In Therapy with Borderline Personality Disorder

The phrase “I have BPD” is often used to justify destructive or immature behaviour, while therapists, unintentionally influenced by fear and the urge to “save,” may inadvertently reinforce this dynamic with their clients.

As a therapist, I will try to explain why this is the case and propose to address the fact that borderline personality disorder (BPD) is simply a type of personality with its own unique traits and characteristics, similar to any other personality type found in people. Let’s take a look at the features of BPD as well as the myths and realities surrounding this condition which are often exaggerated in therapy.

The main reason for the formation of BPD is a painful, traumatic childhood experience. And I’m not talking about a conventionally “cold” mother or a withdrawn father. Trauma is any form of abuse (sexual, physical, emotional) and/or a situation in which a child has been abandoned in difficult conditions and by himself. In response to experiences that are unbearable for a child’s psyche a certain psychophysiological adaptation occurs which is absolutely normal in unnatural and abnormal conditions. Borderline personality disorder is largely about post-traumatic stress, not about psychiatric disorders in any way.

Let’s discuss the main criteria for BPD.

What does this mean? When a psychotherapist asks a client to describe their character the client often closes up and speaks in a fragmentary and superficial way using words like “I’m evil” or “I’m kind”, but can’t provide a detailed description of themselves. Intelligence is not the issue here as the inability to characterize oneself has more to do with the brain’s response to ongoing trauma. In these situations the child’s brain blocks acute emotional reactions in order to protect itself and these emotions cease to be painful. Next to the emotional zone there is also a zone of self-awareness that is captured and suppressed leading to the loss of a sense of self. This physiological explanation helps to understand why some people struggle to describe themselves.

There is a second aspect which is psychological. The child perceives his own personality as the cause of the adult’s attitude. Violence creates an unconscious fantasy about why the parent is abusing them which leads to extreme self-hatred. Sadly, his aggression becomes a frozen self-image and is experienced as “I am so disgusting that I should not exist.” As a result, no positive characteristics can be seen in the child’s own image. As a result the child’s self-esteem is lacking any positive qualities.

Many therapists are hesitant to upset clients with BPD, so they avoid confronting people’s feelings of worthlessness and focus more on their emotional weaknesses. In fact self-hatred is a natural response to abuse that child may have experienced in order to survive. This suggests that there are underlying forces for stability within an individual.

After a couple of years of therapy the client may find the strength to say: «I’m a complex person”. These words may sound with a heavy bitterness, but it will be a sign of their ability to grieve and accept themselves. Freezing the perception of trauma can also create an unrealistic view of reality as if life were a dream or a demo-version that soon will be replaced by something real. On one hand memories of past events constantly loom in front of the person’s mind, but on the other hand their psyche is unable to fully process these memories, so life feels like it is happening in two parallel universes. Therapy can help a person begin to live in the present moment by helping them work through trauma and post-traumatic stress.

In a friendship or romantic relationship, a person with (BPD) is constantly checking the reliability of the connection. The partner’s fatigue, temporary unwillingness to communicate, separation, or even sleep can cause severe anxiety and a desire to attack or escape. The main reason for these emotions is not just feeling worthless, but an unconscious need to attach to a “saver” figure. In response to unbearable reality a child creates fantasies about a person who can alleviate his suffering and provide healing from painful experiences. This idealized figure would be incredibly affectionate and caring, without any negative traits and would act as a parent with clear boundaries, providing adult and nurturing care. This «saver» would embody all the qualities a child needs in one person.

Another important component of fear of abandonment is self-loathing for the childhood experience. People with BPD jokingly talk about their past with violence, shielding themselves from the shame of feeling helpless with a smile. It really takes a lot of hard work to overcome that shame and realize the level of harm caused by those who had to protect and care.

As a result, by entering into interpersonal relationships a person with BPD unconsciously drops a child they hate for adoption to a “rescuer” who is unable to emotionally care for themselves. Therefore when there is a separation, whether physical or emotional, from a supportive figure, they suddenly find themselves feeling alone, helpless, and experiencing severe anxiety. This feeling can seem to last forever.

Speaking of «rescue»: «savers» are those who unconsciously divide themselves into “good” and “bad” rejecting anything that doesn’t fit their idea of an ideal person. To maintain this image they need a “bad partner” who will be needy for care and support. People with borderline personality disorder often find themselves connected to these «savers» and this connection can further reinforce their tendency towards the fantasy of their own unworthiness. They stay with an «ideal» partner who accepts and supports a lonely child whom they reject.

This connection type can be quite dangerous in therapy. The therapist may believe that the client is unable to be independent and may become lost in endless complaints and suffering. This is a dead end. In fact working through the fantasy of salvation can help to accept the past and the reality of violence which can’t be changed. This allows for a fuller emotional care for yourself, self-reliance during difficult times, and simply the ability to not lose yourself in a relationship, while still maintaining your own maturity and independence. This gives a source for a more complete emotional self-care, self-reliance in difficult times and the ability not get lost in a relationship keeping own maturity and independence.

These swings are based on a primitive (meaning simple) mechanism of adaptation to life situations in childhood. In families of people with BPD, cruel periods were followed by calm moments. The child didn’t have stable relationships with parents who were perceived as both good and bad. Instead he experienced either hatred or indifference from their parents, where indifference was interpreted as an ideal connection.

Therefore, in adulthood, these people have a split perception of others. Their partner’s flaws, mistakes and shortcomings instantly cause feelings of disaster and betrayal while at other times the other person is idealized to the maximum possible extent. This trait can be treated in therapy through the interaction between the client and the therapist. The therapist due to his ability to withstand strong emotions helps the client gradually stabilize his perception of self and therapist as people with both flaws and advantages. With time the client develops an ability for realistic perception which also helps in building healthy and stable relationships.

If a person experiences sadness on a Saturday evening or anger in a quarrel instead of simply accepting the emotional state as normal and appropriate, he tries to “get rid” of it through instant action. This happens due to several factors. Firstly, there was a lack of parents in childhood who could empathize and stabilize emotional experiences of a child. Instead adults were cruel and humiliating. In response to traumatic experiences a child also develops a protective perception of their own painful emotions as signs of weakness and lack of worth. During therapy, if a client is asked about the meaning of sadness or anger the first thing they may feel is that these emotions indicate a lack of self-worth.

The emotional behavior of a person with BPD is more about a fear of experiencing fear than an actual experience of difficult situations. However this doesn’t mean that these people can’t analyze and control their actions. In the back of their minds they always have a fully functioning observing ego that is aware of the emotional turmoil they are experiencing. The truth is that childhood deprivations create a fantasy that the world still owes them, and the injured individual feels like a victim destined to suffer forever.

As a result, everyone around may be expected to be obligated to them. With a more subtle analysis it becomes clear that behind the outward appearance of helplessness lies a more aggressive expectation that everything should be allowed and others have to understand and forgive them. Therefore, in addition to working on emotions it’s important to help a client to realize his demand from the world (or people around) to repair his damaged childhood which unfortunately has happened and can’t be changed in this reality. It is necessary to be responsible for your own life.

This feature creates the impression that people with BPD are inadequate or extremely unhappy. However, suicidal thoughts and actions have several reasons that reveal quite optimistic possibilities. The unwillingness to live is the sign of a strong hunger for changes. When a child experiences suffering he develops a hope for a different world without unbearable pain.

This fantasy accompanies throughout his whole life, but during periods when feelings of loneliness or anger escalate the door to another world opens and this can provoke an impulsive suicide. I believe this is a rejection of the current situation and a strong wish for better reality. When a client expresses suicidal thoughts or intentions at the beginning of therapy, I never attempt to dissuade him. It’s important for a person to maintain hope and control over his life, so attempts to convince could be perceived as a misunderstanding which would confirm the fact that nobody accepts the client’s feelings. When discussing suicide, borderline clients are more likely to express feelings of abandonment rather than a genuine desire to commit suicide.

Parasuicide can also be related to this problem, specifically autodestructive behavior such as self-cutting and self-burning. This is a way to pass through negative emotions, particularly feelings of guilt after negative events in their lives (more frequently breakups). Parasuicide is an extension of aggression towards oneself, especially during times when a person with BPD feels abandoned, unwanted or goes through a separation. Cuts and burns allow people to punish themselves in some way while also helping to cope with feelings of emptiness. After injuries the brain releases endorphins which lead to a brief feeling of euphoria. However negative thoughts, fantasies and the tendency to focus on self-hatred are also ways that people can inflict wounds upon themselves. Clients with BPD often get a sense of relief when talking negatively about themselves.

I have already mentioned emotional swings, but let me elaborate on them in the context of testing boundaries and difficulty in perceiving emotions. Affective outbursts are also linked to a disrupted natural “fight or flight” mechanism which in a psychologically healthy state allows us to react to danger.

A child in a violent situation can’t fight back against an adult and protect himself mentally or physically. As a result he freezes up (in psychology this is called dissociation – emotional disconnection from reality). Adults with BPD react weakly to emotional danger at the moment, for example, when a loved one offends or humiliates them. During therapy a person who has experienced this freezing in childhood gradually remembers how he used to freeze up during moments of violence. However in calm periods people with BPD need to release their anxiety and anger, that’s why they frequently find reasons for aggression and arguments.

This sense of loneliness is different from when there is nobody to talk to and it can be quite scary, like being completely abandoned in the universe as a single person. It feels like a scene from the movie “Vanilla Sky” when Tom Cruise found himself in Times Square, totally alone. When this happens people experience strong panic and act impulsively, running from home to the bar in search of random connections or just inviting themselves over to friends’ houses. The presence of others, even just the fact of communicating, somehow mirrors a person’s existence, confirming that he is alive. However, once the conversation ends, the sense of abandonment returns. This often happens on weekends or holidays, when people are away from work.

But there is no such emotion as “abandonment”. The feeling of emptiness is associated with an unconscious fantasy of own worthlessness and plenty of aggression towards oneself. In a state of loneliness a person feels a sense of meaninglessness and instead of self-support intuitively reinforces this negative experience, making it even more painful.

Tony, the main character in the TV series “The Sopranos”, was assumed to have BPD. However it’s important to note that cruel and antisocial behaviors are typical for individuals with malignant narcissism. People with BPD often have short tempers, especially when they feel misunderstood or rejected, but their outbursts of anger aren’t intended to harm.

As I wrote above, people with BPD tend to choose partners with a rescuer complex who subconsciously need a “bad partner” and who may covertly undermine them. For example, a man will covertly provoke his borderline girlfriend into hysteria and then through silence during her fit of rage he will enjoy his own steadfastness in the face of his unstable partner.

By the way, during aggressive outbursts a person with BPD may attack a partner with fists, but he won’t aim for painful spots. He will scream and knock as if seeking help and trying to get attention. These actions are of course destructive, but I would like to emphasize the lack of intention to hurt. There may be intense emotional outbursts and intense feelings that take over a person for a while, but they are not meant to be hurtful.

A relationship with a borderline personality is presented in literature as something unhealthy. I think these descriptions also show the need to invalidate people with BPD. As a psychotherapist I will say that the main interpersonal conflict of a borderline personality is the situation of “want to stay and want to leave” without an option to make a choice. How does it manifest itself?

On the one hand a person needs an extremely strong connection with a partner. Some of my clients shared fantasies about desire to get under the skin of their partner, literally becoming them or becoming an embryo inside them. Just the “me-you” relationship is not enough; it requires an endless and sexless “us”. But this connection can be suffocating and the next step is to break free from the symbiosis and regain a sense of independence. That’s what people use to say when they are in a close, symbiotic relationship: «I want my freedom back». But freedom can be a source of emptiness and loneliness and attempts to escape from these feelings often lead to an even deeper connection. This internal conflict creates a chaotic pattern of behavior from idealized honeymoons to destructive conflicts. Emotional instability and anxiety about attachment can be tools for understanding this deep unconscious pattern. Only facing this conflict may give people with BPD a sense of stability and peace.

Most importantly, borderline personality disorder is not a barrier to a fulfilling social life. It’s simply a character that has traits which noticeably disrupt well-being and adaptability, but doesn’t make an ordinary life impossible. This is an absolutely adequate character that simply appears as adaptation to abnormal life conditions. In therapy, the client often comes to the realization of how much they hate the child who allegedly turned out to be weak and worthless and was unable to cope with the destructive actions of adults and work through that during the vital process of self-management.