Borderline Client Therapy

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Border client comes to therapy with a request that cannot be satisfied in the form in which it is presented. The borderline client does not strive for integrity (which is a value for the therapist), but regresses to the format of early relationships and maintains his split … Makes the therapist extremely unfree, because he himself cannot endure his freedom. A therapeutic relationship, in which the therapist needs to contain the split pieces and be one step ahead of the client's awareness experience, does this well early in the therapy. The border guard wants to return to the place where he lost the ability to belong to himself in order to punish for this or take away what he was deprived of. The borderline client wishes to exploit the therapist by absorbing him rather than using him at the borderline. Therefore, instead of building more realistic relationships, there is a great temptation to maintain this primitive interaction, fearing aggressive reactions of the border guard to any change in the established order.

The borderline client, even more than the neurotic client, will seek to perpetuate his way of manipulating reality. The therapeutic alliance is based more on stabilization than on the possibility of desired changes. In some cases therapeutic relationship with a borderline client, they can even more fix his pathological experience of experiencing his separateness and the impossibility of being near someone. For example, when the therapist reacts to projective identifications and returns the client his raw emotional material, thereby rejecting his way of establishing a relationship, acting too bluntly. This happens when separating from the client too quickly and building boundaries that he still cannot get close to.

If one interprets the borderline client as neurotic it actually poses a kind of threat to the existence of a well-functioning system for isolating intolerable affects and leads to retraumatization … The request of the borderline client, which does not sound but is implicitly contained in all messages to the therapist, can be formulated as follows - be patient with me, I need to observe the experience of resilience, the opposite of rejection, in which I have lost some of my emotions. Try to curb my inconsistency at a higher level of abstraction, which is inaccessible to me, but to which I aspire.

Thus, the task of integration is reformulated in accordance with what directly occurs in therapy, namely, it is necessary to identify the resources that are present in real contact with a real therapist. If we use the metaphor of mental metabolism, then the borderline client is saturated very quickly, without understanding the taste, without chewing food, trying only to fill himself with volume. The borderline client is greedy for any manifestation of humanity, but cannot be in contact for a long time, because he does not have the experience of long-term relationships in which one can take his time, in which it is possible to feel the more subtle nuances of communication instead of the one available - grab and run. In other words, frustration the habitual way of gaining recognition, on the one hand, threatens the therapeutic alliance, and on the other hand, it turns the borderline client into a different format of the relationship. A relationship format more similar to the reality in which he needs to gain a foothold.

It can be said that the borderline client gains control of the situation by absorbing representation of an object interest and building relationships with this introjected image. As a result, life can go far ahead, but the border guard does not seem to notice these changes, maintaining the dynamics of “internal” experiences that cannot be placed outside, since they have long lost their relevance. The attempt to impose a certain role on the therapist in accordance with some expectations is a necessary stage in the development of therapeutic relationships and the vector that determines the direction of their development - from defensive transactions to real interactions with the potential for change.

Thus, we can observe two opposite tendencies in the therapy of borderline clients. On the one hand, the borderline client is even more reluctant to change than the neurotic client. And most of his expression in therapy is aimed at precisely this, at the desire to capture the therapist and keep him in his territory. Supporting him in this desire actually means retraumatization at the moment when the therapist himself, sooner or later, loses the opportunity to test reality and tries to become a parent to a non-existent child. However, building boundaries quickly can be seen as rejection. Therefore, it is important to both frustrate the swiftness of the border guard in erasing borders, and then support him in this frustration, do not let the opposite pole of merging unfold - rejection and devaluation. The support is just to pay attention to the fact that in actual relationships it does not look like fantasies and does not correspond to expectations, but nevertheless exists and can be assimilated as an experience - very small, maybe not very valuable, not as interesting as we would like would, but nevertheless held.

Deterioration during therapy can often lead to confusion of the therapist … However, in the case of the borderline client, such a deterioration indicates rather the right tactics. The fact is that the split-off and ignored elements of identity need to be actualized before they are integrated into the structure of actual relations. Intrapsychic conflict, separated from the system of relationships that gave rise to it and become sufficiently autonomous in order to avoid the reality check, must again be made a figure of interpersonal interaction. This is necessary in order to transfer the need behind it to the present, since it has the opportunity to satisfy it.

In other words, the adult borderline client does not need a mother to do now what she could not do then; he needs a harmonious, holistic sense of himself, which is the result supportive and developing relationships … You cannot return the past, this is true, just as you cannot return the opportunities left in it. But it is also true that the border client does not really need it. The feelings of self that we talked about can be the result of relationships in therapy.

At the beginning of therapy, the borderline client has little contact with himself, instead he is actively involved in manipulating other people, including the therapist, since, from his point of view, the demonstration of expression requires a certain preparation of the environment. The surrounding are like the wrapping material with which the border guard surrounds his fragile nature, and they are necessary only so that he can feel safe. The borderline client acquires a certain completeness in dependence and thereby reinforces the impossibility rely on oneself.

The people around do a very important thing for the border guard, namely, they confirm his existence as an important and significant object of their reality and, accordingly, through this, they guarantee some constancy of his inner world. The neurotic level of development presupposes the presence of a stable positive self-image - I feel good alone, but in a relationship it can be better. For an edge client, this positive image arises only within relationships and upon exiting them seems to be lost - I feel good only in relationships, without them I do not feel alive. Therefore, the constancy of the image is ensured by the need to be in fusion. The biggest question for the borderline client is how to do for myself what I want but don't get from others? How can you become for yourself a kind of external observer who would look at the work of his own hands and say that it is good?

The border client masterfully ignores strangers boundaries, while being very reverent about their own. Of course, this is due to the feeling of increased vulnerability, the desire to crawl under the skin of another so that it would not be possible to refuse to surround him with his corporeality. However, if such a thing happens with a mildly disturbed partner, his immune response sooner or later leads to predictable rejection. So, the weakness of the borderline client is self-doubt at the ontological level.

For the borderline client, understanding that the truth is somewhere in between is very speculative. Rather, he lives in two dimensions at once, which are around this “in the middle” and, thanks to the forces of mutual repulsion, do not allow each other to mix, equalizing the inconsistency of opposite messages. On the one hand, the borderline client for the therapist is a very large figure who can harm his destructive affects, and the therapist does not have the ability to resist this and have his own reactions to what is happening. On the other hand, the borderline client turns out to be such a small figure for the therapist that she cannot claim adequate perception; it is so small that it loses any power in the therapeutic situation. The unattainable truth in the center - both the therapist and the client are equal participants in the interaction, which greatly reduces the intensity of the experienced emotions of guilt and shame on the part of the border guard. This point is important to consider, because such a split vision of the therapeutic situation leads to the fact that the borderline client, relying on his subjective reality, ceases to see the therapist as the guarantor of his safety.

In fact, much of the work with the borderline client takes place in the background, namely in changing the emotional color of the current relationship with the therapist. The border guard internalizes object relations with a therapist in which he feels sufficiently recognized to stop fragmenting his self. The duration of the therapeutic relationship allows one to gain constancy no longer in the form of fixed behavior, but in the constancy of the process - one and the same person is behind all the variety of expression. The current paradigm of being in the world replaces the previous experience in which the relationship was divided into separate parts, because the good part cannot exist next to the bad and some of them had to be removed to the backyard of the unconscious. Ability test reality correlates with the ability to rely on a holistic experience, the less the client is able to notice in himself, the more he populates reality with his rejected parts.

The criterion for the success of therapy is development the observing ego … The borderline client is in a stream of experiences that he regards as Ego-syntonic, that is, he is merged with his drives, unable to assess them, correlate with internal authorities or reality. The borderline client gets angry, not being able to look at his anger as if from the outside, or idealizes, considering such a state as the only possible one at the moment. Therefore, any attempts to draw his attention to what is actually happening at the beginning of therapy lead to outbursts of rage, as if he is afraid of any pause that occurs within the procedure of instantaneous response. This rage is a reaction to a feeling of helplessness that requires immediate action to fill the void. An attempt to name what is happening, to understand and symbolize, is perceived as an attack, the best defense against which is to break the distance, devaluation and destruction of the therapist … So when the borderline client starts talking about what he is doing, including this action in a broader symbolic order - for example, I really attack you because I usually do this with all men who do not have sex with me - this is a sign of a beginning integration, in which the behavior is now not random or spontaneous, but dynamically reflects the inherent internal logic. This is an important gain because the borderline client is characterized by a loss of a holistic and continuous perception of his personality. Instead, he rushes between various poorly correlated states, captured by them and unable to control their change.

The borderline client learns to recognize something in common in individual fragments of his expression, overcoming the need to give up part of the traumatic experience. In this sense, the subjective criterion of positive dynamics in therapy will be the ability of the border guard to master his drives, navigate them and maintain the stability of the emotional state, without experiencing entrapment and confusion. The borderline person loses to some extent the ability to be in a pause between stimulus and response. During the course of therapy, we can observe how these clients slow down and better withstand uncertainty, since such a swiftness is characteristic of a high level of anxiety.

The criterion for the right direction in therapy is to increase congruence borderline clients, in which they become more aware of the reality of contact, rather than continue to act as if the other person simply does not exist. A similar feature follows from the phenomenology of border guards who do not test interpersonal boundaries, I will be confident that they already know what is happening in someone else's head. Hence the treatment of the therapist as with his own hand, from which, of course, it is foolish to ask how she feels before squeezing out toothpaste. It can be touching to observe how, some considerable time after the start of therapy, the border guard stumbles upon the therapist's boundaries and gently retreats back, returning to his own, and not trying to make them common.

The borderline client most of the time is in contact not with the real therapist, but with his fragmented parts with which he projectively identifies. That is, he explores and justifies his anger, provoking the therapist to experience such emotions. At the initial stage of therapy, the therapist's attempt to escape from the projections and demonstrate himself to the present often leads to rage on the part of the border guard, because there is too much going on for him. By and large, he needs to scare the therapist in order to justify this way of eradicating negative affects from oneself. The borderline client must face his rejected parts without feeling that they are terrible and the therapist's job is largely determined by the need to endure acting out. A metaphorical therapeutic strategy can be illustrated by relationships Beauties and Beastswhen the latter first tests his original hypothesis (I am terrible and disgusting), and then accepts himself as an unsplit, holistic image. There is a return to oneself and the integration of the denied parts at a qualitatively different level of abstraction, at which there are more shades and nuances of relations.

The unfinished developmental challenge that the borderline client faces in therapy is overcoming the fear of autonomy. The trauma of poor separation, after which the border guard has a feeling that his own resources are clearly not enough to survive a little more successfully, leads to dependence on others and the need to manipulate them. Accordingly, in therapy, we can frustrate manipulativeness and maintain activity in gaining independence.

In therapy, the borderline creates internal boundaries through external, in the space of therapeutic relationships. The infant experiences a catastrophe when he needs to define the boundaries of his body. To successfully complete this task, he needs a parental hug, which narrows the threatening space and makes it supportive, that is, they create a kind of external structure, which is then introjected in the form of internal supports. Internal supports are a kind of foundation of feelings of security and acceptance that allow you to present yourself to the environment in search of the necessary resource for development.

The borderline client asks - I'm having trouble getting in touch with you in a way other than what I'm currently using, so let me continue; when I scare you, could you be scared a little longer, and not immediately become invulnerable in your perfection; I miss your living human reactions to me so much that I myself lose the sense of life, endure a little more of what goes on in the projective part of my identity.

What qualities should a therapist have when working with borderline clients? It seems to me to demonstrate quite clearly how polar states can be integrated. For example, it is necessary to be very persistent and consistent in terms of setting external boundaries and at the same time as non-directive as possible in situations of manifestation of client personality. Maintain a persistent attachment in response to aggression. Be patient and steady enough.

It is very difficult for the border client to ask for something because there is always a risk of rejection in the request. This risk is associated with the allegedly catastrophic experience of rejection and loss of relationship following rejection. Therefore, the border guard organizes contact in such a way that he has to requirerather than asking. That is, he forms the conditions of relations in such a way that, within their limits, he seems to receive the right to immediately and categorically satisfy his needs. And when this happens, and it happens very often, he, in turn, rejects and leaves the first, loudly slamming the door. The whole art is about handling certain tolerances that seem obvious and fundamental to the borderline client. For example, a border guard may think that the therapist sees right through him and if he does not react to pain he barely feels, then he is callous and soulless. In general, it is very difficult for a border client to legalize their experiences as a phenomenon of contactrelated to what happens to him with the therapist. More often, he either considers his experiences a consequence of therapeutic manipulation or does not need a therapist at all, being content with contact with his projections. Therefore, disappointment in this way of interaction has a powerful therapeutic effect. More often, however, it results in the borderline client ending therapy because they are not being helped in the way they would like.

In the course of work, the therapist first accepts whatever the patient is demonstrating without focusing on a particular experience or story. This stage is a kind of test of the therapist for strength - to what extent he is ready to accommodate what the client has. The latter, in order to assemble the puzzle of his personality, first needs to "dump" all the fragmented elements of his identity on the table, and only then establish connections and relationships between them. The stage of "falling out" can continue for a long time and the therapist is bewildered, with pleasure and ease of healing neurotics - and when will the actual work take place? - can negatively affect the therapeutic relationship with the borderline patient for whom work has already begun. The therapist, as it were, supplements the client's individual puzzles by linking their plot with the general plan of identity and creating the prerequisites for their inclusion in the holistic picture of the self. In theory, the therapist should be slightly less disturbedthan his client, because he does not just collect the disparate into a whole - the client rather introjects not the content prepared by the therapist, but his way of dealing with him, not the phrases, but the language in which they are spoken. That is, the client introjects a model of relationships, within which he begins to feel more holistic, autonomous and consistent. This introjected relationship experience makes up the content internal resources and supports.

Another aspect of integration is that the elements diffuse identity borderline client refer to different experiences of nonconformity, occurring at different times and under different circumstances. They don't have a common denominator, central self-representationthat would remain unchanged and independent of external factors. The experience of a therapeutic relationship allows one to abandon the past in favor of the present. Moreover, the tendency to look back at the past makes its attribution dependent on what is happening here and now. By gaining acceptance in the present, the client will less need to grieve about the past and unconsciously want to change it. Recognition in the present destroys the primitive causal logic that the present is dependent on the past. The present depends on the present.

The therapist contains the emerging experiences and thereby resists the invitation to merge. Also, such a retention of energy is necessary in order not to fall into reactive psychosis and maintain a relationship. Through containment, we restore the client's ability to use the ego function. Containment creates boundaries and structures for curbing client affects, however, carried out through the psychic anesthesia of the therapist, with prolonged exposure, it can end in death or insanity. Therefore, dynamic supervision is required when working with an edge client.

The borderline client is thus treated with a relationship in which he introjects both a holistic image of himself and a supporting and recognizing figure of the therapist, that is, that minimal set of resilience (an image of himself, the world around him and the relationship between them) that allows him to make his life more rooted in the present reality and less dependent on the vulgar unfinished experiences of gaining maturity. The more fully the client is present in the relationship, the more complete his integration will be.