Tag Archives: BPD help

#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

#15 – Heroes of BPD: Gerald Adler

Here is the front and back cover of the book I’m about to discuss:

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Back

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Heroes of BPD: Gerald Adler

Several years ago, when I feared that full recovery from BPD was impossible, my therapist recommended me to read Gerald Adler’s book Borderline Psychopathology and Its Treatment.

Now in his mid-80’s, Adler had earned a reputation as one of the best psychodynamic theorists writing about Borderline Personality Disorder. In the early 1990s, Adler visited the Washington School of Psychiatry to give a talk which my old therapist attended.

What impressed my therapist most was not Adler’s knowledge or clinical skill, but his compassion and goodwill. Out of all the speakers she remembers, only Adler stayed two extra hours to answer questions from junior therapists.

I have met Adler in Boston and spoken to him via phone and Skype five other times. He engaged my fears about BPD compassionately yet forcefully. He had a wonderful quality of being active in directly addressing what was bothering you, but in a manner that felt supportive not intrusive. He reached me even though I was regressed and depressed at the time.

In this article, I’ll discuss some of the key theoretical views of Gerald Adler on Borderline Personality Disorder. Get ready to learn from a master!

The Primacy of Introjective Insufficiency

First, I would like to quote some of Adler’s views on the importance of borderlines’ lack of positive relational experience.

Several decades ago, psychodynamic writers debated about whether inability to tolerate ambivalence – i.e. to see people and oneself as good and bad simultaneously – was the primary problem for borderlines, or whether the main issue was an earlier failure of nurturing which led secondarily to the inability to tolerate ambivalence. Here is Adler’s position (from Borderline Psychopathology and Its Treatment, pages 10-12):

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“In the ambivalence theory account of borderline functioning, introjective insufficiency results from an inability to tolerate ambivalence toward the whole object. But my own clinical experience suggests the utility of a different theoretical approach.

If the primary issue for borderline patients were the need to keep apart introjects of contrasting affective coloration, then there must already have been substantial solid development of positive introjects around which the self is organized. While ambivalence toward the whole object may then lead to a lack of self-cohesiveness, it would not issue in the felt threat of annihilation.

Only a theory that views insufficiency as primary – and not merely a secondary or reactive expression of ambivalence – can fully account for the borderline patient’s “annihilation panic” in regression. In other words, only a primary inner emptiness, based on a relative absence of positive introjects around which the self is organized , can adequately explain the borderline patient’s vulnerability to feeling that his very self is at risk.”

Explanation of Adler’s View on Introjective Insufficiency

This might seem confusing. Very simply, Adler is saying that the primary problem for borderlines is not their all-good all-bad splitting – which is a symptom – but rather their lack of sufficient positive introjects, which is the underlying cause of their psychopathology.

By “introject”, Adler refers to an internalized mental representation of another person and the way they make us feel. “Positive introjects” are comforting, supportive representations of other people, for example those of caring parents. A healthy child develops solid, reliable positive introjects to soothe itself based on mostly good experiences with its parents. Such a child can use “evocative memory” to comfort itself by remembering how good relationships feel even when the external person is not physically present.

“Negative introjects” are persecutory, hurtful memories, for example those with neglectful and abusive parents. Negative introjects predominate in the minds of future borderline children. A relative deficit of positive introjects, whch are outnumbered by negative persecutory introjects, causes borderline psychopathology in Adler’s model

“Introjective insufficiency” means a lack of sufficient positive introjects to comfort oneself. It is this introjective insufficiency that results in the feelings of emptiness, panic, and fear that borderlines often experience.  In stressful situations, the lack of positive introjects leads borderlines to feel that their very psychological being is under threat.

That is what Adler means when he discusses “annihilation panic”. In a healthier person, stress would be challenging – i.e. it would affect their “self-cohesiveness” and make them feel “not like themselves” – but it would not make them feel that their psychological being was threatened.

However, with borderline individuals who have had little positive nurturance growing up, and whose positive introjects and self-comforting are therefore tenuous, emotional stress leads to the feeling that they may be destroyed psychologically. In Adler’s view, the strength and frequency of this phenomenon supports the idea that a lack of positive introjects is primary for borderlines, and that inability to tolerate ambivalence is secondarily based on this deficit.

As humans we need positive relationships, and positive introjects derived from them, for our psychological survival and well-being. Positive introjects serve the mind the same way oxygen serves the body. When they are weak, we feel existentially threatened, like a mountain climber running short of oxygen.

Adler’ view of BPD is a “deficit” model – he focuses on what is missing in a person’s psychological development, and on what is needed to remedy the deficit. Other therapists focus more on “conflict”, i.e. what conflicts associated with “bad” relationships block the borderline’s psychological development. These approaches are complementary and could be considered sides of the same coin.

Adler’s View on the Cause of Borderline Personality Disorder

(from pages 20-23)

“The fundamental psychopathology of the borderline personality is in the nature of developmental failure: Adult borderline patients have not achieved solid evocative memory in the area of object relations and are prone to regress in this area to recognition memory or earlier stages when faced with certain stresses. The result is relative failure to develop internal resources for holding-soothing security adequate to meet the needs of adult life.

To repeat, the formation of holding introjects – of both past and present figures – is quantitatively inadequate, and those that have formed are unstable, being subject to regressive loss of function. The developmental failure appears to result from mothering that is not good-enough during the phases of separation-individuation. Although the young person is ready for the neuro-psychological development of memory needed to form holding-soothing representations and introjects, the environment does not facilitate it.”

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Discussion of Adler’s View on the Cause of BPD

Adler’s point is that parental support is usually lacking in the histories of children who become borderline, and that lack of support leaves them unable to comfort themselves as adults. According to Adler, future borderline children are psychologically capable of developing self-soothing capacity, but they experience too much neglect and/or abuse to allow for it. Adler noted that in virtually every case of BPD he treated (comprising dozens of borderline patients over a 40-50 year career), the borderline patient reported significant neglect or abuse in their childhood.

I believe that genetic strength or weakness is a factor too. However, I place less much value on this aspect BPD’s etiology than genetic researchers, most of whom, unlike Adler, have never worked with borderlines in depth. In my view, the dynamic interaction of the environment with the individual generates borderline symptoms. The prevalence of neglect and abuse reported by borderlines underscores the crucial importance of human relationships in causing borderline symptoms. This issue is elaborated on here:

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

Adler also discusses how positive introjects are “quantitatively inadequate” in BPD. This is a critical concept. Borderlines simply do not have enough positive experience with the outside world to be able to comfort themselves or to tolerate ambivalence. The main problem that causes all other borderlines symptoms is borderlines’ relative lack of positive experience with other people (and the associated lack of positive memories/introjects). This concept of the relative balance of positive and negative self-and-object units is discussed further here:

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

Adler’s Three Phases of BPD Treatment

In an earlier article, I described Searles and Seinfeld’s four phases of treatment for BPD. Adler has a related model comprising three phrases. Here I’ll quote the way Adler describes these phases at length. I have slightly paraphrased some areas to make them more accessible, while keeping the meaning intact.

Phase 1: Phase I: Inadequate and Unstable Holding Introjects

Here is Adler’s description of Phase 1, from Borderline Psychopathology and Its Treatment, pages 49-53. It has been shortened and sometimes paraphrased for clarification:

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“The primary aim of treatment in the first phase is to establish and maintain a dyadic therapeutic relationship in which the therapist can be steadily used over time by the patient as a holding selfobject. This situation makes it possible for the patient to develop insight into the nature and basis of his aloneness, and to acquire a solid evocative memory of the therapist as sustainable holder, which in turn serves as a substrate out of which can be formed adequate holding introjects. That is, developmental processes that were at one time arrested are now set in motion to correct the original failure.

This process would simply require a period of time for its occurrence were it not for certain psychodynamic obstacles that block it in therapy just as they block it in life… The inevitability of rage is one such corollary that interferes with the process of forming holding introjects. This rage has three sources…
1) Holding is never enough to meet the felt need to assuage aloneness, which enrages the patient. The patient expects to lose the therapist through the therapist’s responding to his rage by turning from “good” to “bad”.
2) The holding selfobject that does not meet the need is not only the target for direct rage but is also distorted by means of projection of hostile introjects… The inevitable result of this projection is the loss of the good holding object.
3) The object that is so endowed with holding sustenance is deeply envied by the needy borderline patient. This envy necessarily involves hateful destructive impulses.

Any of these sources of rage can lead to transient loss of holding introjects. At such times the patient is subject to the terrifying feeling that the therapist has ceased to exist.

There is yet one more impediment to the use of the therapist as a holding selfobject. It is a primitive, guilt-related experience that involves the belief by the patient that he is undeserving of the therapist’s help because of his evilness. In extreme situations this guilt can lead to suicide attempts.

Acquiring insight into and working through these challenges are necessary in order for the borderline patient to develop a stable evocative memory for the therapist as holding sustainer. Each of these impediments must be worked through in the standard ways as it manifests in transference, through use of the therapeutic maneuvers of clarification, confrontation, and interpretation. The amount of support required may considerably exceed that involved in most psychotherapies.

The outcome of the work is this: The patient learns that the therapist is an enduring and reliable holding selfobject, that the therapist is indestructible as a “good object”, that holding closeness poses no dangers, and that the patient himself is not evil. Hope is aroused that the relationship and the therapeutic work, involving understanding of object and selfobject transferences plus genetic reconstructions, will open the way for psychological development and relief.

The healing of longstanding splitting of the type Kernberg describes must await the formation of stable holding introjects. Efforts to bring together the positive and negative sides of the split can be therapeutic only after development of more stable holding introjects along with correction of distorting projections that have acted to intensify the negative side of the split.

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Discussion of Phase I

Some of the technical terminology might be confusing. By “holding” Adler means the comforting psychological aspect of a relationship, not literal physical holding. “Holding” is a primary psychological element of any deep friendship, love relationship, or therapeutic alliance.

The “selfobject” is a term referring to the way the therapist is experienced as a comforting person or “good parent” by the patient. It describes how the patient experiences the therapist as serving their emotional needs, without fully realizing that the therapist is a separate person psychologically. That is why there is no space between “self” and “object” as written. It was invented by Heinz Kohut who wrote about its value to narcissistic patients.

Adler’s main points are that the borderline needs a new, positive relationship to grow psychologically, and that emotional resistances to forming that relationship must be confronted and removed. Borderline individuals reading this can probably agree that rage, fear, and guilt create obstacles to forming a positive relationship in therapy.

In the book, Adler details how the resistances to forming a positive new relationship to the therapist – i.e. rage about the imperfections of the therapist, envy of the therapist, fear of closeness, guilt – must be directly interpreted and confronted to allow the patient to internalize the therapist as a positive new object. This is a lengthy, gradual process taking many months and sometimes years.

Adler’s last paragraph is important – about how splitting cannot be resolved until a stronger positive relationship between patient and therapist exists (with correspondingly stronger positive introjects in the patient). In my early attempts at recovery, I worked on seeing things in a less black and white way. I had little to no success.

I eventually gave up and focused on building a positive relationship to my therapist, and also to my family and new friends. Eventually, the process of resolving splitting happened naturally a few years later, once more positive relationships were in place. My experience confirmed Adler’s view that correction of splitting must await the development of more stable positive relationships/introjects.

Adler also notes the importance of correcting “distorting projections that have acted to intensify the negative side of the split”. I learned much from this insight. What it means is that overly negative, distorted beliefs about the external world serve to prevent borderlines from seeing themselves and others ambivalently. It is necessary to “extract” these negative beliefs and correct them into views that are more realistic and balanced. This sets the stage for ambivalence rather than splitting.

In my case, I had various distorted views of the external world, for example:
1) That everyone thought I was ugly.
2) That women would not want to date me if they knew of my sexual inexperience.
3) That most therapists agreed that BPD was untreatable.
4) That therapists couldn’t be trusted and only cared about money.

I thought and acted as if people actually believed these things. It was necessary to correct these beliefs in order to view other people and myself realistically.

I liken the process of confronting such “distorted projections” to that of cleaning an infected wound. As long as the pus remains inside the wound, it festers, hurts, and may get worse. Draining the infected area is painful, but ultimately brings relief and allows for healing. Likewise, confronting painful, guilt-laden beliefs is uncomfortable, but ultimately freeing, promoting the development of a more realistic view of the world.

Lastly, Adler’s entire Phase 1 can be compared to Phases 1 and 2 (Out-of-Contact and Ambivalent phases) plus the early part of phase 3 (Therapeutic Symbiosis) in Jeffrey Seinfeld’s conception of BPD treatment, described here:

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

Phase 2: The Idealized Holding Therapist and Introjects

Next, Adler describes the phase of treatment after the borderline has developed a stable positive relationship to the therapist. From pages 58-60:

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“In general the holding introjects established in phase I are considerably unrealistic; they are idealized in a childlike fashion. Were treatment to stop here, the situation would be quite unstable, for two reasons. First, the unrealistic idealization of the holding introjects (based on the therapist), along with the projections of them onto persons (in the patient’s external life) who serve as holding selfobjects, would eventually be confronted by reality and would inevitably break down.

Second, at this point the patient is still heavily dependent on a continuing relationship with holding self-objects (including the therapist), as well as holding introjects, for an ongoing sense of security; this is not a viable setup for adult life, in which selfobjects cannot realistically be consistently available, and must over the years be lost in considerable number.

The therapeutic work in phase II parallels that described by Kohut in treating narcissistic personalities. Kohut describes the therapeutic process as “optimal disillusionment”. No direct interventions are required. The realities of the therapist’s interactions with the patient and the basic reality orientation of the patient always lead to the patient’s noticing discrepancies between the idealizing holding introject, based on the therapist and reflected in the transference, and the actual holding qualities of the therapist.

Each episode of awareness of discrepancy occasions disappointment, sadness, and anger. If each episode of disappointment is not too great, that is, is optimal, a series of episodes will ensue in which insight is developed and unrealistic idealization is worked through and relinquished. (Any disappointments that are greater than optimal precipitate recurrence of aloneness and rage in a transient regression that resembles phase I).

Ultimately the therapist as holding self-object is accepted as he realistically is: An interested, caring person who in the context of a professional relationship does all that he appropriately can to help he patient resolves conflicts and achieve mature capacities. Holding introjects come to be modified accordingly.”

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Discussion of Phase II

Here, Adler describes the progression that can occur after a stable, trusting relationship has been achieved in therapy. His main point is that, due to their childlike needs for dependence and support, borderlines tend to unrealistically idealize the therapist and view him as perfect during phase I, and that this idealization must eventually be made more more realistic in phase II. The introjects (mental representations) of the therapist that borderlines develop to comfort themselves are correspondingly unrealistic, and prone to breakdown under stress when others do not treat them perfectly.

To deal with this issue, Adler describes how the patient must gradually realize that the therapist is not a perfect parent, but is an actual therapist who is nevertheless sincerely interested in the patient. If the patient can come to see the therapist more realistically, as both good and bad, this carries over to relationships in the outside world. This intrapsychic progress helps the patient to be less sensitive to failures in empathy from other people, who will inevitably disappoint the patient from time to time. This process should occur gradually, so that the patient is not confronted too suddenly with the reality that his earlier idealizations were unrealistic.

In my view, the harder work, and in a way the more fundamental work, is what Adler describes in phase I. It is the work of Phase I – building a positive, trusting relationship and fully relaizing that one is not a bad person – that makes one no longer borderline. The work of phase II is also important, albeit easier. It is like building a base camp on a safe island (phase II) that one has reached after being shipwrecked and having to swim to shore in  a stormy ocean (phase I).

Adler’s phase II can be compared to the later part of Seinfeld’s phase 3 and the early part of his phase 4.

Phase III: Superego Maturation and Formation of Sustaining Identifications

Lastly, Adler describes a late phase in which the former borderline makes further progress:

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“To become optimally autonomous – that is, self-sufficient – in regard to secure holding and a sense of worth requires two developments: (1) A superego must be established that is not inappropriately harsh and that readily serves as a source of a realistically deserved sense of worth. 2) The ego must develop the capacity for pleasurable confidence in the self and for directing love toward itself that is of an affectionate nature. This development of the capacity to love the self contributes not only to enjoyment of being one’s self but also makes possible a reaction of genuine sadness in the face of losses that involve the self – accident, disease, aging, approaching death.

The therapeutic endeavors in phase III are based on the principle that capacities to know, esteem, and love oneself can be developed only when there is adequate experience of being known, esteemed, and loved by significant others.

Often, (formerly borderline) patients require help to gain the capacity to experience subjectively the factualness (validity) of their esteemable qualities, as well as the capacity to experience feelings of self-esteem.

In this phase of treatment, the ego evolves as its own resource for pride and holding through development of intrasystemic resources that are experienced as one part providing to another, both parts being felt as the self. These ego functions are developed through identifications with the homologous functioning of the therapist as a selfobject. That is, the therapist, verbally at times, but largely nonverbally, actually does provide the patient with a holding function, a function of loving in the affectionate mode of object love, a function of validating the patient’s competencies, and a function of enjoying the exercise and fruits of the patient’s competencies.

The experiential qualities of these newly gained ego functions might be expressed as follows:

1)      “I sustain myself with a sense of holding-soothing,”
2) “I love myself in the same way I love others, that is, affectionately, for the qualities inherent in me,”
3) “I trust my competence in managing and using my psychological self and in perceiving and interrelating with the external world, hence I feel secure in my own hands,” and
4) “I enjoy knowing that I am competent and exercising my competence”

Total self-sufficiency is, of course, impossible. For its healthy functioning, the ego requires interaction with the other agencies of the mind as well as with the external world, and no one totally relinquishes use of others as selfobject resources for holding and self-worth, nor does anyone relinquish using selected parts of the environment (art, music, and so forth) as transitional objects. These dependencies are the guarantees of much of the ongoing richness of life.

It is only through the developmental acquisitions of phase III that the former borderline personality acquires genuine psychological stability.”

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Discussion of Phase III

In this passage, Adler’s compassion and positive outlook on human nature can be observed. Psychodynamic therapy is often criticized for over-focusing on what is wrong or pathological. Adler stands out in that he emphasizes what needs to go right in healthy emotional development.

In this phase, Adler describes how former borderlines can learn to love themselves affectionately and enjoy being themselves. He explains how crucial it is to feel loved and appreciated by others before a person can reciprocally do that for themselves. This phase could be compared to the later part of phase IV (Resolution of the Symbiosis) in Seinfeld’s phases.

To me, what Adler says here is self-explanatory and obvious. However, I expect that many people will be surprised to read such positive language about BPD. The public remains largely unaware that borderlines can become fully non-borderline, living normal lives in which they enjoy themselves. You don’t find this in the DSM!

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Adler’s View on the Validity of the BPD Diagnosis

During my contacts with Adler, I had a chance to ask him if he considered Borderline Personality Disorder a valid diagnosis. He answered that his main concern was helping people get better, and that he thought very little about diagnosis. He said that giving someone a diagnosis doesn’t tell you much about them, and that understanding their individual history and current problems is much more useful.

I pressed him to say something more about the BPD diagnosis. Adler said that he thinks it is useful for insurance reimbursement purposes, but not much else. Adler added that he sometimes wishes that the word “borderline” had never existed. He agreed with me that diagnoses like BPD have not been scientifically proven to be valid, but said it doesn’t really matter.

Adler added that he doesn’t view BPD as a fixed diagnosis, but rather as a subjective area along a continuum or spectrum of personality / emotional development. He defines BPD via the patient’s ego development – for example, by the relative presence or lack of self-soothing capacity, and by the degree of splitting – not by the other symptoms in the DSM. Adler joked that the DSM gets updated every few years to torture people like him who have to learn new diagnostic codes for insurance reimbursement.

The high and low points of the BPD diagnosis are discussed more here:

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

Adler’s View on the Curability of BPD

On one of our phonecalls, I asked Adler if he thought BPD is cureable. He answered that “cure” is not the right word for BPD, since it implies the removal of a medical or physical condition, and connotes an idealized state where no problems remain.

But Adler did tell me that the majority of the borderlines he treated improved dramatically, and that many are no longer remotely borderline. He said he has worked with many former borderlines who have “largely worked it out and live good lives.” He emphasized that he was still very optimistic about borderlines doing well in long-term intensive therapy. Adler added that people in general are not “cured” in therapy. Rather, he said that no person becomes perfectly well or free from life’s challenges, but they can become better enough to live well.

Concluding Thoughts

There is much more in Adler’s book that cannot be discussed in the space here. For those interested, Adler’s book discusses  the therapeutic alliance, how to handle borderline acting out, BPD’s relation to narcissistic personality and schizophrenia, the positive aspects of regression, hospital management, etc.

Two points will suffice to conclude this entry. The first is to reemphasize the importance of educating oneself about Borderline Personality Disorder. Understanding BPD psychodynamically gave me an advantage in planning my recovery and in understanding myself.

Borderline Psychopathology and Its Treatment was among the first of dozens of books I’ve read about BPD. Despite its age, its formulations are relevant to borderlines and their therapy today. Adler’s viewpoint on deficits in self-soothing capacity and positive introjects are not the only way I conceptualize BPD, but they are important.

The second is to remain skeptical. I do not agree 100% with Adler’s views. For example, I think he focused insufficiently on conflict (versus deficit) and on how internal bad objects operate in the mind of a borderline to actively block new positive relationships. Jeffrey Seinfeld and others write better on this topic. However, I get more than enough out of his work to like it and find it useful. That is the way to handle writings about BPD – take what is useful from them, and leave the rest.

I hope you, the reader, don’t blindly accept everything I say either. Although I know that BPD can be recovered from, I am not perfectly informed about nor do I have all the answers for BPD. Therefore, I encourage people to read widely about BPD online and offline, and to accept what feels right to them. Nevertheless, I hope people will benefit from reading some of Gerald Adler’s views on the condition. He is a great person, and I will miss him when he’s gone.

#6 – Life After Borderline Personality Disorder – My Vacation

Spending the last two weeks visiting my extended family in England provided a great opportunity to reflect on my journey over the past few years.

I had not returned from America to my homeland for six years. In 2007, the symptoms of BPD had a powerful hold over me. Extended travel away from home was so stressful that I could barely appreciate the positive aspects of a holiday trip to visit loved ones.

In the past, overwhelming feelings of being alone, abandoned, and afraid would prevent me from relating meaningfully to my extended family. Being healthier emotionally than my own parents, my uncles, aunts, and cousins would make genuine efforts to reach me and make me feel accepted.

However, these efforts barely reached me, because my emotional suffering canceled out everything else, and because I had no idea how to love or be loved by others. In fact, I experienced my relatives’ efforts to show me love as a threat. Emotional closeness had barely existed in my immediate family, and so its sudden appearance in them seemed alien, strange, and frightening.

In the Lord of the Rings trilogy of movies, there is a scene where King Theoden of Rohan is possessed by the evil spirit, Lord Sauron. Theoden looks aged beyond his years, and is unnaturally cold, with his coat and beard covered in ice. He barely recognizes his loving daughter and son. When the heroes of the story visit him, he unfeelingly asks why he should welcome them.

As those who have seen the movie may remember, Theoden is freed after the wizard Gandalf exorcises Sauron’s spirit from him. With the curse lifted, Theoden appears immediately younger, warmer, and is shocked at how coldly he acted previously. He returns to life and becomes able to love his family again.

When I saw this scene, I immediately associated it metaphorically with the way in which traumatic, neglectful experiences “possesses” people who are later said to have Borderline Personality Disorder. Abuse and neglect can warp people’s personalities and transform them into shadows of who they otherwise would have been. In technical terms, they are possessed by “bad objects”, or negative experience from the past, which prevents them from becoming the loving person they could be in the present.

Back to my trip to visit extended family – I had a fantastic experience! For the first time, I could deeply feel the love they had for me. I was nervous about how my family might react, since I had not visited for many years. However, they went out of their way to make me feel welcome. They provided a warm place to stay, included me in family meals, helped me get around London, and showed real interest in how my life in America was going.

When I was swamped with borderline symptoms, it had never dawned on me that these people had their own work, relationships, and interests. But now, I could perceive my relatives as separate, distinct people and really come to know them in the meaningful sense of that word. Previously, I would use them, but have no interest in them beyond their ability to satisfy my immediate needs. This year, I discovered my uncles, aunt, and cousins as real people for the first time.

While exploring London, I was fascinated to discover how people in London, UK live so differently than in my American suburb – for example, they use public transport all the time, walk great distances, have few big cars, shop at tiny grocery stores, etc. Christmastime was fantastic – there were crafts markets full of international artisans, outdoor ice skating rinks everywhere, magicians and acrobats peforming in public parks.

These varied sights were meaningful in that when I was severely borderline, I would not have noticed them, or at least would not have delighted in them. I would have been like King Theoden, “possessed” by my negative emotions and prevented from taking in good things from the outside world. However, in 2013, a childlike sense of wonder and discovery dawned on me.

In his great writing on borderline conditions, the psychoanalyst Harold Searles described how the successfully treated borderline patient would eventually experience a psychic “rebirth”. The person would belatedly experience a sense of wonder and discovery, of being the child that joyfully explores the world for the first time.

It is important that such a regression not go on too long, because it is also critical to mourn the real losses in a childhood marked by severe abuse, and to develop mature adult emotional capacities in general.

However, every borderline deserves to one day feel this childlike joy – the delight of knowing that you are better, that you are alive, and that the world is there for you to discover.

Another primary emotion in me right now is vindication. This recent vacation is yet another, among hundreds of positive experiences in the last few years, by which I have disproven those who say that BPD is incurable and hopeless. I know that one can recover fully from Borderline Personality Disorder – and not even have the disorder at all anymore – because I am living that recovery.

If I’m to become more fully mature, I’ll need to fully relinquish the desire to get back at those who kept me down in the past. However, proving people wrong remains one of my favorite things, and so it won’t be too damaging to delight a little bit in my ongoing victory over the “false prophets of Borderline Personality Disorder.”

Among the “false prophets of BPD”, I include:

– Those therapists and laypeople who say that Borderline Personality Disorder is life-long, i.e. that once you have BPD it cannot ever fully go away, the implication being that it can only be managed while living a life periodically afflicted by its symptoms.
– Psychiatrists who believe BPD is biologically- or genetically-caused and needs to be treated primarily with medication.
– Anyone who says that borderlines are bad or evil, that they are not motivated to get better, and that they have a bad prognosis or are hopeless.

To all such pessimists, I am delighted to prove you wrong on a daily basis. There is a reason this post is titled, “Life After Borderline Personality Disorder.” Whether or not you believe what I write doesn’t matter one iota, because my feelings and experiences are 100% real to me. I am your reckoning.

I only hope that other borderlines will take heart from people like me who have recovered. Borderlines have enough challenges with which to deal on the road to recovery, without being burdened by the discouraging opinions of those who stigmatize them.

My message to borderlines reading this is – Don’t pay one bit of attention to the pessimists and liars that say you can’t get better. Borderline Personality Disorder can be fully recovered from, and life can be far better than you imagined. Let yourself dream of a better tomorrow for yourself and those you love.

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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

#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!

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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