourage regression. If a therapist feels intimidated by the client’s aggressive demeanor and infantile demands, a “Borderline Without Borders” situation will eventually consume the therapeutic frame. Additional fears of being perceived as uncaring or inaccessible during therapeutic interactions may cause therapists to feel guilty or inadequate. As a result, exceptions to standards of care are made to keep their “special client” engaged (aka VIP syndrome). BPDs occupy a privileged position as mental health clients, because they often respond in treatment according to the whims of an unruly child while being granted the respect and legal rights of an adult. In some cases, therapists may feel as if they’re being negligent by upholding professional standards. Borderlines also have an aptitude for making others feel responsible for their feelings, and the gravity of this burden can turn some caregivers into deferential doormats. Crying spells during periods of despondency may compel therapists to provide comfort through proximal reassurance. Of course, comforting a Borderline is like trying to diffuse a bomb if you don’t respond according to their expectations (anything you do, or say, or don’t do, or don’t say has the potential to upset them even further). The BPD’s intense psychological pull has the capacity to draw therapists into their kaleidoscopic world of emotional mayhem. Furthermore, an erroneous belief may emerge that accommodation must dictate the direction of all future interactions. In other words, the rules of therapist-client engagement become secondary as the therapist is provoked by growing confusion. In everyday relationship circumstances, it’s advised to limit or avoid contact with those suffering from untreated personality disorders; however, therapists have no other options but to engage with caution, or to initiate an appropriate referral if one is available. Subsequently, over-involved therapists may already be digging their own clinical grave sites. To be sure, Borderlines will defy boundaries without compunction while expecting caregivers to suspend the reigns of professionalism if therapy is perceived to be uncomfortable or uncaring. BPDs can “play nice,” but only if you’re following their shifting rules and expectations. BPDs do not trust others because they couldn’t trust their parents; furthermore, they can’t trust themselves. Most importantly, therapists must not let their objectivity become a slave to the Borderline’s subjectivity. If a boundary free zone is established, therapists should expect an escalation of efforts by the BPD to dominate the direction of all subsequent interactions. Whenever the floodgates of unconditional acceptance open up, Borderlines become Dionysian tornadoes bent on annihilating the Apollonian structures of psychotherapy. BPDs can be rewarding to work with if you know what you’re doing, but you must always be aware of the fine print. The only predictable variable when working with this population is unpredictability.
“This good and bad dichotomy plays out in the therapist’s office. The client may try to entice the therapist to gratify their dependency needs and the therapist may feel compelled to collude with client’s regression. If the therapist does not gratify, but rather confronts the lack of responsibility, for example, then the client may feel abandoned and compensate with rage, seeing the therapist as ‘mean’ and not supportive. Therapists unconsciously collude by giving too much advice, not expecting the client to act responsibly in all situations, and tolerating acting-out behaviors. The therapist may fear the client will judge them harshly and leave if they are too confrontational,” states Dr. Patricia Frisch.
- obsession with someone who is considered an authority figure, celebrity, circumstantially unavailable, or of a higher social status
- constantly sending letters, emails, or gifts to the other person
- persistently making phone calls to the other person
- stalking their target of obsession in person or online
- being convinced that the other person is trying to secretly communicate through glances, gestures, or coded messages in the news, television shows, movies, or social media (aka ideas of reference)
- paracosmic fantasy (viewing reality through a lens of complex fantasies and magical thinking)
- creating elaborate but false situations in which the other person is pursuing them, persecuting them, or trying to get in touch with them
- feeling jealous due to a belief that the other person may be in contact with other “lovers” or may not be faithful
- harassing the other person in public, sometimes to the point of being reprimanded or arrested by law enforcement
- losing interest in activities other than talking about the other person or focusing on subject matter related to them
Classification of erotomania has always been object of debate. J. Reid Meloy formulated the hypothesis that there are two forms of erotomania: One traditional form, clinically accepted as delusional erotomania; and another “borderline” type in which there is no clear delusional disorder but rather where there is a major attachment or binding pathology colored by symptoms of continual pursuit and potential violence towards the erotomanic object. This second form of erotomania is characterized by its narcissistic, hysterical, paranoiac, and psychopathic traits. The degree of the disorder is determined by the discrepancy between the object’s emotional attachment to the erotomanic and the intensity of the erotomanic’s attachment to the object. For this type of erotomanic, relational intrusion is persistent and separation from their target is perceived as rejection and humiliation. This perception awakens rage-like feelings of abandonment that could result in chronic harassment, stalking, or death (aka Fatal Attraction Syndrome). The unexpected emergence of erotomania in a treatment setting can become extremely dangerous to the professional integrity and well-being of the therapist while developing a therapeutic alliance. Stalking is a pathology of attachment (Meloy, 1992), often driven by the force of fantasy (Person, 1995). In particular, erotomanic stalking is not amenable to reason and does not respond well to normal methods of deterrence (legal or otherwise). In the end, stalking is about power and control (emotional terrorism towards their target). Unfortunately, patients can become love obsessed with their mental health provider due to the intimacy of therapeutic communication and the nature of therapeutic alliances. Clients who stalked therapists fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders. According to Meloy, “Stalking motivated primarily by a personality disorder and fueled by abandonment rage will generally show a poor response to mental health interventions, especially if the subject is antisocial or worse, psychopathic. In the latter case, treatment should not be considered, since there is none, and aggressive prosecution is recommended to ensure lengthy segregation from their target. Most habitual criminals and obsessional followers are pathologically narcissistic and their intolerance of shame, defensive rage reactions, inability to grieve loss, and compensatory fantasies of entitlement and retaliation should not be forgotten. The abandonment rage fuels the subject’s pursuit, with an intent to devalue the object in real life, paradoxically restoring the subject’s narcissistic linking fantasy to the idealized object.” *Borderline patients do not need an additional diagnosis of erotomania to engage in stalking behavior.
For the erotomanic, negative attention is better than no attention at all. It’s their psychotic melodrama, and your participation is not needed to perpetuate the obsession. Nonetheless, you’re at the mercy of an obsessive, paranoid, and possessive mind. Risk assessment must precede client engagement because fixation becomes the erotomanic’s substitute for healthy human connection. Some delusional convictions can be as compelling to therapists as they are to the client, especially if these beliefs are presented as minimally counterintuitive propositions. Delusions are categorized by the nature of their content, such as persecutory, grandiose, somatic, and erotomanic delusions or delusions of jealousy or reference. If erotomanic delusions are misinterpreted, the therapist may confuse the client’s attachment-driven psychosis with an intense connection that transcends the therapeutic framework. Aspects of the therapeutic relationship can produce misunderstandings about the nature of the intimacy generated and about appropriate boundaries. Empathy or assistance from an authority figure may be interpreted by the erotomanic as evidence of true love. Consequently, the therapist may feel overwhelmed or aroused by the prospects of attending to such erotically charged inducements (i.e., falling in love with the idea of making the client feel loved). As a result, two people become entangled with the power of a delusion. Reality testing breaks down and the distinction between patient and therapist becomes obsolete. It’s a textbook example of folie à deux.
What the erotomanic desires, experts say, is an idealized romance that resembles a spiritual union. As noted in the book I Know You Really Love Me by Doreen Orion, M.D., “An abiding problem with managing these cases is the almost total lack of motivation for treatment. Those caught up in pathological love do not see themselves as ill, but as blessed with a romance whose only blemish is the tardiness of response in the beloved or the interference of third parties (often including the would-be therapist). The benefits of these disorders for the patient should not be forgotten, for they provide some solace for their loneliness, some support for their damaged self-esteem, and some purpose to their otherwise empty existence.”
“The object of affection becomes an ink blot, a Rohrshach test,” says Stuart Fischoff, professor of psychology at California State University, Los Angeles. “Whatever the object of desire says, the delusional lover brings into it anything he or she wants.” In other words, it’s the erotomanic’s movie and your part is not fully revealed until the credits start rolling. Because erotomanics have an egocentric bias, they’re perpetually attributing unrelated information as personal messages from their object of attachment. Not being in contact can be as problematic as occasional contact, because the search for signals (both positive and negative) keeps the erotomanic from feeling disconnected. The pathological process of delusional misinterpretation of perceived signals from the social environment itself may result from poor reality testing due to a failure of social meta‐cognition. In clinical training, therapists learn to put their patient’s welfare before their own, which makes it easy for them to underestimate or deny the potential for danger in certain situations. If the therapist hasn’t been burned alive by the BPD house fire, they may get chewed up in the erotomanic meat grinder. “A lot of the times, people can go on with their life, ostensibly normally and not have any perceived psychotic disorder,” says Meloy, who has stumbled across erotomanic behavior in his patients while treating them for other conditions. “It surprises you. You don’t know that it’s there.”
Characteristic of erotomanics is la belle indifference, which explains how they can profess to love their victims and yet remain so indifferent to the pain they cause them (Zona, Palearea, & Lane, 1998). An erotomanic almost always displays la belle indifference toward the suffering of their victim, and the complete disruption in the victim’s life they have caused. In this way, erotomanics are narcissistic in the true sense of the term; only the suffering they have experienced at the hands of their capricious “lovers” counts, because they believe, with all the unshakeable conviction of delusional truth, that they are entitled to a relationship at any and all costs to their victims (Orion, 1997).
Yeah, yeah, my shit’s fucked up; it has to happen to the best of us. — Warren Zevon
A veritable recipe for disaster awaits therapists who are coping with issues of their own, such as compassion fatigue, major life transitions, marriage issues, family problems, work stress, anxiety, or depression. To be certain, there will come a time in every therapist’s career when their personal problems will match or surpass those of their clients. Improving the lives of others leaves little time for improving one’s own life, and treating an untreated Borderline is an insurmountable challenge if the therapist is not operating on all cylinders. Therapists must suppress their emotions due to the nature of their work, but this occupational necessity can make working with BPDs exponentially problematic. Contrary to professional stereotypes, therapists are not emotionally impervious automatons, and many come into the field replete with their own trauma histories. Therapists, by definition, are expected to be accepting, non-judgmental, calm, and supportive of their clients, but the process of therapy can be emotionally draining. Because BPDs relate to the world through a labyrinth of dysregulated emotions, the therapist must work even harder to manage theirs. As a reminder, a therapist’s unresolved conflicts, family history, stressors, and personal problems will become magnified through transference-induced provocations whenever interacting with mental health clients, but especially when conducting therapy with Borderlines. A reliable axis of balance is required before being able to identify various degrees of imbalance in others. Likewise, losing one’s proverbial mind can sometimes occur as a byproduct of treating those who have already “lost” theirs (e.g., vicarious traumatization and burnout). Working in mental health can be very rough on your mental health. Therapists do not have all of the answers, but they’re often expected to provide quick solutions and immediate relief for clients who do not understand that therapy is a process. Borderline clients, in particular, will pressure therapists with their impatience. However, if therapists acquiesce to avoid conflict, therapy will become a meeting of the minds with two minds short. Burnout can also result in therapists trying to heal themselves by healing their clients. When working with trauma-related issues, desires to “repair” the client may represent an unconscious motivation by the therapist to address their own trauma history (remediation by proxy). Additional problems occur when a therapist in crisis begins to rely on comfort and emotional support from their clients (therapists in crisis cannot adequately help others in crisis). Therapists must not allow social work to become their social life, or else they’ll start to blend in with their patients. Burnout is gradual, so therapists are usually unaware of its insidious effects. Elements that may cause burnout include: lack of control, unclear job expectations, dysfunctional dynamics, oppressive workplace, monotonous tasks, chaotic work environment, high workload, and work-life imbalance. Therapists need therapists too. Without proper self-care, the ability to provide the best care for patients will eventually disintegrate. Errors of judgment can happen when a therapist is under stress. Because the onus for countertransference misadventure is always on the therapist, being fit for duty matters. Being a repository for other people’s frustrations, unhappiness, and horror stories can make therapy a very stressful and isolated occupation.
Well-Functioning is defined as the enduring quality in the therapist’s professional functioning over time, and in the face of professional and personal stressors (Coster & Scwebel, 1997). Therapists have many factors to contend with in life and practice aside from the dynamics of working with borderline patients. The most common personal problems interfering with therapist well-functioning are emotional exhaustion and fatigue (Mahoney, 1997).
For the clinician, it may be just another day at the office; but for the Borderline, it’s survival of the neediest. This is why ongoing supervision and consultation are essential, including a willingness by therapists to accept objective input and monitoring. Therapists shouldn’t be afraid to ask for help. In fast-paced clinical settings, there may be insufficient bandwidth for pursuing in-depth analyses of complicated psychiatric patients. Ongoing administration tasks, demanding clients, and continuous emergencies can condition therapists to become perfunctory multitaskers, adrenaline junkies, and trigger-happy fire extinguishers. Of course, no client is better at building fires than a Borderline. The emotional exhaustion of caregiving is difficult enough without having to manage an emotionally unstable client. The phone is always ringing with bad news. Therapists often feel frustrated by their inability to do more for their patients, and Borderlines will evoke additional feelings of incompetence. Psychoanalyzing a thin-skinned BPD is much more difficult when the therapist is already worn thin from occupational stressors. BPDs can expose a therapist’s deepest insecurities while causing them to question their clinical expertise. Borderlines will figure out the combination lock of amenability to avoid abandonment and hang on for dear life. Without proper training for early identification and comprehensive management of BPD, therapists are potentially lost in an ocean of misapprehensions and clinical missteps. Working with a misdiagnosed Borderline is like conducting therapy in Plato’s Cave, because the client’s fractured identity will present itself as an ongoing mystery—it’s like trying to nail jelly to a wall. If the therapist is not careful, the BPD’s regressive behavior will quickly capture the limelight. Logic is an enemy of the emotionally impaired, so don’t fall for the belief that logical arguments will overcome emotional reasoning. However, if you don’t maintain a rational and non-reactive position, you’ll set yourself up for the Borderline’s emotional ambush. Consequently, the therapist may become a reluctant participant or a willing accomplice in the BPD’s quest for enmeshment. Soon thereafter, a disconcerting array of rationalizations are incorporated by the therapist to maintain denial about their growing sense of fear, obligation, and guilt (FOG). Other reactions may include pity, excitement, anxiety, and fascination. Overall, it’s the fear of how a BPD will react that keeps clinicians locked into a toxic holding pattern of approach-avoidance that mimics the patient’s interpersonal style of approach-avoidance. Therapists spend their days trying to transform the lives of their clients, but Borderlines have a talent for transforming therapists. With BPDs, the Rogerian maxim should be carefully reconsidered with a strong dose of the conditional.
“The limit of the therapist’s caring is often tested through pushing the agreed parameters and boundaries of the patient-therapist relationship. Prolonged engagement with a nurturing therapist can intensify dependency wishes and lead to desperate attempts to engage the therapist when uncontrolled neediness is triggered. The empathic therapist will detect the patient’s desperation and child-like qualities, and naturally respond with rescue fantasies of his/her own. If treatment parameters are not maintained, a vicious cycle may ensue entailing progressive regression to a helpless, infantile, and dependent state, alternating with rage and/or self-destructive behaviors. The therapist has the feeling that he/she is in the midst of a feeding frenzy,” warns Robert J. Gregory, M.D.
And you may ask yourself, am I right? Am I wrong? And you may say to yourself, ‘My God! What have I done?’ — David Bryne
Pervasive patterns of acting out conveniently thwart BPDs from exploring the origins of their neuroticism. As a result, they never learn to effectively cope with deep emotional wounds. Although dissociation and confabulation obviates emotional pain, it ultimately prevents introspection and results in more sensation-seeking behaviors. Borderlines, if they are anything, are invariably misunderstood by others. Similarly, they abhor personal criticism and do not appreciate humor at their expense (everything is personal). BPDs believe that other people must acknowledge their persistent feelings of emptiness and emotional suffering. It’s about their feelings, not yours. Borderlines understand the value of the squeaky wheel, but they’ve forgotten the parable of crying wolf. BPDs are not looking for solution-based therapy as much as they’re looking for reassurance, validation, and collusion. Therapy with some clients is like trying to teach someone how to walk again, but Borderlines will become obsessed with the crutches. In addition, BPDs rely on others for advice that is seldom integrated in any meaningful sense (solution implementation is a problem for Borderlines due to active passivity). A therapist’s decision to suspend protocol for purposes of alleviating a BPD’s unabated separation anxiety and recurring pathos is just around the corner.
“The ongoing temptation in the psychotherapy of borderline patients is to try to provide gratification for longings that cannot possibly be satisfied in a professional relationship. Indulging the patient’s wishes is a strategy bound to fail and also bound to engender regression by reinforcing infantile expectations, which will only intensify the patient’s eventual rage,” states Dr. Glen Gabbard.
Despite their age, Borderlines must be approached with adequate caution and consistent restrictions. Because of their emotional instability, immaturity, and impulsivity, propitiation is a mug’s game. BPDs prefer to outsource causation for their behavior because it prevents the pain of self-reflection. There is no such thing as contingency planning or critical thinking for a mind overwhelmed by emotions. The biggest mistake a therapist can make with a Borderline is to interact with them as if they were rational adults with an age-appropriate sense of personal responsibility. No therapist wants to infantilize an adult client, but BPDs sometimes require Romper Room referees more than collaborators. As a defensive response, therapists may become aloof or hostile (negative countertransference) to compensate for the Borderline’s periodic temper tantrums. However, being too reserved or defensive could lead to accusations of being distant, cold, uncaring, cruel, or judgmental. This oleaginous tightrope is even more hazardous if the therapist is unaware that such boundary testing maneuvers are part of the BPD’s need for unambiguous acceptance. What initially felt like a once-in-a-lifetime clinical opportunity to help someone in need could result in occupational suicide if accidentally mishandled.
But then you let me down, when I look around; baby, you just can’t be found. — Madonna
Borderlines often seek support from those with limited availability because they anticipate abandonment in advance. Of course, whenever this “doomed attachment” is disrupted, their object of adoration will quickly become an object of aversion. Borderlines view separation as betrayal, and perceived rejection by a caregiver will provoke abandonment rage. Without the availability of a compliant object for emotional support, the former idealization of the therapist quickly evaporates as the BPD’s fear of abandonment begins to surface. Borderlines will search for malicious intent where none exists, and their primary mode of communicating disappointment is through reactionary rage. Without being able to regulate their conflicting emotions, and without being able to make sense of others (lacking in whole object relations), vilification ensues. Sadly, the therapist has been conditioned by the warm glow of being considered an ideal caregiver and will be confused and terrified when “the turn” appears. The emotionally starved and competitive Borderline wants love to be a possession, whereas the therapist may become lovesick in their pursuit of healing the client. BPD relationships alternate between gluttony and starvation; it’s all or nothing. Ironically, assisting Borderline clients can initially feel invigorating for therapists—the rest of the world disappears as the caregiving lens focuses on rescuing the needy. However, the therapeutic lifeboat will invariably hit an iceberg of Borderline indignation before caregivers come to their senses. BPDs prefer continuous streams of validation instead of being challenged, and they’re remarkably proficient in achieving such ends. Any ambiguity in the Borderline’s search for acceptance is terrifying, and the prospect of change is unbearable. Borderlines seek stability, reassurance, approval, safety, and unambiguous gestures of affection, but it ends up being at the expense of significant others, family members, friends, and primary caregivers.
I am because my little dog knows me. — Gertrude Stein I am because my little dog won’t leave me. — Borderline
According to Dr. Robert J. Gregory, “Persons with BPD have been noted to have a need for certainty and for complete understanding from others (Bateman, 1996; Shapiro, 1992). They employ a binary system of logic and attribution that excludes alternative perspectives that may create ambiguity. For example, they may tell their therapists, ‘If you really cared about me, then you would let me call more often. All you care about is your money.’ On the surface, the proposition appears logical and irrefutable. However, there is an underlying assumption that the therapist’s primary mission should be to care and nurture their patients like a mother. There is also an implied dichotomy or split in the perspective of the therapist as either totally caring and accommodative, or totally cold and callous. There is no room in such a polarized attribution system for a more ambiguous and realistic perspective of the therapist as having complex motivations, including some genuine caring for the patient, but within certain limits. What makes working with this population so difficult is the patient’s ability to provoke others into responding in a way that is consistent with the patient’s attributions and expectations. In other words, the patient expects others to behave in a certain way, and the therapist may feel compelled to behave in a way that is consistent with the patient’s expectations—an interpersonal process that has been called enactment. The confluence between the patient’s expectations of others and the actual behavior of the therapist results in reinforcing the patient’s expectations and the distorted attributions of self and other upon which those expectations are based. Therapists may have a difficult time discerning whether negative encounters with a patient resulted from the patient’s attributions and responses or from the therapist’s responses.”
Dr. Perry D. Hoffman, president and co-founder of the National Education Alliance for Borderline Personality Disorder, explained one of the defining aspects of the disorder: “It occurs in the context of relationships. Unlike other psychiatric diagnoses, if you put someone with schizophrenia on an island all by themselves, their mental illness would still be evident. If you put someone with BPD on an island, you wouldn’t necessarily see the symptoms—whatever happens, happens in the context of [interacting] with someone else.”
Instead of becoming a storm chaser, it’s better for therapists to understand the nature of the storm.
I’ve waited hours for this; I’ve made myself so sick. — Robert Smith
Because Borderline Personality Disorder is essentially an attachment deficit disorder, the client’s approval-seeking behavior, neediness, and search for unconditional love is often insurmountable. However, overly attentive responses to the accumulating demands of BPDs will result in an unavoidable crash landing. The problem is that therapists have been issued the caregiving equivalent of a pilot’s license and will be held accountable for any loss in therapeutic altitude. To be sure, many support planes have disappeared while flying solo over the Borderline Triangle. However, if BPDs could rewind the flight recorder, and muster a modicum of objectivity, they would find themselves bombarding the analytic cabin space and taking over the control panel. Just as the therapist has misinterpreted the client’s tales of victimhood, the BPD will undoubtedly misinterpret the therapist’s efforts towards appeasement and feel betrayed if extraordinary caretaking promises aren’t kept. This potentially high-conflict personality can become extremely volatile if their chosen “protector” appears to have forsaken them on purpose. After all, the therapist has been providing a steady supply of validation, reassurance, and emotional support in a safe holding environment. Unprepared therapists will be marinating in a clawfoot tub of Cluster B bathwater before waking up to find themselves circling the drain. Emotional riptides in the Sea of BPD can quickly sweep therapists into shark-infested waters. If the Borderline’s sense of identity is experienced as being dependent upon a stabilizing other, the therapist has just abrogated the client’s recognition of self; it’s like denying refills on life-saving medication. The remediation of this disorder depends upon the availability and compassion of others, but this disorder is also perpetuated by the availability and compassion of others. The therapist has unwittingly been serving as the BPD’s missing internal part, and now that part is wearing out. In the end, Borderlines will pull the rug of congeniality from underneath their caregivers whenever the support cart goes off the rails (cessation trauma). The Borderline’s dichotomy of self will vacillate as the previously dependent victim quickly becomes the omnipotent avenger. With record-breaking speed, the former idealization of the therapist is replaced by a 180-degree devaluation phase. A critical threshold of stress has been reached and the Border-lion within has been unleashed. Negotiation is pointless—it’s like trying to simultaneously de-escalate and outrun a cheetah. Uncomfortable feelings are not permissible, and the most negative and paranoid interpretation of events will be the BPD’s final interpretation. No catastrophe left behind. What was once an entirely “good” object is now a completely “bad” object (splitting), because there is no middle ground in the Borderline’s world of internalized object-representation. An overwhelming desire to feel safe again compels BPDs to bifurcate people, messages, and situations into digestible categories. Borderlines consistently put their needs at the forefront, so any sudden reduction in narcissistic supply will always end badly. If the therapist acquiesced to meet the needs of the Borderline until now, there must have been an ulterior motive (they might even make bold assertions about the “sinister motivations” of the therapist). In fact, most BPDs don’t know how to interpret generosity or compassion because of the contingent “love” offered by their parents (i.e., rewards followed by punishment and vice versa). A therapist can work overtime to develop trust with a Borderline, but the client will ultimately decide when that trust is broken, or if it was ever “real.” Building trust through reassurance with a BPD is like making multiple deposits in an account that never accrues interest and declares insufficient funds when it’s time to withdraw your savings. The Borderline’s performative paranoia is unavoidable—even the most innocuous comments or gestures can trigger fears of rejection. The resulting devaluation may include verbal attacks, physical assault, and other forms of angry retribution as their self-fulfilling prophecy of abandonment continues unabated. Most disturbingly, BPDs are unable to recognize the unreasonableness of these behavioral discharges during or after contentious interactions, even if they struggle with guilt or embarrassment. Memory and composure collapse because they’re reacting in an altered-dissociative state. Shame is avoided by projection. Bad feelings are disowned by demonization. What cannot be integrated must be eliminated. Destruction galvanizes the Borderline’s sense of power within chaos, and power is affirmation of their existence.
“Borderlines display a signature trait, poor observing ego, which is a dense denial of vital aspects of reality and irrationality to a degree that almost has to be seen to be believed,” says Dr. Daniel J. Zimmerman. Identity disturbance is evidenced by the BPD’s intense and tumultuous attachment to their love object. They yearn for affection, yet may eventually wish to destroy the love object, or significantly devalue the person’s life. The gratifying sensation of vengeance makes resentment feel justified as the “bad” parent is symbolically punished in a dramatic fort/da reenactment. In order to protect themselves from unbearable disappointment, the Borderline will attempt to regain a sense of control over what they perceive to be an invalidating experience (impulsive BPD subtypes with antisocial features are particularly prone towards destructive recrimination whenever enmeshment is threatened). The angry-impulsive child is experienced by the BPD’s intense rage that is rooted in childhood resentment for not receiving proper parental care. Borderlines must feel a sense of control over others, and they’re easily capable of destroying what they cannot have. The beauty of shared experience is reduced to a competition for supremacy.
“The spoiler child refuses to grow up, remains dependent in some way on the parent or a parent surrogate, and ruins and/or denigrates everything the parents try to do for them,” states Dr. David M. Allen. “The spoiler role is difficult to maintain, so the child needs to continually practice it with other people. The usual candidates for them to practice on are lovers, spouses, and of course therapists. No one else will continue to put up with them.” The phrase no good deed goes unpunished has come home to roost.
The end may justify the means, as long as there is something that justifies the end. — Leon Trotsky
Borderlines often reframe events for advantageous purposes, but retrospective discrepancy identification will separate what is true from what is exaggerated or false. BPDs are poor historians, because the past is written on the pages of their emotions. Facts are replaced by feelings. The arc of chronology is contested by the Borderline’s perceptual distortions in such a way that removes fault on their behalf. Confronting and coping with feelings of shame is not going to happen on the BPD’s dysregulated watch. Part of this disorder is the person’s inability to see their obsession with control and emotional reasoning as disordered. For the Borderline, what feels right must be right! BPDs seek immediate emotional relief, even if their behavior is irrational, dangerously impulsive, and consequential. Borderlines do not see their part in causing or contributing to their problems, because admitting such agency would require an uncomfortable awareness of unresolved emotional wounds. Likewise, BPDs believe that most of their problems in life are caused by external factors because they cannot sit with themselves long enough to accept what they’re forever running away from.
Therapists will reignite wildfires of neediness if they try too hard to soothe a Borderline’s emotional flames—transforming themselves into volunteer firefighters searching for the next batch of smoke. Doing too much for these patients inevitably results in unintended harm (the Hippocratic oath is eventually replaced with hypocrisy by proxy), because Borderlines don’t know what’s best for them. BPDs must learn how to make the unconscious become conscious, and they must accept responsibility for the unreasonable demands they place on others to avoid abandonment anxiety. Otherwise, they’ll perpetually seek enablers and forestall emotional maturation. Remember, Borderlines are living in a state of arrested development and will overreact like unmanageable toddlers whenever confronted with emotionally challenging situations. Outlandish accusations of imaginary crimes and inappropriate responses can occur in relation to minor inconveniences or misunderstandings. Borderlines would rather be in control than held accountable (not in a punitive way, but in a way that encourages growth), and winning is more important than self-reflection. As a reminder, aggression and defiance are not indicators of self-reliance. The need for enmeshment comes from fear, and fear of losing enmeshment is offset by internalized or externalized aggression. BPDs see the world in terms of love and war, because there are no shades of grey on the Cluster B color wheel—it’s a fixed mindset without middle ground. If the therapist feels personally responsible for the Borderline’s acting-out behaviors, they will put themselves in the impossible position of becoming a designated babysitter (parentification of the provider). However, reparenting is an impossible task for most caretakers, especially when working with highly impulsive and combative adults. Because of their immaturity, BPDs do not recognize the line of demarcation where their needs stop and another person’s needs begin. Assuming that Borderlines are receptive to rational compromise is an erroneous assumption. Normalizing or minimizing the abnormal, however tempting, is the most precarious decision a mental health clinician can make. Professional integrity depends on recognizing the parameters necessary for self-preservation.
“Psychoanalysts view borderline personality as arising from failure by the patient’s mother to foster coherent differentiation between self and object in the first 18 months of life, leading to the development of pathologic ego defenses. The patient does not learn to tolerate negative affects associated with separation; this continues the child’s clinging into adulthood, as if others were desperately needed parts of the self. Sexuality and dependency are confused with aggression. Needs are experienced as rage. Long-term relationships disintegrate because of an inability to find optimal interpersonal distance. Because of inadequate ego mechanisms of defense, there is little ability to master painful feelings or to channel needs or aggression into creative outlets. The patient has a fragmented mental picture of the self and views others as all bad and simultaneously all potent, a chaotic mixture of shameful and grandiose images,” states Dr. James E Groves.
There’ll be someone else where you used to be; the world don’t care and yet it clings to me. — Tom Waits
By using whatever means available, the focus of all future concerns will be relocated to the Borderline’s elaborate amphitheater of victimhood, thereby disabling all possibility of self-reflection and responsibility. Misfortune solicits sympathy from others, no matter how much of this misery has been manufactured. In a Borderline’s binary mind, you’re either for them or you’re against them. The BPD’s desperate longing to use the therapist for positive mirroring has created an unexpected house of mirrors effect. It’s a peculiar gambit that occurs unconsciously for the Borderline: “I have successfully transformed you to serve my needs, but I will use this transformation against you for rejecting me.” An old country song creeps into the frame: I turned the tables on you, now I’m eating your food. The script has been flipped and DARVO (deny, attack, reverse victim and offender) is the new standard. The Karpman Drama Triangle has been played out by two participants on auto-repeat until the rescuer could no longer afford the electricity bill. Unfortunately, the very act of rescuing a Borderline reinforces their early experiences of abuse. Reminders of parental neglect become inevitable when the rescuer fails to match the BPD’s benchmark of idealization. Keeping up with a Borderline’s endless search for emotional satisfaction is impossible, and making customized adjustments to fulfill these unwavering desires only facilitates regression. The therapist, no matter how personally compromised, ethically unmoored, or professionally misguided, will eventually be considered part of a syndicated rejection conspiracy. Borderlines own copyrights to the phrase: It’s you, not me! This risible act of projection restores narcissistic equilibrium in the patient while protecting them from unbearable emotional injury. Accepting responsibility for decisions and behaviors is not part of a Cluster B’s externalized game plan. What was once an ideal caregiver for the clinging child has been cast down as an untrustworthy demon who must be annihilated by the punitive parent (talionic revenge). The “omnipotent” therapist has now become the personification of everyone who has previously disappointed and abandoned the Borderline. As intensified rage propels the BPD down a seek-and-destroy warpath, the chances for conflict resolution are nil (some Borderline’s internalize their rage rather than externalize; some do both). The Borderline’s polarized thinking, projection, seething anger, dissociation, paranoia, amnesia, capacity for mendacity, and revisionism are the perfect building materials for constructing a gaslit firewall to make sure that accountability will always be a one-way street. Confabulation reduces the pain of mortification and loss. Deny and project; rinse and repeat. Because they were hurt in the past, the person with BPD will do just about anything to avoid feeling hurt again. In the Borderline’s extensive collection of defensive battle maneuvers, there is none more famous than blame-shifting. If they can’t change their environment, they’ll blame their environment (some Borderlines will blame themselves, depending on the circumstances). Generally speaking, accepting blame subconsciously reminds the Borderline that they’ll be ridiculed, reprimanded, and punished by their most abusive parent, so the conditioned fear response is projection. High-conflict BPDs, in particular, will blame others for their feelings, decisions, behaviors, and unhappiness (aka “persuasive blamers”). Anyone who becomes attached could be blamed for the Borderline’s dysphoria, and anyone who tries to make their life better may suffer a similar fate. Someone must pay for the BPD’s past, present, and future! There are no limits to these disturbing deficits in self-awareness, because Borderline Personality Disorder is a disorder of the self. Disappointment will not be tolerated, and blame-shifting quickly erases feelings of shame, guilt, and humiliation. If the therapist fails to maintain such impossible standards of care, the BPD will lash out with the ferocity of a wild animal when panic and dissociative rage pushes them into the collapsed realm of F2 psychopathy. Someone unrecognizable has emerged. Lifeless eyes, black eyes, like a doll’s eyes. Welcome to the howling abyss. Who is this person? How could the paragon of love and affection so quickly become the personification of hate? But, you see, this “other person” was always lurking beneath the surface. The switch has been flipped and welcome to the split. A horrified child has been awakened, and there will be blood. In a metaphorical sense, this is where the exorcism has gone wrong. The therapist has uncovered something raw, and now it wants out of its cage. Primal fury and terror are being released without restraint (the irresistible impulse). The Borderline’s reactivity serves to protect their fragile ego, but it also exposes it.
Retaliatory fantasies may become a reality whenever reality comes crashing down on the Borderline; the emotionally helpless becomes an emotional terrorist. For some Borderlines, these episodic meltdowns are so intense that they literally black out from rage. Rejection sensitivity may result in reactive psychosis when coping mechanisms for stress management are absent. Paradoxically, BPDs often feel conflicted about their behavior after their dissociative frenzy finally subsides, but emotional memory blocking allows for revisionism and post-hoc rationalizations. However, collapse results in rumination, and rumination results in abandonment depression. In other words, BPD outrage is eventually reshaped into resentment and carried over into future encounters, thus resuming the cycle. Borderlines sabotage the things they want most in life because they believe that it’s the responsibility of others to make them feel complete as a person—a job that cannot be sustained by anyone. Creating an enemy is how BPDs avoid the fact that they are their own worst enemy (externalize what cannot be realized). Borderlines punish those who act as surrogates for their parents, which means they’re symbolically punishing their family of origin. For BPDs to consider: Threatening someone to love you is probably not the best strategy for long-term relationship success. For clinicians to consider: Allowing yourself to become a human punching bag will result in your own need for trauma-based therapy. It’s not enough for Borderlines to be discouraged by unfulfilled expectations, such disappointment means they’ll spread this surplus of misfortune to their object of opprobrium (the abandoner). It’s a heads I win, tails you lose situation for caregivers. Unreasonably impatient in their wishes for emotional fulfillment, a familiar pattern is repeated. For the Borderline, the mistakes and limitations of others are intentionally designed to cause them pain. After all, it’s what they’ve learned from childhood (no one cares; love is a cruel illusion; people cannot be trusted; and the world is a dangerous place). BPDs falsely believe that everyone hates them, but the reality is that they have learned to despise themselves. Self-hatred was taught to them at a young age, and this hatred will be projected onto their nearest and dearest recipient. Squaring the circle of Borderline determinism doesn’t make the circumference any less chaotic.
“The BPD’s perceptiveness and knowledge of unfair rules of interpersonal play make her capable of shredding the therapist’s confidence and effectiveness. Her neediness and identification with abusers drive her to ruthless extremes with the therapist. For example, a BPD may detect and appeal to the therapist’s need to be seen as a loved and lovable person. She will offer presents, ask to go to dinner, bring a bottle of wine to the session, plead for hugs and kisses, draw the therapist into confessions about his or her personal problems, and so on. If the therapist appropriately refuses to accept these offerings, he or she is called ‘uptight, cold, uncaring.’ On the other hand, if the therapist accedes to any such gestures, he or she is ‘dead meat’ at a later point in therapy when the BPD is angry about the inevitable perceived abandonment. After desperately and skillfully pleading with the therapist to allow such intimacies, the BPD is completely capable of switching to the following: ‘You violated standard professional ethics when you . . . and I am going to [see a lawyer/call your wife/tell my husband/kill myself and leave a note explaining why].’ It is at this point that a therapist can really ‘lose it.’ We therapists are vulnerable human beings. BPDs are victims who have learned the tactics of abuse, and they are willing to use them on caregivers. The BPD is addicted to empathy and nurturance, but it is vital that such support be given in the service of good functioning rather than in service of chaos, misery, and regression. No matter how lethal the verbal attacks, or how seductive the offers from the BPD, the therapist should hold to the basic terms of the therapy contract,” according to psychologist Lorna Smith Benjamin.
I was a peripheral visionary. I could see the future, but only way off to the side. — Steven Wright
What was once believed to be legitimate desperation during a crisis is now seen as pervasive patterns of emotional dependence. What was formerly considered to be justifiable anger derived from victimization can now be interpreted as ongoing manifestations of low distress tolerance, repetition compulsion, separation anxiety, morbid jealousy, and emotional reactivity. What appeared to be moments of confidence, assertiveness, and intellectually justified defiance can now be understood as compensatory grandiosity, externalized aggression, poor impulse control, and a lack of boundaries. Displays of youthful exuberance, offset by periods of terrifying tantrums, have been identified as forms of age regression and emotional instability. What was once thought to be situational anxiety is now understood to be a combination of fear, insecurity, and paranoia. Demands for validation and intimacy have been providing cover for an overwhelming fear of abandonment. An inability to recognize the needs and limitations of others is now exposed as object inconstancy and solipsism due to inadequate mentalization. Unpredictable mood shifts are retrospectively linked to the client’s perceived levels of gratification or disappointment during interpersonal interactions. Idealization and devaluation are explained by the client’s Manichean mindset and zero-sum approach to relationships. People and situations are rearranged to fit the emotional reasoning of the Borderline to obtain a sense of safety and control. Destruction is justified by perceived rejection. What was once a victim of abuse is now an agent of abuse.
Blessed is he who expects nothing, for he shall never be disappointed. — Alexander Pope
Borderlines tend to remember others based on their last encounter: The Great Moment of Disappointment. Everything that was previously done to indulge the BPD’s demands for special consideration will suddenly be forgotten, because holistic integration of interpersonal experiences do not register for this uncompromising competitor. The therapist has been serving as the Borderline’s stabilizing crutch, and removal of that crutch exposes a painful disability. Exposure = death of the false self, which is experienced by the BPD as a form of biological death. If the person suffering from BPD has a “high splash” response when triggered by fear and frustration, there will be hell to pay. To be sure, their formerly cherished caregiver will be left holding the tab. The BPD’s hypervigilant surveillance system obsessively scans for potential insults, slights, disagreements, and signs of rejection to maintain a self-fulfilling panorama of paranoia. Everything is personal, and they’ll interpret any inconvenience or change of plans as a form of deliberate abandonment. The slightest mistake or misunderstanding will be interpreted as a global catastrophe. Deflection and projection. Impulse and emotion. Passion and punishment. Grievance and resentment. BPDs do not have the ego strength or maturity for compromise, and their tenuous image cannot endure mortification. Without compassion for themselves, there will be no compassion for you. Informal resolution is not on the Borderline’s menu, because they demand absolute control over the final narrative. Reject facts and information that counter feelings, because emotional convictions cannot be contested. Distortion (smear) campaigns, exaggerations, false allegations, harassment, legal retaliation, stalking, and other acts of obsessive revenge may follow; sometimes months or years after contact has ended. There are no limits to what can happen when a BPD’s emotional supply source is cut off. The better the fuel, the harder the fall. Grudges never die easily for Borderlines. And don’t expect to get credit for your generosity, empathic consideration, or the tasks you’ve accomplished. Remember, it’s all-or-nothing, no matter how many times you’ve given it your all. In the Borderline’s mind, your beneficence was either disingenuous or a devious plot. Why would anyone care? What’s in it for them? To be fair, Borderlines aren’t aware that such irrationality and destructive overreactions are primitive defense mechanisms to avoid feelings of low self-worth, shame, and abandonment that were formed during early childhood. And, to be clinically concise, the therapist has royally screwed things up because of an initial failure to see the forest for the trees. A series of clinical mistakes has resulted in a series of personal mistakes. The German language contains a splendid word to describe this type of regret-ridden hindsight: Treppenwitz (a devastating rejoinder thought of only after leaving the bottom of the staircase). You don’t have to be an ophthalmologist to appreciate the excruciating lessons of hindsight. The therapist’s professional miscalculations, poor judgment, and personal issues cannot be whitewashed, but expecting the unexpected is par for the course whenever working with Borderlines. Being consistently inconsistent is what makes this disorder so insufferably persistent.
“The Brutal Clock is a variation of the Brutal Test where the Borderline sets up impossible expectations of others. When others are unable to meet these unreasonable expectations, they are punished with emotional abuse, which is justified by the Borderline’s sense of being the victim because they did not get what they wanted,” explains Dr. Daniel S. Lobel.
Free will is the internal forces I do not understand. — Marvin Minsky
A final question remains: Are the Borderline’s cataclysmic reactions to real or imagined abandonment intentional or purposefully malicious? No, not in any normal sense; exceptions involve high comorbidity with features of malignant narcissism, sadism, and Machiavellianism—aka the dark triad—suggesting a “malignant borderline.” The confluence of early childhood attachment disruptions, severe psychopathy, other personality disorder pathology, and a traumagenic abuse history are factors that represent the worst recorded manifestations of BPD. PCL-R Factors 2a and 2b are particularly strongly correlated to Antisocial Personality Disorder and Borderline Personality Disorder and are associated with reactive anger, criminality, and impulsive violence. Although various traits of psychopathy are present among all Cluster B disorders, antisocial behavior for Borderlines is usually a consequence of emotional dysregulation during periods of acute adversity (hence, F2 psychopathy). According to the American Psychiatric Association, the prevalence of BPD in correctional settings is typically higher than in psychiatric in-patient settings (about 20 percent), and more than double that of out-patient mental health clinics (about 10 percent). For those suffering from Borderline Personality Disorder, unfounded paranoia, panic, anger, impulsivity, and severe dissociation are the primary precursors to reactive rampages. An incomplete, incorrect, or emotionally biased interpretation of reality lights a “short fuse” that detonates the BPD’s unhinged behavioral responses. By contrast, there are highly sensitive people who have been misdiagnosed with Borderline Personality Disorder because they vaguely identified with some of the most common traits (self-report is an unreliable metric). Although recognizing BPD traits in themselves, these individuals would not relate to the character portrayal in this fictionalized account. In addition, there’s undoubtedly a segment of Borderlines in treatment who continue to rely on their diagnosis to justify selfish and destructive behavior, but their actual motivations would be difficult to determine with accuracy. This is where the No True Borderline fallacy becomes relevant. For example, people with BPD will say, “I’ve been diagnosed with Borderline Personality Disorder, but I don’t behave like that; therefore, the person you’re describing is not a true borderline.” By contrast, those who are married or related to a person suffering from BPD will say, “I’ve lived with a Borderline for many years; therefore, this is how a ‘true borderline’ thinks and behaves.” In the end, we’re left with anecdotes, varieties of subjectivity, factual accounts, misunderstandings, assertions, beliefs, assumptions, informed opinions, clinically accurate assessments, and elements of truth that are lumped into the ongoing BPD controversy. In reality, many things can be true or false at the same time (we’re all on the honor system). So much depends on the storyteller, the situation, historical patterns, and the evidence. Borderlines will tell you what it’s like to be them, and others will tell you what it’s like to interact with Borderlines. Nevertheless, we must admit that no two people are identical. Generalizations are sometimes useful, but the person and the context will always be somewhat unique. Borderline Personality Disorder exists on a spectrum, just like the experiences of those who interact with personality disordered people. That being said, members of the Cluster B brigade are maestros at invalidating the experiences of others through gaslighting, and they often maintain denial about their own behavioral inconsistencies. Borderlines confuse subjectivity for reality because they lack a reality based ego (the defensive structure of the disorder prevents whole object relations). Partners of Borderlines not only feel like they’re walking on eggshells during these relationships, they also feel like they’re walking on eggshells whenever they attempt to recount their experiences (accusations of ableism are expected). Nonetheless, there are BPD behaviors, beliefs, and proclamations that repeatedly converge like a broken record. Likewise, many people who interact with Borderlines have witnessed these converging patterns as if they were written into a customary blueprint, just ask anyone recovering from a BPD relationship. Borderline Personality Disorder follows a trajectory that is identified over time with many universal features, regardless of severity. The key is to recognize these patterns before becoming entangled with the person’s disorder. Diversity among sufferers is not a vindication of the disorder or its negative effects. If anyone should have animosity towards BPD, it should be those who suffer from it. For the most part, BPDs are hard-wired to impulsively think and behave in ways that will allow them to get their immediate needs met. In other words, Borderlines are aware of their behavior, but they’re not aware that their behavior is generated by pathology (the disorder prevents them from seeing themselves as disordered). They believe their thoughts and behaviors are justified according to the whims of their emotions. So, it could be said that Borderlines intend to get their needs met; their motivations are unconscious; and their behavior is automatic. Bullying, seducing, pouting, coercing, gaslighting, and threatening others to comply with their desires is how BPDs communicate. Causing pain through punishment—towards themselves or others—is a dysfunctional way of signaling that they’re in pain, but it’s all they know. When love is withheld, the world is set on fire. The drama is the point, of course, because chaos fills the void. Emotional reactivity isn’t privy to the concept of courtesy, or having consideration for long-term consequences. Most Borderlines have low distress tolerance, but some have no distress tolerance. Another Borderline paradox: BPDs live in a state of distress; identify with distress; expect distress; create distress; but they cannot cope with stress. As a general rule, the survival of the Borderline will overrule the survival of anyone who gets in their way. Disproportionate reactions to misunderstandings or perceived threats often result in destruction without compunction. You’ll be punished for not maintaining your role in the BPD’s theater of need. But don’t take it personally, it’s just Borderline business. However, the incalculable damage left in the wake of their rage will feel very personal. Hurricanes destroy lives, because natural disasters lack self-awareness and restraint. To be sure, Borderlines are the heavyweight champions of emotional storm systems.
The long-awaited one has come; I ask nothing more of the sea. — Madame Butterfly
A musical analogy for therapy-client relations gone wrong with a Borderline is the ebb and flow of symphonic development. In other words, the therapist’s efforts to appease the BPD were constructed from variations on a simple motif: You are worthy of being loved. Unfortunately, “proof of love” for the Borderline is contingent upon reassurance, unrealistic expectations, and commanding the will of the therapist to avoid abandonment. The tempo of the second movement is similar to that of the first, but subtle changes in dynamism make it more consequential than it may at first appear. The evolution of this unsustainable saga results in a rapid crescendo of dramatic fusion during the third movement towards an ecstatic final stanza. As with therapy, it’s never a single session, but a series of misguided steps over many sessions that move incrementally before resulting in a complex web of enmeshment that has to be unraveled as painstakingly as it developed. Unfortunately, the Borderline demands loyalty and insists on maintaining the emotional intensity of the third movement. If the magnitude of the emotional bond is not maintained, the performer (therapist) will be punished by the BPD who feels immense anger for the abandonment of a quixotic attachment. The therapist, who unfortunately became a volunteer performer in the Borderline’s theatrical search for devotion, forfeited the conductor’s role of mediating between order and chaos. As a result, the therapist has subverted the structure of the compositional (therapeutic) framework, and the disheartened BPD has unleashed a cyclone of emotional turmoil throughout the concert hall.
*It’s important to respect your rhythm instead of trying to keep up with the tempo of a Borderline. In other words, therapists should concentrate on reducing the BPD’s “beats per minute” rather than meeting them halfway, or becoming swept away by their impulsive speed of need. Keeping pace with Borderline time is unsustainable (it’s the accelerated rhythm of hypervigilance) and the frenetic pulse will burn out even the most measured of metronomes. Borderline entrainment is a fast-moving train, and it’s best for therapists not to leave the station.
Assumptions held by BPD sufferers (according to bpdcentral.com):
- I must be loved by all the important people in my life at all times or else I am worthless. I must be completely competent in all ways to be a worthwhile person.
- Some people are good and everything about them is perfect. Other people are thoroughly bad and should be severely blamed and punished for it.
- My feelings are always caused by external events. I have no control over my emotions or the things I do in reaction to them.
- Nobody cares about me as much as I care about them, so I always lose everyone I care about—despite the desperate things I try to do to stop them from leaving me.
- If someone treats me badly, then I become bad.
- When I am alone, I become nobody and nothing.
- I will be happy only when I can find an all-giving, perfect person to love me and take care of me no matter what.
- But if someone who is “perfect” loves me, then something must be wrong with them.
- I can’t stand the frustration that I feel when I need something from someone and I can’t get it. I’ve got to do something to make it go away.
Absence is a house so vast that inside you will pass through its walls and hang pictures on the air. — Pablo Neruda
At the end of the abandonment rainbow, the disillusioned Borderline will be encouraged by sympathetic allies to collect misadventure points while reclaiming victimization. However, the clinician will suffer a much greater loss because professional boundaries were not clarified before sauntering into such a formidable therapeutic landscape. The path by which any therapist deviates from protocol can be retraced, fittingly, by understanding how mysterious the realm of human psychology can be during such unorthodox encounters. Clients with characterological disorders can elicit out-of-character responses in their clinicians. All therapists have professional blind spots, biases, and personal weaknesses, but there is perhaps no client better at uncovering those blemishes than a Borderline. BPDs are searching for the ultimate caregiver to remove intolerable feelings of pain leftover from childhood wounds, and they will go to great lengths to make this fantasy become a reality. For historical clarity, the distinction between pervasive patterns of behavior versus circumstantial aberrations must be identified for all participants.
“We often think of boundary violations and therapist misconduct as being malevolent in nature,” Dr. Bryant Welch writes. “But with a borderline patient, a therapist can get into trouble by virtue of his or her wish to help and have a therapeutic effect. Under enormous pressure to prove he or she ‘really cares,’ the therapist is either going to cross boundaries and/or ‘withhold,’ thus becoming a ‘bad object.’ The grounds are fertile for BPD rage and disappointment in either direction.”
You just keep me hanging on. — Lou Reed
Rationalizations often emerge in direct proportion to the Borderline’s increasing demands for validation and reassurance. BPDs need someone to lean on, but too much safety rope given to a clinging client may become the noose that hangs the therapist. To add insult to injury, it’s embarrassing for any therapist to admit that they’ve become emotionally ensnared with a client as a result of clinical misunderstandings, communication errors, insufficient boundaries, and trauma bonding. Like a surgeon who encounters complications in the operating room, the very act of trying to remove a person’s suffering can sometimes exacerbate it. Many therapists have too much pride in their abilities to call for backup, but backing out of Borderline Boulevard is never an easy ride—there will be damage. The margin of error is very narrow for making clinical errors with a BPD, because forgiveness is not part of their reactionary repertoire. Replacing the parts as they break (fixing the symptoms) will never repair an engine that needs to be rebuilt from scratch. No matter how rewarding the process of empathic appeasement may feel for caregivers, taking extraordinary risks to accommodate a client’s needs is not the same as encouraging them to establish their own sense of equanimity and independence. Becoming too involved with someone who self-sabotages in relationships is itself a form of self-sabotage. Borderline Personality Disorder is a matter of principle and implication. If the therapist understands the principle, they’re in a better position to handle the implications. If not, they’re likely to become a casualty of those implications.
Forgiveness is the fragrance that the violet sheds on the heel that has crushed it. — Samuel Clemens
Specialized training programs to diagnose, effectively treat, and facilitate the management of Cluster B pathologies should be mandatory as a preventive measure to avoid Type II errors in assessment and countertransference disasters. There are more than 200 classified forms of mental illness, and no clinician is an expert on everything. The human mind is a strange place, and it becomes a lot stranger as therapists learn more about themselves while attending to the maladies of their clients. Respecting commonly understood boundaries among consenting adults is usually taken for granted, but it’s not guaranteed during emotionally complicated and confusing clinical encounters. It’s up to the therapist to understand the importance of defining clear limits at the beginning of therapy while being intrepid in the face of aggressive boundary testing. Recognizing clinical shortcomings, admitting personal issues, seeking consultation, and following ethical guidelines will ensure a professional relationship for the sake of everyone’s well-being. Similarly, it’s up to the Borderline to courageously work on developing insight by understanding how a lifetime of dependency and defensive reactivity has prevented developmental growth and behavioral accountability. In cases involving ineffectual therapeutic dyads, understanding what went wrong should be given far more significance than determining the correct calculus of blame. We are all products of our genes and our environment. Some of us are profoundly unlucky in the lottery of life. No matter how hard we try to escape the past, we can never fully escape our vulnerabilities. Motivated by misapprehensions and a desire to indulge the client’s desperate need for human connection, the therapist became an enabler rather than remaining a professional guide. When working with well-documented BPDs, analyzing should never yield to appeasement; confronting should never yield to catering; and challenging should never yield to capitulation. When working with an undiagnosed or misdiagnosed Borderline, good luck trekking through those enigmatic eggshells (armchair deductions writ large). Ultimately, therapists who remain committed to pleasing others need to practice saying “No” whenever their client’s needs become overwhelming. BPDs will not respect a therapist’s sacrifices, they’ll learn to expect them. Sacrificial gestures become nothing more than a transactional endeavor that circumvents self-reflection, emotional discomfort, and the process of change. There are no shortcuts. BPDs want others to acknowledge their vulnerabilities, but their mindset is not equipped to fully contemplate the vulnerabilities of others. As Gunderson reminds us, clinicians who work with Borderline patients must have an extensive knowledge of this disorder; adequate experience working with this disorder; and an actual desire to treat those suffering from this disorder. Those who try to help a person with BPD the most may be the ones who suffer the most consequences, especially if they’re not prepared in advance.
“Working with patients suffering from borderline personality disorder begins with an acceptance that they live in an immature psychological world, fueled by certain constitutional vulnerabilities, where they attempt to shield themselves from conflict and anxiety by splitting the world into all good and all bad. Although this produces an illusory sense of psychological safety, in fact, it renders relationships fragile and chaotic and drives away the very people who are so badly needed to stabilize the patient,” states Dr. Marcia Goin.
Now that my ladder’s gone, I must lie down where all the ladders start, in the foul rag and bone shop of the heart. — W.B. Yeats
For better or worse, the therapist will realize that being a caretaker, despite the best of intentions, cannot include the responsibilities of completely taking care of someone. The three Cs need to be reviewed: The therapist did not cause it; the therapist cannot control it; and the therapist cannot cure it. Consolation should be the fourth C, and it’s never enough for a Borderline. Becoming a surrogate parent, unfaltering friend, love object, support structure, or omnipotent rescuer to save someone from a lifetime of dysphoria is a recipe for disaster. There’s no pier strong enough to stabilize The Great Ship of Desperation. The therapist will need a bigger lifeboat to endure the Borderline’s self-generated waves of fear. No single individual can successfully meet all of the emotional and physical needs of another. Being supportive, empathic, and comforting should never drift into the realm of everlasting availability. Likewise, Borderlines should be discouraged from providing transference-based gratification to their caregivers by association. The ephemeral anodyne of validation may satisfy the desire for human connection on both sides of the couch, but therapists may never find their way back home once the process of BPD pacification begins. If a clinician falls off the Cluster B tree early on in the therapeutic process, they’re likely to hit every countertransference branch on the way down. When all is said and done, the therapist cannot invoke the Nuremberg excuse: I was only following orders. Codependent quicksand is a formidable force.
The only one for me is you, and you for me. — Alan Lee Gordon
There’s much debate regarding the term codependency and the popular idea that all individuals who become intimately involved with a person suffering from Borderline Personality Disorder are essentially “codependents.” Codependency being defined as excessive emotional or psychological reliance on a partner, typically one who requires support on account of an illness or addiction. However, Codependent Personality is not recognized in the DSM because codependency is considered a non-clinical psychological construct. Furthermore, human psychology is a soft science that does not allow for all statements, or any declaration that demands 100% certainty, to suggest otherwise would be committing the fallacy of illicit transference. Although common pairings in borderline relationships involve partners with Narcissistic Personality Disorder and nominal codependents, there are plenty of healthier-minded individuals who find themselves caught up in these relationships before understanding anything about the disorder; sometimes several years after the relationship has ended, sometimes never. In many cases, the partner of a Borderline has tried everything at their disposal to make the relationship work until a combination of confusion, frustration, exhaustion, and unexpected fallout forces a contentious separation—the personal, social, and financial burden can be enormous. Maybe this is testimony to a partner’s patience, compassion, commitment, love, and resilience rather than a tendency towards codependency? In fact, the most common tendency among partners of BPDs is to view this type of suffering as peripheral rather than pathological. Interpreting and managing a Borderline’s unpredictable moods, while simultaneously attempting to solve the riddle of object inconstancy, would be highly counterintuitive and difficult for anyone (add a dash of identity diffusion for extra confusion). More often, the BPD’s episodic dysphoria, abandonment anxiety, and need for reassurance are the primary sparks that trigger the codependency time bomb. Another mistake is when partners try to simplify this complicated disorder by becoming crisis custodians—believing that each crisis is “fixable” rather than enduring. Many individuals stay locked in these relationships because Borderlines will assert, in no uncertain terms, that their partner has the cure for what ails them (i.e., love, special assistance, and emotional support). These assertions are so compelling that partners of BPDs will work even harder to “do better.” Let’s face it, it feels good to feel needed. Conscientious people do not want to disappoint those in distress, and tolerance develops through adversity (culture reinforces the idea that we should never give up on committed relationships). Unfortunately, the source of a Borderline’s gratification and stability will inevitably become the source of their unhappiness and resentment. Over time, their preferred support system will run out of emotional energy, physical energy, and resources. When this happens, the BPD will angrily assert that their partner never really cared or loved them. In fact, clinical depression, apathy, alcoholism, and PTSD are common among current and ex-partners of Borderlines because of the cognitive dissonance and chronic stress involved with the roller-coaster nature of these relationships (similar problems can occur in adult children of a Borderline parent). BPD meltdowns have the power to melt mountains when their rage supersedes the melting point, and the anxiety it causes for their partners is often detrimental. There are documented cases of partners being physically assaulted by their BPD spouse with weapons of opportunity during heated arguments; committing suicide from prolonged exposure to borderline abuse; losing their jobs and reputations; or having their lives ruined in some manner that defies comprehension. Because the person with BPD often presents differently in public than behind closed doors, convincing others of the truth will likely be met with disbelief. Some partners of Borderlines become equally abusive when they can no longer suppress their own anger and frustration. Others are berated into submission or find inventive ways to escape the trauma of the relationship. Giving up due to a lack of motivation is normal when the fighting, salvo of insults, circular conversations, and drama never ends. This is why Borderline Personality Disorder is sometimes referred to as a “disordering disorder,” because anyone who gets too involved in the sufferer’s life becomes disordered by association. Furthermore, a delayed onset of diagnostic features can appear long after these relationships have been consolidated by cohabitation or marriage. Most couples rationalize warning signs when intoxicated by the early stages of companionship, and no one is immune to making interpretive mistakes about another person’s character. Red flags evolve incrementally and are excused without further appraisal by those who are forgiving. The partner of a BPD is initially designated as someone who can do no wrong, until they can’t do anything right. Idealization followed by devaluation causes partners of Borderlines to question their own sanity as they scramble to get back in good graces. Intermittent positive reinforcement is a powerful incentive that offsets the initial confusion caused by Borderline splitting. Hope is a helluva drug. After all, everything seemed so wonderful in the beginning. Borderlines are especially exciting and affectionate in the beginning of a relationship, and have many positive qualities that are accentuated by their intense emotions. Being blinded by the splendor, the BPD’s psychological wounds and internal conflicts are not apparent to the casual observer. The partner of a Borderline, in essence, becomes the unsuspecting bird who breaks its neck by trying to fly through a picturesque window. The idealization phase was nothing more than being temporarily anesthetized in the eye of a Category 5 hurricane, but the strongest winds are on the horizon. What can’t be predicted is usually what ends up hurting us the most. Cloud nine rapidly morphs into a never-ending nightmare as the BPD reactivates their traumatic history. Perhaps the spookiest aspect of Borderline Personality Disorder is that the disordered individual doesn’t understand how they’re affecting others; wouldn’t believe it if you told them; or believe that their behavior is entirely justified based on their delusional perceptions. Borderlines are damaged people who damage intimate others as a consequence of their pervading instability. Overall, there must be a distinction between codependence as a toxic predisposition and codependency as an emergent behavioral dynamic that occurs during the process of communication and negotiation with a person suffering from Borderline Personality Disorder, or any other personality disorder (rigidity of character obstructs negotiation). In other words, most partners of Borderlines are gradually converted into a state of situational codependency through recurrent interactions that become increasingly untenable. Just as there are people who possess borderline traits, but do not meet full criteria for the disorder, there are also people who exhibit codependent traits (empathic sensitivity, conflict avoidance, and self-sacrifice) without being considered lifetime codependents (people with low self-esteem who seek approval and acceptance with an exaggerated sense of responsibility for the actions of others). However, a person who continues having relationships with pathological individuals may meet criteria for Dependent Personality Disorder. It should be recognized that Borderlines also share traits of Dependent Personality Disorder because of their core insecurities and emotional dependency. For this reason, they’re also vulnerable to being taken advantage of in abusive relationships—especially with narcissistic or psychopathic partners. Having BPD doesn’t mean that someone can’t have legitimate grievances or that their feelings are always driven by dysfunctional thought processes. Nonetheless, assertions made by a person with this disorder usually require an objective third party to separate emotional convictions from the evidence. Any behavior that occurs in relation to others should be evaluated on a spectrum. That being said, adult children of a personality disordered parent are far more likely to become subconsciously attracted to and enmeshed with someone suffering from Borderline Personality Disorder. Both partners in these relationships are symbolically returning to the womb for emotional nourishment that was unavailable during childhood. In these cases, codependence is “predestined” and likely pervasive in other contexts because of maladaptive attachment styles (the resonance of archaic wounds). Historical familiarity is the most consequential vulnerability for individuals who come from traumatized families. Trauma bonds do not make good investment bonds.
Borderlines presume that they will be abandoned, and then act in a manner that makes such abandonment virtually certain. — Jordan Peterson
What’s interesting about Borderline Personality Disorder is that it represents a subset of pathologies that can upend therapy as a result of trying to effectively respond to it. Very few disorders have the power to expose a caregiver’s gullibility and naïve optimism like Borderline Personality Disorder. Therapists must be very grounded in their personal lives to withstand the strenuous provocations involved with BPD psychodynamics. Those suffering from Cluster B disorders unconsciously exploit the compassion of others because they’re starving for special recognition. As with all Borderline relationships, there are only three options for therapists to consider: Avoid, challenge, or appease. For any progress to occur, these clients need be challenged rather than appeased. However, BPDs don’t like being challenged because introspection and change is seen as evidence of their imperfections. Go figure. Furthermore, the power of love is only powerful if the BPD can learn to love themselves while acknowledging the limitations and imperfections of others. It’s not that Borderlines are irredeemably “bad” people, or fundamentally unworthy of love; rather, they’re completely baffled by the give-and-take dynamics required for healthy relationships. Borderlines confuse their inner experiences with the outer world until the two inevitably collide. Assuming that everyone will abandon them, there is no room for negotiation or compromise. Borderlines are running scared, and this is why they often scare others away. To be clear, BPDs would benefit immensely from stable companionship, but they must first develop the skills that allow for individuation, fear reduction, anger management, self-acceptance, and self-regulation. Therein lies the great Borderline paradox: Part of the solution to a Borderline’s suffering is the availability of a relationship, but part of the reason why this disorder persists is because of how they behave in relationships. Even if a Borderline found their perfect “soulmate” and target of blame, they’d still have all of their work ahead of them. As a disorder, BPD has characteristics that allow it to be proficient at obtaining relationships, but it doesn’t have the maturity to sustain relationships. Granted, relationships aren’t easy for anyone. Borderlines split in relationships in the same way that therapists split regarding their opinions about those suffering from this counterintuitive, misunderstood, and stigmatized disorder (the stigma is often related to the amount of damage it causes for everyone). Overall, BPDs need to learn how to have a healthy relationship with themselves. Nonetheless, silver linings must exist for both the client and the therapist if meaningful insights are to be realized after such emotionally charged imbroglios. In retrospect, the message and value of compassion should not be determined by the origins or magnitude of our fragility.
We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time. — T.S. Eliot
In summation, the therapist was flummoxed by the Borderline’s misdiagnosis, victim identity, false self, emotional reasoning, and incomparable powers of projective identification when the therapeutic relationship was in its infancy. An underestimation of the BPD’s internal disturbance resulted in normalizing what was clearly pathological. An erroneous confirmation bias was tenaciously defended, and the therapist allowed their own emotions to undermine the protective protocols of professionalism with an emotionally unstable client. Instead of detaching and observing, the therapist has absorbed, deferred, and enabled—thereby becoming an enmeshed participant in the client’s internal fantasy structure. Subsequently, the therapist’s shield of reason was systematically broken down by the BPD’s idealization, demands for nurturing, and intense fear of abandonment. What was easily recognized in the Borderline’s family of origin went unrecognized in the client until it was too late. Something that should have been ruled out was regrettably overlooked, and the therapist-client enmeshment has taken its tragic toll. The appeasement to this type of mindset was preconditioned by the therapist’s own upbringing. This uncanny familiarity comes from a complicated dance that was set in motion many years before the clinician and client finally met on that fateful therapeutic stage.
Life can only be understood backwards; but it must be lived forwards. — Kierkegaard
Exploring adverse childhood experiences, to understand how past relationships and unresolved conflicts have conditioned us in adulthood, is what matters in the end. Memories, unconscious motivations, and embedded responses from interacting with our families of origin are reactivated for all participants during every therapy session. Many therapists are unable to identify the innumerable faces of transference or recognize and manage complex countertransference reactions. Likewise, most clients are equally unaware of the influential depth that these symbolic-based forms of communication have on their own psychological motivations. Countertransference is the Achilles heel for therapists who become too invested in establishing meaningful relationships with their clients. A good question for therapists to consider is why they chose to work in the profession of caregiving to being with. For many, it could be related to the power of human connection; the virtue of compassion; the alleviation of suffering; and not wanting others to feel alone in their experiences. Most would agree that these values embody the essence of effective altruism. But can such aspirations become problematic? Are there exceptions to unconditional acceptance? Trying to lift certain people up in life without limits may result in them dragging you down (misery loves company), and this is an important lesson for caregivers to learn. Some clients require impossible standards of care that can only be assuaged by learning how to love and care for themselves. A therapist should never abandon their professional identity to alleviate a Borderline’s fear of abandonment. As a final caveat, be careful what you care about.
There are two tragedies in life. One is to lose your heart’s desire. The other is to gain it. — George Bernard Shaw
Borderline Personality Disorder is perhaps the greatest paradox in the Analects of human psychology. It’s a disorder that craves love, but it doesn’t understand the meaning of mature love. It’s a disorder that seeks relationships, but it doesn’t grasp the dynamics and limits of healthy relationships. It’s a disorder that yearns for proximity, but it doesn’t trust the sincerity of anyone who gets too close. It’s a disorder that begs others to experience its suffering, but it cannot see that this is the very reason why it continues to suffer. It’s a disorder that desperately seeks liberation from the outside, but it doesn’t realize that transformation comes from within. It’s an existential insecurity that cannot believe in the power of accepting itself, because it was not accepted when it began. It’s an anachronism searching for an idealized form of attachment. It’s desire without a solution, and loneliness without resolution. It’s pain and terror cloaked in a bouquet of artificial flowers.
And your long-time curse hurts, but what’s worse
Is this pain in here
I can’t stay in here
Ain’t it clear?
That I just don’t fit
Yes, I believe it’s time for us to quit. — Bob Dylan
Stacking a house of unstable cards is naturally going to collapse if you don’t understand the true nature of what you’re stacked up against. Therapists who prematurely fold their boundaries in the face of something they don’t yet understand will lose the game every time. Betting against a Borderline’s nature is impossible, because they can always read the hand of accommodation that you’re holding. Even when the mysteries of chaos are finally revealed, the embers from that raging Queen of Hearts will continue to burn.
This should have been a noble creature:
A goodly frame of glorious elements,
Had they been wisely mingled; as it is,
It is an awful chaos—light and darkness,
And mind and dust, and passions and pure thoughts,
Mix’d, and contending without end or order,
All dormant or destructive. — Lord Byron
In memory of John G. Gunderson (1942 – 2019)
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