June 2021
When I first started practicing as a psychotherapist, I had a client who intrigued and confused me. We’d just be getting somewhere (or so I thought) after tumultuous emotional upheavals to a quieter place, when another tsunami of emotions would come battering her. More calm, more intense emotion, more calm…. This went on, over and over, for a couple of years, week after week, to the point that I really didn’t know what to do. I sought advice from other practitioners and they said all I could do was ‘be there for her.’ Somehow this didn’t sit well with me, but maybe, maybe not.
This behavioural pattern fits the borderline personality criteria. The core features of borderline personality disorder (BPD) are impulsivity and instability in relationships and mood. Their emotions are intense, erratic and can shift abruptly move from passionate idealisation of the other to contemptuous anger and back again. I experienced all this. One week, I was glorified and worshipped; the next, I was wrong wrong wrong. Neither attribute had any real reference to the me-ness of me.
People with BPD haven’t got a clear and coherent sense of self. This manifests sometimes in their ideologies, career choices and values. My client, for instance, moved from career to career to career, saying each time that now she’d found what speaks truly to her heart - until the next bout of severe depression swamped her and then the burst of grandiose discovery of something else more appealing.
The borderline disorder of self is characterised by a reliance on others (a sort of “you are, therefore, I am”), and a particular sensitivity to signs of rejection and abandonment. They equate individuation with withdrawal of the other and thus they avoid self-expression and self-activation in order to maintain what they see as closeness. When they feel abandoned, rejected, there is an upswelling of intense affect that may manifest as hopelessness, helplessness and rage, and thus the giant wave of seeking closeness to the detriment of developing their own agency begins again. Some may experience transient psychotic and dissociative symptoms when extra stressed. They are also likely to have high levels of anxiety and engage in self harming behaviours, like binge drinking, cutting (maybe in order to “feel”), suicide attempts, eating disorders, and the like. Such clients, thus, do need support from their practitioner.
Why do some people suffer in this way? There are a few theories, ranging from neurobiological factors: deficits in sensitivity to the neurotransmitter serotonin and frontal lobe problems (the brain’s frontal lobes are thought to regulate emotions); social factors, such as childhood abuse; to object-relations theory, a psychodynamic approach, that focuses on the way children internalize how they felt about their caregivers (a relational way of thinking). The internalized images (object representations) become part of the person’s ego and influence how the person reacts to the world.
Object-relations theory, as a way of understanding our inner world, most appeals to me probably because I was shaped by these ideas of psychodynamic therapy since the age of about sixteen and it is integral to the way I live and work. Our inner life interests me.
In object-relations theory, the person with BPD was a child who experienced and internalized a confusing mix of parental behaviour. They knew love and attention inconsistently given. The child was praised when she achieved scholastically or out on the field, but rejected when she was frightened. In this way, she internalized the disturbed object representations of caregivers. The why of this, relates to the caregivers’ own style of being in the world, their own core sensitivities. These might value achievement over autonomy and individual agency, rewarding dependence over individuation. The child, having such ideas about what it is to be human in the world, modelled by such caregivers, develops an insecure ego that always seeks attachment and always fears being alone but doesn’t have the inner resources to seek enduring and nourishing long term relationships. This is where psychotherapy comes to its own, in the bringing to awareness and activating what inner resources may be drawn upon when feeling abandoned, is where psychotherapy becomes useful, thus providing much more than mere support.
