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#29 – “The Borderline States” – An Essay by Lloyd Ross, Ph.D., Therapist with 40 Years’ Experience Treating People Labeled BPD

I recently emailed Dr. Lloyd Ross, a clinical psychologist from New Jersey with 40 years’ experience treating individuals labeled borderline. I asked him for his views on the DSM model of BPD, the causes of borderline states, what is the best treatment for BPD, and can it be cured. Here are highlights of his responses, with my emphases in bold:

Highlights of Lloyd Ross’ Viewpoints on BPD, excerpted from his essay below:

On therapists who don’t want to work with people labeled BPD:

Lloyd Ross: “To avoid their own discomfort, poorly trained therapists describe borderline individuals as untreatable. Well trained therapists do not have that opinion. Well trained therapists have done well with these individuals, provided the therapist knows both what to expect and what he is doing.”

On good outcomes for people labeled “BPD”:

Lloyd Ross: “With proper insight oriented therapy, people labeled as borderline do go out in the world and function quite well in relationships, employment, etc. Like the rest of us, the goal is not to be cured from some non-existent disease, but to simply resolve the issues in our development that stop us from functioning in a relatively comfortable manner.”

On BPD as a medical diagnosis:

Lloyd Ross: “(As a medical diagnosis) the only “borderline states” that have any validity for me are on the border of Mexico or Canada… In addition, there is absolutely no real science behind any of the DSM/ICD diagnoses.”

On how the word borderline can be useful:

Lloyd Ross: “To use the term “borderline” from a developmental point of view is very different… Using the term “borderline developmental issues” enables us to go back in time and try to help the individual to undo, modify, and soften development that did not go smoothly the first time around.

On the developmental approach to working with people labeled BPD,

Lloyd Ross: “Using this model, the therapist works toward a stronger continuum of emotional development so that a person can function in a more whole way. Borderline states are not a disease or medical issue and therefore, nobody is “cured.” People just learn to handle various issues in their lives in a smoother, more comfortable manner for them.

On suicide prevention:

Lloyd Ross: “According to Bertram Karon, Ph.D., one of the world’s most prolific researchers on effective psychotherapy with patients labeled schizophrenic, suicidal, and borderline, ‘The best suicide prevention is effective psychotherapy.‘ ”

On the value of medication in treating people labeled BPD:

Lloyd Ross: “The medication approach (anti-depressants and/or anti-psychotics) is useless in people with borderline, suicidal, and PTSD symptoms. In fact, anti-depressants are probably one of the major causes of iatrogenic (doctor induced) suicide in this country in the past 15 years, especially with individuals labeled borderline.”

On trauma as the cause of borderline states:

Lloyd Ross: “The cause of “Borderline Personality Disorder” as with all of the “made-up” psychiatric diseases, is trauma at various times and stages in a person’s development… The failure of all-good and all-bad perceptions to fuse is the genesis of all pathologically borderline states.

My Interaction with Dr. Ross

So (this is Edward writing again) these were my favorite parts of what Dr. Ross said about BPD; for the full context, see his essay below. I had originally found Dr. Ross because he is a member of ISPS, the International Society for Psychological and Social Approaches to Psychosis, with which I’m also involved. In my first email, I asked Dr. Ross for detailed answers to my questions about what causes BPD, what best treats it, is it curable, and how best to understand Borderline Personality Disorder.  I wanted to see how much his viewpoints agreed with mine, and to share an informative and hopeful professional viewpoint on BPD with readers of this blog.

In response, Dr. Ross decided to write a single essay incorporating his responses to all the questions. That essay, “The Borderline States” forms the main part of this post. I highly recommend reading it to see how a psychologist who’s worked with over 100 people labeled BPD understands the condition. To Dr. Ross, thank you for taking the time and for giving me permission to post your essay here.

For anyone wanting to know more about Dr. Ross, he is a leading member of the International Society for Ethical Psychiatry and Psychology (ISEPP), and is listed halfway down this page: http://psychintegrity.org/isepp-leadership/

LloydRoss1

Lloyd Ross, Ph.D.

Dr. Ross also features in a Youtube interview about helping people labeled schizophrenic here: https://www.youtube.com/watch?v=wyL0jjI93OI . I want to note that Dr. Ross did not edit this video (the silly cartoonish elements, which in my opinion detract from its message, were added by the filmmaker Daniel Mackler). But you can see from the way Dr. Ross talks that he is an experienced, committed therapist.

Lastly, I want to note that Dr. Ross’ viewpoints appearing on my site does not mean that he endorses or agrees with everything else on this site. His viewpoints are his own. Here is his full essay:

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THE BORDERLINE STATES

By Lloyd Ross, Ph.D.

During my 40 years as a clinical psychologist, I have worked with approximately 100 to 150 people who would be considered to fall into the developmental framework of what psychiatry, in its simplistic and arbitrary way, views as borderline. These people were seen by me for at least one year or longer, some multiple times per week, and others once per week. Some were also seen at multiple times in their lives with months or years separating periods of therapy.

Before discussing this topic, I would like to make clear the issue of psychiatric diagnoses of “mental disorders.” I am a clinical psychologist who was psychoanalytically trained from an ego-developmental point of view. I have been in full time practice for almost 40 years and have always avoided psychiatric diagnoses, as I see the various recreations of the DSMs/ICDs as nothing more than an attempt to medicalize things that are not medical to begin with (human behavior, experience, and development). On that basis, the only “borderline states” that have any validity for me are on the border of Mexico or Canada.

In addition, there is absolutely no real science behind any of the DSM/ICD diagnoses. All of them were developed in committee rooms inhabited by mostly elderly white psychiatrists, many of whom represented the financial interests of the pharmaceutical industry. When I do write down a DSM or ICD diagnosis for a patient, and only at a patient’s request, it is usually because they need it to submit their claim to an insurance company (Unfortunately, that is the way things are in this society). The diagnosis I use is almost always “Post Traumatic Stress Disorder,” for several reasons:

  1. It is the closest thing to a real diagnosis in the entire list of diagnoses, in that anyone who is having enough emotional difficulties to seek help has had personal trauma of some sort as one of the factors that caused their difficulties.
  2. From a developmental point of view, the stage of development we are in or approaching when trauma occurs is a good predictor of how, when, and where it will manifest itself in a person’s life.
  3. The term itself, “Post traumatic stress disorder,” is sufficiently vague and innocuous to the public to make the term less of a problem for an individual than terms such as schizophrenia, psychopathic or sociopathic personality or borderline personality disorder, none of which have any real scientific meaning.

I approach human (not medical) diagnosis as a strictly developmental issue. This is because of the influence of Margaret Mahler on my training, with some influence from Donald Winnicott, Edith Jacobson, Anna Freud, Renee Spitz, Heinz Kohut, and Ruben and Gertrude Blanck. I come primarily from Mahler’s framework and was supervised by her. Therefore, any real diagnosis that I do comes from an ego-developmental point of view.

The Causes of Borderline States

When looking at a detailed history of people commonly diagnosed by others as “borderline personality,” I and others have found that these people have experienced emotional trauma at around the time in development when children make and solidify their attachment to the mother figure. To be a bit more specific, it is associated with trauma during that time frame and there is always deprivation around that time frame also. I am sorry for making it such a complicated thing, but when you don’t simply slap a diagnostic label on somebody, but are instead dealing with a real live very unique individual and their complex developmental problems, the issues are no longer simple. In addition, to perceive a human being as literally being a diagnostic category—a “Schizophrenic” or a “Borderline” –dehumanizes that person.

The cause of “Borderline Personality Disorder” as with all of the “made-up” psychiatric diseases, is trauma at various times and stages in a person’s development. That is why taking a carefully detailed history of that person’s development, events in his life, and memories in his life is so important. All extreme mental states, whether with someone diagnosed as schizophrenic, borderline, neurotic, etc. which are meaningless terms, are the result of things gone awry or not having been negotiated at various stages in development, resulting in trauma.

Even if a child seems to progress just fine, if and when trauma occurs, it lingers or appears dormant. When, even years later, that trauma is reactivated by another trauma, that person seems to exhibit or feel the original trauma again without ever connecting the two. That is why I use the diagnosis “Post Traumatic Stress Disorder” with insurance companies, for everyone, and not just those who come for help. There is no human being that I have met who has never experienced trauma, although the ramifications for some are more disturbing than for others.

A Personal Example of Trauma

I will give you a vivid example of trauma in myself. From the time I was five years old, until I was ten years old, I was ordered by my parents to come home from school immediately, without lingering with my friends, to babysit my grandmother because I left school at exactly 3:00 P.M. and the lady who took care of my elderly grandmother left at exactly 3:00 P.M. My grandmother was a very nice roly-poly lady who only spoke Polish and Yiddish, was blind except for being able to see shadows, and was able to walk from her chair to the bathroom to the bed by feeling along the wall. I, on the other hand, did not speak Polish or Yiddish.

My grandmother was alone for the five minutes it took me to get home and I would run all the way because I was told that if anything happened to her, it would be my fault, a rather heavy burden for a five year old. I would sit with her in a second floor apartment with very little communication and stop her from trying to cook. I would lead her to the bathroom and to the bed so that she didn’t fall, and sometimes would make her tea, watching that she didn’t spill it on herself. Either my aunt or my parents would come home between 5:00 P.M. and 6:00 P.M., but quite often, they went shopping first or had something else they had to do, and I would be stuck with my elderly grandmother for two to five hours. Also, since she couldn’t see, she kept all the lights off to save money so the apartment was usually dark.

When I turned ten years old, I was offered a part-time job and because work was so important to everyone in the family, when I got the job, my babysitting for my grandmother was over. What I remember most about the babysitting was that everything was always dark and boring. One day, I was very bored, and I could hear my friends playing ball in the street below. I opened the window and sat on the ledge, playing catch with a friend who was in the street. Someone called the police because they thought I was a jumper and they yelled and screamed at me.

After getting three advanced degrees, and spending a year in a horrific war, I came home and met my wife to be. I was always relaxed, mellow and calm, yet at the same time I could be cutting and sarcastic, all of which I admired in myself. After getting married, several days per week I would work late and come home when it was dark. When the lights were on in my house, there was never a problem, but if I came home to a dark house, I would feel enraged and walk in complaining, arguing, and finding fault with everything.

Since I was in my own training analysis at the time, I brought it up, thinking it had something to do with my time in Vietnam. I finally made the connection between the rage that I felt when forced to stay in a dark house watching my grandmother, and the rage I felt when I approached my house with the lights off. Having made that connection, I no longer became enraged when the lights were off, but I didn’t feel wonderful either. My wife and I discussed it and she kept the lights on for me, just like motel 6. Another point is that learning the connections don’t necessarily take away all the feelings but they do put you in much better control of those feelings.

That is a relatively minor cause of Post-Traumatic Stress Disorder. Who is a victim of it? Everyone, unless their childhood was just perfect, wonderful and magnificent, and so far, I haven’t met anyone who falls into that category, although I never met Donald Trump.

Understanding Borderline States Developmentally

I would like to discuss development at this point because most of the people seen by psychotherapists fall into this particular phase, including those with the arbitrary junk-science diagnosis of borderline personality. In normal development, when a child approaches the end of the first year or year-and-a-half of life, he/she begins to recognize that he is not one with his mother, but is really a separate person. This infantile recognition marks the beginning of the end of the “symbiotic” phase of human development and the very beginnings of the “practicing” sub-phase, sometimes better known as “the Terrible Twos.”

The practicing sub-phase is an early part of what we often refer to as the “separation-individuation” phase of development, which is so critical to our development that Margaret Mahler describes it as “the psychological birth of the human being.” In fact, she wrote a classic book just about that phase of human development. During the practicing sub-phase, the child’s mission in life is to prove that he is a separate, autonomous human being, while at the same time not losing his mother. He does this by exploring his world, by trying to do things independently from his mother, and by oppositional behavior, (saying “NO”.)

Sometimes, this phase of development can seem like a battle against parental figures, hence the name “terrible twos.” Problems that develop in the early parts of this phase of development which a child is unable to successfully negotiate often result in what they call “borderline issues” because they develop during the beginnings of the quest for reality on the part of the child, which occurs right on the border of these two stages. Let me go on with a description of the next part of the child’s emotional development.

The Identification Process, Splitting and Fusion in Childhood Development

While beginning the Separation-Individuation phase of development, the child begins to identify himself with others. This is also the beginnings of object-relationships. Since the primary object for all of us is mother (whoever mothers us, which could be the actual mother or a mother-substitute) a child will view his mother in very black and white terms as he begins the identification process. Mother in her nurturing role is seen as “good mother.” However, when mother says no to the child, restrains him in some way or frustrates him, mother is then seen as “bad mother.”

From a child’s point of view, “good mother” and “bad mother” are really two different people. This view occurs because of the absolute black and whiteness of the child’s thinking process at this age and is a normal age appropriate distortion of reality. The process is called “splitting.” When mother gives me what I want, she is “good mother” but when she doesn’t give me what I want, she is “bad mother.” These are totally two different people to the child.

Over the next year or two, depending upon intervening variables as well as the child’s developmental progress, the image of the “good mother” and “bad mother” slowly start to come together in a merging process. At a certain point, these objects “fuse” and we no longer see our mothers as a split object, one mother good and the other mother bad. When these objects fuse into one object, one mother, we begin to entertain a different, more sophisticated perception of mother. Now, mother is seen as basically “good mother” who sometimes is not so good. However, both the good and the bad are housed in the same person.

This is a much more benevolent view of mother and allows for imperfection. Since mother is the “primary object,” the first person that a child identifies with, his perception of mother is vital to his perception of himself. Once the good and bad objects are fused, the extreme view of the child is softened. He now also looks at himself and is able to perceive that: “I’m basically a good child, but sometimes I do bad things. Even so, I’m basically a good child.” This benevolent perception does two things. First, it brings us in closer contact with reality, and secondly, it softens out perfectionism both toward ourselves and toward others.

When Fusion Doesn’t Take Place, or What Causes BPD

The failure of all-good and all-bad perceptions to fuse is the genesis of all pathologically borderline states. Please be aware also that I am using the word pathology to simply indicate development gone awry or developmental stages that were not properly negotiated by the child for multiple reasons.

Sometimes, due to external issues that limit or skew a child’s development, or because of internal developmental issues, a child is unable to fuse the good and bad objects into one unified whole. In that case, the split object remains and the child continues to perceive dual mothers; one totally good and one totally bad. Under such conditions, when the child identifies with the primary object (the mother or mother substitute) and then looks in the mirror, he sees either a totally good person or a totally bad person with no redeemable good qualities, a rather harsh view of oneself. Under the above conditions, the child’s development makes him a potential candidate for suicidal thoughts, feelings, and actions as well as borderline personality issues.

In the so-called “borderline personality, the core issues precede the problematic object relations and there are also introjective insufficiency problems with good and bad objects. Most people dealing with this issue feel an “annihilation panic” based upon the relative absence of positive introjects that pretty much explain the “borderline” person’s feeling that he is existentially at risk.

In other words, in the so-called “borderline personality, it isn’t just the all-good, all-bad splitting that is a problem, but the paucity or insufficiency of positive introjects. Therefore, in people who are labeled borderline, the negative introjects predominate. Also, in come cases, they are able to solve the introject problem by, in a sense, becoming their own object or mother, thereby being able to comfort themselves without the need for anyone else. In the psychiatric establishment, these individuals are referred to as “psychopathic” or “sociopathic” personalities. They don’t need mothering because they can self-comfort.

Let’s go back for a moment to clarify what the mother-introject is. In normal development, the child internalizes a mental representation of the mother figure and the way in which she makes the child feel. Negative introjects always come from abuse that has taken place at around this time. (Sorry if I am blaming the mother figure but that is the way it goes.)

Gerald Adler, also a student of the ego-developmental model, extends this work further. He describes ideal treatment as an attempt to establish and maintain a dialectic therapeutic relationship in which the therapist can be used over time by the patient to develop insight into adequately holding onto positive introjects. In this manner, the arrested developmental process is set in motion to correct the original developmental failure. This is called the “Deficit Model” in that the focus is on what is missing in that person’s development. Therefore, the core of borderline issues precede the destructive internal object relations. The issues involve abuse, the absence of a positive introject, and an overwhelming constant feeling of being at risk, primarily due to the insufficiency of positive introjects.

Treatment for the Borderline, Suicidal or PTSD individual:

In this section, I would like to consider a number of treatments for these people and then the treatment of choice.

Electroconvulsive Shock; (ECT):

ECT, in short, involves placing two electrodes on the skull over the frontal area of the brain and then administering voltage that is comparable to being hit by lightening. This does several things. First, it causes a brain seizure which is not very pretty to observe. To avoid looking like a scene out of the movie “One Flew Over The Cuckoo’s Nest,” psychiatrists first administer sedative drugs to mute the external manifestations of the electric shock such as thrashing, broken bones, etc.

However, when they do this, to cosmetically improve the look of the treatment, they also have to increase the voltage, thereby creating greater cell damage and cell death in the brain, flatness of personality and affect, and slower thinking processes. This damage is similar to what occurs as a result of long-term heavy alcohol use, only more rapidly and in more focused areas, particularly the frontal lobes of the cortex or the cognitive and feeling areas of the brain. Keep in mind that ECT is similar to a motorcyclist head injury or explosion in that it is a “traumatic head injury,” only it is being caused by a physician. One of the side effects of killing off brain tissue in the frontal lobes is apathy, flatness of personality and affect, and slower thinking processes.

As a result of all this brain damage, suicidal thoughts (all other thoughts as well) are deferred and drastically slowed up. Therefore, ECT may temporarily defer suicide or soften the borderline issues, but it does not prevent it and when a person slowly and partially recovers from the shock, he may realize the lesser functioning he is left with permanently, an even greater motivation for suicide. ECT also significantly and drastically disrupts any psychotherapeutic process that is being carried on. Earnest Hemingway was “cured” of suicidal tendencies by ECT.

Bio-psychiatric Treatments:

The medication approach (anti-depressants and/or anti-psychotics) is useless in people with borderline, suicidal, and PTSD symptoms. In fact, anti-depressants are probably one of the major causes of iatrogenic (doctor induced) suicide in this country in the past 15 years, especially with individuals labeled borderline. Also, feeding a patient cocktails of neuroleptic (anti-psychotic) drugs acts simply as a temporary chemical restraint, often called a “chemical lobotomy.” In that sense, these drugs mimic ECT. I do not consider either real help for any individual and they make insight oriented therapy almost impossible.

Insight Oriented Psychotherapy:

According to Bertram Karon, Ph.D., one of the world’s most prolific researchers on effective psychotherapy with patients labeled schizophrenic, suicidal, and borderline, “The best suicide prevention is effective psychotherapy.” He goes on to say: “Of course the most effective way to prevent a suicide or a homicide is to understand the psychodynamics and deal appropriately in therapy with these issues.”

There are also a number of things that need to be confronted in any psychotherapeutic situation with a suicidal, borderline, or homicidal patient. Among them are his anger and rage, his and the therapist’s loss of control, and in a child, the significant parental issues, the patient’s developmental history, the ways in which the patient transfers his feelings (mostly bad and angry feelings) to the therapist, as well as other issues.

From the therapist’s perspective, he must be able to handle the transferential rage and aggression as well as his own feelings of lost control and counter-transferential issues. Finally, the therapist needs to deal with his own fears of the patient’s potential for suicide. Untrained,

fearful therapists, when they hear that a person has suicidal issues, get frightened and immediately refer to a psychiatrist, as though a psychiatrist has some magical powers to treat this problem. Unfortunately, when a therapist does this, the message to the suicidal person is “I am afraid of you and am not equipped to deal with your issues. The therapist is then immediately written off by the suicidal person.

Many therapists also do not want to work with people diagnosed as borderline for two reasons. The first is the rage that gets directed at the therapist. Borderline development results in a huge need to get rid of the aloneness they feel which results in rage that makes the therapist cease to exist. The counter-transference from an untrained therapist is a feeling of “I’m wasting my time here.” The second is that the amount of support needed is greater than with other kinds of development. You cannot resolve splitting until a strong positive relationship exists between the person and the therapist. In treatment, the unrealistic idealization of the therapist that the borderline person feels must be slowly worked through and discussed before it is relinquished and replaced by a more realistic view. The therapist’s goal is to slowly build up the earlier foundations of the ego structure through the relationship so that what is established is a not-so-harsh superego and thereby, less black and white pain in the face of imperfections and losses.

It should be understood that using this model, the therapist works toward a stronger continuum of emotional development so that a person can function in a more whole way. It is not a disease or medical issue and therefore, nobody is “cured.” People just learn to handle various issues in their lives in a smoother, more comfortable manner for them.

A Brief Word on Narcissism

Narcissism is often a component of borderline development. Narcissists are particularly hard to treat. They find it difficult to form the warm bond with a therapist that naturally evolves with most other patients. Instead, they often become cold or even enraged when a therapist fails to play along with their inflated sense of themselves. A narcissistic patient is likely at some point to attack or devalue the therapist, and it is hard to have to sit with such people in your office unless you are ready to accept that.

But narcissism is not limited to the most extreme cases who make their way to the therapists’ office. A healthy adjustment and successful life is based to some degree on narcissism. Healthy narcissists feel good about themselves without needing constant reassurance about their worth. They may be a bit exhibitionistic, but do not need to play down the accomplishments of others to put themselves in a good light. And although they may like adulation, they do not crave it.

Normal narcissism is vital for satisfaction and survival. It is the capacity to identify what you need and want. Pathological narcissists, on the other hand, need continual reassurance about their value. Without it they feel worthless. Though they have a grandiose sense of themselves, they crave adulation because they are so unsure of themselves that they do not know they have done well or are worthwhile without hearing it from someone else, over and over. The deeply narcissistic person feels incomplete, and uses other people to feel whole. Normally, people feel complete on their own.

”Narcissistic vulnerabilities,” as psychoanalysts refer to them, make people particularly sensitive to how other people regard them. You see it in marriage, in friendships, at work. If

your boss fails to smile when you greet him it may create a withdrawn, anxious feeling. If so, your self-esteem has been hurt. A sturdy self absorbs that so it’s not unbalanced. But if you’re vulnerable, then these seemingly small slights are like a large trauma. On the surface, extreme narcissists are often brash and self-assured, surrounded by an aura of success. Indeed, they are often successful in their careers and relationships. But beneath that success, feelings of inadequacy create the constant need to keep inflating their sense of themselves.

If they do not get the praise they need, narcissistic people can lapse into depression and rage. Thus, many workaholics put in their long hours out of the narcissist’s need to be applauded. And, of course, the same need makes many narcissists gravitate to careers such as acting, modeling, or politics, where the applause is explicit. Many difficulties in intimate relations are due to narcissism. Marriage brings to the fore all one’s childhood yearnings for unconditional acceptance. A successful marriage includes the freedom to regress, to enjoy a childlike dependency. But in marriage, a couple also tend to re-enact early relationships with parents who failed to give them enough love. This is particularly hard on those with the emotional vulnerabilities of the narcissist. All narcissists fall within the borderline spectrum of development, but not everyone in the borderline range of development is narcissistic.

In summary, a therapist who is not trained well will usually not want to work with a borderline person for all the reasons mentioned above. To avoid their own discomfort, they describe them as untreatable. Well trained therapists do not have that opinion. It is not a “mental illness,” (disease.) Rather, it is a breakdown of a developmental phase that we all go through and involves issues such as splitting, negative introjects, probably early abuse, suicidal issues, and narcissistic issues.

Well trained therapists have done well with these individuals, provided the therapist knows both what to expect and what he is doing. Because it is not a disease, no one is cured. However, with proper insight oriented therapy, people labeled as borderline do go out in the world and function quite well in relationships, employment, etc. Like the rest of us, the goal is not to be cured from some non-existent disease, but to simply resolve the issues in our development that stop us from functioning in a relatively comfortable manner.

Finally, the term “borderline,” when used as a medical or psychiatric diagnosis, is both useless and harmful in that it is suggestive of some evasive disease. To use the term from a developmental point of view is very different and can be helpful in understanding what in a person’s development, was not negotiated properly or fully successfully. Using the term “borderline developmental issues” enables us to go back in time and try to help the individual to undo, modify, and soften development that did not go smoothly the first time around. This is something that is being done all the time by private-practice therapists, but not by what I call “the mental health industry.” However, that is a topic for some other time.

Below, I have listed a few books that should be helpful in understanding the treatment issues with individuals who are dealing with borderline issues. I have also included several books that support my opposition to the medical model approach.

Bibliography

Adler, G. (1977). Borderline Psychopathology and Its Treatment. Northvale, N.J.:Jason Aronson.

Breggin, P.R. (1994). Toxic Psychiatry. New York: St. Martin’s Press.

Jackson, G. E. (2005). Rethinking Psychiatric Drugs. Bloomington, Indiana: Author House.

Jackson, G.E. (2009). Drug Induced Dementia: A Perfect Crime. Bloomington, Indiana: Author House.

Blanck, G., & Blanck, R. (1972). Ego Psychology: Theory & Practice. New York: Columbia U. Press.

Colbert, T.C. (1996). Broken Brains Or Wounded Hearts. Santa Ana, California: Kevco Publishing.

Ferenczi, S. (1950). “Introjection and Transference.” In Sex In Psychoanalysis: Selected Papers. 35-93. New York: Brunner/Mazel.

Freud, A. (1936). The Ego and The Mechanisms of Defense. London: Hogarth Press.

Freud, A. (1965). The Writings of Anna Freud, Vol. VI: Normality and Pathology in Childhood Assessments of Development. New York: International Universities Press.

(Hartmann, H., Kris, E., & Loewenstein, R. (1949). “Notes on the theory of aggression.” The Psychoanalytic Study of the Child, ¾, 9-36.

Jacobson, E. (1954). “The self and the object world: Vicissitudes of their infantile cathexes and their influence on ideational and affective development.” The Paychoanalytic Study of the Child, 9, 75-127.

Jacobson, E. (1964). The Self and the Object World. New York: International Universities Press.

Karon, B.P., & VanderBos, G. R. (1994). Psychotherapy of Schizophrenia: The Treatment of Choice. Northvale, New Jersey: Jason Aronson, Inc.

Kohut, H. (1972). “Thoughts on narcissism and narcissistic rage.” The Psychoanalytic Study of the Child, 27, 360-401.

Mahler, M. (1960) “Symposium on psychotic object-relationships: III. Perceptual differentiation and ‘psychotic object-relationship’.” International Journal of psychoanalysis, 41: 548-553.

(51) Mahler, , M. & LaPerriere, K. (1965). “Mother-child interactions during separation-individuation.” Psychoanalytic Quarterly, 34: 483-498.

(52) Mahler, M. Pine, F., & Bergman, A. (1975). The Psychological Birth of the Human Infant. New York: Basic Books.

(55) Masterson, J. (1973). “The mother’s contribution to the psychic structure of the borderline personality.” Paper read at The Margaret Mahler symposium on Child Development, Philadelphia, May, 1973. Unpublished.

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#18 – Heroes of BPD: Jeffrey Seinfeld

A few months ago I discussed Gerald Adler, a clinician who treated BPD using a psychodynamic method. Today I’ll write about Jeffrey Seinfeld, the New York-based social worker who pioneered a Fairbairnian approach to Borderline Personality Disorder.

On this blog, it has been discussed several times how psychodynamic therapists have already “cured” BPD. Here is an example of a borderline patient’s recovery from Jeffrey Seinfeld’s book, The Bad Object.

seinfeld1

I thought the reader might be interested to hear in detail about one of the “successes” in BDP recovery that are often referenced on this blog. Her story shows how complex, challenging, and interesting the journey may sometimes be. Some of this account is paraphrased, while the parts in quotations come straight from the text:

A Case Study: Kim (from The Bad Object, pages 101-123)

At the start of her therapy with Jeffrey Seinfeld, “Kim” was a 22-year-old Irish-American young woman. From ages 17-22, she been in regular treatment with another therapist, but had made little progress. After dropping out of high school at age 16, Kim lived at home with her mother. She did not work or attend school; rather, much of her time was spent abusing alcohol and illegal drugs.

With her first therapist, Kim showed no motivation to change, and indeed would boast about antisocial and destructive behavior, including tempting friends trying to quit drugs into again using them. She would regularly miss therapy appointments without calling to cancel. Her therapist as the time described her attitude as, “Who can blame me for messing up with all I’ve been through?”

Eventually, Kim’s first therapist referred her to Jeffrey Seinfeld. He had not lost hope for her, but felt that they had reached an impasse and that a change of approach might help her. Seinfeld scheduled Kim for twice-weekly appointments at a social-work center. For the first year or so of their work, she continued to regularly miss appointments without cancelling ahead, and to abuse drugs and alcohol regularly.

Kim’s Early Childhood

Seinfeld describes Kim’s childhood in this way: “Kim was an only child in an intact family. Kim’s mother alternately neglected and overindulged her. During Kim’s first year of life, her mother often ran out of the house to escape a psychotic husband… The mother would promise to return later in the evening, but often stayed away for days at a time. Kim therefore had repeated experiences of awakening to find herself abandoned by her mother. She grew to hate falling asleep if her mother was present, and she had frequent tantrums, insisting that her mother sleep with her…”

“Kim’s psychotic father had delusions that he was Jesus Christ and that demons possessed him. He underwent psychiatric hospitalization, and his condition was finally stabilized with psychotropic medication. Kim’s mother went to work when Kim was 3 years old, leaving her at home with her father, who was on disability. He would ignore her as he read the Bible or sat in a catatonic-like stupor. If she disturbed him with her romping and playing, sometimes designed to get his attention, he would beat her…”

“Throughout childhood, Kim was on a merry-go-round in her relationships with her family members. First she would side with her mother against her father. When her mother upset her, she would go to her father and side against her mother. When her father upset her, she’d go to her grandfather and side against everyone. As an adolescent, Kim took no interest in learning at school but instead “hung out” with peers and smoked marijuana daily. She dropped out of high school at the age of 16.”

Kim’s Early Therapy – The Out of Contact Phase

Seinfeld described how Kim’s life had little structure outside of her regular abuse of alcohol and drugs. She had trouble sleeping at night, and often slept during the day instead. Kim could not bear to be alone, and would often call her drug-abusing friends from high school to chat at all hours of the day. However, these friends were becoming less interested in her as they grew older and got jobs or moved away.

Kim felt that people were always too busy for her and would eventually abandon her. Thus, according to Seinfeld, her internalized bad object was a “busy object” who did not make time for her. Kim projected this image onto outside people based partly on experience with her real mother, who often did not take time to care for her.

(If the reader is not familiar with projection of internal object relations onto present day relationships, based on past bad experience with parents, the following article may be useful – https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/ )

Seinfeld notes that his main experience in relation to Kim early on was that she was oblivious to him psychologically. Seinfeld felt that Kim was unaware of his separate presence, but simply “told him stories” about her adventures with drugs, friends, alcohol, and other adventures. She did not expect any help, understanding, or admiration from her therapist. Referencing the out-of-contact phase, Seinfeld stated, “My position as an object was that of a witness as opposed to an admirer.”

After several months, Kim showed the first sign of becoming aware of Seinfeld’s intent to help when she wrote about him in her diary. She felt concern that her life was “going nowhere,” and wished that she could work or attend school. Shortly after this awareness, Kim cut her wrist with a razor. Seinfeld describes how “the self-mutilation is an antidependent attack against the vulnerable, libidinal self’s expressed need for an internal holding object. The antidependent self thereby reestablishes a closed, internal, invulnerable position.” In other words, the patient identified with how people rejected her need for help and support in the past, and repeated the same behavior toward herself in the present, acting as the bad parent and punishing herself (the bad child) inside her own mind.

This early phase of Kim’s treatment was an “Out of Contact” emotional phase, as described here:

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

Dwelling on the Rejecting Object

Seinfeld acknowledged noted how Kim’s life was in reality extremely difficult. Her “friends” were self-absorbed and did not truly care about her, she had little support from her parents, and she had no structure in terms of a work or academic program, in addition to addictions to drugs and alcohol.

However, despite these severe difficulties, Kim did not respond by looking for positive ways out of her predicament. Rather, as Seinfeld describes,

“Kim was constantly preoccupied with how her friends and family exploited, rejected, and did not care about her. She would dwell on the rejecting object and rejected, unimportant self-image through the day and so would remain in a depressive, victimized position… Even when the external person did not in reality reject her, Kim would interpret the situation as rejection…. All of this is not to say that the external objects did not often treat Kim badly; on the contrary, they often did. But Kim had her own need to perpetually activate the all-bad self-and-object unit.”

Seinfeld noted that if one person in her life disappointed her, she would flee to a different person, but then find them equally disappointing. For example, Kim would go from her too-busy mother, to her drug-abusing and neglectful boyfriend, to her psychotic father, to friends who were moving on with their lives and did not care. Frustrated by each of these people, Kim comforted herself by using drugs, alcohol, and by stealing her mother’ car and “joyriding” despite not having a license.

Seinfeld said that none of his interpretations of her self-destructiveness worked at first. He stated,

“Throughout the first of fourteen months of her treatment, she seemed relatively out of contact with mer. She would recount her adventures and seemed to expect nothing from me but my continued presence… There was no spontaneous, gradual shift in her relatedness. She continued to miss sessions at the same rate as characterized her previous (five year) therapy… She used my empathy to justify her “who can blame me” attitude.”

The Safety of the Bad Object

Seinfeld began to intervene with Kim by gradually making her more aware of how her feelings of rejection and worthlessness were caused not only by the actual behavior of other people, but by how she responded to and interpreted their actions. Seinfeld states, “When she described a bad experience in reality, I empathized with how she felt but then shifted the focus to what she was doing to herself in her mind with that experience. It was not difficult so show that all of the external people she discussed reflected one image – that of rejection in relation to her own image as rejected.”

Seinfeld notes how Kim eventually became aware that she continually maintained a negative pattern of thinking and expectation about others, even when nothing happened in the outside world to justify such thinking. Seinfeld commented to her that such dwelling on negativity might occur because it felt safer to Kim to feel rejected than to feel accepted.

Seinfeld also beautifully described how, “I listened to all that she said and commented from the vantage point of the activation of internal object relations units. I listened to this patient as one would follow the stream of consciousness in a novel by Joyce or Proust, in which reality is always brightened or shaded by the narrator’s internal vision and experience. Kohut (1984) has suggested that such novels reflect the fragmented sense of self in severe psychopathology. One does not ignore external reality from such a vantage point; rather, close attention is given to the subtle but constant interplay between internal and external worlds.” In other words, when listening to a borderline patient speak, the skilled therapist constantly tries to perceive how reality is distorted or “colored” in a positive or negative direction by the patient’s splitting defenses.

Ambivalent Symbiosis

Seinfeld notes that the foregoing work gradually move Kim toward an ambivalent symbiosis. She gradually became aware that Seinfeld cared about her and wanted her to get better. For the first time, Kim asked her therapist in subtle ways about whether he was interested in her viewpoint. She was no longer only telling stories or complaining about abuse. She would ask Seinfeld if he felt that her mother and boyfriend cared about her. She wanted to know if Seinfeld understood the desperation and uncertainty she felt. Seinfeld described how Kim displaced many of her wishes for closeness and support from him onto the mother and boyfriend, because it was initially too threatening to get close to Seinfeld and trust him directly.

The relationship now assumed a stormy, emotional, push-and-pull quality. Kim would want support from Seinfeld but then be angry that she only saw him occasionally for therapy. She wanted him to understand her feelings about her family, but then criticized him as overly intellectual and detached. She became jealous that Seinfeld’s own family own family got most of his time and love, while she only got the leftover scraps. Outside of sessions, she began to cut down on her drinking, but then would return to it when she felt that two hours a week with Seinfeld was inadequate. She would perceive Seinfeld, “sometimes as a saint and at other times as a psychotic with delusions of grandeur, like her father.”

Seinfeld therefore described how Kim tried to take in his support and acceptance, but would then reject it, both due to her familiarity and loyalty to the rejecting object and to her fear of vulnerability and openness toward the good object. For example, Kim asked Seinfeld for help with getting a referral to a doctor who worked in the same hospital as Seinfeld for a minor medical problem. When Seinfeld responded helpfully, she rejected the referral as inadequate by viewing the doctor negatively. This related to her being threatened by feeling that someone truly cared about her.

At this point, Kim began attending therapy regularly and never missed sessions, even becoming upset if she was forced to be late. Rather than being upset with her mother or friends as often, she became intensely upset with Seinfeld if he did not meet her demands for caring and empathy in a perfect way. Despite Seinfeld making extra time to talk to her on the phone outside of regular appointments, she would become angry when he eventually had to leave to go see his family. She viewed him as a “too busy” bad object just like her mother and friends had been the “busy bad objects” before. She again felt angry with Seinfeld for expecting her to depend on him for support, but having only a few hours a week to spend with her. She continued to alternately view him as a caring, supportive person whose help she desperately wanted, and then suddenly to transform him into a too-busy, uncaring, impersonal therapist.

Seinfeld comments on this ambivalent symbiosis in the following way:

“The patient activates the all-bad self-object unit to defend against internalization of the positive self and object unit. The insatiable need serves the antidependent defense. By making her need for contact with the external object insatiable, the patient can perceive of herself as rejected regardless of the external object’s behavior. Therefore, the patient is always able to think of her needs as being unmet, to think of herself as rejected and of the object as rejecting. The activation of the all-bad self and object unit results in depression and rage. Insatiable need, the oral self-exciting object relationships (e.g. use of alcohol while rejecting a truly supportive other), is then activated to counter the depression and rage. In this regard, the all-bad self-object relations unit becomes a vicious cycle constituting both the rejecting and exciting objects… Insatiable need serves to maintain the perception of the object as rejecting in antidependent defense. This patient succinctly stated the antidependent position, “If I don’t think you like me, why should I bother to like you?”

In other words, it’s necessary to understand how the patient is an active agent in perpetuating their view of the therapist and others as rejecting (creating an impossible-to-fulfill, or insatiable need) rather than potentially helpful and positive.

The Transition to Therapeutic Symbiosis

Seinfeld now constantly remarked upon the ways in which Kim focused on the ways in which he (Seinfeld) was not available because this felt safer and more familiar than focusing on the ways in which he was available. Kim came to recognize more and more how she herself played an active in viewing the external world negatively and keeping herself in a depressed state. She realized that if she were not provocative and looked for positive things in the outside world, they would appear there much more often than she expected. In this way, she could become an agent of positive change.

Gradually, Kim became aware of how unstructured and vulnerable her current life situation was. She realized how she was hurting herself by her continuing alcohol and drug use, and by ignoring opportunities to return to school or work.

Regarding the developing therapeutic symbiosis, Seinfeld stated,

“Kim’s vulnerable self became more connected to the internal holding object (the therapist as supporter of independent functioning and provider of love) through the transference, and she experienced severe separation anxiety. She faced the fact that her life was a mess and that she felt like a vulnerable child. She began to believe that I really was going to help her, that our relationship could affect the direction of the rest of her life.”

Seinfeld continued to explain that, at the same time as these positive feelings emerged, Kim feared that letting Seinfeld get too close to her would allow him to overpower and dominate her sense of self. She still feared trusting another person closely due to all the rejection from her past. So, she had to be very careful and gradual in the way she came to trust Seinfeld, lest he turn “bad”. Occasionally, she had dreams in which the “good” Seinfeld would turn into a psychotic madman like her father.

Gradually, Kim let herself get more and more attached to Seinfeld, and as this happened she began to feel self-empathy for the first time in her life. She remembered the alone, fearful child she had been and wanted to help herself.

Strengthening the Therapeutic Symbiosis

Kim bought a pet parrot that she would care for at home. She imagined herself as a good parent nurturing a good child most of the time. When the bird became difficult and squawky, she would briefly view herself as the bad mother and the bird as bad child. As her relationship with Seinfeld improved, she came to nurture her pet more and more and to be bothered less and less by its noisiness. As a projective container, it reinforced her positive internal self-and-object images via the fantasies of love she projected into it, supported by her relationship to Seinfeld.

Over the next year, Seinfeld described Kim’s progress as follows,

“As Kim became less depressed and angry , her vulnerability and strivings for autonomy emerged. Having decided that she must do something to change her life, she managed to earn a high school diploma. She then pursued college courses and part-time work… She brought to me her ambitions and interests for mirroring admiration. Her ambitions, which were originally grandiose, gradually became realistic. She informed her drug-addicted boyfriend that he had to stop using cocaine if he wanted to continue to see her. She saw him less as a rejecting object and more as a person with problems that interefered with his capacity for intimac. His family eventually arranged to have him go for detoxification. Kim remained in contact with him but also started to see other men.”

Seinfeld then described how Kim gradually focused more and more on her own goals and independence, and became less dependent and close to Seinfeld as she had been at the height of the therapeutic symbiotic phase. Thus she transferred into a more “resolution of symbiosis”-like phase, as described in Article #10.

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Comments on Seinfeld’s Case of Kim

In this case study, one can see how in the early phases of treatment, Kim was at first oblivious to Seinfeld as a potential helper, due to the extreme neglect and abuse she experienced as a child which left her with a structural deficit of positive internal self and object images. She literally could not recognize help and love when she saw them.

As she gradually became aware of Seinfeld as a potentially helpful therapist, her fear that he might reject her like her parents had done, as well as her general unfamiliarity with and distrust of genuinely kind people, caused her to distance herself from him as a potential good object. It required painstaking work to become aware of how she herself continually viewed others (and later Seinfeld) as “all-bad” while rejecting the good aspects of the outside world in order to overcome this phase.

Eventually, the therapeutic symbiosis took over, and Kim was able to trust Seinfeld and take in his love and support. At this point, she was no longer “borderline”, and began to feel well and stable much of the time. She resumed school and work, developed new positive relationships with other men, and gained a healthy capacity to view people like her mother and abusive boyfriend as troubled people rather than persecutory rejectors.

In reading this article, I learned how important it is to identify the subtle ways in which we distort others into “all-bad” and “all-good”, when we are borderline. We can apply these case examples our own lives, since we all distort external reality to a greater or lesser degree. Since they are often based unrealistic projections from past negative relationships, learning to “distrust” or question our initial negative perceptions can be a positive, corrective process. It allows us to realize how the world outside is much more positive than it sometimes appears when we are viewing things through the lenses of “bad objects.”

Seinfeld As An Author

Seinfeld is one of those authors I read about a certain topic and say, “Wow, this guy is brilliant! That really is how things are!” I remember being struck right away by his penetrating descriptions of borderline problems and what was necessary to transform them. The reader is again recommended to his book, “The Bad Object”, which is available used on Amazon. Its case studies of successfully treated borderlines are some of the best of any book I’ve read, especially the cases of “Kim” described here, along with similar-length successful cases of “Justine”, “Diane”, “William”, and “Peggy.”

To understand Seinfeld’s concepts, it may again be useful for the reader who is unfamiliar with the psychodynamic explanation of BPD to skim through the following articles:

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

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

Seinfeld adapted an object relations theory of trauma, building on theories developed by Ronald Fairbairn working with abused children in the early 20th century. Seinfeld understood how parental neglect and abuse became internalized by the (future borderline) child, and then was constantly replayed in their adult life, causing the borderline symptoms. He adapted the four phases that Harold Searles pioneered with schizophrenic patients, and modified them for use with less-disturbed borderlines. These phases – Out-of-Contact, Ambivalent Symbiosis, Therapeutic Symbiosis, and Individuation – involved “reparenting” the borderline individual so that they learned to love themselves and eventually became able to love other people.

It’s hard to summarize everything else from Seinfeld’s book on how to treat Borderline Personality Disorder (The Bad Object). So, as with the post on Gerald Adler, I will focus on a few key points.

#1: The Concepts of Structural Deficit and Bad-Object Conflict

One of Seinfeld’s foundations for understanding BPD was seeing a borderline individual as having both “a structural deficit of positive self-and-object images” and “bad object conflict.”

What the structural deficit means is that, compared to a healthier or “normal” individual, a borderline has not taken in sufficient positive experiences with the outside world to feel secure psychologically. This results in an inner emptiness or psychic void that makes it harder for the borderline to take in new positive experiences in the present, since they have trouble recognizing them as positive. This is the same concept as Adler’s notion of introjective insufficiency:

https://bpdtransformation.wordpress.com/2014/04/30/15-heroes-of-bpd-gerald-adler/

In healthier people, who have had much nurturing, love and security in childhood, the high number of past positive memories serve as “receptors” that help them recognize, seek out, and take in new positive experiences. By contrast, the borderline-to-be child usually receives very poor responses to their need for nurturance. Instead of internalizing a sense of love, security, and blessing, the future borderline child is left with an emptiness or longing for love which then becomes repressed. That is the structural deficit as described by Seinfeld and Adler – the quantitative insufficiency of internal positive memories based on a lack of past external positive experiences.

It is the structural deficit that results in the borderline’s being relatively unreceptive to new positive experience. For the adult borderline, positive experience – for example, being offered friendship, acceptance, and interest by other people – will seem unfamiliar, strange, alien, and even threatening when they are encountered. This is why, early on in the therapeutic process, Seinfeld found that severely borderline patients often didn’t know how to relate to him in a positive way. Rather, they experienced him in his helping role as, “an alien creature from another psychic planet.”

#2: Bad Object Conflict

As for “bad object conflict”, Seinfeld understood this to mean that not only is there a lack of positive memories, but there is a predominance of powerful negative memories (or images of oneself and other people) in the borderline’s mind. These scary, traumatic negative memories don’t just sit there – they act to reject the internalization of new positive memories. They are like metaphorical demons or monsters that scare the patient away from trusting others.

The child who becomes borderline internalizes many memories of being unloved, rejected, and even hated by inadequate parents. These memories collectively form the unconscious “internal bad object” or “rejecting object.” Despite its painful nature, relating to a rejecting other as an adult often feels safer and more familiar than trusting someone new who might prove disappointing. Also, the borderline tends to feel a perverse loyalty toward the people who abused him in the past, and to feel he is “bad” and therefore unworthy of help from good people.

For both these reasons – fear of being vulnerable toward good people, and loyalty toward the bad people from the past – the borderline individual tends to reject potential help and remains attached to the image of themselves as a worthless, undeserving, bad person. This can be acted out in many ways – via remaining alone and isolated, via abusive or neglectful relationships with present-day partners, via staying attached to the original abusive parents in the present day, via self-injurious acting-out behaviors, and so on.

Therefore, Seinfeld described how the borderline acts in subtle and overt ways to actively maintain an internal negative view of themselves and others. I would call this, “Perpetuating the past in the present.” The bad-object conflict thereby works in a vicious cycle to maintain the “structural deficit” because as long as the activities focused around bad perceptions of oneself and others predominate, quantitatively speaking, then new positive experiences are not being taken in in sufficient amounts to “tip the balance” and effect lasting psychic change.

Seinfeld likened the negative and positive relationships of a borderline patient (as long as they remain borderline) to a mathematical equation. In his formula, negative relationships to external others are activated more frequently than positive relationships, maintaining the attachment to the internal bad object and preventing the internalization of a good set of self-and-object images strong enough to displace the bad object.

According to Seinfeld, unawareness of the good object (“object” meaning person or people) tends to occur more in the out-of-contact phase, and active rejection tends to occur more in the ambivalently symbiotic phase, as described in post #10 on the Four Phases. Active rejection is necessary in the ambivalent symbiotic phase, because the good-object images are strong enough in that phase to pose a threat to the internalized bad object, which the patient unconsciously fears losing (since it is what he is familiar with).

#3: The Exciting Object

Another key concept from Seinfeld’s writing is the nonhuman exciting object. The exciting object is any addictive, stimulating, non-human object that serves to fill the void created by the lack of the good object. Food, drugs, sex, alcohol, medications, excessive use of TV or internet, and other nonhuman “things” can provide an addictive fix to compensate for the lack of love that a borderline feels.

The exciting object is part of Seinfeld’s mathematical equation of how BPD works. Because of the structural deficit and the bad object conflict, the all-negative split self and object units are mostly dominant in the borderline’s mind. These all-negative images reject the taking in of new positive experience which could be soothing, and therefore the borderline feels mostly empty, unhappy, and unstable emotionally.

To try to assuage these bad feelings, the borderline turns to nonhuman exciting objects as described above. These exciting objects plug the “hole” or emptiness created by the lack of truly satisfying positive relationships to good people in the outside world. However, exciting objects can only do so temporarily, since they are not truly satisfying long-term. Once their effect wears off, frustration will set in, and the borderline will usually return to involvement with the bad self and object images. This will then lead to more psychic pain around bad objects, resulting in the need for more exciting objects to assuage it, and so on.

#4: Interrupting the Rejecting-Exciting Object Cycle – Therapeutic Symbiosis

The main focus of Seinfeld’s book was not on the negative aspects of how a borderline functions, but on how to heal them. Seinfeld believed this could be done by interrupting the constant oscillation between rejecting and exciting objects via the internalization of a new good object relationship.

In normal language, the borderline needs to overcome their fear of trust and dependence, allowing themselves to develop a satisfying, loving relationship with the therapist. Seinfeld emphasized that successful therapy must move beyond a detached, professional relationship, and should explicitly involve love and closeness between patient and therapist. This does not mean that the pair are friends outside the sessions; rather, it means that a parental-like relationship of vulnerability, tenderness, and support is nurtured within the frame of the sessions.

This is the phase of therapeutic symbiosis. Seinfeld described how, “In this phase, there is a full reemergence of the vulnerable, regressive true self, in the care and protection of the idealized holding-therapist… At first, the patient’s vulnerable self is increasingly related to the therapist as holding object. The Internal positive self and object representation unit is increasingly dominant over the negative self and object representation unit, as long as the external therapist is highly available to reinforce the strengthening of the positive unit… As one patient said, “So long as everything is all right between you and me, I feel that all is well with the world. The good internal object serves to neutralize the bad, persecutory, rejecting object….

“In the later part of therapeutic symbiosis, the patient internalizes and identifies with the therapist to the point at which he is no longer so dependent upon the external therapist… The patient can now increasingly comfort, soothe, and mirror himself, regulating his own affect, mood, and self-esteem. In unconscious fantasy, he is now the comforter, sympathizer, and holder, as well as the comforted, empathized with, and held… All goodness is taken into the self; all badness is projected into the external object world…. In this way, the patient can establish a psychic foundation (of primarily positive self and object images) to eventually integrate the good and bad self and object units into whole, or ambivalently experienced, self and object images.” (pages 73-74)

Seinfeld’s Model of BPD – The Inversion of the Normative Developmental Psychic Process

Seinfeld continues, “The healthy child tries to take in or internalize the good object and reject or externalize the bad object. In the model I’m developing, the borderline patient manifests an inversion of the normative developmental process. Instead of taking in the positive object relations unit and rejecting the negative object relations unit, he takes in the negative object relations unit and rejects the positive object relations unit. In Fairbairn’s terms, he is attached to the internal bad object. The out-of-contact phase and ambivalent symbiosis are manifestations of the pathological inverted symbiosis in terms of the attachment to the bad object and rejection of the good object. Symbiosis becomes therapeutic when the patient adopts the normative but primitive developmental position of taking in all that is good and rejecting all that is bad. In this way, the patient can establish a psychic foundation to eventually integrate the good and bad object relations unit.” (page 75)

To me, this is a beautifully clear model of what causes BPD – bad relationships are taken in during development and reenacted continuously during adulthood, whereas good relationships are not taken in and are rejected later on. Successful recovery from BPD involves an reversal of this process.

Through the phase of therapeutic symbiosis, the patient can gradually gain confidence and make progress in three main areas in their outside life: 1) Leaving behind negative relationships (for example, to abusive partners, friends, or parents), 2) Developing new positive friendships and relationships to replace the bad ones, and 3) Developing enhanced autonomous functioning, work and interests.

In this way, the formerly borderline patient reverses the mathematical equation that had predominated when they were “borderline.” Instead of remaining attached to the all-negative images of themselves and others, the patient engages in new relationships and activities that are good, encouraging and self-supporting. In this way they take in a quantitative predominance of positive self-and-object images, and “spit out” the bad self and object images.

How To Interrupt the Rejecting-Exciting Object Cycle – Insight

The reader is probably interested as to how a borderline may start to break out of the negative-exciting object attachments. What Seinfeld worked on in therapy (and what one can work on with oneself) is developing the insight into how one sabotages oneself, which allows one to start making more constructive and adaptive choices instead.

Attachments to bad objects from the past are like schemas or relationship-templates that one replays over and over in the present “perpetuating the past in the present”), even though one doesn’t have to keep doing so. A person needs to identify how they are replaying bad relationships in the present, and treating themselves in the way that their parents did, to begin realizing how their behavior could change. As they become aware of the structural deficit (of positive self and other representations, resulting in unreceptivity toward good experience), and of the bad object conflict (which actively rejects and causes a person to fear good relationships), the borderline can start to actively seek out better experiences.

A great way to illustrate how this process works is via a case example. Hopefully, in the case of Kim above, the reader should be able to identify the structural deficit, bad object-conflict, use of exciting objects, and the ways in which Seinfeld interrupted these activities and nurtured insight in the patient, to encourage internalization of the therapist as a good object.

Recovery as a Mythic Journey

Lastly, I loved Seinfeld’s view of the therapy process as a mythic or epic journey. Seinfeld states (page ix), “This volume shows how to help the patient overcome what has been decribed as the most serious obstacle to psychotherapy: the negative therapeutic reaction. It is the bad object that is predominantly responsible for this reaction. The patient and therapist enduring the travails of the therapeutic journey often resemble Odysseus and his crew forced to outwit the demons, sirens, witches, and Cyclops threatening to thwart the long voyage. In fact, those mythological demons personify the manifold masks of the bad object often described as exciting (but not satisfying), enticing, bewitching, addicting, engulfing, rejecting , punishing, and persecuting…

“The bad object is comprised of the actual negative attributes of the parental figures – often a composite of both mother and father along with later figures resembling them – and the child’s fantasies and distortions about these figures. In this regard, the unsatisfactory experiences with the parental figures give rise to frustration and anger, which color the child’s perception of the object… The designation “bad” regarding the other person does not refer to a moral valuation but rather to the child’s subjective unsatisfactory experience with it… Therapeutic progress threatens the patient and therapist with the terrible wrath of the bad object. The patient is conflicted between his loyalty and fear of the bad object and the longing to enter into a good object relationship that will promote separation from the bad object… Fairbairn believed that the term “salvation” was a more apt designation than that of “cure” for the patient’s subjective experience of his need to be rescued from the bad object.” (preface page x)

This article is getting long enough already! I hope the reader, whether having borderline traits themselves, or wanting to help or understand someone with BPD, has found some interesting insights in Seinfeld’s approach to treating Borderline Personality Disorder.

Lastly, here is an interview and memoriam for Jeffrey Seinfeld, who sadly passed away a few years ago.

http://www.orinyc.org/JeffSeinfeld_InMemoriam.htm

Please share any comments you have below!

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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

#12 – Cracking the Borderline Code

In this post, I’ll explain the concept of Borderline Personality Disorder as an emotional programming language. While recovering, I developed emotional strength and insight which allowed me to consciously redirect destructive thought patterns. This formed part of a long-term plan by which I reversed the early course of the disorder.

Here I’ll explain how my plan worked, and provide some suggestions for current borderlines and their families to consider.

I’ll begin with the idea of BPD as a destructive code and the sufferer as a spy who must break and reprogram that code. While struggling to recover from BPD years ago, I often imagined myself in metaphorical roles. The most prominent was as spy or code-breaker.

Today, having more of a neurotic personality organization, I can mentally play with such roles without taking them seriously. However, when I was severely borderline, they felt real – I almost believed myself to be a real-life espionage agent or warrior, trying to outwit and defeat the sinister forces arrayed against me. My lack of a strong observing ego caused me to have difficulty distinguishing fantasy from reality.

Recently, memories ran through my mind about these difficult days. I remember the keenness of the desperation, how getting through each day presented a titanic struggle. I was deathly afraid of never “making it,” meaning not succeeding in work and relationships as an adult. And I did not know how I was ever going to fully trust another human being.

The Bourne Identity

I loved watching movies about characters who played soldiers or spies. Doing so gave me a powerful feeling of motivation, of being alive and active. One of my favorite spies was Jason Bourne. In the clip below, Matt Damon demonstrates the intensity and coolness under pressure which define Bourne. He uses expert planning and deception to outmaneuver the Central Intelligence Agency, which is attempting to kill a witness who knows too much:

http://www.youtube.com/watch?v=DUd5RPVDjPY

I related to this scene because I too felt persecuted and pursued by a heartless, inscrutable adversary. In my case, it was the past memories and present-day projections of my abusive father that haunted me. Since I did not know love as a child, I could not perceive the goodness in other people as an adult. I always expected people to ignore and abuse me like my father had done. For years, it did not dawn on me how unrealistic these (mis)perceptions were. Right before my eyes, people were far kinder than I could ever have imagined.

Fighting through the maze of persecutory misperceptions to reach human help was, for me, emotionally equivalent to the desperate escape from murderous persecutors shown in this Jason Bourne scene. For my college-age self that watched it years ago, Jason Bourne represented my evolved, adult-self, and the victim represented my vulnerable child-like self, which the adult self sought to protect from persecution. Today, I watch this clip with a tremendous sense of pathos toward my past self.

Jason Bourne also personified a determination, focus, and ruthlessness that I admired. Since I was entering the adult world without the necessary emotional equipment to navigate it, I felt that I had to be absolutely committed to finding help at all costs. There was an element of ruthlessness to my personality at that time, and I did use people.

Today, I am much kinder and gentler, but there is still a lingering dark aspect to my personality. When I occasionally feel threatened in some real-life situation, my “protector” side, the inner Jason Bourne, will come rushing back. But it doesn’t dominate my mind like before, since I now know that I’m re-experiencing the past in the present.

I always had some sense of the great challenge facing me after enduring repeated physical abuse and an unloving childhood home. It would take every bit of ingenuity, cunning, courage and endurance I possessed to create a good adult life. And that is why I identified so strongly with creative, fearless characters like Jason Bourne.

Taken

Bryan Mills, the father played by Liam Neeson who seeks to free his daughter from ruthless kidnappers in Taken, became another of my favorites.

I always identified with fearless, intimidating male protagonists who endeavored to save a weaker, vulnerable character from a heartless persecutor. This, of course, represented what I had been unable to do for myself in the face of my father’s abuse. It also signified my failure, at that time, to work through the feelings created by my father’s abuse or to forgive him. Here is an example of Liam Neeson playing the father-spy-protector in Taken:

http://www.youtube.com/watch?v=wcjY-VN8_l4

It may be disturbing, but my old self loved the confidence in Liam Neeson’s voice as he talked about tracking the criminal down. He exhibited such absolute certainty that he would punish the bad guys and recover his kidnapped daughter. It represented the strength and freedom to take action that I wished I had when my father abused me. Although I did have murderous thoughts toward my father sometimes, I never would have followed through with them as Liam Neeson’s character does in this movie.

How Splitting and Projective Identification Recreate Past Experience in the Present

My identifications with Matt Damon and Liam Neeson in their spy-soldier roles demonstrate important aspects about how splitting and projection in Borderline Personality Disorder.

In earlier essays, I discussed Fairbairn’s object-relations model, and four phases of BPD recovery derived from that model:

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

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

The reader is referred to these essays for more detail on these topics, which will form the foundation of the current discussion.

In my life at the time, I was constantly reliving my past abusive experience in the present. I always feared that other people would reject or abuse me like my parents had, and so I could never feel safe or comfortable in relationships. Even after leaving the family home to go to college, I felt unsafe, alone, and threatened.

Intra-psychically, I was constantly projecting “all-bad” (negatively split) images onto other people. This occurred regardless of whether the people were nice or not-nice in reality. In fact, if they were kind, the all-bad splitting happened even more, because I was afraid of intimacy and therefore wanted to create distance. In this way, I unconsciously prevented myself from perceiving their actual kindness and good intentions. The strong observing ego that is writing this post was not there then, so I was truly emotionally blind to my own self-sabotage.

Therefore, I was “transforming” any new person (in my mind, as I saw it at the time) into uncaring, mean people like my parents. The defenses that did this were splitting – or viewing people unrealistically as all-bad, based on my internalized parents – and projection / projective identification – meaning putting these images onto new people in the outside world, and relating to them in provocative ways which made them respond negatively. These defenses serve to distort the external world and to confuse the emotional past and present.

My identification with Jason Bourne and Bryan Mills occurred in a roundabout way. In my own life, I was continually recreating threatening, all-negative scenarios with new people. For this self-perpetuated reason, I continued to feel alone, unsafe, and unloved. This gave rise to the need to save myself by finding someone to help me. Therefore, I identified with strong movie characters, like these spies, who personified the strong male savior that I wanted to be. If I had not been borderline, I would not have identified with them in the first place.

BPD Deconstructed

For me, the essence of Borderline Personality Disorder is that it involves, 1) An inversion of the normative developmental process, and 2) A constant, nightmarish reliving of the past in the present. What does this mean?

1)      An inversion of the normative developmental process: This means that the borderline individual pursues unsatisfying relationships and rejects satisfying ones. Borderlines are continually focused on, is sensitive toward, and addicted to bad, frustrating, persecutory interpersonal relationships. By contrast, they reject or are relatively unaware of loving, good, supportive relationships. This represents the “attachment to the internal bad object” that Fairbairn discussed, with the concomitant “rejection of the internal good object.”

2)      Reliving the past in the present – Most people diagnosed with BPD have severely traumatic histories filled with neglect, inattention, and abuse from inadequate parents. The borderline adult recreates this childhood experience in their present-day life. They do so by continuing to view the external world, no matter how different it really is in the present, as filled with mainly bad, frustrating, and persecutory people. And they do it by rejecting and remaining oblivious to those who try to help. In other words, the inversion of the normative developmental process, described above, represents a continuation and present-day reliving of past traumatic experience in the present day.

In my case, as a teenager and college-age boy, I constantly preoccupied myself with the ways in which other people ignored me, disliked me, thought I was weird, and/or directly rejected me. Emotionally, I kept reliving the feeling of being ignored and rejected that I felt at home. I repeat this point again because it is so important for understanding common borderline processes.

It is important to see that people in the outside world did not usually set out to treat me this way. Rather, I unconsciously looked for only the bad aspects of the outside world and rejected the good aspects.

In this way, I “created” what became my felt reality – that I was rejected and worthless, and other people were uncaring and mean. Healthier people would have experienced their peers at my high school and college very differently. But, since I had had very little loving, emotionally close experience growing up, I lacked “receptors” – or positive memories – which would have helped me to recognize good things when I saw them. In that sense, I was emotionally blind.

This is something I find that non-borderline individuals often misunderstand about BPD. They think the borderline’s lack of receptivity to positive gestures and their inability to trust is intentional. Hopefully, my experience demonstrates that the issue is far more complex. For the most part, borderlines would like to trust and take in more help, but they simply don’t know how to.

The Paranoid Position

This constant negative psychic activity – of clinging to bad perceptions and people and rejecting good ones – creates the emotional ground where the outside world seems dangerous and threatening. It generates the nine symptoms of Borderline Personality Disorder that are listed in the DSM, and it is the very heart of what perpetuates the disorder.

Technically termed the “paranoid-schizoid” position, this is the earliest period of emotional development in psychoanalytic theory. It describes the position of the young child’s ego or self when they have just come into the world. It represents the young child’s emotional position before they become able to trust outside people and to view them ambivalently as mixtures of good and bad.

Cracking the Code of BPD

In both Taken and the Bourne series of movies, the leading characters must penetrate an initially-mysterious and threatening network of criminals. Jason Bourne turns the tables on his pursuers and discovers the truth about his identity from a time before the CIA brainwashed him. Bryan Mills penetrates a shadowy network of criminals to recover his beloved daughter.

In both cases, I learned from the way in which the main character defeated their adversaries. Both Bourne and Mills already knew or learned everything they could about their enemies before turning the tables on them. In Machiavellian fashion, they did whatever was necessary to overcome the obstacles, without concern for anything outside themselves and their loved ones.

In my case, the past “enemy” was the emotional abuse from childhood that I internalized and kept re-inflicting on myself in the present. My present-day opponents were splitting, denial, projection, and projective identification. These defenses distorted the external world, and caused me to constantly repeat bad relationships while rejecting good people who wanted to help me.

How I Used My Understanding of BPD to Recover

My weapons were my intelligence and my unwavering motivation to improve. I realized that I would have to learn everything I could about Borderline Personality Disorder, understanding it in much greater depth beyond DSM descriptions.

In fact, the DSM-allied psychiatrists who said that BPD was untreatable (or treatable but not cure-able) became a new enemy. Their pessimistic, medicalized views, which advocated symptom management and medication, represented capitulation and defeat. I wanted to understand WHY borderline symptoms happened, and I wanted to recover fully and live a great life as a non-borderline. And that is why I taught myself the “code” of object-relations theory, which for me best explains why borderline symptoms occur.

Once I understood how my mind had been “hacked” by my past abuse, implanted with relational “code” that made me to endlessly repeat bad relationships, I realized that I could change the pattern. I needed to specifically address my inability to trust other people, and to devote time and energy to cultivating new positive relationships.

That process began with my therapists, who were able to confront the many ways in which I distorted them into “bad” people so as not to trust them. I am extremely grateful to my therapists for their help in confronting my projection and splitting. I learned from that process and continued the work of perceiving others more realistically with new friends and family members.

After several years, my positive images (memories) of myself and others became strong enough that I could fully trust other people and develop deeper, intimate relationships. As this happened, the borderline symptoms all gradually lessened and faded away. I developed the abilities to control previously destructive behaviors, to regulate my own feelings, to distinguish past from present, and to tolerate frustration. I came to feel alive, real, and happy most of the time.

Today, when I watch movies like Taken or the Bourne Supremacy, I no longer identify with the main characters personally. But, I wistfully remember how attached I was to them years ago.

Borderlines Starting in Recovery

Many recently diagnosed borderlines who share their story on web forums have, understandably, not yet come to deeply understand the genesis and causes of their problems. These borderlines and their families are the primary people that I hope will take something away from this site.

In my view, our society’s approach to Borderline Personality Disorder is shallow, symptom-focused, and often unreasonably pessimistic. How many therapists truly understand the causes of BPD in the ways I describe on this site? That may be a bit arrogant of me, but there are many poorly trained and incompetent therapists out there.

I recommend that sufferers and families do not simply trust one therapist or psychiatrist, but instead do their own research and reading about the disorder. Self-help, self-education, and self-therapy can make a huge difference. If I hadn’t taught myself about what BPD really is and what causes it, I would probably still be on three medications, not working full-time, not in good relationships, and not happy.

Looking Beneath Symptoms

The key point that I would like borderlines and their families to take away from this article is to look beneath symptoms. There is so much more to gain from looking at the object-relational causes and patterns that drive BPD symptoms.

Focusing on BPD symptoms alone, i.e. how to reduce or control them, can only be palliative. This means it will reduce symptoms but not treat the underlying causes. Medication used for years on end and superficial therapy focused on symptom management are examples of these approaches. It is because of unthinking treatments like these that many borderlines continue to suffer, year after year after year, with no real long-term improvement in their emotional wellbeing. It’s time for that to change.

If borderlines do not understand and take action to change their attachment to internal bad objects, then their self-abusive cycle, the pattern of recreating bad relationships and rejecting good ones, repeats endlessly.

A Dramatic Example of Repeated Self-Abuse

I recently watched a horror movie that illustrates this phenomenon, Triangle. Its trailer is here –

http://www.youtube.com/watch?v=SQk2NpfQm7k

In this movie, a woman gets stuck in a time-loop where she must survive a nightmarish situation on board a cruise liner. The nature of the time loop is such that her past self always confronts her present self and kills it just as it is about to break free. Her job is to realize, as the trailer states, “It’s starting over again, that’s what going on…. Everything that happens to you, happened to you before!” The solution is “to change the pattern… if we change the pattern, we’re not trapped!”

As the reader should see, this movie’s plot is reminiscent of the way in which borderlines can endlessly repeat negative pas experiences. It is only by understanding what one is doing to oneself, and by taking responsibility for change, that it can get better. Near the end of this movie, the woman gains insight into how she is contributing to her own repeating problem, and this leads to hope about changing the outcome.

An Optimistic View of BPD Recovery

I would like to repeat that I am very optimistic about full recovery from BPD being achievable, as stated in earlier articles on this site. To be more exact, it’s not whether or not BPD recovery is achievable. I know that it is. It’s that I’m optimistic that the resources needed to recover are reachable, and the work doable, for motivated people who are diagnosed with BPD.

 “Cracking” the borderline code is not impossibly difficult; but it takes a significant amount of time and work. I encourage those with BPD to look beyond shallow, limiting, symptom-focused descriptions of BPD. Instead, focus on learning how the disorder works in depth in order to break the destructive cycles that cause the symptoms. In this way, transformation and full recovery are real possibilities.

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, 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

#5 – What to do if you are diagnosed with BPD

If you have recently been diagnosed with Borderline Personality Disorder, you are probably wondering what to do to start getting better. Or perhaps you’re wondering if it’s possible to recover at all.

Deep, lasting recovery from BPD takes a significant amount of time – in my opinion, at least 3-5 years to move far along the road to being emotionally well. However, it is possible to begin going in the right direction immediately. The early years of recovery for a borderline individual, while sometimes very challenging, can be rewarding and meaningful in the long run.

Step 1 – Educate Yourself about BPD

One of the most important things for someone diagnosed with Borderline Personality Disorder to do is to become informed about the disorder. In my opinion, three interrelated areas are useful to learn about:

1) What BPD is and how it “works” from different viewpoints.
2) Different treatment options.
3) Case studies of former borderlines who have now recovered.

For step one, the most basic, but limited way of understanding BPD is reading its definition in the DSM. After that, basic books like The Borderline Personality Disorder Survival Guide (Chapman), Stop Walking on Eggshells (Mason), and I Hate You, Don’t Leave Me (Kreisman) can give a basic overview of BPD’s characteristics.

While they can be useful initially, I no longer give much credence to these books, since they are superficial and give little guidance about how to recover. They tend to cater to friends and family, rather than to the individual diagnosed with BPD. Also, some of them hold the viewpoint that BPD is a disease to be struggled with for life, rather than a condition that can be fully recovered from. That is something that my experience has disproven.

Books that Helped Me Understand BPD And Have Optimism About It

To address steps one and three – how BPD works, and stories of people who recovered – I learned the most from two sources. First, from reading therapists’ case studies of borderlines who they successfully treated. These case studies usually  illustrate important facets of the disorder, including its developmental genesis, the use of splitting and projective identification, typical phases of treatment, how the attachment to bad relationships works, the fear of trust and dependence, and so on.  Second, I learned from reading material on the internet and in print by borderlines in recovery. These first-hand accounts of recovery written by former borderlines can be more powerful and direct than second-hand accounts of recovery seen through the eyes of a therapist. All of these books provide hope that lasting recovery from BPD is real and possible.

Realistic hope for BPD recovery is critical – hope that committed, hard work over a lengthy period will lead to a better life free from borderline symptoms. One of the lessons I’ve learned is that how one thinks and fantasizes about oneself in relation to Borderline Personality Disorder makes a big difference. At first, via my research and through therapy I worked on convincing myself that BPD could be deeply recovered from. Replacing my former pessimism and fear about BPD being a hopeless, life-long disorder with optimism about recovery helped me immeasurably. Later on, I came to question whether BPD was a valid diagnosis at all, which I no longer believe it is. But that is not so important initially as nurturing the simple belief that no matter what one’s problems are, they can get better.

At the bottom of this article, you can find listings of books by therapists about their successful treatment of BPD patients. They are mostly psychodynamic or psychoanalytic, since that is the viewpoint that was most useful in my own journey. I bought all these books used for low prices off Amazon. Also, some good online and print sources written by recovered borderlines are described.

Treatment Options – Psychotherapy

If one is diagnosed with BPD and can afford it, therapy can be one of the most important drivers of recovery. As a teenager, I was fortunate to have my therapy funded by my parents. Later on, I lived frugally while paying for treatment myself. Therapy can be expensive, but many therapists use a sliding scale of reduced fees correlating to ability to pay. If you want therapy but feel you cannot afford it, do not give up. Make sure you search around your area for different reduced rate or pro bono options. In large cities, there are hospital-based nonprofit clinics which offer low-rate or even free group and individual therapy.

What type of therapy is the best? Obviously, that is a question that cannot be answered objectively. In my view, the more important factors are the motivation of the person suffering with BPD, and the personal qualities of the therapist regardless of their orientation. However, with that caveat I believe that that the two best kinds of therapy for BPD are psychodynamic/psychoanalytic therapy and Dialectical Behavior Therapy (DBT). I am biased toward psychoanalytic treatment for BPD because it worked for me. I have no direct experience of DBT. However, it has worked for many others suffering from borderline symptoms, so I recommend it also.

Many uninformed therapists are pessimistic about BPD or do not know how to treat it. However, there are also many therapists out there who are skilled at treating BPD. They know from experience that lasting recovery from BPD is possible. If you seek treatment, it is obviously important to find the latter kind of provider.

How To Find A Therapist

My favorite source for finding therapists is the Psychology Today’s Therapist Finder. It can be accessed at:  http://therapists.psychologytoday.com/rms/

This site has the largest and most up-to-date listing of therapists currently available in the United States and Canada. Once you click on a region, you can search for therapist by orientation (psychodynamic, dialectical, etc.), by specialty (borderline personality disorder, eating disorders, anxiety, etc.), and so on. For example, I just searched in the large American city nearest me, and found over 70 therapists who specialize in treating Borderline Personality Disorder. You can also find therapists that are covered by different insurance providers, which is important because insurance can often cover a significant part of the cost of therapy. And you can directly email or call the therapists directly from the site.

My Therapist Interview Process

I used Psychology Today’s site to find a good therapist several years ago. What I did was to email and call all the therapists I was interested in, asking them a few brief questions. I introduced myself in a friendly way and asked them some version of the following:

– Do you have a lot of experience treating personality disorders, in particular Borderline Personality Disorder?
– Do you believe that individuals with Borderline Personality Disorder can be successfully treated? In particular, do you believe that a sufferer of BPD can become free of the disorder over the long term, i.e. come to live a healthy life free largely free of borderline symptoms?
– Are you willing to meet with me for a 15 minute free in-person consultation to see if we might be a good fit?

If the therapist answered no to any of these questions, I rejected them. For me, a therapist who won’t volunteer 15 minute of their time for a brief consultation is not worth your time. If the therapist had little past experience treating personality disorders, I discounted them. That might be arbitrary, but it made sense to me that I wanted someone with a lot of experience treating a difficult condition. And most important, if they were at all pessimistic or doubtful about recovery from BPD being possible, I moved on. I met two therapists in person who thought that BPD was a lifelong “disorder”, the symptoms of which could be managed but would always remain with the sufferer. These “therapists” were poorly educated charlatans who shouldn’t be given the time of day. I was happy to walk out of their offices and go on to find someone much better.

Alongside these kinds of questions, one might also ask if the therapist offers a sliding scale of fees based on income. Good therapists often do this, but they will not always advertise it up front, since of course they have to treat many patients at full price to make a good living.

For me, finding a good therapist for BPD was like shopping for a car or a house. It’s a big decision that requires careful consideration and research. In some cases, the buyer should beware.

Much more could be written about different types of therapy. Those will not be explored here, mainly because I am not an authority on different types of therapy for BPD (I only know a significant amount about psychodynamic-psychoanalytic approaches). However, I encourage you, if you are diagnosed with BPD, to research other types of therapy and come to the best understanding possible of your options.

Medication

I hesitate to include this part, because it is controversial. However, it is best to be honest about one’s views. For most people, I do not believe that psychiatric medication is a major long-term contributor to recovery from BPD.

Medication can play a role in the early phases of treatment. It can be useful because it controls symptoms in the short term, usually for a period of months. If a borderline individual is struggling with overwhelming suicidal impulses, or with terrible, unamanageable anxiety, medication can be useful to stabilize them. It can bring down the temperature and stop a person from “overheating” emotionally. I was prescribed anti-depressant medication for this reason myself in my late teens and early 20s. However, I then decided to taper off of it, and I have not used medication at all for the last six years.

However, beyond stabilizing short-term symptoms, I believe that medication is a waste of money and potentially dangerous. I recently read the books Anatomy of an Epidemic, by Robert Whitaker, and The Myth of the Chemical Cure, by Johanna Moncrief. These and many other books on the subject make clear that psychiatric medication carries with it the risk of severe long-term side effects that are currently poorly understood. In particular, there is the scary and very real possibility of tardive dyskinesia (uncontrollable, often irreversible movements of the mouth and other body parts) in those who take psychiatric medication long term.

For me, there are several problematic emotional aspects to using medication long-term in the treatment of BPD. Using medication long-term promotes the myth that taking a pill can magically solve one’s emotional problems. It implies that one does not have the ability to deal with long-standing issues interpersonally. And it suggests that the primary source of one’s problems is biochemical or genetic, which for me is pessimistic and false. As referenced in Whitaker’s book, disturbing long-term studies are now showing that if they take medication long term, patients with several types of psychiatric disorders do worse on most measures of recovery than those who never take them. Big Pharma companies are denying these results. But of course, they have billions of reasons to do so.

I recommend that people do their own research and come to their own conclusions about medication. My position is that therapy, self-help, and support from family and friends are the main drivers of recovery. If I were to start over with recovery, I would remain open to taking medication in the short term to provide relief from overwhelming symptoms. However, I am so glad to be off medication for the past six years. It gives me the empowering feeling that my own actions are responsible for my recovery, that I am a free agent.

Other Sources of Support Early In Recovery – Family and Friends

On my recovery journey, learning about how the borderline disorder works, reading stories about how former borderlines recovered, and finding an effective therapist were key early steps.

Support from family and friends is also very important. If one’s family can come to understand BPD in a compassionate way and be supportive of one’s recovery, that can obviously be tremendously helpful. My mother never actually knew that I had BPD, but she nevertheless supported me  to go to therapy, gave me a place to live, and was available to talk for several years after I graduated from college. Without her financial and emotional support, I would not be where I am today.

Opening up to friends about BPD can also be valuable, although it can feel risky. Over the course of five years (between ages 17-22), I told four people I met about my history of physical abuse and the problems between my parents, who divorced when I was 18. Although they never knew that I had BPD, Gareth, Julian, Andrew and Helena did discover that I was severely depressed, occasionally sometimes suicidal, and that I had great difficulty trusting and opening up to other people. They became invaluable sources of support and helped me to feel less alone during the early period of my recovery.

I was very hesitant initially to confide in these people, since I had no real friends at the time and feared that they would reject me. The antidependent side of me did not want to risk asking anyone else for help. However, the healthier, dependent part of me correctly sensed that they were kind, mature people, and it eventually won out. Gareth was an older family man in his 40s that I met through tennis, Julian was a fellow high school student in the class above me, and Andrew and Helena were young people in their mid 20s who worked at a spiritual retreat center that my family went to every summer.

Where to Find Friends Who Support Your Recovery

If you don’t have friends like this yet, there are many people out there willing to help. Online web boards and forums can be useful places to find support, but nothing replaces meeting people in real life and talking face-to-face. For that reason, I believe that group therapy and 12-step groups are extremely valuable. I attended both in my late teens and in my 20s.

Many therapists listed on the Psychology Today site above run or make referrals to group therapy. To find such groups it is usually necessary to get referrals from therapists or local hospitals and social work clinics. I went to a group for emotionally troubled young people at the state college that I attended. The university hospital ran this group, and it was free.

Regarding 12-step groups, I met several great people at these meetings that became friends whom I could call or meet in person during difficult periods. Twelve-step groups exist for almost every possible emotional problem, including eating disorders, sex addiction, drug and alcohol addiction, gambling, self-harm, and many more.  Here is a list of 30 different 12-step groups, along with their websites:
http://www.12step.org/12-Step-Groups/

Also, Meetup (www.meetup.com) is a great way to make new friends in your local community. This worldwide online platform creates groups for specific interests that meet in real life. I met several of my current friends through Meetup groups in my area. This might not be the very first step to take in BPD recovery, but once the borderline individual is more confident and ready to leave behind past abusive relationships, Meetup provides access to a whole new world of people.

I hope this article has provided some useful ideas for those wondering where to start looking for help with BPD recovery (and please also see the books below). The central, overriding goal throughout my recovery from BPD was to learn to trust and develop satisfying relationships with other people. Good long-term psychotherapy can help a borderline individual come to trust and truly depend on another person for the first time. Therapy groups, 12 step programs, friends, and family can be invaluable sources of support, with or without individual therapy. Lastly, the individual’s own self-advocacy and motivation to get better are perhaps the most critical drivers of their recovery.

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Therapists’ Books About Borderlines Who Recovered

The Bad Object – By Jeffrey Seinfeld. Seinfeld’s successful cases of Kim, William, Justine, Diane, and Peggy are detailed 20-30 page “stories” of these borderline patients’ lives. Seinfeld tells how they went from severely borderline to learning to trust him and becoming increasingly functional and independent. Seinfeld, a New York-based social worker who recently passed away, is one of my heroes for how optimistically he writes about BPD.

Six Steps in the Treatment of Borderline Personality Organization – by Vamik Volkan. This internationally renowned psychoanalyst was a master at conceptualizing and treating BPD. In this book he illustrates his conceptual understanding of BPD, and outlines six phases of successful treatment that he used. His account of his treatment of Patti, the borderline patient whose history fills half this book, is a touching and ultimately triumphant story of how Patti became a mature adult over a period of several years.

Borderline Psychopathology and its Treatment – by Gerald Adler. In this book, Adler defined specific phases in the successful treatment of BPD and reviews the treatment course for several borderlines with whom he worked. Adler, a Boston-based psychiatrist, uses a deficit model of BPD which is different from some other psychodynamic writers. He focuses on the relative absence of positive introjections and the inability to regulate emotions, rather than on the attachment to bad objects. I met Adler in Boston in 2008 to discuss BPD, and he is still very optimistic about treating the disorder, while not being unrealistic about the major challenges involved. Adler is such a kind man, and he is another one of my “idols of BPD” 🙂

Psychotherapy of the Borderline Adult – by James Masterson. Masterson describes his theory of BPD treatment, which is focused on working through negative feelings and encouraging independence in the patient. He tells the stories of several young and middle-age adult patients who had strong outcomes, becoming able to love and work. I’m not a big fan of Masterson’s theories, since for me they overemphasize autonomy at the expense of dependence and closeness, but I respect his success in treating BPD. Until he recently passed away, Masterson practiced therapy in New York where he developed an institute which trained other therapists in how to treat personality disorders including BPD.

The Difficult Borderline Patient, Not So Difficult to Treat – by Helen Albanese. This book has a strange title, but it’s a great book! It was written in 2012, by a Texas-based university therapist who has worked with borderlines for decades and is very optimistic about BPD. In this short volume, she describes her understanding of how borderlines repeat and cling to past traumatic experience. She describes how therapists can help separate the borderline from bad external relationships and promote the development of an authentic self.

The Angry Heart: Overcoming Borderline and Addictive Disorders – by Santoro and Cohen. This was one of my first introductions to BPD. It is a very empathic and informed view of BPD and how to recover from it, from a mainly cognitive-behavioral viewpoint. However, it does not have the lengthy case studies of some of the other titles above.

Listening Perspectives in Psychotherapy and Interpreting the Countertransference – Lawrence Hedges. I hesitate to recommend these books because they is quite technical. However, they moved me toward my current viewpoint about BPD being more useful as a metaphorical term than as a mental health diagnosis. In this work, California psychoanalyst Hedges explicates his theories about Borderline Personality Disorder, as well as about psychosis, narcissism, and neurotic conditions. He explains how these conditions are formed in past childhood trauma and perpetuated by adult relational patterns and defenses. However, Hedges also believes that these disorders do not exist as distinct medical entities,  and he explains why. When I went to Los Angeles last year, I got a chance to meet Hedges in person. He is still very optimistic about borderline-spectrum conditions. He told me how he, his colleagues, and his supervisees had treated dozens of people with severe borderline conditions over the past several decades, often with significant success.

Online and Print Accounts of Recovery by Borderlines, in their own words

Borderline Personality From the Inside Out – by A.J. Mahari

You can find A.J.’s website at http://www.borderlinepersonality.ca
In my opinion, A.J.’s website is the best online source of information about BPD. A Canadian blogger who was diagnosed as borderline many years ago, A.J. writes with great wisdom and experience about every aspect of the borderline experience. By the mid 1990’s, A.J. had meaningfully recovered from BPD, and she has spent the last 15+ years encouraging others to do the same. She also offers “recovery coaching” services to current borderlines. If I had known about her 10 years ago, I would not have hesitated to get coaching from her (well, being honest about myself 10 years ago, I might have hesitated, but that’s another story! 🙂

Healing from BPD – by Debbie Corso.
Debbie’s website is – http://www.my-borderline-personality-disorder.com/
Debbie is a young woman from California who tells the story of her journey to recover from Borderline Personality Disorder using DBT. Over the past few years, Debbie has progressed to the point where is no longer diagnosable with BPD, and she is a great example of how motivation and hard work can lead to successful recovery. I highly recommend her website and blog.

Get Me Out Of Here: My Recovery From Borderline Personality Disorder – By Rachel Reiland.

Rachel Reiland, a young mother and wife, suffered from severe BPD which manifested itself in symptoms including anorexia, promiscuity, and suicide attempts. In this book, she tells the story of how she faced these challenges using intensive psychotherapy and the support of her family and friends. By 2004, when she published this book, she had meaningfully recovered from BPD, and her recovery has been stable and lasting for the past 10 years. Today, Reiland does radio interviews, blog postings, and generally spreads the message that recovery from BPD is real and possible. More information about her can be found at http://www.getmeoutofherebook.com

The Buddha and the Borderline: My Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy, Buddhism, and Online Dating – by Kiera Van Gelder

This is another moving account of long-term recovery from BPD. Van Gelder honestly describes her traumatic family history and the resulting behaviors it led to including drug addiction, suicidal thinking, and severe mood swings. She courageously sought help via group therapy – the book contains interesting accounts of how DBT works in groups – and via the unconventional methods of Buddhist spirituality and online dating.  These unusual things that helped Van Gelder are reminders that every recovery process is different, and that what works for some people may not work for others. I would not use online dating, but I’m glad it helped her!

———————-

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, 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

#2 – How Did I Recover from Borderline Personality Disorder?

People reading this page are probably searching for hope and encouragement, either because they have problems related to Borderline Personality Disorder or they care about someone who does. Or, perhaps they are simply curious and wonder whether BPD can be recovered from.

On this page, I will describe what allowed me to move from being an emotionally immature young person, suffering from many painful borderline symptoms, to being the relatively mature, functional, and symptom-free adult that I am today.

When I Was “Severely Borderline” – Teenage and Young Adult Years

From approximately ages 13-23, I was severely emotionally ill. I had the following symptoms, most of which are in the DSM-IV definition of BPD:

– Severe anxiety and depression most of the time, with little ability to comfort myself.
– Constant feelings of emptiness and low self-esteem.
– Acting out in various ways, especially overeating.
– Viewing other people and myself as all good or all bad, accompanied by childlike clinging toward the “good” people and extreme rage against the “bad” people.

– Very poor personal relationships in terms of their emotional depth – I had no real friends and tended to use people for my needs and then quickly lose interest in them.
– No clear identity or long-term goals – I usually only planned a few days or weeks ahead.
– A tendency to be paranoid and fear that other people were “out to get me”.
– Intense fear of losing important family members (fear of abandonment).
– Suicidal thinking when I became very depressed.

These symptoms persisted relatively constantly for 10 years starting in middle school. It is difficult to describe in words how painful or frustrating they were. Externally, I tried to appear normal and to function in school and work, but internally it was a constant emotional nightmare. I felt myself to be cursed, a walking example of Murphy’s Law, existing in a personal hell on earth. When first working on recovery, I had no idea where to go. Emotionally, I felt like a cork caught in the waves of a stormy sea.

My Progress Toward Being a Mature Adult Today

However, here is how I would describe myself today, at age 28:

– Able to regulate my feelings– I can comfort myself and rarely become anxious or depressed.
– Able to think in an ambivalent way, and to see others and myself as good and bad at once.
– Have confidence in myself, possessing a clear sense of what I want to do in work and relationships. I think long-term, able to plan months and years ahead.
– Able to feel genuine concern and interest in others, rather than only using them to satisfy my needs.

– Have had a good romantic relationship and several meaningful long-term friendships.
– No paranoid thinking, suicidal ideation, or fear of abandonment.
– Able to function independently in a job I enjoy; no need to cling to other people to function well.
– Have a strong core identity which persists through difficult times.
– Much reduced acting out – I still do occasionally overeat when under unusual stress at work, but it’s much less of a problem than before.

I am pretty happy with how my life is going today, and proud of myself for the work I did. How did I make these changes to develop a good life, and to lose almost all of my borderline symptoms?

What Helped Me Become Healthy and Non-Borderline

1) Long-term psychotherapy

Starting in my late teens, I was fortunate to be able to attend psychodynamic, psychoanalytically-informed psychotherapy. At first, I went once a week, and then for several years I went an average of twice a week, sometimes going three times a week during difficult periods. It was extremely expensive, and I was fortunate to have parental financial support to go to therapy (I later financed myself, sacrificing in other areas of my life so that I could go to therapy). Essentially, I used psychotherapy as a reparenting process in which I worked to be able to deeply trust someone else for the first time. My various therapists – I had four significant ones – provided me with crucial emotional support that allowed me to become independent in my job and to develop better interpersonal relationships. They were the substitute mothers for my emerging true self.

In other articles, I will discuss more extensively how and why therapy helped me, my views on therapy vs. medication, as well as options one has if one does not have the money to go to therapy initially (therapy is certainly not the only path to getting better, although it can be very valuable).

2) True friends

Starting in my late teens, I was fortunate to develop a close friendship with a man, Gareth, who knew about my history of physical abuse (my father beat me throughout my childhood). He was an older, middle-aged family man who I met via the shared interest we had in tennis. I took the risk of opening up to Gareth about my problems, and we developed a friendship that has endured to this day. We spent hundreds of hours talking through my past and present problems. There were many times I cried with him, as well as some periods when I became angry or paranoid and misunderstood his kind intentions. However, most of the time his support was extremely helpful, coming during a period of my life when I desperately needed love and understanding. I will be eternally grateful to Gareth for his decision to help me.

From about age 15 until the present day, I developed three other close friendships, with two men and one woman, all of whom helped me tremendously and gave me hope that life could get better. My relationships with Julian, Andrew, and Helena were similar in quality to the first one described above, in that I took the risk of opening up to these people, telling them my life story, and asking for help. However, they were not as deep or intense as the first one.

Today, I also have a number of other important friendships, but they are more “normal friends” that I enjoy for themselves and can share my present-day sense of self with. These friends do not know my history of being borderline in nearly as much depth as the four people I opened up to in my teens.

I will write more in another article about how genuinely opening up to another person for help is one of the most important risks a borderline person can take.

3) Family – My mother

Despite her faults, my mother supported me financially to go to psychotherapy, and she did genuinely care about me although it was difficult for me to feel that fact early on. She had a very difficult relationship with my father, and her decision when I was 18 to divorce him and live alone provided me with a stable, safe place to live for several years. As I became a young adult, I came to trust my mother more and risked talking to her openly about some of my problems. This occurred in parallel with my trusting and opening up to the friends noted above. To my mother’s credit, she matured along with me, becoming a supportive listener and a cheerleader for my developing independence. I owe much of what I am today to her heartfelt efforts to help me.

4) My passion – tennis

The one thing I always liked as a young child was the sport of tennis. I took group classes at the local club and viewed the coaches as substitute father-figures. The process of hitting the ball and running around with other children became addictive, and I developed an obsession with the pro game and players like Roger Federer. Perhaps surprisingly, this interest endured during my teens and early twenties even when I was struggling with all the horrible emotional symptoms associated with Borderline Personality Disorder.

Tennis had great value as something that distracted me from my emotional suffering during the most difficult periods, and had meaning for me in its own right. It also led me to work with children as an assistant coach in college, which eventually led to my present day job, in which I work with kids.

5) My own study of Borderline Personality Disorder

When I first learned about BPD, and later was diagnosed with it, I was terrified because of all the pessimistic descriptions about how difficult it was to help people with the diagnosis and how many therapists did not want to treat them. Online web forums were filled with horror stories about manipulative, evil, hopeless borderlines.

Over time, I researched BPD extensively and came to a more nuanced understanding of it. I understood it from a developmental perspective, meaning how traumatic childhood experience shapes later adult problems, as well as from an object-relations perspective, referring to how the traumatized individual uses psychological defenses and modes of relating that distort the external environment based on pathological internal views of themselves and others. More on that in later posts.

I studied the writing of many therapists who had successfully treated individuals with BPD, including Harold Searles, Vamik Volkan, Otto Kernberg, Heinz Kohut, Gerald Adler, James Masterson, Peter Giovacchini, Jeffrey Seinfeld, and others. I met Gerald Adler and James Masterson in person and interviewed them about their views on the treatability of BPD. From this research I developed an overall picture of what was necessary in the “big picture” for borderline individuals to become non-borderline. In essence, the traumatized person needed to learn to trust and accept support from another person, and to be helped via a therapeutic alliance to develop healthy adult ego functions that they never developed as a child. By around age 20-21, I understood BPD in more depth than many therapists do. Understanding it taught me what was necessary for a successful recovery process.

I will write much more about these issues in later articles, but for now, the point is that having a map of where to go when struggling with BPD helped immeasurably.

6) Eventually abandoning the concept of BPD

Paradoxically, I now no longer believe that Borderline Personality Disorder is a valid diagnosis. This is despite the fact that I was diagnosed with it, and have recovered from having almost all of its symptoms.

As I improved, I continued to be periodically worried or depressed by the idea that I was still a borderline. I would often fear that maybe the writers who said borderlines were untreatable and hopeless were right, that I would always be a borderline, and that if I did improve I would inevitably relapse.

Today, I view BPD as an archaic, outdated term, one fabricated by psychiatrists to (mis)label a wide range of severely abused and neglected people. To me, a more realistic view is that “borderline” symptoms exist on a continuum of severity, i.e. that there is no firm line that divides borderline from non-borderline. Looking back, it is obvious that as I recovered there was no past time at which I suddenly no longer “had” BPD, if I ever had it at all. Of course, I did have (and gradually stopped having) all of its symptoms, which were real and extremely painful.

Once I realized this, I experienced a paradigm shift in which I was no longer worried by the diagnosis of BPD, since I regarded it as invalid.

7) My curiosity, resilience, and aggression

By my nature, I have always been curious. This helped me when dealing with BPD, since it spurred me to extensively investigate the disorder and how it could be treated, as well as to eventually question its validity as a useful diagnosis.

Even more important, I am one tough cookie (I was going to use another word, but want to keep this blog’s language clean!). Starting in my early teens, I promised myself that I would get better or die trying. After reading about how borderlines often failed to improve, I defiantly predicted that I would recover. I weathered the long, slow storm of many years of depression, anxiety, rage, and uncertainty, never giving up despite times when things seemed hopeless.

Lastly, I can be a pretty direct and blunt person. Aggression is often regarded as a “bad” thing in our society, but aggressively seeking out the truth or defending oneself when under attack can be good things. My aggressive rejection of those who are pessimistic about BPD was important in my recovery. I’m not afraid to say what I really think, as you will see on this site!

These qualities are partly genetic. They certainly helped me with my challenges. Each person has their own strengths, and there are other ways in which I’m not as gifted as others. For other people working to recover from past trauma, it may be these or other strengths that are most useful on their journey.

 ——————

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

#1 – The Goal of My Website About Borderline Personality Disorder

The main goal of this website is to show that meaningful recovery from Borderline Personality Disorder is possible, and to illustrate one way of getting there.

My Life Today

My name is Edward Dantes, and I’m 28 years old. I am a teacher working in an academic institution in the Eastern United States. At age 18, I was diagnosed with Borderline Personality Disorder by a psychiatrist. I have spent the past 11 years working to recover from severe childhood abuse and neglect, and have now reached a place where I can definitively say that I am better.

By “better”, I mean that for the most part I’m emotionally healthy – I like my work, enjoy several hobbies, have good intimate relationships with family and friends, can regulate my self-esteem, and can handle difficult emotions without acting out. Most days, I feel real, alive, and excited about what I’m doing.

I still have periodic struggles and doubts. But my core self is so much stronger than before. Or rather, I have a core identity where there was none previously. As one of many people who have recovered from severe childhood problems, I hope my story will encourage other survivors who want to do the same.

My Past Struggle

In my late teens and early 20s, I was severely borderline. My life was a living hell dominated by severe depression, constant anxiety, terrible self-esteem, suicidal thinking, acting out of various kinds, a lack of any intimate relationships, being unable to sustain full-time school or work, and the horrible feeling that things would never get better. As a young adult, I often despaired of ever succeeding at a job, having real friends, or having a successful romantic relationship.

However, slowly but surely, I did get better. I educated myself in great depth about BPD, and discovered what had helped others with the condition. I sought therapy and found friends to support my recovery. I rejected the prevailing societal view of the disorder as a biologically-caused, life-long condition that can only be managed rather than fully recovered from. This shift in my thinking became critical. I found out the truth – that meaningful recovery is possible, and that many people diagnosed with BPD have recovered enough to live good, rewarding lives.

Today, I have 0 of the 9 symptoms of BPD, whereas 10 years ago I had at least all 9 symptoms listed in the DSM-IV definition of BPD. I trust my progress and have every reason to believe that it will continue.

Confronting the Pessimists

Apart from promoting this positive vision of recovery, another purpose of this site is to confront those who say that Borderline Personality Disorder cannot be effectively treated. Many people on internet forums and the therapeutic community believe that BPD is a life-long condition. They believe that it can only be managed and “lived with”, but not deeply recovered from.

Nothing could be further from the truth. Getting better from BPD is possible, although it requires hard work over a period of years. Recovering to the point where one is essentially healthy and “normal” in the sense of enjoying work and relationships has been achieved by many former borderlines. Unfortunately, many borderlines and their families are not aware of the resources that are needed to recover, nor do they understand the disorder in depth.

On this site, I will present a powerful counterexample to pessimism about BPD. I will explicate the disorder from a variety of viewpoints, and present strategies which were useful in my recovery.

Additionally, this site will confront the American medical view that seeks to cast BPD as a genetic or biologically-based disorder, one that needs to be treated primarily with psychotropic medications. It will expose the lack of strong scientific basis for such claims, and will analyze the emotional and financial factors that might motivate supporters to hold this viewpoint.

The Validity of the Borderline Disorder

Lastly, I wish to radically challenge the notion that BPD is a valid scientific diagnosis as it is defined in the DSM. From my own research and life experience, and despite being diagnosed with it myself, I now believe that the DSM version of borderline personality disorder has little validity. That is not to say that the symptoms BPD represents are not profoundly real and that people do not suffer from them greatly – they are, and people do.

However, my viewpoint is that BPD is more useful as a metaphorical or symbolic term that encapsulates a range of severe problems in functioning and relating. In other words, BPD represents a large, nondistinct area of severe psychological distress, rather than a discrete syndrome. Psychodynamic theorists would call this region “preoedipal” and “preneurotic”, but not “psychotic”. Re-conceptualizing BPD has been a useful step toward recovery, since it allowed me to view myself as existing on a subjective continuum between sickness and health, rather than as having a discrete “disorder”. For me, this was freeing.

Disclaimer

Lastly, this website should not be taken as the advice of a medical professional, but rather as the opinion of a layperson. However, coming from the “inside out”, I can give a viewpoint of BPD and how to recover from it that is fundamentally different from any professional opinion.

It is my hope that this website will prove useful both to those who have been diagnosed with BPD and to family members of such people. If it does nothing else, it will hopefully challenge people to think differently about BPD, both in terms of what the disorder actually is, and in considering how much people diagnosed with it can change for the better.