Monthly Archives: February 2014

#11 – From Borderline to Healthy – The Evolution of My Needs

Vacationing in San Diego, CA this week let me reflect on how much life has changed since I began recovering from BPD. In this post, I’ll consider how what I look for from relationships and work has evolved over the past ten years.

I spent this week with one of my closest friends, Gareth. We visited some beautiful places, including San Diego’s beaches, Joshua Tree National Park, downtown Los Angeles, and Venice Beach, the former home of Arnold Schwarzenegger. The trip accomplished my goals of visiting fascinating new places while finding time to relax in the sun.

Earlier on this blog, I described how Gareth helped me when I first developed BPD symptoms around age 17.

For the first six or seven years of our friendship, Gareth showed extraordinary patience and endurance in containing my depression, terror, and rage. These feelings often emerged during our frequent phone calls and visits. He showed me what real friendship and concern for another person meant, concepts which were initially incomprehensible because of my traumatic childhood.  Eleven years later, we remain good friends, although our relationship is very different today.

Today, at age 28, I am increasingly focused on long-term goals in work and relationships. Running my own business for four years, buying my first house, and developing positive new friendships and dating relationships have all helped me feel more independent. Where it was once an unending nightmare, life is now an adventure, full of worthwhile challenges and opportunities. I now look forward to the future.

To consider how my needs have changed, it’s best to start with the most difficult times, the days when my needs were urgent, primitive, and overwhelming.

The Long Emergency

By my mid-teens, I had developed the symptoms of Borderline Personality Disorder as an inevitable consequence of the physical abuse and lack of love I experienced in childhood. I had no real friends, nor was I close to my parents. I did not trust anybody. Most of my energy went toward containing the terrible feelings of fear and despair which constantly threatened to overwhelm me. I had no idea what I needed to get better, or who to turn to for help.

I had been extremely hurt by my father’s abuse. Frustrated with his job and marriage, my father would attack me given the slightest provocation. On one occasion, he threw me ten feet across a room onto the corner of a wooden desk. On another, he chased me up to my bedroom, broke the door clean off its hinges, and assaulted me with close-fisted blows to my head and body. These incidents started around age six. My mother did not protect me; instead, she ignored my father’s behavior and pretended that we were a functional family.

These abuses were not the worst thing. Even more damanging was the silence – the fact that no one in our family talked to each other. Warmth, intimacy, spontaneity, and love were alien concepts, as far from my knowledge as cell phones, cars, and computers to a caveman. Outside of the occasional intense confrontation with my father, we related to each other in a robotic, automatic way. My father, mother, younger sister and I went to school and work, ate and slept, but never connected as real human beings. I never developed a sense of myself as valuable, as a part of the family that anyone cared about. It was this experience, and the horrible void it created, that led to the borderline symptoms.

The Vulnerable Self’s Demands

However, even in this dark, challenging time, I had some sense of what I needed. I wanted love, even though I couldn’t verbalize it at the time. There was a voice inside me which always said, “We have to find help!” I named this voice “Dudie”, based on the friendly word, “dude,” and talked to it as if it were another person. In the face of Dudie’s repeated demands, I gradually realized that my vulnerable inner self desperately wanted someone to care about me. In reality, I was talking to myself. Pretending to be two people was a defense against facing how truly alone I was.

I remember being in high school science class and feeling absolutely desperate. Dudie would say to me, “You have to find someone, Edward!” and “What are you doing to help us?” and “Feeling like this can’t go on any longer!” and “You have to do something!” This borderline psychotic state was an expression of my helplessness and of my desperate need for love and support.

I was frequently on the verge of tears during high school classes, and it was not normal sadness. Rather, it was a desperate, life-threatening feeling – a sense that if I did not find help soon, the core of my being would be destroyed. The problem was, I didn’t know what sort of help I needed. The terror at this helplessness filled my whole body and made me scared to move. Feelings of rage – outrage, because it felt wrong, unfair, and abnormal for anyone to feel this way all the time – constantly exacerbated the feelings of hopelessness and fear.

Rage and The Need for Love As Shown in The Crow

Around age 16, I first saw The Crow, starring Brandon Lee. In this dark, tragic film, a man and his beloved girlfriend are murdered, and the man returns from the dead to seek revenge on the gang members who killed her. The movie features an intimidating-looking young man stalking city streets at night, carrying out execution-style murders, and finally reuniting with a ghostly vision of his girlfriend.

I remember identifying deeply with the main character’s overwhelming, constant rage and with his fervent desire to reunite with his girlfriend. My childhood deprivation and abuse created the rage that I experienced vicariously through Brandon Lee. And my longing for someone to love me caused me to identify strongly with the final scene of reunion.

Here is a typical violent scene from the movie – http://www.youtube.com/watch?v=gffvxlENZIw&list=PLCA31E34EE14C2520&index=4

This scene may be disturbing to some readers, but I was never violent. This scene allowed me to vicariously experience the rage and wish for revenge against my father. Today, I have forgiven my father and no longer want to get back at him. Also, if one has watched the full movie, it contains scenes of friendship and hope (especially Eric Draven and the young girl), and I liked these also.

And here is the reunion scene – http://www.youtube.com/watch?v=k5dEM6xhL-Q

My Needs During the Dark Years

During the difficult years from around ages 16-23, my urgent need for understanding and support drove my behavior. In developmental terms, I desperately wanted a dependent, parent-child form of relationship. I wanted someone to mother me, to give me primary love and unconditional acceptance. In the void created by the lack of such a relationship – a relationship most people successfully complete as very young children – I experienced catastrophic rage, fear, and hopelessness. These overwhelming emotions precluded all other needs.

I painfully and enviously saw other young men getting girlfriends, developing networks of friends, and getting jobs. But these things presented overwhelming challenges for me, because I never felt well for more than a few hours, and most of the time I felt terrible. With no self-confidence, no identity, no inner stability, I couldn’t hope to become independent and forge good age-appropriate relationships.

A poignant indicator of the gap between my desires and my abilities was Laura. She was a beautiful, tall, blonde high-school girl who preoccupied me throughout high school. Her gorgeous body captivated me, but I had no idea how to relate to her as a person. It never crossed my mind to ask her about her opinions or interests. I hardly ever spoke to her, but always looked at her longingly whenever she was not looking.

One year, without saying anything, I timidly gave Laura a box of chocolates for Valentine’s Day. Luckily, she was a kind girl, and never made fun of me despite my awkwardness. Had I believed in myself, I was probably good-looking enough to have attracted her interest. But without the basic confidence that comes from having a long-term good relationship to a parent-figure, it proved impossible for me to even approach her.

At college, I wanted to make friends and join some student clubs. But my first two years at a prestigious state school turned into a social nightmare. I expected that other people would dislike me, and although that was not always the case, it seemed that way. I rarely looked people in the eye and had trouble maintaining conversations. Other people felt this awkwardness, and so tended not to invest themselves in getting to know me. In reality, my negative expectations and projections created this reality.

As I continued in college, I felt increasingly desperate and alone. By this time, I knew that I desperately needed someone to help me and to understand my struggle. But I still didn’t know where to start.

The Reconnection

Toward the end of my first two years at college, I started to drive home on weekends to see my mother, who had divorced my abusive father and moved into a new house. These visits with my mom comforted me for the first time. My mother somehow understood that I needed emotional help. We had a number of long talks, in which I would tell her awkwardly about my struggles in classes and with making friends at college.

Eventually, I broke down and cried with my mother, telling her how alone and hopeless I felt. Although it felt embarrassing, it was such a relief. I had often cried alone in my dorm room and at home during high school. It had been a lonely, desolate type of crying, the type of mourning in which there is no one there to hold you. Having another human being there felt incredibly redeeming. It reminded me of the final scene from the movie The Crow.

Dudie was invigorated. For the first time, real human help had reached me. Dudie began to speak to me during the week at college. He urged me to return home every weekend, and told me that there would be severe consequences if I did not go!

Eventually, my mother’s support, and my continued loneliness and unhappiness at college led me to return home for good. My mother and I developed a “symbiotic” relationship for the first time.

Psychotherapy

At the same time, I found a new psychodynamic therapist. During this year, around age 21, I had been reading Jeffrey Seinfeld’s work for the first time. From my own study, I understood how Borderline Personality Disorder results from “introjecting” (taking in) bad relationships and rejecting good relationships. I understood that the failure to develop a long-term loving relationship in childhood underlay all of the borderline problems, and how full recovery could only come through a long-term good relationship with someone in the present.

Based on this theoretical understanding, I directed all of my energy toward developing a positive relationship with my therapist. This did not mean that I avoided rage, fear, and hopelessness. I felt and discussed these emotions often. But as Seinfeld noted poignantly, there is something even more important that the borderline’s preoccupation with bad feelings and unsatisfactory relationships. That something is their terror and avoidance of positive, vulnerable relationships. The borderline feels that good relationships and love are forbidden, dangerous, and undeserved. This was the case with me.

During the first few years of therapy, I invented every possible reason to distrust and reject my therapist. My therapist was, 1) Not experienced enough, 2) Not optimistic enough about borderlines, 3) Not attractive enough physically (yes really!), 4) Too preoccupied with money, 5) Not perfectly on time, 6) Guilty of advocating medication, which I hated, 7) Not caring enough, 8) Not perfect. I used each of these as reasons to create distance and avoid intimacy in treatment. Eventually, I understood that I artificially created these “problems” with my therapist in order to punish myself. I dwelled on them to avoid noticing her good qualities which would lead to a good relationship. In other words, I continuously activated the all-bad self and object images (via splitting) and rejected the internal good self and object units.

Eventually, over the course of several years, I let these doubts go and experienced a prolonged therapeutic symbiosis. This period was among the most wonderful times of my life. I felt loved like a little child, as if everything was right with the world. The experience reminds me of the opening lines of Dylan Thomas’ famous poem, Fern Hill:

Now as I was young and easy under the apple boughs
About the lilting house and happy as the grass was green,
The night above the dingle starry,
Time let me hail and climb
Golden in the heydeys of his eyes,
And honored among wagons I was prince of the apple towns
And once below a time I lordly had the trees and leaves
Trail with daisies and barley
Down the rivers of the windfall light.

And as I was green and carefree, famous among the barns
About the happy yard and singing as the farm was home,
In the sun that is young once only,
Time let me play and be
Golden in the mercy of his means,
And green and golden I was huntsman and herdsman, the calves
Sand to my horn, the foxes on the hills barked clear and cold,
And the Sabbath rang slowly
In the pebbles of the holy streams.

All the sun long it was running, it was lovely, the hay
Fields high as the house, the tunes from the chimneys, it was air
And playing, lovely and watery
And fire green as grass.
And nightly under the simple stars
As I rode to sleep the owls were bearing the farm away,
All the moon long I heard, blessed among stables, the nightjars
Flying with the ricks, and the horses
Flashing into the dark…

Words can hardly describe this time, but this poem captures some of the childlike omnipotence, the carefree feelings of joy and delight, the direct sensual experience of the outside world that characterize therapeutic symbiosis. After years of emotional darkness, the flowers, grass and the sky seemed much brighter, as if my world had morphed into Technicolor. I felt that I had cheated death and entered a kind of heaven on earth. For years I had been planning to recover, and finally it was real! Hundreds of times I had promised Dudie, my inner self, that I would find someone to love him, and now his dream had come true.

My Needs in the Resolution of the Symbiosis

Being unrealistically all-good, this period of therapeutic symbiosis could not last forever. Eventually, my doubts about my therapist had to be worked through again, and new problems with school, work, and relationships emerged. Much work remained to be done. But the loving relationships with my mother, my therapist, and Gareth had proved transformative. I would never again be so vulnerable to despair and terror. I had a hard-won sense of myself as a worthwhile person. And I kept fighting to develop good new relationships, and to succeed in college and work.

In the years following, I became director at two learning centers where I teach children. I bought my own house, began to invest in other real estate, and made new, mature friendships. My need to be loved in a childlike way diminished greatly, and I began to genuinely care about other people’s wellbeing. Where before I had only feigned interest, I now wanted to find out what other people were interested in and how they thought.

The desperate need for a savior (a mother-figure to be dependent on) has been replaced by a serious consideration of what qualities I look for in friends and in a girlfriend. I want people who are mostly kind, funny, intellectual, active, loyal, unselfish, on-time, and reliable. I am quite conscious about who I choose to spend my time with based on these and other qualities. My needs have evolved from one-sided dependent relationships in which I only “take” from people, to two-way peer relationships in which there is both give and take.

With work over the past four years, I have learned a massive amount from managing a small business on my own. I’ve learned accounting, advertising, marketing, and most of all how to teach children of all ages. After college several years ago, full-time work was not a priority because I did not feel well enough to commit to it. Work was a stress to be avoided, rather than a need. But today, full-time work is a challenge that I enjoy. Finding a balance between succeeding at work while having time for relationships is a primary goal.

At work itself, I’m trying to challenge myself in other ways. I like to learn new ways to teach kids and to automate my accounting and advertising, but I also want to start another side business that links tutors and students outside of large institutions. Whether or not this succeeds, I will learn more about entrepreneurship through the process.  Lastly, I am developing long-term financial goals, saving and investing to make me more secure in the future.

Conclusion – Good Challenges

One challenge today is that the woman I have been dating for much of the past year, Aletta, has become seriously physically ill. She is a wonderful, kind, intelligent, and attractive woman, and I have benefitted greatly from knowing her. Even though she’s several years younger, I credit her with teaching me a lot about how to have a mature, respectful romantic relationship. She might think I’m out of my mind for saying that, but if so she should give herself more credit J

Although I’m quite worried for her, I believe Aletta will be able to persevere through her physical problems and recover fully. Notwithstanding these challenges, she may choose to work outside of my state in the long-term, which would make it more difficult for us to stay in regular contact. Despite the uncertainties, I enjoy staying in touch with her, since she remains a lovely person. I would be delighted if Aletta returned to live in this area, and sad if she does not, but will be able to handle either outcome.

My struggle to recover has taught me that one never reaches a place where things are all easy or problems completely go away. I am often faced with challenges and problems today. The difference is that they are not overwhelming, and I relish many of them. Despite life’s challenges, I feel genuinely well most of the time.

It’s my hope that this essay has demonstrated something of the way in which needs evolve to more mature levels during recovery from Borderline Personality Disorder. The borderline individual begins recovery with needs which are primitive, urgent, and overwhelming. He is focused on finding a basic, parental form of loving support that will fill the inner void and reduce his terrible emotional suffering. Over time, as he experiences a therapeutic symbiosis, the recovering former borderline develops mature ego capacities and an identity. He becomes increasingly able to form mutually satisfying relationships with peers, to decide what qualities he wants in others, and to find satisfaction and autonomy in his work.

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes

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#10 – Four Phases of BPD Treatment and Recovery

In their treatment of Borderline Personality Disorder, certain psychodynamic therapists developed a four-phase object-relations approach. The four phases included:

1)      The Out-of-Contact Phase

2)      Ambivalent Symbiosis

3)      Therapeutic Symbiosis

4)      Resolution of the Symbiosis (Individuation)

The Washington, DC-based psychoanalyst Harold Searles originated this approach in his work with hospitalized psychotic patients in the 1960s and ‘70s. He later adapted it to use with less disturbed borderline-spectrum patients. In the 1990s, New York social worker Jeffrey Seinfeld updated Searles’ four-phase model in his book The Bad Object.

Over the last 10 years, as I worked to transform my borderline illness in therapy, I passed through these four phases sequentially. They describe a severely troubled person’s emotional experience at different stages of treatment, while providing an object-relations model which delineates the relative strength of positive and negative self-and-object units. For me, they are the most accurate way of conceptualizing the progress of a borderline individual in recovery.

None of this is meant to minimize the great differences which exist among individual people diagnosed with BPD. These phases are not meant to be exact descriptions of what each borderline in recovery experiences. Rather, they are a rough map of the recovery journey.

This model’s four phases of therapy for BPD can be subjectively described as follows:

1)      Out-of-Contact Phase – In this earliest phase, the borderline individual is emotionally cut off from the outside world, existing in a “closed psychic system” where little to nothing from the outside world influences them in a positive way. Searles described the patient and therapist in this phase as being “isolated in their own psychic territories”. Out-of-contact patients experience themselves passing through life like automatons, with little to no subjective emotional experience. They experience profound depersonalization and derealization (not feeling real).

These people bring to mind tragic characters from Franz Kafka’s novels, individuals who experience life as meaningless and the outside world as full of capricious, heartless persecutors. They are symbolized in T.S. Eliot’s The Wasteland as “men who have lost their bones”. The wasteland represents the internal psychic world of people who, because of overwhelmingly severe neglect and/or abuse, have lost all hope of forgiveness, love or redemption. Instead of hope, there is the view of the outside world as cold, empty, unforgiving, and punishing.

The out-of-contact phase represents the most severely emotionally ill borderline individuals. These individuals usually have chaotic lives in which they are unable to commit themselves consistently to jobs, living places, or relationships. In therapy, they experience the therapist in his empathic helping role as being like “an alien creature from another psychic planet” (Seinfeld). They do not tend to develop a positive relationship to the therapist, or to understand what therapist is about.

2)      Ambivalent Symbiosis – This second phase represents those borderlines who have had enough positive emotional experience to hope that recovery is possible. They believe in the possibility of reclaiming a good relationship with the outside world. They form an ambivalent relationship in which they want to trust the therapist, but at the same time fear being retraumatized and thus maintain distance.

Searles described this phase as “the therapist and patient driving each other crazy.” There is a constant struggle between accepting versus rejecting the therapist’s help. The feeling tone between patient and therapist is primarily one of aggression, wariness, and provocation. In this phase, the patient will find complex, often subtle ways to maintain distance from the therapist and prevent the development of a therapeutic symbiosis.

The struggle of an ambivalent symbiotic patient to trust their therapist, and accept loving support from the world in general, brings to mind Joseph Campbell’s classic conception of the hero (from The Hero with a Thousand Faces). The archetypal hero must struggle against demons, ghosts, monsters, or human enemies to reunite with good people with whom they have lost contact.

A famous example is Homer’s Odyssey, in which Odysseus must prevail against monsters, sirens, and traitorous suitors to reunite with his beloved wife and son. Analogously, the ambivalent borderline patient must overcome the metaphorical demons of past neglect and abuse, fighting through their distrust and fear of closeness to become able to love other people again.

My favorite example of this transformation occurs in the Disney movie, Beauty and the Beast. The Beast must overcome his distrust and anger toward the outside world, and learn to love another, or be forever cursed to live in non-human form. His castle metaphorically represents the type of “closed emotional system” that many borderline individuals live in.

Compared to out-of-contact patients, ambivalent borderlines tend to commit themselves much more consistently to regular jobs, living places, and relationships. They have more real, positive emotional investment in the outside world, and thus more basis for hope that things can improve further. However, because they are afraid of intimacy and of really trusting others, their overall personality structure remains fragile, and they are vulnerable to separation stress.

3)      Therapeutic Symbiosis – If the borderline patient can come to deeply trust the therapist, the phase of therapeutic symbiosis gradually emerges.

Searles described the feeling tone of therapeutic symbiosis as characterized by “maternal care and love.” In this phase, the vulnerable, childlike aspect of the borderline reemerges and is nurtured by the therapist, who is idealized as a perfect parent.

For the borderline patient, who has struggled his whole life to achieve psychological wholeness, it is difficult to overstate the benefit of a prolonged therapeutic symbiosis. A genuine therapeutic symbiosis is a psychic rebirth or redemption, a transformation in which the person comes to feel truly alive for the first time. It marks the beginning of the subjective sense of self, and the first true awareness of psychological separateness from other people.

During this phase, the borderline’s independent functioning is enhanced. They become more assertive in achieving goals in work, study, or other interests. They begin to be able to tolerate separation from other people better, without always feeling lonely or abandoned. And their self-esteem improves dramatically.

Because of the awareness of separation and the gain in self-esteem, the (former) borderline in therapeutic symbiosis usually develops healthier, rewarding relationships with new people in the outside world. They become increasingly aware of how many positive experiences they have missed out on during their earlier years as a borderline personality.

4)      Resolution of the Symbiosis / Individuation – In this final phase, the (now former) borderline comes to function increasingly independently, and to need the therapist less and less. Gradually, the patient becomes disillusioned with the therapist, realizing that the therapist is not their parent, cannot solve all their problems, and will not be there forever.

In this phase, the patient increasingly develops an individuated sense of themselves as a unique and valuable person. In a parallel fashion, they become more and more aware of other people’s separateness and of the individuality of others. In a successful treatment, the patient gradually tapers down the frequency of meetings with the therapist, coming increasingly to manage life’s challenges using their own inner resources.

Comments on the Separability of The Four Phases

In reality, these four phases are not strictly separate. For example, a given patient could have periods of being out-of-contact, alongside periods of being ambivalent toward the therapist. Often, one phase at a time will predominate. But sometimes, the patient will show aspects of multiple phases at once.

Searles described how patients may oscillate between phases, progressing in a two-steps forward, one-step back fashion. This is particularly the case when a patient is transitioning from one phase (e.g. from being mainly ambivalent and doubtful toward the therapist) into another phase (e.g. to trusting and accepting the therapist’s support).

Like the diagnosis of Borderline Personality Disorder itself, these phases are not scientifically validated or based. They are based purely on the observation of therapists working with borderline patients. For that reason, they should be viewed with caution, since they may not be useful or a fit for everyone diagnosed with BPD. However, in my experience, these phases and the underlying object-relations they are based on (to be discussed below) form a remarkably accurate and useful way to conceptualize BPD recovery.

 An Object-Relations Analysis of the Four Phases

To better understand them, it is helpful to describe the four phases using object-relations terminology. For an overview of object-relations, please see my last article below, on the theories of Ronald Fairbairn, one of the founders of object-relations theory.

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

Writers like Searles and Seinfeld thought about early psychological development in terms of the “good” and “bad” object relations units theorized by Fairbairn. They then integrated these units into the sequential four-phase theory of treatment for borderlines which I am outlining here.

Here are the four phases again, this time considered in terms of the relative strength of positive and emotional self and object images within the mind of the borderline patient:

Out-of-contact Phase’s Object Relations – This phase features a strong dominance of all-negative mental images of self and other. These self-and-object units actively reject internalization of anything positive from the outside world. The patient continuously maintains a “closed system” in which he is “attached to the bad object” (Fairbairn). There is no symbiotic interaction with the therapist, no recognition that a positive relationship is even possible, and no projection of a hoped-for good object into the transference relationship.

Ambivalent Symbiotic Phase’s Object Relations – The all-negative images of self and other are still stronger, but there is a larger (minority) proportion of positive images compared to the out-of-contact phase. This relatively greater quantity of positive images result in the patient becoming aware that a positive, nurturing relationship with the therapist is possible. In other words, the patient possesses an internal “hoped-for good object.”

However, the dominance of the all-negative images during ambivalent symbiosis result in the patient distrusting the therapist and using projective identification to reject them. The patient distorts the therapist, turning him “all bad” in their mind in order to block the development of a positive relationship. In other words, the patient sabotages himself by actively attacking his potential positive relationship to the therapist.

The patient turns the therapist into someone disappointing and rejecting, even when the therapist’s actions in reality do not warrant this view. As long as it continues, this projective activity maintains the dominance of the negative self-and-object units by rejecting the internalization of the therapist as a good object.

As an ambivalently symbiotic relationship evolves, the patient will gradually reveal more of themselves to the therapist, coming to feel more trust and support. This process happens gradually, in a two steps forward, one step back fashion. Like a slow drip, like grains of sand in an hourglass, each positive experience makes the patient’s positive self-and-object images slightly stronger. This gradually tips the internal balance away from the negative images toward the positive self-and-object images.

Therapeutic Symbiotic Phase’s Object Relations – This phase begins to predominate when the all-positive images of self and other become stronger than the all-negative images. Once this internal balance shifts, the patient comes to fully trust the therapist and to strongly internalize the therapist’s positive attitudes. Of course, the therapist must be a truly “good” person in reality for this to happen.

Therapeutic symbiosis is still based on splitting, in that the patient unrealistically sees the therapist as all-good, disavowing and splitting off any less-than-perfect aspects of the relationship. Emotionally, the patient feels the therapist to be an all-good parent figure relating to the patient as a perfect child.

This stance is maintained via extensive projective identification by the patient, who now maneuvers the therapist into the role of good parent, expecting to be treated well (a contrast to the earlier phase of ambivalent symbiosis, in which the patient unrealistically rejects the therapist as untrustworthy, projecting past bad objects into the present transference relationship).

As therapeutic symbiosis proceeds, the dominance of the positive images of self and other grows. The patient feels gradually less vulnerable to the now-unconscious, persecutory, all-bad self-and-object images. Over time, the patient internalizes the psychological functions that can only come from an extended good-object relationship. These include the ability to comfort themselves, regulate negative emotions, maintain self-esteem, and delay gratification.

Resolution of Symbiosis / Individuation Phase’s Object Relations – In this phase, the patient begins to integrate the all-good and all-bad sets of images (resolving splitting). They will gradually realize that the therapist is not a perfect parent. Like in the ambivalently symbiotic phase, but in a less distorted way, the patient will again perceive the therapist’s imperfections. However, this time, with a stronger positive set of self-and-object images as a foundation, he will arrive at a “whole object” integrated view of the therapist as a mostly good, but slightly “bad” person.

In a parallel way, the patient will “update” their view of themselves. They will see themselves as mostly good and worthy, but possessing some shortcomings and weaknesses. They will finally see themselves as a whole person.

The therapist now becomes a repository for the patient’s remaining all-bad object images. By practicing his independent functioning while objectifying the therapist as an imperfect, disillusioning, sometimes needy parent, the patient feels increasingly separate intrapsychically from the “bad objects” of his past. Over time, he individuates, coming to develop his own unique interests, preferences, identity, and sense of self.

#9 – The Fairbairnian Object-Relations Approach to BPD

In this post, we will explore Ronald Fairbairn’s approach to Borderline Personality Disorder. Fairbairn’s understanding of BPD was remarkably intuitive and deep, and helped later psychodynamic clinicians to effectively treat the disorder.

Psychodynamic Therapists Have Already “Cured” BPD

Most people do not know that psychoanalytically-oriented clinicians long ago “cured” BPD – meaning helped individuals with BPD to recover and live satisfying lives in work and relationships. These therapists include Gerald Adler, Vamik Volkan, James Masterson, Donald Rinsley, Jeffrey Seinfeld, Otto Kernberg, David Celani, Peter Giovacchini, and dozens of others. Their books convincingly present dozens of detailed case studies of borderlines who fully recovered, a reality which is totally contrary to the belief on many BPD web forums that BPD is life-long and incurable. These books are cited in the following article –

https://bpdtransformation.wordpress.com/2013/12/15/what-to-do-if-you-are-diagnosed-with-bpd/

It should be noted that these therapists worked with borderlines in intensive treatments lasting 3-5 years or more, meeting with their patients on average at least twice a week (no, I do not believe that one absolutely has to have long-term therapy multiple times a week with a psychoanalyst in order to get better). Today, most of these therapists are unknown to the public, partly because modern psychiatry has tried to redefine BPD as a biologically-based, genetically-caused disorder. However, as discussed in the post below, there is little evidence to support this deterministic conclusion.

https://bpdtransformation.wordpress.com/2013/12/09/is-borderline-personality-disorder-caused-by-faulty-genes/

Who was Fairbairn?

Ronald Fairbairn was a Scottish psychiatrist working mainly in the 1920s, 1930s and 1940s. At the time, the ideas of Sigmund Freud dominated psychological theories. One of Freud’s main beliefs was that innate drives like sexuality and aggression were the primary motivators of human behavior. Fairbairn rejected that view and instead developed the idea that human relationships – “object relations” in psychoanalytic terms – are the primary force influencing human decisions. This view might seem obvious, but it was not at the time. Fairbairn then developed a theory of human psychology based around children’s attachment to good (libidinal) and bad (anti-libidinal) people in the outside world.

Fairbairn’s work with abused children

When developing his theory, Fairbairn was heavily influenced by his work with troubled children at Scottish hospitals. Some of these children were orphans, and others were children from difficult households where physical abuse and lack of love were common.

Fairbairn poignantly noted that these children, having been separated from their abusive parents and taken to the hospital for therapy, often feared asking for help. Usually, the children preferred to stay attached to their bad parents rather than risk opening up to potentially kind new doctor.

From his work with these and other patients, Fairbairn noted common themes in those who experienced severe abuse and emotional deprivation in childhood. Among other things, he noted:

– The children felt a perverse “loyalty” toward the parents who abused and neglected him, and a duty to protect the parents from exposure by the outside world.
– The children tended to blame themselves for the abuse and neglect they received. In other words, they believed that they were treated badly because they were “bad” children, not because they had poor parents. Fairbairn called this the “moral defense.”
– Using the moral defense, children could trick themselves into thinking that if only they were not so “bad”, the abuse would stop and the bad parents would become good parents. It maintained the fantasy that they had some control over a situation in which they were truly helpless.

– Fairbairn noted that the children rejected efforts to help them by external “good objects.” They distrusted the motives of new, potentially helpful people, expecting that at any moment these “hoped-for good objects” could turn bad and become abusive like the parents.
– Fairbairn called the part of the child that rejected good people the “internal saboteur”, a.k.a. the “anti-libidinal ego” (libidinal means loving or positive). He was dismayed by the great power of the anti-libidinal ego’s attachment to abusive people in childhood and adulthood.

– He saw that the children fiercely resisted attempts to separate them from the original parents, as well as from later figures (e.g. abusive romantic partners) that resembled the parents. Fairbairn called this the “attachment to the bad object.” He viewed this as the most stubborn obstacle to successful psychotherapy – that the children themselves strongly rejected efforts to help them. This occurred even when they became young adults or in situations where the original parents were long gone.

Object Relations as a Theory

Most people intuitively understand that our minds are filled with internal “images” or representations of people based on our experience in the outside world. In fact, we have many different images of ourselves and of other people inside our minds, and we often fantasize about these images  when we are alone. These images could also be called emotional memories.

These images or memories have feelings attached to them; they are a combination of cognitive/intellectual knowledge and positive/negative emotions. They are like our minds’ “code” for the knowledge and feelings we have toward ourselves and other people. We use these images as a map to understanding ourselves, others, and what is possible for us as we relate to the outside world. These ideas very roughly explain “object relations theory”, which is used by psychodynamic therapists to understand problems including BPD.

The Endopsychic Structure of BPD

Fairbairn created a model for how the abused person managed internal psychic representations of other people. He called this the Endopsychic Structure. This model explained the behavior of individuals who would later be diagnosed with Borderline Personality Disorder.

In later versions of Fairbairn’s object-relations model, healthy development was promoted by a predominance of good, comforting, loving experience in early childhood relationships. A secure attachment to the parents allowed the child to confidently explore the world and to develop mature relationships as an adult.

Fairbairn noted that good relationships in early childhood promoted the development of ego functions like tolerance for ambivalence (seeing things as mixtures of good and bad), frustration tolerance (being able to sacrifice short-term discomfort for long-term gain), the ability to comfort oneself, the ability to be alone and not feel abandoned, etc. The reader will recognize that these are exactly the ego functions that modern-day BPD sufferers do not have.

Fairbairn called the mature adult ego the “central ego”, and noted that it contained a mixture of positive and negative perceptions of self and other, with the positive being stronger or integrated with the negative.

By contrast, the borderline or abused person had a “split ego.” Fairbairn described how when abusive, neglectful experience predominated in childhood, the child seemed to hold apart the mainly negative experience in one part of his mind, and to keep the occasionally positive, redeeming experience in another. Integration (seeing people as mixtures of good and bad qualities) could not occur since it was too threatening. There was no reason for the abused person to combine the two sets of images and see how weak the good experiences had been and how helpless they really were, until the ratio of good-to-bad experience improved.

Fairbairn realized that the abused person’s view of themselves and others was completely unrealistic, although they had enough of a hold on reality to avoid permanent psychotic regression (called schizophrenia today). Instead of seeing the outside world in shades of grey, the borderline saw people as all-good or (usually) as all-bad, and related to them as such.

Everyone has slight distortions or differences in how they see the outside world, which is why we have the truism, “perception is reality.” But in the borderline’s case, these distortions of other people are massive and create serious relationship problems, since people are not nearly as bad or as good as the borderline thinks they are. People do not normally appreciate being the target of projections by borderlines who view them as saints or demons.

The Attachment to the Bad Object and Rejection of the Good Object

The borderline’s unrealistic view of the outside world involved the belief that most people were untrustworthy, uncaring, rejecting, “bad”, etc. In other words, the borderline projected the original “bad object” experience with their parents onto new people they met. The “bad object images”  – all the memories of abuse and neglect from parents – dominated their expectations of the outside world.  They were emotionally blind to the reality that many kind, genuinely helpful new people existed.

Not only were borderlines relatively unaware of potential help, but they actively rejected it when it appeared. Fairbairn saw that a new, helpful person could easily be mistrusted and seen as someone who would eventually disappoint, abandon, or turn on them. In this way the borderline feared that a new “hoped-for good object” would morph into a “bad object”.

Fairbairn’s “moral defense” described how borderlines blamed themselves for the poor treatment they received in order to, 1) Protect the truly bad parents from blame and thereby avoid retaliation from that parent, and 2) Prevent awareness of the helplessness of their situation (i.e. “If only I were not so bad, my parents would treat me better.”).

The moral defense created another massive obstacle, because it made borderlines blame themselves as “bad” and judge themselves as unworthy of help.

The Inversion of the Normative Developmental Process

Fairbairn understood how the abused child’s mistreatment early in life resulted in adult borderlines who continued to abuse themselves and form abusive, disappointing relationships with adult partners (or, simply avoid positive relationships and remain alone). It is no coincidence that women who repeatedly return to abusive partners frequently, but not always, have borderline psychopathology.

This is the ultimate meaning of Fairbairn’s “attachment to the bad object.” It means that the borderline individual continually recreates and maintains bad relationships, whether he means to or not. By distrusting potential good new relationships and clinging to people who disappoint and reject him, the borderline remains attached internally (emotionally, at the mental image level) to “bad objects” and continues to believe that the world is rejecting and “bad” like in childhood.

A dramatic example of the attachment to the bad object appears in Alfred Hitchcock’s film, Psycho. The leading character, Norman Bates, wants to befriend an attractive young woman who stays at his hotel. However, he later kills her (i.e. rejects the internal good object) and therefore maintains the attachment to the bad object, his possessive mother. Norman fantasizes that his mother, who is actually long dead, would be jealous, and would not want him to relate to this potential new good person. Therefore, Norman’s “internal bad object” (the mother) dominates his mind and makes him reject the good object. Norman Bates was actually psychotic, but the object relations mechanisms involved are similar to borderline object relations.

The writer Jeffrey Seinfeld (in his book, The Bad Object) described how the borderline’s mental processes involved an “inversion of the normative developmental process.” What this means is that instead of seeking out good experience and rejecting bad experience, the person with BPD seeks out bad experience and rejects good experience. In other words, consciously or unconsciously the borderline individual does the opposite of what healthy people do. Borderlines are “attached to the internal bad object” – they avoid accepting, loving relationships, and stay attached to uncaring, abusive ones.

What is Needed to Let Go of the Attachment to the Internal Bad Object

In earlier posts, I wrote about how borderlines need to develop a dependent, trusting long-term relationship with a therapist or friend. This builds self esteem, develops basic trust in others, and helps to develop self-control, tolerance for ambivalence (not splitting), frustration tolerance, etc. A healthy ego, able to manage the challenges of adult living, can only be developed through long-term support and love, in other words, through good object relationships. For more on what is needed for recovery from BPD, please see these posts –

https://bpdtransformation.wordpress.com/2013/11/23/how-did-i-recover-from-borderline-personality-disorder/

https://bpdtransformation.wordpress.com/2013/12/15/what-to-do-if-you-are-diagnosed-with-bpd/

How Fairbairn’s Theories Helped Me Recover From BPD

Most people who are familiar with BPD know nothing about Fairbairn’s theories. This is unfortunate, because for me they represent the most penetrating and useful explanatory model of Borderline Personality Disorder.

I benefitted greatly from understanding the ways in which I sabotaged myself after reading Fairbairn’s work. Because of the abuse from my father, I tended to distrust people who really wanted to help me. This understanding helped me to reverse destructive patterns of staying alone, being critical of other people, acting out via overeating, and rejecting people who were available as friends or dates. I learned to be very conscious about seeking out accepting people and staying in contact with them, which can be challenging in today’s modern, fast-paced world. I also needed to accept and learn to tolerate my fear of rejection.

Since I am no longer borderline today, I am much less afraid of rejection, including when dating. Although disappointment is always possible, I’m no longer afraid to take risks that may lead to rejection. I know that for the most part I’ll be accepted, since people tend to be more good than bad, and because I see others as mixtures of good and bad.

In Fairbairn’s terms, I project “bad object” images into other people less and don’t expect them to turn out like my disappointing father. From the good, dependent relationship I had with my therapist for many years, I internalized many “good objects” (positive memories) using her support and caring about me. I used these to build up my self-esteem, develop adult ego functions, and begin to expect that the outside world would respond well to me.

Eventually, when I had a better ratio of good to bad memories, I developed the ability to view myself and others more ambivalently, as both positive and negative. This process happened fairly spontaneously over a period of a year or two.

Today, I still use Fairbairn’s models to understand some of my friends and family that are undergoing relationship problems. Fairbairn’s object-relations models can help to understand anyone, since we all have good and bad relationships with other people.

As noted in the post below, I do not believe Borderline Personality Disorder truly exists. Instead, attachments to bad objects based on abusive experience can occur to greater or lesser degrees in anybody. The difference in those people who are diagnosed with BPD is that their histories are usually much more traumatic, and therefore their attachments to bad objects tend to dominate their whole lives rather than posing temporary problems.

https://bpdtransformation.wordpress.com/2014/01/16/a-unicorn-the-paradox-of-the-bpd-label/

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes