Depatologization Of The Border Client. Richard Schwartz

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

Learning to manage your fears

Many borderline clients inevitably provoke their therapists from time to time by sharing their trauma history. And the therapist's ability to take responsibility for what is happening to him, instead of blaming the client, can be a turning point in therapy.

I have specialized in the treatment of severely sexually abused survivors for many years, which means that many of my clients fit the diagnostic profile of borderline personality disorder.

Typically, therapists are terrified of these clients, because they are the most difficult, unpredictable and often make us unconscious. For example, many of my clients were suicidal - some threatened to commit suicide, thus manipulating me, others quite seriously attempted to kill themselves. Many had a tendency to self-harm, cut their hands or body, showing me fresh open wounds. I knew that they abuse alcohol and it is harmful to their health. They could drive in this state and come drunk to the session, they were able to steal and get caught, or get into such a mess on the road or on the street that their lives were in danger.

Often they developed a dependence on me, similar to that of a child. They wanted, and often demanded, not only my constant consolation, but also my help in making even small decisions, such as getting a driver's license or not. If I left the city, some would have fits of anger. Others wanted regular contact between sessions and inquired about the details of my feelings towards them, as well as my personal life. They tried my boundaries over and over again, seeking special treatment such as free sessions and extra phone time to discuss every detail of their lives. Or they violated my privacy by finding the address where I live and showing up at my house without warning. When I tried to impose tougher limits, setting clear times when they might or might not call me at home, some responded with hints or open threats of the possibility of suicide.

Sometimes I was idealized: "You are the only person in the whole world who can help me!" At other times they attacked me with a knocking unpredictability: "You are the most emotionless person I have ever known!"

During therapy, some clients suddenly began to behave like very frightened little children. Others fell into violent anger in response to the slightest provocation. Repeatedly, the progress in therapy was replaced by sabotage or discontent with me, which made my work like a Sisyphean nightmare.

At the beginning of my career, I reacted to this behavior as I was taught: I tried to correct the client's false idea of the world or me, rigidly reinforced my boundaries, allowing only minimal contact between our weekly sessions, and refused to reveal my own feelings. And he also contracted with clients to prevent them from repeating their attempts to harm themselves.

Such a rational, impeccably “professional” approach not only did not work, but, for the most part, hurt. My cautious neutral reactions seemed to exacerbate the client's feelings. I've spent most of my life dealing with clients who never seemed to get better.

Looking at this in retrospect, I can see that, despite my best intentions, I have subjected many of my clients to some kind of therapeutic torture.

I interpreted their behavior, which frightened me, as a sign of severe pathology or manipulation. By doing so, I only harmed the therapy process. I hardened my heart towards these troubled clients and they felt it. They felt that I was rejecting them emotionally, especially during crises when they especially needed loving acceptance. My well-intentioned attempts to control their risky behavior were often perceived by them as a misunderstanding and even a danger, not unlike that of their persecutors / rapists.

Of course, I am not the only one who has experienced this from personal experience. Many therapists try to distance themselves, defend themselves, and become directive when faced with the thinking and behavior of their borderline clients. And it is really very difficult not to have such reactions when you feel responsible for someone who is losing control. Some therapists, on the other hand, become even more caring, pushing boundaries far beyond their comfort level, until they feel completely absorbed and frustrated. The result is that they end up passing their clients on to someone else.

From the point of view of the theory of Systemic family therapy of subpersonalities

The outcome of this struggle can be influenced both by the therapist's response to the client's behavior and by the intrapsychic manifestations of the client himself. How the therapist responds is largely determined by his understanding of what is happening. The Systemic Subpersonal Family Therapy (SST) approach, a model that I have been developing over the past thirty years, offers an alternative to the usual way of working with clients with so-called borderline disorder. It makes the therapist's task less daunting and depressing, and more reassuring and rewarding. In terms of the SCTS approach, the symptoms exhibited by these clients represent a cry for help from different parts of the self or subpersonalities. These parts are carriers of extreme beliefs and emotions - what we call a "burden" due to the tremendous trauma and humiliation that the client endured as a child.

The main task of STS therapy is to work with these parts of the Self in such a way as to allow the intact core of the client's personality (Self) to emerge and start the process of emotional healing. If every part, even the most damaged and negative, gets a chance to reveal the origins of its cargoes, it will be able to demonstrate itself in its original high-value state, as it was before it became so destructive in the client's life.

Suppose that as a child you were constantly sexually abused by your adoptive father and could never tell your mother about it. As you become an adult, you may be the bearer of parts of you who are stuck in these scenes of violence, isolation and shame. These parts remain young, scared and desperate. When they suddenly appear in consciousness, you seem to find yourself back in those terrible times. This spiral raises all those terrible emotions, memories and sensations that you vowed decades ago to never experience again. I call these parts the Exiles because you are trying to expel them and hide them deep inside. However, if they weren't traumatized, these parts might be sensitive, gullible, playful, and imaginative. Thus, suppressing them leads to a decrease in your ability to love and creativity.

Most of the time, these parts remain hidden. They are held by other parts that protect them. And these defenders use a variety of strategies to prevent the Exiles from meeting. In the first place is the strategy of protecting the Exiles from “triggers”, that is, provoking things and situations. The Guardian Units organize your life in such a way that you avoid meeting anyone who might, for example, remind you of your adoptive father. They also keep you at a safe distance from people in general. They constantly scold you, forcing you to do your best to be perfect in order to prevent rejection or any criticism in your direction. They also help to avoid anything that can cause feelings of shame, fear and worthlessness that the Exiles carry. However, despite these efforts to protect, the universe is constantly sending out “triggers” to the Outcasts, and, in addition, they themselves constantly want to break out of their inner prison so that you can notice them. This manifests itself in the form of flashbacks, nightmares, panic attacks, or less flooding but also very intense feelings of anxiety, shame, or despair.

To avoid the ill health caused by the Exiles, your other parts develop an arsenal of distractions that are used as needed. For example, you suddenly feel an urge to get drunk, or you suddenly go numb and feel embarrassed and exhausted. If these efforts don't work, you may find yourself having suicidal thoughts that are both calming and terrifying at the same time. If you have been diagnosed with borderline personality disorder, this practically means that you also have two sets of protective parts that specialize in managing relationships with others: the Seekers and the Mistrust.

Imagine that your mind is a home with many children without parents. Younger children are suffering and destitute. And those that are older, unable to cope with the task of taking care of the younger ones, locked them in the basement. Some of the older ones are trying unsuccessfully to find adults who can take care of the orphans in the basement. These are the Seekers. They are looking for suitable candidates: therapists, spouses, acquaintances. And they use all their charm to attract these people to the role of savior. However, these seeking parts share with your Exiles in their opinion that you are fundamentally worthless, that as soon as people see how vile you are, they will immediately run away from you. They believe that you need to prove that you are special in some way. Or you need to manipulate people to act as saviors. These protective units also believe that caring for your Exiles is a full-time job. And it takes up all of their time. Therefore, they try to completely occupy the life of the person they take care of.

Among the older children in this home of your psyche, there is a coalition (The Unbelievers) that is trying to protect the children in the basement in a different way. They trust no one and keep the Exiles away from people who, in their opinion, can deceive, giving hope of liberation. These defenders have seen in the past what happens if the Exiles become too attached to a potential savior who inevitably betrays them without helping enough, or even repels them out of fear of their never-ending needs. Defenders see the irreparable damage inflicted on the children from the basement when the savior ceases to love them and rejects them. Therefore, these "big brothers" must be sure that you remain isolated, without attachments, completely absorbed in work and emotionally unavailable. They remind you that saviors are running away from you because you are disgusting. And if you allow someone to come closer to you and let them see who you really are, then the other person will only feel disgust.

Whenever your Seekers ignore the warning of the Distrustful and you approach another person, these Distrustful defenders watch every move of the other, looking for signs that indicate that the other is deceitful and dangerous. They will thoroughly research your therapist. From the style of dress and office furniture to the slightest movement of his mood and the length of his vacation. Then they use these imperfections as evidence that he does not care about you or that he is incompetent. Especially if he ever does something to remind you of your past persecutor / rapist. If the therapist uses similar phrases or wears a similar shirt, he “becomes” your foster father.

Thus, unknowingly, the therapist enters the house of your psyche and quickly becomes embroiled in a struggle between two coalitions of defenders: some are ready to do anything to keep him, while others are ready to do anything to drive him out. If the therapist manages to hold out long enough, he will face the oppressed needs of the children from the basement, as well as with the discouraging methods of older children to keep the Izganniks in captivity. Thus, a therapist who is not prepared for such a hidden war, or is not trained in how to interact with these internal coalitions, risks being drawn into endless battles.

First wake-up call

Early in my career, before I developed the Systemic Subpersonal Family Therapy Model, I started dating Pamela, a 35-year-old woman who worked as an office manager. She went to the mental health center where I was working with complaints of depression and binge eating disorder. When we first met, she said that she believed her mood swings might be related to the nanny violence she experienced at the age of 10. And besides, she felt very lonely and had to do the hated work. She liked the fact that I was young and seemed kind and she asked if she could attend our meetings 2 times a week. I, in turn, was delighted to be able to work with her, assessing the degree of her readiness and interest, especially in comparison with the gloomy teenagers who made up the main part of my then practice. Over the course of several sessions, I accompanied her in the process of deciding whether to quit her job. We also developed a nutrition plan. I was sure that her confidence in me was growing and I was enjoying the work, which seemed to be going well enough.

Then it was time for a session where she started talking about rape. She was very scared, shedding tears and did not want to leave my office at the end of the hour. I extended the session until she regained consciousness and was able to leave the office. I was somewhat confused about such a change in the therapeutic process, but I realized that we had stumbled upon a very emotional topic.

In the next session, Pamela apologized and worried that I would no longer work with her. I assured her that the last session was the beginning of something very important and that my responsibility to help her remains valid. She asked to increase the number of meetings to three per week, partly explaining that she had suicidal thoughts. I agreed.

This pattern was repeated in the next session: she began to talk about violence, then she became taciturn, began to cry, it seemed that her despair was growing. I tried to be as empathic as possible, trusting my Rogerian instincts. The ensuing session began in a similar vein and then someone knocked on the door. Despite the fact that I ignored this knock and asked Pamela to continue working, she exploded with rage: “How could you let this happen? What's wrong with you?!"

I apologized for forgetting to post a notice about the session, but she did not accept my apology and rushed out of the office. I tried to call her to no avail several times in the following week, my panic steadily escalating as she missed appointments. I was about to call the police when she showed up at my office without warning, expressing remorse and begging me to continue seeing her.

I continued, but from now on not with an open heart. Some of my subpersons felt helpless and frightened during the weeks she was away. Other parts of me were outraged at the way she treated me. I had to agree to continue working with her, but I believed that her behavior had crossed all conceivable boundaries. I began to resent any of her requests that went beyond the agreed time.

Now I am sure that working with Pamela, by and large, was not successful precisely because she felt this change in me and in my attitude towards her. Several more suicidal episodes followed, increased demands for support and more time. I started to meet her on the street. I began to suspect that she was watching me. From these thoughts, goose bumps began to run through my body. I tried my best to hide it. And I am sure that my irritation and antipathy often seeped out, which drove her Seeking parts to despair, who were losing hope of my help, and intensified the attempts of her Distrustful defenders to distance her from me.

After two years of this kind of work with her, she died suddenly of a heart attack related to her overweight. I am ashamed to admit that I almost felt relieved. I never succeeded in realizing my real role in her accelerating deterioration, and I only felt the ever-increasing heaviness from this “hopeless borderline”.

Strengthening the leadership of the Self

After many years of working with clients like Pamela, I have learned a lot about the organization of their internal systems and my therapy style has changed radically. From my experience with her, I understood why so many therapists lock themselves in their inner fortress, hiding their panic and anger behind a facade of professional detachment. If you do not have a systematic view of what is happening, you are faced with something that you perceive as a set of militant personalities, often contradicting each other.

However, from the point of view of the Systemic Family Subpersonal Therapy model, such a change in behavior, signaling the emergence of different subpersonalities, is by no means bad news. Instead of taking this as evidence of a high degree of pathology in the client or low competence of the therapist, the emergence of these subpersonalities can be regarded as a signal that the client feels safe enough to show them. In the STS field, phenomena such as flashbacks, dissociation, panic attacks, resistance and transference are tools used by different parts of the personality. And, in this case, they can serve as important indicators indicating what should be happening in therapy.

When therapists look at borderline personality disorder from this angle, they can more easily tolerate client mood swings, attacks, heavy addiction, apparent regression, as well as controlling and coercive behaviors. Since this kind of behavior is not a sign of profound pathology, it should not be attributed to the personality as a whole. This is only part of the territory.

These attacks come from the defenders and their job is to make you feel bad and back down. Regression is not an indicator of a shift in borderline toward psychosis. This is a sign of progress, as the system feels secure enough to release the traumatized Exiles. Manipulation and coercion are not signs of resistance or personality disorder. These are just indicators of fear. Self-injurious behavior and suicidal symptoms are not signs of a frightening pathology, they are the client's attempts to comfort himself, to alleviate the pain.

This point of view will help you keep your self during the storm. Stay grounded and compassionate in the face of extreme behaviors in your client. It's like X-ray vision. You see the pain that guides the parts-defenders, which helps you not to move to react, not to start defending yourself. The more accepting and understanding you become of the parts of your client when they show up, the less your clients will judge or attack themselves, or panic when they feel the situation is spiraling out of control. The better you can handle the protector part checks, the more they relax, allowing your client's calm, confident, considerate whole personality to break free of protectors and come to the fore.

The hallmark of the STS model is the belief that behind the top layer of these disparate parts, each client has an intact, healing Self. At the very beginning of therapy, most borderline clients are not even aware of the existence of this inner whole person and feel completely disassembled. In the complete absence of internal guidance, the parts become frightened, rigid, paralyzed, like older children in a house abandoned by their parents. And if the therapist stubbornly continues to remain calm, stable, compassionate, the client's inner parts relax, calm down and the client's Self begins to manifest spontaneously. From this point on, the client feels differently. It's as if the stormy waves of life are becoming more navigable.

Systemic family therapy of subpersonalities in action

I recently started working with a 42-year-old client named Coletta who has already seen several treatment centers for eating disorders. And in the last two centers, she was diagnosed with borderline personality disorder. Like many borderline clients, she experienced childhood sexual abuse - in her case, it was a neighbor. However, her previous attempts at therapy have focused primarily on investigating and correcting her irrational judgments around an eating disorder.

She told me that she had heard that I could help people with their injuries. I replied that I could help her with parts of her personality that had suffered pain and seemed to be stuck in the past. I also added that we will not come into contact with these parts until we know as much as possible about them and receive their permission to turn to painful emotions and memories. In subsequent sessions, I helped Colette establish a dialogue with some of her advocates, including those responsible for eating disorders, and persuade them not to fear our contact with the Exiles.

Once she was allowed to continue, I encouraged her to focus on remembering the abuse. She saw herself as a curious five-year-old girl who was lured into a nearby house to play with domestic rabbits. Colette was able to witness the ensuing violent scene and be compassionate for her youthful side. Mentally, she was able to enter this scene and take the girl to safety. Her defenders were relieved that this part was no longer so vulnerable and informed that they were considering taking on new roles. As Colette left this session, she said that for the first time she felt hope. I was very moved by the intensity of the work and am grateful for the privilege of accompanying her on this journey.

However, during the next session, Colette was distanced and shut down. She said that she did not remember what we did in the last session and that continuing to work with me did not seem like a good idea to her. And she added that she had only come to inform us that this was our last meeting. And there could not even be a question of trying to dissuade her from this.

Even though I already had a much greater understanding of what was going on, there were still young parts in me who were frustrated by such a sudden decline and others who felt unhappy when my efforts to help were not appreciated. At that moment, one of my defenders came to the fore, and I coldly, with the detachment of a clinician, said that I was, of course, sorry, but if she made a decision, I would be happy to give her goodbye recommendations. Since we talked for some time, I was able to recognize the part of me that reacted in this way to this “trigger”. I reminded this part of me, through internal dialogue, that it does not have to prevail. I told her the following: “I know that you consider her ungrateful, but this is only a manifestation of her frightened protective parts. Relax a little. Let me figure it out, and I'll talk to you after the session."

As my protective side retreated, I felt a return of empathy and concern for Colette, and it became clear to me why she was so distant. I interrupted our conversation and said, “I have to apologize. Your desire to interrupt therapy surprised and disappointed me. I was very pleased with the work that we have done and would like to continue it. I realized that during the last session I was very upset about some of your parts that we probably need to listen to. And I am completely open to that."

Colette thanked me for the time with her and said that she appreciated my honesty, but still wanted to interrupt therapy. Then, the next week, she called to ask if we could meet again. At the next session, she admitted that what I told her about my desire to continue working with her meant a lot to her. And that she had already agreed with the part that fired me to give me another chance. I replied that I was glad to have another chance given me, but I do not quite understand why I was fired. She said that she herself did not really understand this and then I suggested that she focus on the part that got rid of me so abruptly and ask her "why"? When she did this, the part who dismissed me refused to answer and began to swear at Colette. I suggested asking her if she would like to talk to me directly. An affirmative answer followed.

Dick Schwartz: Are you here?

Protector of Colette, in a terrible voice: Yes. What do you need?

LH: So, you are the part that got rid of me. This is true?

ZK: Yes it is! She doesn't need this shit. And you are such an asshole!

(I have a part that reacts reflexively to swearing. I had to ask that part to calm down in order to stay interested.)

LH: I appreciate your willingness to talk to me. I'd like to better understand why you think we were doing nonsense or why you don't like me.

ZK: You are no different from the two previous losing therapists. You give her back hope, and then you shit on her.

(I felt a part of me that wanted to argue with her protector and convince him that I was different, that I was safe and would not hurt her. I reminded this part that this approach does not work.)

LH: I understand that you have no reason to believe me. She was betrayed by many who called to trust them. And many times the hopes resurrected in her were deceived and she again and again suffered disappointment. I also realized that your job is to prevent such stories from recurring, and you have the power to do so. You're the boss, and we're not going to do anything about her injuries without your approval.

ZK: Oh, you asshole! I can see right through you! And I understand what you are trying to do with this careful therapeutic shit!

(Now part of me began to say that this was a pointless and tiresome waste of time and that I was already tired of these insults. I asked her to take a step back).

LH: OK. As I said, I do not expect you to trust me before I prove that you can rely on me. I appreciate that you are allowing Colette to continue to see me despite the feelings you have for me. And I would like to meet with you more often in order to keep track of how we are progressing. Now I would like to talk to Colette again. Colette, are you there?

Colette: Yeah. It was weird. He always treated me so badly! I never thought he was trying to help me. When he spoke to you, I felt his sadness.

LH: And how do you feel about him now?

TO: I am sorry that he has to be so tough while he himself is so sad.

LH: Can you tell him about it? See how he reacts.

TO: (after a pause) He seems to have softened. He doesn't say anything, he just looks very sad.

As Colette listened to my conversation with the defender, she looked at him differently. When I asked what she began to feel towards him after what she had heard, it became clear that her Self was more clearly defined. Her voice became calmer, she began to demonstrate trust and compassion, which were so lacking during our previous conversations about this part.

She still sympathized with this advocate during the next session, and I invited her to express her new experience of compassion for her part through internal dialogue. At first, this part of her reacted with habitual contempt, the same as in relation to me before that, telling Colette that she was a stupid fool, since she trusted me. But I helped my client keep her heart open and the part with whom the dialogue was conducted was satisfied that Colette finally saw her desire to help.

Later in therapy, after Colette was able to free many more Exiles with my help, she began to make major changes in her life. She stopped hiding her emotions and making excuses. She ended a relationship in which she recreated some of her old victim patterns. I liked her more and more and I believed in the possibility of her further development and in my ability to help her. Suddenly, one fine day, another call from her seemed to pour a cold shower over me. A low, threatening voice on the answering machine said, “You won't get it. She is mine! . And at the other end they hung up.

I called back, but no one answered me. Suddenly I felt a lump of panic in my stomach, similar to what I experienced with Pamela. Somewhere my client was in danger, and I could do nothing to help him. Thank God I had a few days before our next session to work on my distress. I asked a colleague to help me with my early part of my life when I felt helpless and unable to help anyone. This work has proven to be very liberating and valuable.

When Colette came to the next session, she looked depressed and announced that she was back where she started. She humiliates herself again and tries to regain the relationship she left. For the first time this year, she was visited by thoughts of suicide. She remembered calling me, but could not remember what she said. Since before that I was very inspired by her progress, at that moment my heart sank and I heard a familiar inner voice asking the same question - have we even budged in this joint work of ours? I asked this part to allow me to remain present. I joined Collette and felt a shift towards greater community. This happens when my Self is more “embodied”, turned on.

I asked Colette to focus on the suicidal impulse and ask the part that feared it to take a step back, letting the client just be curious. Then Colette was able to ask another part of her - why she wanted her dead. A terrible voice from the telephone receiver replied that it was his job to "destroy her." I had to contain my own nervous parts and help her maintain curiosity about the reasons for such a desire to destroy her. She was told that she deserved to die and it was important to make sure that this happened for sure. Colette looked at me and said it looked like pure evil. I asked her to remain calm and interested so that there was an opportunity for dialogue and we could be sure if this was true.

Colette: Why do you think I deserve to die?

Suicidal Part: Just do it, and my job is to see that you do it.

TO: What are you afraid of, what might happen if I don't die?

Midrange: I'm not afraid of anything!

Dick Schwartz: Ask her what good will be in your death.

TO: Ok, then what good will it be if I die?

Midrange: You won't be nice to yourself.

TO: So you don't want me to treat myself well?

Midrange: Yes, because you are the most useless piece of shit and empty space!

TO: What is so terrible about it if I have a good opinion of myself?

Midrange: (after a long pause) Because then you will try.

TO: What's wrong with trying?

Midrange: You will continue to be hurt.

Ultimately, the Suicidal Part says that another failure is impossible to survive. It is better to die than to experience another disappointment. Colette expressed her gratitude to this part for trying to protect it from such an outcome, and we asked the Suicidal part for permission to heal those parts that have suffered from frustration in the past.

Fortunately, Colette's story ended better than Pamela's. She realized that the Suicidal Part was actually none other than another, even more ferocious protector who played a huge role in her life. Because she firmly believed that pain and suffering were her property, and that all the good things that came into her life were false and illusory, her ability to experience happiness or feel a sense of confidence was severely limited. The client's healing trajectory shot up as this unconscious pressure ended.

The difference in achievement between Pamela and Coletta was due to differences in my attitudes towards borderline personality disorder. And what helped me even more was my ability to notice those parts of me that reacted to Colette as a trigger, the ability to work with them at the same time and then return the leading role of the Self. Regardless of your professional orientation as a therapist, this ability to constantly monitor your heart openness and recover quickly from a “part attack” is especially critical when working with borderline clients. In my experience, your clients' distrustful advocates are constantly monitoring your heart. And as soon as they feel that your heart is closing, they begin to torture you or leave therapy.

One of the greatest injustices in life is that a large number of people who are traumatized in childhood are re-traumatized again and again throughout their lives because the initial trauma made them extremely vulnerable, unprotected and prone to reactive reactions. Borderline clients will inevitably, from time to time, serve as triggers for their therapists, provoke them, causing them to feel fear, resentment and despair. Your ability to recognize what is going on inside you and sincerely attempt to reconnect can be a turning point in therapy.

Many borderline clients have suffered from a lack of recognition in their lives. Usually, when they found themselves in a conflict situation, they were shamed and rejected for their increased sensitivity, emotionality or impulsiveness. As a result, they often live with the feeling that they are destined to be alone with an arsenal of unusually reactive and extreme defenders.

These clients deserve to be in a relationship with someone who, while initially provoked, was able to return to a position that clearly shows pain leading to behaviors such as explosive rage, icy withdrawal, or controlling manipulation.

Once you become aware of your own parts that are trying to protect you from these clients and convince them to allow you to demonstrate the inner light of your Self, these “difficult” clients will become your greatest reward, and your level of self-leadership (the ability to manage yourself) and compassionate presence.

author: Richard Schwartz, Ph. D., Director of the Center for Self Leadership, Founder of Systemic Family Systems Therapy and You Are the One You’ve Been Waiting For: Bringing Courageous Love to Intimate Relationships.

Translation: Julia Malik www.agapecentre.ru

Editorial staff: Julia Lokkova www.emdrrus.com

Source: www.psychotherapynetworker.org