Counter-Transference Management with High-Level Borderlines

"It is often useful to identify the current nature of one's unresolved ambiguities, then sit still with them for a while, then journal about what comes up." Duh.

Work with abandoned-here / abused-there, abandonment-fearing-here / abuse-fearing-there, abandonment-projecting-here / abuse-projecting-there, level three and four borderlines (see Garrett, Kernberg, and Meissner) is never a cakewalk. The therapist is forced to utilize dialectical mindfulness tools (see Linehan, McKay et al, and Van Dijk) to keep his or her own ship from tipping over into personalizing what the patient says about him or her. And the patients will say plenty.

For the borderline organized mind is one that flip-flops from fear-of-abandonment-driven boundary diffusion to fear-of-abuse-driven boundary breeching in a "hot" (affective) second.

What I have done here is synopsize some online exchanges with a pair of borderline-organized subjects in such a way that the patients' privacy is protected, but the issues are revealed. Both subjects have "executive ego" compartments (see Gunderson) that are capable of observing, recognizing and radically accepting the core beliefs, current appraisals, cognitive processing distortions, affective and behavioral results (see Wessler et al) of their developmentally contaminated (see Erikson), infantile egos (see Freud in Gay) or "not-okay inner children" (see Harris).

Subject No. 1 here is a formerly, full-fledged, DSM IV-R, Axis One, epigenetic and classic "double-bound" / "paradoxically injuncted" / "family-of-origin-crazy-made" schizophrenic (see APA DSM, Bateson, Jackson, Watzlawick, Lidz, Laing & Esterson, Laing, Esterson, and Henry) who, with the help of a "cocktail" of a dozen and more medications, as well as more than a decade of psychotherapy, has been able to reintegrate at a more functional, but still very disabled, borderline level of perceptual / cognitive / affective / behavioral organization.

Other aspects of the subject's etiological, early life will become apparent in the exchanges.

Background on scenario: The subject wanted to package her creative writing and send it to me as a book which she then wished to use as a platform for discussion of her problems. Much of her work is insightful, but it is heavily compromised with victim identifications. Having read numerous entries over the course of several years, I did not wish to reward her for identifiying herself as a victim and suggested that she select certain entries that had more profound meaning to her and email them to me.

I did not hear from her for some time, suspecting that she had gone "spiteful" (as borderlines will) when their attempts to control significant others are thwarted. So I emailed her and asked her about the work. In return, I received a polemic, but I chose to attempt to utilize it as a wedge in the door, and interpret the nature of her reactivity, knowing that in the past she had ultimately been able to come to grips with such interpretations. I am aware that others who disdain psychoanalytic methods will be critical of my actions.

Thus, with awareness of her psychological-mindedness and intellecual sophistication, as well as motivational interview technique (see Miller & Rollnick, and Rollnick & Miller), firmly in mind, I wrote back:

"Might the unresolved, hurt parts of one whose parents rescued them here and persecuted them there see other people as projected rescuers here and projected persecutors there?

"Are those parts really in a position to actually know why I refused to do things as you wished?
Or are those parts only able to presume that they know?

"Is it possible that those whose parents abused and abandoned them expect that others will do the same? Will those parts ever be able to stop blaming others for how they feel?

"Having worked with me on your previous journal entires via email, wasn't it self-evident that it was easier for both of us to do so?"

"One other matter I will ask you to consider is this: How much time did I spend with you -- in person and online -- in an effort to assist your recovery? And how many of your past (and present) therapists did your injured inner parts suddenly attack?"

I know that some therapists will find this to be too confrontational for upper level borderlines, but my own experience is that patience with processing will prevail, especially with a borderline who has some edification via literature on codependent enmeshment and boundary concepts (see Beattie, Mellody, Schaef, Weinhold & Weinhold, and Whitefield). Continuing...

"One of the things we come to understand in working with adults abused as children is that they will attack us for not giving them what they want from the abusive parent. This is almost always the case when they...

"1) are financially dependent upon the abusive and/or abandoning (rejecting) parent,

"2) have been conditioned to believe in 'sin' and see themselves as 'bad' or 'evil,'

"3) cannot bring themselves to admit and accept what they truly feel about that parent, because it is 'sinful' to feel about the parent as they do,

"4) want in the worst kind of way to be understood, accepted and 'loved' by a parent who simply cannot do that because the parent does not know what 'love' is,

"5) has another parent who is more accepting and understanding of them, but who cannot confront the first (usually dominating) parent's inability to see the issues, and

"6) learn that it is safe to attack those who will not react to their attacks,

"7) because the patient splits off when she does not get what she believes she must have to be okay, and must project the other person as 'all bad' rather than 'all good.'

"Regardless of how various parts of your mind may see me in order to 'protect' themselves against the threat of abuse, I will never see you as 'sinful,' 'evil,' 'all bad' or 'intolerable.' I will simply see you as no more or less 'perfectly imperfect' (see Mellody) than the rest of us."

In return, the subject sent an email rejecting this as "psychobabble," a common borderline accusation, and foreclosing on further communication, ostensibly forever. But if past patterns stand up, her foreclosure will only last until the next time her house of cards decompensates and she becomes "intolerably" depressed and anxious.

I am aware that rational argumentaion is off the table with right-hemisphere-dominated borderlines, especially in the view of Hayes, Strosahl, Wilson and other ACT therapists who view use of words as counterproductive. I tend to support that view most of the time. My experience, however, is that left-hemisphere-dominated borderlines -- e.g.: those who had a legalistic, (ir-) rational, intellectual, parental abuser -- can, and sometimes should, be "met where the patient is at." I say this because I have seen that so doing often produces at least intellectual awareness of the function (see Hayes et al) of such defensive behavior.

Further, it's been my experience that left-hemisphere-dominant (or at least equal), level three and four borderlines will not accept direction to engage in right-hemisphere-dominated, experiential, mindfulness meditation, gradient exposure (see Hayes & Smith, Follette & Pistorello, McKay et al, Orsillo & Romer, Siegel, Siegel, and Van Dijk) unless or until the left hemisphere signs off on it.

Responding to the subject's "foreclosure" email, I wrote:

"If people want to work with me, they work with me according to my knowledge of what will work to advance their mental health.

"The part of you that is caught up in needing to be seen, understood and appreciated by a father who has put you off again and again cannot see how desperately it seeks to be seen, understood and appreciated by others it designates as 'father.' (And neither can it see how angry it gets when it does not get its way.)

"Can you see the part your not-okay inner child has taken? Can you see also that it has become a 'prisoner of resentment' [see Beck] towards your parents but cannot confront them with that resentment because to do so will lead to being cut off by its original tormentors?"

Again, I understand that such an approach begs criticism from professionals who will view it as unduly confrontational. My experience, however, tells me again (and again, and again) that pussyfooting around with dominance-and-submission-habituated / control-obsessed borderlines is counterproductive.

* * * * *

The other subject of this discussion is a formerly level three borderline-organized, sex-and-romance-addicted, "functioning" alcoholic in denial who has progressed to a level two, borderline organization with occasional acceptance and identification, but continuing unwillingness to move to recovery stage three commitment and action (see Garrett, DiClemente & Prochaska, and Prochaska & DiClemente). This subject continues to believe that he can (and should) defend himself against his narcissistic injuries and existential fears with substance and behavior addictions.

Background on scenario: This subject comes from a duplicitous, morally self-righteous, family financial powerhouse accustomed to getting its way. A number of family members have been utilized as "duty victims" to assure the wealth accumulation of the more sociopathically narcissistic among them. The subject contacted me to report an incident with his latest romance object, a sophisticated women with her own uncleared, developmental hurdles. Quickly addicted to each other over the course of a few months in a mutual Gestalt of "pain relief" for the sake of dissociating from undigested affects, they have progressed to the "getting real" stage of vomiting their undigested material upon each other. I responded:

"[Name] seems to have as much unfinished business as all the rest of us. She seems to have some parts that are triggered into resentment about having time stolen from being with you in the manner she prefers that split off into other parts that transfer her resentment on to the beloved. In other words, she is a "normal" member of our sick, stress-addicted culture.

"Someone attacked me in similar fashion this morning. Had she done so in person, she might have tripped my old resentments about being abused, as well as my boundary-setting switch. But because she did so in an email, I was able to read it, set it aside, come back to it, sit still with my triggered feelings, and respond with a considered explanation of her continuing transferences.

"Something that has both saddened and edified me over the last two years is a growing awareness that almost no one I know (including myself) is free of triggers from stress, especially stress that sets off re-engagement with stuffed memories of their abuse and/or abandonment.

"The truth is that regardless of what many have learned to believe in recovery, we will have to sit still and feel what we feel in the face of triggered, misplaced aggression / transferred hostility from others. After all, how realistic is it to assert that the other person should never feel or express what we feel and express?

"But in the slowly creeping path of the awakening of the masses, those who have encountered only the 'fairness doctrines' of pop psych -- as opposed to "the fair is in Pomona" doctrines of more edified, experience-based awareness -- will continue to point their fingers at the other for causing their feelings.

"Mature, functional relationship is built on an experience-based awareness of actual human nature. Actual human nature is, as Pia Mellody stated 20 years ago, 'perfectly imperfect.' By that, Mellody meant the results of genetic predispositions and common cultural conditioning.

"To expect otherwise is to live in fantasyland. We will split off to our hurt, abused, resentful inner children now and again. And if sufficiently trained to be mindful, conscious, aware and responsible, we will be able to...

"1) see our 'perfect imperfection,'

"2) admit it as culturally normal,

"3) radically accept (see Linehan, and Brach) that it has been, is and will continue to be there, and

"4) make amends to the other our "perfect imperfection" impacted.

"That is reality in intimate relationships, not some fantasy that we will never 'lose it' and be able to anal-compulsively retain our unprocessed, undigested stuff-ing.

"All that said, I would not bring this up with her unless or until she is far less stressed than she is now... if ever. The culture we live in is a cult of stress-inducing wealth accumulation. Although many "see" this intellectually and verbally, few see it experientially. Almost everyone believes they have a duty to run on the wheel in the squirrel cages the wealth accumulators have provided.

"Attempting to explain this to them -- even to those who are somewhat conscious -- is usually met with mystification at best, and presumptions, and, at worst, that the explainer is 'radical,' 'an anarchist, or 'just plain crazy.'

Becsause the explainer must be viewed by the explanee as an authoritative rather than authoritarian, authority (see Baumrind, and Altemeyer). Viewed as the former, the explainer has credibility. Viewed as the latter, the explainer has none. And we will have to accept that when dealing with borderlines who will flip back and forth from cognitive-process-dominating fear of abandonment and isolation to equally cognitive-process-dominant fear of abuse and persecution.

This is, after more than 30 years of experience in Alcoholics Anonymous and other 12 Step endeavors, after almost 25 years of working with newly recovering substance and process behavior abusers, and after more than a decade of exposure to severely ego-injured borderlines, where I have arrived... at least for the time being. (I refuse to foreclose on anything anymore; I can, must and will tolerate ambiguity and lack of resolution as soon as I recognize it and recall the requirement to do so.)

We need to balance empathy, compassion and unconditional positive regard for the patient with a willingness to present reality to them in such a manner that they can apprehend it. We must demonstrate our own boundary-setting functionality in the face of their boundary-diffused and/or boundary-jumping dys-functionality.

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