On the Receiving End of Borderline Rage

Joseph Burgoin
Points of Departure
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The Psychotherapy Relationship
121

I had an email from another therapist this week, asking whether I'd written anything for professionals who work with people who suffer from features of borderline personality disorder. She had recently been "fired" by one such client and felt upset about it. In fantasy, I imagined that it had happened in a very angry way, the client speaking to this therapist in abusive language and then storming out.

I've have been "fired" in just this way by a number of deeply troubled clients over the years. Broadly speaking, they would be considered "borderline," although I hesitate to use that term because it has such pejorative connotations, even for mental health professionals. These clients often begin therapy with heightened expectations; they express commitment to the work and idealize their new therapist. Something will then happen in the course of the treatment (I'll have more to say about what that "something" is) and the client will abruptly turn on the therapist. Often this means the end of treatment.

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The Invisible Child

Joseph Burgoin
Self-Esteem and Self-Sabotage
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The Psychotherapy Relationship
72

I've always struggled with the term attachment, used in my profession to denote the relationship that is supposed to develop between mother and infant during the earliest months of life. I may be too concrete, but it makes me think of those poor monkeys in Harlow's experiment, clinging to that cloth-covered metal skeleton; it seems to imply a kind of physical connection when in fact, it's all about the emotional relationship. In his video on attachment theory, Allan Schore brings that relationship to life when he speaks about the complex interactions between mother and baby -- the role of eye contact, physical interaction and facial expresions in creating secure "attachment" -- but it still seems to me to be the wrong word.

I've had a similar problem with Kohut's word, mirroring, because to my concrete mind, it suggests that what the mother does is behave like a physical object (a mirror), though lately, I've been feeling better about it. In my work with several different clients, I've been struck anew with the role of our parents' attention in creating our sense of self, how important it is that we feel that we are seen. In a fundamental way, we come to know who we are by witnessing our parents' responses to us; in particular, the joy and love we see in our mother's face convey to us that we are beautiful and important. Allan Schore has shown how the infant comes with a set of inbuilt expectations and behaviors geared to elicit those parental responses; when the reality of an engaged and loving mother meets those expectations, the result is a secure "attachment" (ugh).

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Bearing Witness and Being Seen

Joseph Burgoin
The Psychotherapy Relationship
54

Many features of the psychotherapy relationship contribute to growth and psychological "healing" to the extent it is possible. In an earlier post about attachment theory, I discussed the importance of the emotional bond between client and therapist for development, especially the therapist's ability to empathize with and ultimately feel genuine affection for his or her client. Implicit in that emotional attitude is the therapist's conviction that the client's experience, however painful and chaotic, is worth paying attention to. It has value and meaning. The simple fact that the therapist devotes his or her full attention to the client's experience -- bears witness to it -- contributes to the healing process in ways we don't often mention.

Human beings are social animals: part of our sense of self comes from our relation to other humans -- being seen, acknowledged and validated by other members of our pack or tribe. To an important degree, this is what it means for life to have meaning. I have a number of clients who live extremely isolated lives; they're deeply pained because they feel they don't matter to anyone, that they're invisible and that it wouldn't matter if they were to disappear. It isn't just that they feel lonely and long for emotional contact with others; without anyone to bear witness to their lives, they have trouble maintaining a sense of their own personal worth and the meaning of their existence.

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‘Hard’ and ‘Soft’ as Character Traits

Joseph Burgoin
Defense Mechanisms
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Shame/Narcissism
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The Psychotherapy Relationship
43

I haven't written a post in two weeks -- unusual for me -- because during that period, I have felt almost overwhelmed by the events in my life, mostly enjoyable and of great meaning to me: my oldest son's 21st birthday, my middle child's high school graduation, my daughter's promotion from middle school, two flights (one to Chicago, one to Los Angeles), followed by the drive cross-country to Colorado, where I will continue to work throughout the summer. My fatigue levels have been made worse by some poor choices I've made along the way, and I've watched myself "hardening up" in response. Now that I've recovered a bit, I thought I'd take this opportunity to talk about the importance of choice "after psychotherapy," and what can happen when you don't respect your limitations.

At the beginning of May, I had set as a goal for myself to complete a rough draft of my book on defense mechanisms before leaving for Colorado; that way, I reasoned, I would have an entire month to review and revise it at leisure, before my summer break. I really wanted to achieve that goal. At the same time, I wanted to keep up with this blog as well as the one on PsychCentral, and especially to continue practicing piano. I can become very cranky if I have to forgo my practice; I normally get up at 5 a.m. in order to make sure that I have uninterrupted time alone, so piano doesn't impinge on work and family life. Even before May became truly hectic, I knew it was unlikely that I'd be able to accomplish everything I had set out for myself. I probably should have accepted that piano would have to take a back seat if I were going to finish my book.

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