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.
I’ve been screamed and sworn at. I’ve been called names, told I had no idea what the f**k I was doing and treated with utter scorn. I’ve had clients slam out the door and never come back, or subsequently leave hate-filled messages on my voice mail. Each time, it’s a deeply painful, toxic experience for me. It takes me hours to recover, sometimes even days, and during this time, I’m reviewing my work in an attempt to regain the feeling that it has value.
This need for the therapist to recover a sense of personal value holds the key to the borderline client’s experience and what led him or her to explode. I think I can best illustrate this with a recent example from my practice. After our first few sessions, Nick told me he’d never met a therapist who so intuitively grasped his pain and what he was going through. He said he felt deeply grateful that he’d found me. I’ve had enough experience with idealization to know that, if I’m on the pedestal now, I’ll eventually end up on the trash heap.
Nick is one of the most intelligent people I’ve ever met. Unfortunately, he has spent decades abusing recreational drugs and hasn’t been able to make full use of his gifts. He’s also spent too many years on an ever-changing cocktail of psychiatric medications. Often better informed about available meds than his medicating psychiatrist, Nick would go to his appointments armed with articles he’d read and persuade his doctor to prescribe what Nick thought he needed. He once told me I was the only therapist he hadn’t been able to run circles around. We’re exactly the same age.
I often felt Nick attempting to communicate with me as if we were colleagues, rather than turning to me in a vulnerable, needy way as my client. In one session, he talked about how much he liked to be the one dispensing wisdom: what he really wanted to do, he said, was write a philosophical-type book and get paid for speaking engagements. It felt as if he were making some comparison between us. In a later session, he made similar remarks; I addressed the ongoing comparisons and told him that it was deeply painful for him to compare himself to me, a man the same age, and to feel what he might have done with his life. The loss of potential, the waste of the years, the shame about his damage felt excruciating and unbearable.
Within seconds, his face was twisted with scorn. “You think I envy you?” he sneered. Within minutes, he’d cut the session short with a few contemptuous parting shots about my incompetence and terminated treatment. Other clients have become much more abusive. Some have screamed at me; others, as I said, have slammed the door on their way out of my office. All of them have left me feeling “shitty,” for lack of a better word.
Burdened with unbearable shame, these clients evacuated all their pain, the feelings of unworthiness into me, as if I were a toilet, and fled therapy in order to escape their pain. Borderline clients in flight want to make their therapists feel shitty, though not consciously. The rage they express as they lash out is meant to fill the other person with all the unbearable shame, the sense of inner defect, to evacuate it all and then to run. I believe the evacuation of shame is a regular feature in borderline rage, which makes it very difficult to bear for anyone on the receiving end. It’s hard enough to be the object of someone’s rage, even harder when the massive projection of shame and unworthiness goes along with it.
I’m sure other therapists have had the same experience but possibly not quite understood why they found the experience so toxic. Our worth and value as professionals have been assaulted, for reasons that are emotionally understandable but hard to bear. It may take days for us to recover our equanimity. I think this is the reason why borderlines are so vilified, even by mental health professionals. The largely negative attitudes are defensive in nature: we want to protect our own sense of worth from being savaged.
Nick periodically resurfaces. First he asked if he might resume treatment but felt he needed a more “collaborative” approach; could we operate more as co-therapists? When I told him I’d be happy to work with him again but I needed to practice as I saw fit, he again dropped out of sight. A few months later, he wrote to me in desperation but an attempt to get started again was quickly aborted. How can he resume treatment when it means reclaiming his shame and all the pain that goes with it?
He may never be able to do so. The tragedy of those men and women who suffer from the symptoms of borderline personality disorder is that, even if they find someone capable of understanding them, the experience of shame in relation to that person becomes unbearable and they often end up savaging the relationship as a defense against that shame it inspires. To escape the horrible feeling of being a “loser,” they attempt to “win” by destroying their therapists and the creative work they do. Usually, the compounded feelings of shame about the damage done stop them from going back, so they end up beginning and ending therapeutic relationships in serial fashion. Some of my borderline clients have managed to hang on, learning to bear their rage and shame over time, but more of them have not.
A NOTE ABOUT MY BOOK: Several people have written, telling me they’ve purchased the book but won’t have it for some time but would nonetheless like to participate in the discussion forum underway. What I’ve done is send them a pdf version of the Introduction and first chapter so they can participate this first week. It occurred to me that some of you might be on the fence about purchasing and would appreciate a sample preview, so I’ve uploaded those pages and they’re available for viewing here.