On the Receiving End of Borderline Rage

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.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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    Joe, I’m not idealizing you when I say you are a great resource and example. I think you hit the nail on the head with the offloading of shame bit. I spent ten days living in the hospital with my mom while she was dying. My mom was an undiagnosed borderline/narcissist. I was her scapegoated daughter. (Scapegoat no more!) As I tended to her every need, tried to have a honest conversation with her, and basically revealed my basic goodness and nurturing capabilities (parentification comes in handy there I guess), I saw her defenses crumble when she was confronted with the reality of who I am. Her unNPD husband could not be bothered, was literally reviewing the will and audi brochures in the hospital room to keep himself occupied when he stopped by. One of my mother’s last lucid words to me were, “I’m so ashamed. I’ve been so selfish.” (thoroughly encapsulating the basic motivations of both disorders as far as I am concerned). The defenses dropped and out came the shame.

    BTW my mom was in counseling for years with a therapist who loved her and participated in the scapegoating of me. No doubt in my mind what kind of pd this therapist had to enable her client for so long.

    That account of your mother owning her shame at the end was moving … and sad. I do think that impending death has a way of tearing down our defenses. Either we can face the truth, as your mother did, or descend into savagery, as I’ve seen other such people do, unable to bear the shame. At least you had that one very real moment there at the end.

    But my name IS Joe! I don’t mind you calling me that. Even though I’m an “authority” about the subjects I address here, one of my goals is to minimize the distance between me and my readers. First names help.

    From an evolutionary point of view, I think impending death disables our defenses because the hiding of shame is viewed as essential to continue to be part of the tribe and being part of a tribe is paramount to our survival. Once your death is inevitable, being part of the tribe becomes unessential and hiding shame pointless. Being in a hospital for days and having it made obvious to her that she was about to die must of gotten through her narcissistic fantasies of immortality and into her unconscious, thus disabling her defenses by rendering them pointless.

    I’ve worked with several dying clients who set aside the painful troubles they’d been dealing with, saying and behaving congruently with
    ” that stuff’s not important any more, and I want to make the most of the time I have left/say goodbyes/arrange my affairs/enjoy what I can.
    It’s startling, almost breathtaking, when truly
    anxious/depressed folks simply decide to let all that go and Live while they’re alive. I remember a quote from a well known [writer, I think], to the effect of how focused the mind is when you know you’ll be hanged in the morning. I’ve also worked with a few folks who were able to experience so intensely in trance their eventual deathbed experience, as if they’d continued many years living in self-inflicted pain, that they resolved successfully to break through impasses they’d been stuck in for years. Dr Bob

    Thanks, Bob. That experience of working with people in trance sounds fascinating and moving. It was Dr. Johnson who made the remark about how the prospect of being hanged focuses the mind. It’s too bad we can’t find more ways to bring that urgency into our work before it’s too late, as you’ve done with your clients.

    It’s interesting that the tipping point for your client was an “interpretation” – quite possibly a correct one, but nonetheless a description of his inner life that could not be known with certainty to be true.

    Is it possible that this is why more skill-based therapy such as DBT reportedly has a better success rate with BPD? Perhaps it is less likely to trigger termination?

    Could be. Based on my experience with people coming to me after DBT, I’m not as persuaded as you are by its success rate. Nice, for example, had been through two entire courses of DBT. I guess it depends on how you define “success.”

    It seems to me that DBT works better than more traditional talk therapies with BPD
    primarily because it’s “psycho-educational” format greatly reduces the likelihood of intense relationship storms by avoiding strong emotional relationship with the therapist. Though I’ve seen DBT to be often quite helpful in BPD when managed by an excellent, experienced and compassionate therapist, it’s far from a panacea when managed by an average clinician/technician.
    The best therapists I’ve known are able usually to be fully present and compassionate in the therapeutic relationship without getting hooked into feeling or behaving in a parental manner — mighty challenging in practice! Dr Bob

    Hi Dr. Burgo,

    Your description of “hours” or “days” to recover from the shitty feeling from being used as a toxic dump grabbed my attention. Have you ever written anything about how attachment objects other than a therapist (for example a spouse) experience and recover from the rage of this type of personality? Or could at least point me toward something more constructive than the “Walking on eggshells” series?

    I’m at the end (separated, pending divorce) of a decade-long relationship with someone who couldn’t seem to handle any negative affect or disagreement from me – and when crying didn’t yield the result she wanted it would escalate into name-calling and threats. In the beginning she would apologize for her breakdowns and assure me the causes were temporary, specific, and external. She promised things would get better when we lived in the same city, I traveled less for work, had a less stressful job, we had a house, were engaged, were married, had a kid. I began seeing a therapist weekly over six years ago, when the house didn’t fix anything and the blame shifted towards me more directly. I thought that meant it was my fault. We got married, and I finally drew a hard line before kids.

    Your website has really helped me integrate my understanding of the terrible pain she is in, and the profile of “Holly” towards the end of your book was spot-on. It also made me thankful we had not added kids to the equation. I’ve also come across other lenses which appear to describe similar behavior, such as Fonagy’s description of attachment-related inhibitions of mentalism and Sue Johnson’s use of attachment theory in EFT. It’s all focused on the patient, though, with the occasional passing acknowledgement of how difficult they can make life for their therapists (if they actually attend).

    I’m looking for something deeper than “deal with it or leave” from the spouse’s point of view. Other than understanding how my childhood left me with a high tolerance for this behavior, I keep getting stuck realizing ways in which I could have been a better spouse or wondering if I’m unfairly connecting her behavior to earlier versions of herself or my childhood experiences.

    Intellectually, I understand the well of her needs may have been bottomless, but emotionally it feels like I can’t forgive myself for not being perfect. I want to feel allowed to blame her a bit. If anything, understanding has dulled my anger and maybe I want some of that anger back. I naively still want to help her, yet realize that she’s the only one who can help herself.

    Over the years I’ve left multiple jobs in order to make the relationship a priority, and allowed myself to become extremely isolated from my own career, family, and friends. I’ll recover, but I feel like I need something more substantive to explain the gap in my career and presence other than, “It didn’t work out” or “We had communication issues we couldn’t overcome.” Yet there’s a limited number of people I want to actually tell of her breakdowns and her accusations of rape, abuse, comparing her to Hitler, etc.

    Maybe all I’m asking is how to ask friends, family, and potential co-workers for patience and help for myself while not making too many accusations against her? Part of my goal in being discrete is the ideal of taking as much high road as I can afford to take, part of it is the practicality of her family’s direct access to the court system and ability to fund it.


    I wish I had a book I could recommend. I’m aware of the “Walking on Eggshells” series but haven’t read them.

    I think the way out for you is to focus on your ex’s unbearable shame, the ways in which she was profoundly damaged but couldn’t face it, instead off-loading that shame onto you via the ongoing blame and accusations. You can be honest with the limited number of people you want to enlighten but retain some compassion for her as you recount what happened. You say you’re concerned not to make too many accusations … don’t make any. Try to help people understand how her inability to face her own pain and difficulties meant she constantly tried to hold you accountable. If you can speak from a place of genuine compassion, it shouldn’t go awry.

    The thing is, you could never have helped her. Nothing you did would ever have been enough because you were a receptacle for her shame. A person can’t grow if her primary mode of functioning is the off-loading of shame into someone else. Unconscious shame continues to arise, and that means ongoing efforts to locate it in someone else. Why you were so ready to take on that role, and why you still hold yourself accountable to some degree and believe you could have done more is a big subject in your therapy, I would imagine. Best of luck.

    In my experience, responsibility for big trouble in a long term, live together couple has always proved to be a 50/50 split. Often one partner’s responsibility is obvious, and can obscure the other’s half. The most successful couple therapies I’ve been part of have always been able to discover both partner’s half of the responsibility for the difficulties, and success wasn’t necessarily defined by the couple’s staying together. Success was felt when each partner found, claimed and did their best to fix their own problems with emotional intimacy. Dr Bob

    Wow, your story is so close to mine it is scary but validating. The hard piece is the gift my ex has of finding sympathetic advocates combined with her ability to live in the “pretend mode” as defined by Fonagy and Bateman. I was not perfect, but what i leatned is that the more I loved her, the more fear my love made in her, increased amxiety, and it would set up.the next episode of drinking, self harm or sitting. My knight to the rescue always set me up..thter was no way out or no way in….paul@cinnamatic. Com

    Hi Joe, again, I found this post insightful in working through my own BPD, and my own therapeutic relationship with my therapist. In response to the above post about DBT, I recently attended a DBT training (I am training to be a therapist) and found that it was insightful and had some helpful elements, but was disappointed that no one could give me a real idea of how transference/countertransference works within the framework of a BPD patient who has abandonment issues and paranoid thoughts related to the therapist. They attempted to answer my questions as I really only understand therapy from a psychodynamic framework, but it seems that DBT is lacking something….nurturing? I was surprised the daily skills cards didn’t mention feelings of “shame” – they discuss all other feelings a pt. might experience daily, but not shame.

    Are you aware of any side-by-side comparisons of the different modalities for treating BPD? Or an efficacy comparison of a psychodynamic model vs. DBT vs. mentalization based vs. some other?

    Your post today about shame was helpful. I’ve felt stagnant in my own therapy and haven’t been able to address too many new core issues lately. I think I will revisit the concept of my own shame and how I envy my own therapist because I’m not there yet (still in studies) and it’s frustrating waiting out the successes and failures that go along with not having any income while I am in grad school.

    Okay, I’ll go buy that book now. Thanks for the the dose of insight.

    Hi J,

    I’m not aware of any comparison studies. As I understand it, transference/countertransference would be more or less irrelevant within the context of DBT. Cognitive-behavioral methods don’t focus on such issues but instead teach new skills and strategies.

    Thanks for buying my book! And when you dig into those shame/envy issues with your therapist, I’d be interested to hear how it goes.

    Oh, there are direct comparisons! Kernberg’s team evaluated three treatments for bpd, transference-focused psychotherapy, supportive therapy and Dbt. In a randomized controlled design.

    They were all effective, but dbt and tfp were significantly more so on suicidality! In another study on the same sample only tfp led to gains in self-observing capacity (mentalization) and secure attachment. Neither dbt nor supportive therapy led to these changes!

    Thank you for bringing in those studies. I’m sure that DBT can be helpful, but the work I do with my clients involves developing a relationship that allows for the types of gains you mention. Putting them in those terms understates their importance, though. What tfp leads to is the ability to contain one’s experience, rather than be overwhelmed by it, and to the ability to sustain real relationships, rather than fluctuating widely between idealization and devaluation. These are huge, life-altering transformations. They take years, of course, but I believe you can’t get them any other way.

    I’ll join in the citation of clinical studies. Here’s a link to just one: http://www.ncbi.nlm.nih.gov/pubmed/16818865

    More importantly, I want to say how different my experience with DBT (at one of the nation’s best hospitals) was from the descriptions throughout this comment section. First, the model followed by the clinicians I’ve encountered is that DBT makes deeper psychodynamic and trauma work possible in the future. The program is explicitly laid out to address a hierarchy of targets, giving priority to serious threats to present-day safety (including suicidality) and then basic quality of life (including issues like homelessness, etc.). Clients learn a wide range of coping, mindfulness and interpersonal skills in both group and individual therapy that allow them to stabilize in the present, and then tolerate the intense emotions that can be elicited by the more psychodynamic work they do later. Clients then move — as I did — towards underlying PTSD and other issues best addressed through psychodynamic therapy, often with a different therapist. In essence, under this model, they graduate from DBT to psychodynamic work once they’re able to do it safely. I have found it to be the opposite of an approach that “gives up” on deep transformation and change — it saved my life so I could do that deeper work later (especially important for me since my primary diagnosis is PTSD).

    I also found my relationship with my therapist — who was available by pager in urgent situations, a level of care that is extremely rare in psychodynamic therapy — to be incredibly nurturing.

    Also, DBT does deal with a form of transference/countertransference under the rubric of “therapy interfering behaviors.” This, like almost all of DBT, focuses on the present day in a very practical way, and differs significantly from what is meant by transference/countertransference in psychodynamic therapy. Nevertheless, it is a very high priority. The main goal is to avoid client termination, which happens so frequently with BPD clients (they say, if you’re not in therapy no progress can be made on anything, so keeping clients in therapy is high on the hierarchy of targets). When practiced as intended, all DBT therapists participate in a weekly consultation group in order to help them manage the intense countertransference reactions their clients can elicit.

    DBT may not be practiced in this way in most places. My sense is that it is not. I feel very lucky to have received the comprehensive high-quality treatment I did, and I know it is unavailable to many. But it feels important to me to share my experience that, when done right and viewed as a pathway to deeper work, DBT can work very, very well.

    If anyone wants more general information, here is the very brief “DBT in a Nutshell” by Marsha Linehan: http://www.dbtselfhelp.com/DBTinaNutshell.pdf

    (Also, as a side note, in my DBT therapy those diary cards were completely customizable. I chose the categories of behavior/feeling/symptom I wanted to track in consultation with my therapist.)

    Intelligent and observant. I thought your admission that you’re not quite ready to go into the envy/shame area with your therapist was honest and brave.

    My mother was Bpd. I understand it well. The unacknowledged lack of trust and esteem, and the need for control, especially when vulnerable and receiving help. I still have patterns of attracting such people and trying to help. In me I have the matching feeling of worthlessness that behaves more in the realm of not setting boundaries.

    I remember the best help I ever got from a therapist. It was a hypnotherapist who tried a couple sessions on me. He told me, without blame our anything negative, that he couldn’t help me. No who when saying it. At first I felt disappointed, but later I realized it set me free with energy to look in other directions.

    Too many therapists can’t acknowledge their limitations realistically. Everyone wants to help. But sometimes being honest that their healing, whatever it is, has to come from outside psychology

    I can really relate to the “shitty” feeling you’re left with at the end of these bpd rages. How do you recover from it?

    My mother is bi-polar with bpd traits. I’m her golden child…the one who always took care of her and covered for her and told her over and over that she was a wonderful mother (when she would break down in tears and self-hatred for being a crappy one).

    I’ve been in therapy for four years, and what you say about trying to recover a sense of self? Yeah. That’s me too.

    I limit my contact with my mother in order to protect my own children, but recently have realized that the limits are for me too. I need to protect myself.

    Thank you for your insightful writing on this disorder.

    The recovery process is mostly a matter of time, and then satisfying, meaningful work with my other clients, good contact with family and friends where I feel valued. The projection of shame feels like a toxin and I guess you could say the mind-body has to detoxify it, just like any other poison.

    Hi Joe I have just started following your sight and was dumbfounded when I read the above. You could have been describing my ex husband . The person left with the “shitty ” feeling myself. We were together for 28years before we seperated 4 years ago and altough I am 100% happier than I was it has left me quiet scarred and I am not sure how to go about dealing with it. The irony of it is that the separation was his doing ( a much younger , and more understanding woman) and although it took me 12 months to deal with the shock and his betrayal I am so glad it happened now. He on the other hand has developed an absolute loathing for me and goes out of his way to make life hard for me if his has the opportunity (we still have a 16 year old son) can you shed some enlightenment on this for me.
    P.S I will buy the book.

    It sounds to me as if he has continued doing to you what he has always done — off-loaded his shame into you — only now, probably because he has some (intolerable and unconscious) sense of guilt that he did wrong, he must project everything even more vigorously into you and hate you for it. I’m so sorry. It’s awful to have a child with a narcissist because, in some way, you’re stuck with him for life.

    Hi Joe
    Your post really addresses my major feelings of burden around managing these behaviours in my mother who also happens to be grieving the loss of my father . I am idolised but exhausted as any attempt to set boundaries evokes her feeling unloved abandoned and emotional manipulation which she admits to using with others to get her way. I feel particularly burdened by my duty to care . She grieves a very emotionally abusive relationship which much of the time she defends and clings to whatever goodness their was. She will not acknowledge the shared pain and expects to be held and cared for.

    There seems to be an inability on my part to share honestly as I can only hear so much criticism in the face of much self sacrifice on my part.i have tried to engage her with therapy to no avail as in her mind these are family affairs

    Can you make any life saving recommendations for someone like me who wishes to go the distance but live life fully ?

    Grace, I wish I had such “life-saving recommendations” to give! I think the challenge is to do the minimum you can to satisfy your conscience (what you feel as your duty to care) and nothing more. I don’t think “sharing honestly” with her is a viable goal since it sounds doubtful that she’ll be able to hear what you say without becoming defensive. Do what you feel you absolutely must do to take care of her and then devote the rest of your energies to taking care of yourself.

    Thanks , I feel that confirms my intuition and there is a great challenge in that option. Being aware of another’s neediness wanting to assist but risking the abuse if I do. It does on occasion , though I am getting better at tolerating it, feel like treading a fine line feeling trapped. The answer for me seems to learn to live with a level of detachment that she doesn’t share which feels incongruent to my way of relating to others. I even have to compartmentalise my relationships with my children and friends as my engagement with them also provokes jealousy . I am so different in values to my mother because of much travel distance my parents careers imposed on us. I am aware that this is a blessing.. Thanks again

    I am very cautious with a new therapist as I recognize they are people with their own issues. I am also afraid of hurting them in anyway by my self disclosure or feelings due to a parent with unfathomable shame. Thus, a struggle for the therapist to get me tp open up rather than just being pleasant and asking techniqual questions rather than my feelings. I am starting to see Shame is my primary area to examine with regard to my defenses that are harming me and my relationships. With regard to my behavior with my therapist I feel after reading this article if I can be open about my fears with our patient/client relationship and that I will need to stay safe if I do feel intense shame during therapy. I have been frustrated with myself due to hiding from the therapist while silently pleading they get me. I realize that is never going to happen rather I need to ask for their support when the shame surfaces and I panic due to intensity. I can see I have a teflon shield with my shame defense mechanisms.
    With clients and rage; I was helped in hospital with a very effective exercise that I will need to do. Take your journal set a timer and for 5 min write down without thinking all of your anger and rage about whoever and whatever. It’s okay to swear or be as explicit as your rage feels. Then set your timer right away to 10 min and thoughtfully write down good things others have told you about yourself or you feel is good in yourself or would like to see in yourself being kind and considerate and gentle. I feel managing anger to be a challenge when triggered in life or therapy. However, I feel gut wrenching guilt if I ferl I’ve hurt someone. I will go back t that exercise as I went from feeling unsafe to feeling relieved and I had processed rage triggered by shame that didn’t hurt anyone in the process.

    I think confronting shame in therapy takes a lot of courage. It’s very painful and it takes time to work up the courage to be real.

    No one likes to be verbally assaulted, but don’t let the B.P.D bastards grind you down. I mean, you know why they do it, why they refuse to suffer any self-revision and can’t tolerate shame. I doubt a young child having a tantrum would leave you feeling ‘shitty’ for days, and B.P.D is not a world apart from that. Go for a run, hammer out some Oscar Peterson on the piano, and think to yourself, hey, I might have my own issues, but thankfully I’m not walking around as destructive and wacked out as that guy. And for that reason alone you’re a better husband, father, therapist and writer.

    Thanks, Warren. I think the reason why it gets to me, and probably to most therapists, is that we’re in the frame of mind where we’ve opened ourselves to the person. By trying to empathize and understand their experience, we inevitably make ourselves vulnerable, so the assault “gets in,” if you know what I mean. But I will take your advice for how to cope with it!

    There’s a reward for moving through life psychologically like an open palm rather than a clenched fist. The sour may taste sourer, but the sweet also tastes sweeter. The sting felt too keenly never smarts for long. And of course with BPD clients, one must be extra careful with counter-transference. They know that you know, that they know that you know if that makes sense !!!

    It does. One of the aspects I enjoy most in working with this population is how incredibly intuitive and insightful they can be, in spite of all the projections and distortions.

    BPD is about pain (shame can be a result of behaving inappropriately)
    They feel intense pain (hurt) and when people do things to hurt them it cuts really deep. Put into simple terms.
    We are all responsible for our own feelings, if you cant cope with treating a borderline. I suggest you look at a new level of treatment and stop depriving the poor BDP patients of recovery. if we are not strong enough ourselves

    I disagree with this assessment of borderline rage. I hope to disagree respectfully and hope also to be guided by you if I use language or strike tones that are not. I fear that this is long, but I hope that it may prove helpful.

    I see anger, functioning normally, as a response to threat. You stand on my toe,
    threatening to break a bone, and I angrily react to get you off my toe and diminish the threat to my body. Anger’s function is to keep us safe.

    My experience of Borderline anger – of being a giver of it – suggests that it destructive in response to stimuli perceived as destructive. That is, the anger response of the Borderline is a response to behaviours perceived as extremely threatening to the psyche.

    Because the anger is extreme it is usually classified as rage. In the Borderline’s highly charged mental environment, I think the rage response acts exactly as anger does in an individual who functions more effectively. But it is more florid because the perceived dangers are more so.

    Borderlines are generally raised in very dysfunctional environments. To understand them, me, is to understand the particularity of that dysfunction. Marsha Lineham refers to ‘invalidating environments’ as being a factor. I don’t know enough about the research, so with some misgiving say I would go further. I was raised in an environment where white was black and black was white. That is not just invalidating but can be perceived as mentally threatening and literally maddening.

    As a child, and beneath the level of my awareness, I responded to such behaviour with the fear that certain people were going to ‘make me mad,’ as in crazy. And, in a sense, they did and my fear was completely sensible. I have behaved, throughout my life, with behaviours that are perceived by others as maddening to experience if not crazy.

    I have also lived with terrible doubts and fears concerning my sanity and have recently discovered that I am also terribly frightened of being pushed into states of madness. I am frightened of those who I believe might ‘play with my mind.’

    My experience suggests that while shame functions as a serious condition in the psyche of the borderline, borderline rage is a response to the fear of madness, and that certain stimuli are perceived by the borderline as so threatening, as so intolerable to their fragile state of mind, that they might go crazy. This makes sense to me, in so far as the original definition of Borderline referred to people who were not insane, but did not act sanely either.

    Rage – the florid outbursts of scorn, of viciousness, of physical aggression, the suicidal threats – accompanied by the flight response, as in getting away from the therapist described as abusive, functions I believe as a defense mechanism to ward off further attacks perceived as extremely dangerous to the psyche.

    These are just my thoughts and this is the first time I have ever clarified, even to myself, that this is what I think is happening in these difficult situations.

    Borderlines are commonly said to destroy therapy. I don’t agree. The borderline is desperately trying to ward off insanity. The rage response is effective, I believe, in that role. They are not trying to destroy therapy. They are trying to keep themselves safe, where safety involves the deeply troubled effort to remain sane.

    In the case of Nick, your response, considered by you to be empathic, that it was “deeply painful for him to compare himself to me,” might have been understood by him as an attempt to ‘play with his mind.’ If that is the case, yes, the rage response is entirely understandable. Nick presumably is still sane. That’s a plus for the Borderline.

    I have certainly noticed that a therapist who tells me what I’m thinking and experiencing tends to be perceived as a threat. I have tended to stop therapy fairly quickly. And anybody who tells me what to do and how to think and feel, or that I am wrong to think or feel what I think or feel, is in immediate danger of a robust response.

    I am not suggesting that ‘driving Nick crazy’ was your intention. I am talking about how your behaviour might be experienced by an individual whose mental functioning is conditioned by fears of insanity and barely remembered experiences of it. For instance, I have been seriously troubled by statements of the type, ‘you are feeling x.’ I am being told what I feel and I do not like it. What would be water off a duck’s back for someone else, keeps me up at nights.

    How does the mind receive this information? I’m no neuroscientist or psychologist, but my sense is that the brain works with templates of experience. It matches an actual perception of an apple to a template held in the brain that is called apple and designates the perceived object accordingly. If you say to me, ‘you are feeling x’ and my brain correlates this to a template which says ‘this is dangerous because it means I’m being told how think and feel and my experience of this that I could go insane,’ then why wouldn’t all hell break loose? The Borderline might be so afraid that they may not even hear the actual content of the statement. The syntax alone could be enough to activate the amygdala.

    The brain matches present experience to mental templates in a most inexact fashion. In a darkened room, the coiled rope in the corner can be perceived as a snake waiting to strike. The research indicates, as Dr Rick Hansen elegantly writes, that the brain has a negativity bias. I suspect that this bias is strong in the Borderline, whose flight and fight response is primed to see the snake and not the rope for good reason.

    I was also very interested in your argument that the Borderline’s rage undermines a therapist’s sense of personal value. I have read of Borderline rage described as “disgusting.” It’s simply not a reasonable anger and I have long wondered why my rage makes enemies of people. So, what is it that I’m doing when I get angry and take aim? Your analysis points the way to an interesting answer: If I am frightened that you might drive me mad, then I’m going to strike hard. In such a context, undermining your confidence in your self, your sense of value and of self-worth makes perfect sense. The weaker and less sure you are of yourself, the safer I am.

    What you call a dumping of intolerable states of shame onto the therapist, or anyone else who triggers such responses, I see as an activation of the flight and fight response, which is designed to keep all human beings safe, and which in the case of the Borderline actually does so, even if it is experienced as very stressful for all concerned. Stressful it is, but madness is worse.

    Borderline rage is also murderous. In my 20s, I was horrified and paralysed by images which spontaneously arose in my mind of murdering my mother. It has taken me decades to better understand these extraordinary mental outpourings of the worst forms of rage. I am a ‘parentified child.’ As a child, I lived my mother’s life. I did not have a life of my own. Even now, 30 years on, saying ‘no’ is difficult and the process of individuation continues to be brutal. In my 20s, I referred to my mother as a parasite which inevitably destroys its host. Recently I was able to make sense of my murderous rage by accepting it as a response to her, if unconscious, need to destroy me in order to live herself. In many senses, these kinds of scenarios are kill or be killed psychic environments, where the brain is truly on fire with fear for its life.

    I don’t write about this easily, but if it is of help to others seeking to understand what’s happening in minds like mine, then I am pleased to make the effort.

    This kind of explanation may also assist with an understanding of the dysfunctional environment in which the Borderline is raised. The rage behaviours will almost certainly have been exhibited in familial environments as desperate attempts to remain safe from the predations of cruelly inconsistent adults, who have probably exhibited narcissistic tendencies. After all, you have to be strongly narcissistic to ‘play with someone’s mind’ and or sexually abuse them and not empathise with their pain.

    This also suggests that a therapist’s strong sense of themselves – real or projected – could in and of itself be a warning sign to Borderlines who may instinctively respond negatively to any sign of narcissism. You may or may not be surprised to hear how many therapists have said to me, “I would do x in your situation.” How ridiculous! Walk in my shoes first!

    Nick’s narcissistic hopes of being a co-therapist certainly suggest that the operative defence mechanisms involve great intelligence coupled with rage, but that he is unable to understand and control his emotional outbursts, which are frightening to experience.

    You write beautifully and compassionately about what it means to be on the receiving end of his rage. I think that is so important. Thank-you! It is vital for people like me to know this as it helps build empathy. But what few people talk about is what the Borderline does when they have stormed out of the therapist’s office. Exactly as you experience, it takes ages to ‘come down’ and it takes an enormity of self-questioning to come back to any kind of relatively normal functioning. Many Borderlines I have read about tend to keep extensive diaries as the brain trawls obsessively through its experience in order to make sense of the layers of confusion that present. Again, the pressure is always on to remain sane and writing does appear to assist with the process of organising experience. That has been my experience and it’s exhausting.

    Also, what do you think would have happened if you had said to Nick: “I see that you are strongly interested in becoming a therapist in your own right. That’s a terrific goal to have. What do you think you need to do to achieve that?”

    This goes to my deepest and heartfelt feelings about the Borderline experience. Authenticity and autonomy are what has to heal in the Borderline, as this is where they have been most deeply damaged. This is not just about authenticity and autonomy of behaviour, but at the very level of thinking and feeling itself.

    At this fundamental level, it involves the mind’s ability to distinguish thoughts, feelings and instinctive reactions which are personally authentic, wholesome and conducive to healthy functioning from those which are not. From this process of discernment, the holy grail of truly autonomous functioning may be brought to life.

    I think you make some very good points, and I especially agree about how borderlines will mis-perceive empathic remarks as “playing with their heads,” etc.

    Thank-you! I was weary after writing, sad and sorrowing that while my mind was getting stronger and I could make such an offering, the years of toxicity had taken their toll so that I had few friends and, given the difficulties of the topic, I could hardly suggest to acquaintances to have a look at what I had written. Also, your work on shame is working its way through my mind and I see how there’s so much shame there and remorse for all the mistakes and all the hurt caused, and all the sad, sad, waste of time and effort. Take care…


    I really enjoyed and benefitted from reading of your experiences, and your thoughts. I found myself irritated by the article, and couldn’t put into words what it was that annoyed me. I don’t really do diagnostic labels; I don’t like the notion of using them as more than an initial plan of accessing deeper conversation. But there’s more than that.

    Dr Burgo, I value your openness in writing about it, and your struggle to regain your equilibrium when you’ve been “attacked”.

    I’ve been on both sides of this sort of experience: as a supervisee, I have felt such rage at continued violations of boundaries that I had very clearly articulated, that I told a supervisor that I was ending my relationship with him then and there. From one moment to the next, he crumpled, and followed me out of the room, pleading with me to come back. I know I left him hurting, and doubting himself, but I had tried all of the other options available to me in order to avoid the force that I used. If he had managed to meet me in the place I was, rather than trying to push me to hear something that I’d already dealt with, he wouldn’t have been on the receiving end of my guillotine.

    In my own practise, I’ve had clients who have walked out of sessions, and I’ve been left licking my wounds, and been in encounter groups where people have blamed me aggressively for fragility that they feel in themselves. From both sides, I think the experience of rage has been one that I have learned a lot from, and continue to learn a lot from.

    I think it’s much easier to dismiss, or easier to judge it as an “attack”, than it is to embrace the experience, whether the one feeling rage, or receiving it!


    I’m unclear about what you meant, Martyn. Was it the use of the diagnostic label that bothered you? I struggle with it myself and dislike labels; on the other hand, there is a particular emotional dynamic, a constellation of features that often go together that I think of as “borderline.” I have pretty good radar and can usually pick it up in about 5 minutes.

    And you can embrace the experience, recognize that it IS an attack, but also understand the tremendous shame and pain that motivates the attack. You can still have empathy for someone who attacks you. I do all the time.

    Years ago, I had the choice of continuing with Western oriented therapy and a DBT course or Buddhism. I chose the latter and have not looked back. In Buddhism, anger, rage and hatred are considered one of the 3 poisons and life is stressful etc – this was the kind of language that appealed to me, with Buddhist teachings and trainings helping me beyond anything that I ever expected. Recently, I was struggling with some difficulties in meditation, and so looked to the BPD literature for assistance. That’s how I got here. Writing as I did helped me define and contain my experience. Being clinical helped me gain distance from difficulties in my mind which were becoming cloudy and messy in meditation. My mind is usually very stressed and incapable of such verbal clarity and dexterity. It was a breakthrough moment, but it’s not the language that I use of myself in any way. I used the language of Borderline, because that’s how the original article was framed, because the ‘constellation of behaviours’ resonates and because I was inspired by the honesty, respect and care on this site.

    From a Buddhist perspective, one can be mindful of being attacked, or of attacking, and contemplate the causes and conditions which keep the behaviours alive with a view to breaking the chain of unhelpful and unwholesome reactivity. All language has limitations, whether Buddhist or that of Western psychology. Ultimately, whatever language one uses, virtue is what matters and being kind and helpful to oneself and others.

    To me the issue is more than the labelling. While I don’t like it, I think it’s a useful way to get an initial handle on how to really help people best. Seems to me that believing in the labels we give people can sometimes allow us to avoid facing up to our own fears, our own stuff that gets in the way of the emergent relationship.

    There’s something in this about ego and acceptance. I learned a lot from spending time with buddhist monks last year, and watching them deal with critical “attacks”. They didn’t take any of it personally, but accepted, even welcomed the experience. They had very little of their self-esteem wrapped up in how they were perceived, and were very focused on acceptance of where the other person perceived themselves to be, rather than judging where they thought them to be.

    I guess that’s the heart of my niggle about your recounting of your experiences with Nick. We readers only have a thumbnail, but what you have chosen to share has the whiff of “therapist knows best” to it. I know that approach would have me dumping a therapist really quickly. I suspect, though, that this article could actually be representing a book’s worth of content, and the condensing of your experience is somehow not adequately capturing the struggles you had in that particular relationship.

    It’s all really complicated stuff to express in condensed form. So easy to misunderstand intent, to miscommunicate.

    In any case, in my practise I think I put less emphasis on the understanding bit, and more on the experiencing. And for that reason I will struggle with different issues and situations.


    The Buddhist trainings are powerful and when you experience them in action, as you describe, it can be a most illuminating experience. The work involves understanding how identity is constructed and responding to others in a particular way: your speech must be timely, truthful, beneficial, pleasing and spoken with a mind of good will.

    The instructions go further. If you anticipate that, “I cannot make that person emerge from the unwholesome and establish him in the wholesome,” one should not underrate equanimity towards such a person.” I find these kinds of instructions interesting, as all effort is geared to understanding how we impact on one another, so that even an attitude of equanimity and good will is in and of itself considered invaluable as a force for good.

    There’s an apocryphal story about a student of a famous monk, who lost his bundle, angrily saying that the teacher didn’t know anything etc. The monk replied that he was glad the student had finally realised he wasn’t perfect and didn’t have all the answers. The student had to find the answers for himself.

    But it’s important not to idealise monks and nuns, who can get it awfully wrong too. They are human beings, with varying degrees of frailty, like us all.

    Thanks for how you clarify issues of context, which was helpful for me to read. Whether Buddhist monk or Western psychologist, strengthening another person’s wisdom and insight and bringing them to greater wholeness and strength is key I think. But it’s simply not an easy task. Take care…

    I find it really funny sometimes how hard it is just to be human. Amazingly deep insights, itty-bitty-little frail body, inaccurate most of the time, yet capable of wrestling with really deep issues. We are such deep paradox. Maris – I really hear you about the idealisation: I think there’s something to learn from all of the different ways of practising good will, the issue is more whether I can be open to experiencing the pain of learning from them!

    Thank you, Joe, for sparking such a rich conversation.

    Thank you for your insightful response. I was hoping someone would attempt a defense of borderline rage. I can’t believe how much work must have gone into sorting out your thoughts and presenting such a clear and detailed analysis. You and anyone else reading this thread might be interested in Jean Knox’s “Self-Agency and Psychotherapy.” She comes to the same conclusions about rage as you do, but she interprets it as a form of self-agency — and a necessary developmental step for people with impaired attachment. Here is one of her conclusions about the analytic task for the therapist working with someone with seemingly impenetrable defenses: “In analytic work, it is therefore vital for the analyst to be demonstrably open to the possibility of alternative meanings in any exchange between analyst and patient, rather than trying to impose a particular view of the patient’s unconscious intentions on him. Otherwise an analytic impasse is inevitable, in which analytic work deteriorates into a battle in which both analyst and patient are fighting for survival, the analyst for survival of the analytic function and the patient for his or her very psychic existence. Indeed, the analyst’s countertransference feeling that his own survival as an analyst is at stake can alert him to the fact that, for the patient, the analyst is another parental figure who requires total subjugation to his needs and the annihilation of the patient’s own self-agency.

    “In spite of the fact that some degree of enactment of this impasse may be inevitable, an analyst who is open to exploring multiple symbolic meanings and to understanding the material from the patient’s perspective, rather than imposing his own, offers a new experience within which the patient can gradually relinquish her defensive mindlessness. The projection of the controlling, devouring parent can gradually be withdrawn as the analyst demonstrates again and again his own reflective function, the awareness of the patient as a separate psychological and emotional being.”

    I think you would find the book, which includes a lot of recent research from neurobiology and attachment studies, very much supports what you have discovered about BPD. Thanks again for the insights.

    Thank you again for the time and effort it took to write what you did. I have certainly benefitted from your analysis.

    After all these years, I still find myself yearning for a caring mother’s touch – my hair caressed by a warm hand, a crumb brushed off my shoulder – the simplicities of such love. There’s a sorrow in such yearning but also awe that the mind knows what it needs to heal and will not let go of it.

    I yearn also to be understood and for the intimacy implied in such understanding. Thank-you, even at such a digital distance, for understanding the effort I and many others make to sort ourselves out. I was moved to read your words, softened and heartened by them.

    Interested also to read of Jean Knox’s work – I have been using words like autonomy and authenticity, and it’s possible that self-agency has a similar meaning. Certainly there’s a sense of wanting to be an agent in the drama of one’s own life. I have always felt that I lived my mother’s life, not my own.

    Interested too to read that rage is considered a ‘necessary developmental step in people with impaired attachment.’ I can recall being criticised by a friend for my anger and its hurtful consequences, and whilst I knew that her response was fundamentally reasonable and caring, I also felt strongly that my anger was vital to me. I did not know why, but there was an intuitive sense that I had to work with it, rather than merely hate myself for it, or seek to divest myself of it. I knew that it was destructive, of course, but I also knew that it had a meaning for me that required exploration and which I was unwilling to give up.

    So, warm thanks for validating alternative explanations of the rage response, as such emotional explosions are so difficult to penetrate and make sense of, and issues of self-hatred, guilt, blame, responsibility are equally complex to unravel.

    There’s little freely available by Jean Knox on the internet, but I was struck by this statement: “The experience of agency depends not only on the impact one has on the other, but also on the capacity to self-regulate one’s own emotional and bodily states.” In that sense, one has no felt sense of agency in response to others or oneself. I am unable to make a reasonable impact on others, and get my own needs met, and in so far as my own emotional life is shifting, volatile and beyond my ability to understand or control, lived experience becomes nightmarish. One is as alien to oneself as others are. One is as frightened of oneself as one is of others. It is a terrible way to live. That has been my experience.

    In another article that I was able to download, Jean Knox talks about love and fear as mixed, and uses language such as parasitic, this is exactly how I described my mother. I do not know how to love without also being mired in fear, and have been working recently on unpacking this connection. So there’s much for me to work with productively in the little that I have managed to find thus far.

    I have however no experience of the kind of therapeutic relationship that Knox describes. My work has been with Buddhist teachings and trainings, for which I am immensely grateful. So I think it is important to suggest that the difficulties under discussion can be dealt with in a number of ways, and that healing and resolution is not solely the province of a positive therapeutic relationship. Those who struggle to find therapists they can productively work with, should not – indeed must not – feel they are fighting a losing battle. The mind is incredibly resilient and its transformational capabilities are extraordinary. Best wishes…

    I felt a kinship in your initial paragraph: Some years ago I was seing a warm and nourishng female terapist weekly. During one session I felt an almost uncontrolling urge to lay at her breast. It took a lot to refrain from acting out on that urge. I was around 55 years old.(and she, the phantacy mother some ten years younger) I grew up with a mother, who “loved” me, in a way,I suppose, but I cannot recall sitting on her lap, or other signs of nearness.

    May we all find a little of what we`re missing.

    Would you like my copy of Jean Knox’s book, Maris? I have finished reading it and would be happy to send it along to you. If you want to send your address to Dr. Burgo (afterpsy@gmail.com), he has agreed to forward it to me.

    How sweet and thoughtful, thank-you! But I don’t live in the USA and my guess is that postage might cost more than the book!! Take care…

    That’s exactly what I would have said (being a Group 1er) if someone offered to send me a book. And because I’m a Canadian (who, it’s been said, always answer, “No, thank you,” regardless of what is on offer). If you change your mind, the offer stands. Wishing you well.

    Mavis, I found your post to be full of amazing insights.

    This especially: Authenticity and autonomy are what has to heal in the Borderline, as this is where they have been most deeply damaged. This is not just about authenticity and autonomy of behaviour, but at the very level of thinking and feeling itself.

    Joe, what if the therapist does something themself to trigger such intense rage? My therapist of four years used to work 10mins from my home and recently moved to be 30-40min from home. They know I have a history of abandonment, early trauma and tremendous difficulties with trust. while i wouldn’t say I have BPD (bc labels can’t define a person) at times I definitely have aspects that one would consider borderline. Anyhow while my therapist is happy to keep working with me, it’s so much more difficult to get there now and it costs me more time, money and time away from my infant son.
    I have been extremely (and outwardly) angry during my sessions for the last four or five weeks and feel no closer to resolving my anger. While I know my therapist is still the same empathic and understanding person, I am having so much difficulty talking about anything meaningful now I know how willing they are to cause massive upheaval in my life that could end in ruining the therapy completely.

    I hope I addressed this in my email to you. Therapists may do something that stirs up anger, but it doesn’t necessarily account for the degree of rage experience by the client.

    You’ve written before about the connection between envy and idealization. There is a sense of something developmentally important in your Client’s twinship. What are your perspectives regarding the positive, growth enhancing aspects of idealization? On another note, thanks for posting the first chapter of your book. After looking at it, I decided to purchase it and am looking forward to reading it.

    I felt that my client’s twinship wasn’t helpful because it exemplified a lifelong problem — instead of being able to bear the slow, hard work of growth, he magically becomes somebody else, all at once. It has crippled him. But I do think there are positive aspects of idealization, where we accurately perceive genuine goodness and make it something to strive for or emulate. I guess it’s when idealization is a kind of denial or lie, an attempt to evade unpleasant truths, that it becomes a problem.

    Thank you for the free chapter – I only found your blog today and I’m planning to buy your book at the end of the month!

    Here’s a thing – after various periods of therapy, counselling etc (mainly limited by money) and lots of reading (undergrad classes and personal interest level) I believe that I do have narcissistic traits, though not I hope of the highly destructive type.

    I’ve never actually been diagnosed outright, probably because I’ve not had any involvement with law enforcement, mandated treatments, or anything that heavy, and also not every person I’ve worked with has used the same modalities, labels, etc.

    But my psychologically literate husband & friends tend to agree, for whatever that’s worth, and I sure do recognise myself in some of the scholarly articles about narcissists, and even in anecdotal accounts – but, I’m a pretty happy and stable person, and doing okay with life and relationships, so it’s not a huge issue.

    What’s amusing me is that I feel personally slighted and even blamed by the replies here in this thread (and this has happened before, on other blogs and sites) made by people who are talking about their narcissist ex, or parent:

    my first gut reaction is to wonder what’s wrong with THEM;

    then to feel superior and contemptuous of their eagerness as total amateurs to diagnose others with a label that has such negative connotations (this doubles if they have poor grammar or too many spelling errors), which I judge as them wanting sympathy from their experiences with the big bad monster, aka “playing the victim”;

    and I then begin to wonder to what extent they benefitted from living with someone whose label we’re all learning to despise, how far they used that to mask their own (probably major) faults and misdeeds, and so on… it’s a total fault-finding exercise, in other words.

    I’m fully aware of the illogic of that, it’s just what comes up for me reading this post, and others like it – it’s all my stuff and not intended as a rational comment on anyone’s posts here.

    Do you think there’s a possibility that this kind of labelling, or acceptance of labels given by others, leads a person to identify with the personality trait to an extent that they may modify their previous behaviour and reactions in order to fit with this perceived self?

    In the same way someone might identify as a Pisces, and then through confirmation bias only notice when they act like a “typical Piscean”?

    And perhaps even begin to create defences around their self-diagnosis, via a sense that if we have to have quirks, ours is the best one to have – I see “those bad narcissists” and feel defensive of “my” “team”?!

    I do feel all the work I’ve done so far has liberated me from fundamentally harmful and unwanted behavioural and thought patterns, and emotions, that it’s been a good thing, so what I guess I’m asking is can there be a downside to accepting a label or classification, and are you aware of this kind of thing causing anyone a problem?

    No, I don’t think that a person’s character or defenses could fundamentally change, simply because they accept a label given my others.

    Dr. Joseph,
    With regard to my post above and anger management exercise

    The feeling of intense rage was after a process group; the anger popped out unexpectedly and I had no tools to deal with the super intense emotion. You don’t have to post my comment because it seems to me it is not relevant to a long term therapist / clent relationship. The context is quite different. I wasn’t feeling anger towards my Dr’s or therapists for feeling the rage towards a dead grandfather. In this context it will skew or confuse the real issue. You were discussing when a long term client has rage towards the therapist and the relationship is severed due to toxicity and resistence. The client made their choice, therapy is not possible unless the client is engaged and willing as the therapist is. It’s a partnership. Your experience sounds painful. Thank you big time for tolerating the strong emotions to help other. I hope you receive all of the support and kindess you can get from your friends, family and colleagues. Best, RS

    Um…(sheepishly)…may I toss a couple of cents on the table…in regard to J’s post asking about DBT ‘missing something’ (nurturing?) vs. other modalities?
    First of all…I’m no professional. Just the not so mainstream, screwed up individual who intellectualizes everything in the futile hope of controlling them. Since I’ve wanted to think that the more information I learned about my ‘issues’….the better chance I had of simply outsmarting it on my own, I have spent hours, days, months reading and researching everything from blogs to case studies, theses to text books to….THIS site. ;> Seems there isn’t much that everybody agrees on. But I did find some really beefy info that surely seemed to resonate with me. I personally have complex ptsd. Well…ptsd. Since ‘complex’ doesn’t exist in the DSM…it’s not like anybodys really ever thrown that adjective in front of my ‘code’….ya know? But everything I’ve read on it helped to illuminate why the simple ‘ptsd’ dx didn’t come close to capturing ….me. Well thing is….I researched BPD first. Why? Because I have SOME….symptoms of BPD (self injury, some splitting…mostly myself not others, some fear of abandonment….but not tumultuous relationships or all of the ways of acting out). Ironic….that many of the symptoms of complex ptsd and BPD overlap. In fact….my jaw drops every time I see a website on BPD stating that one of the thought causes is childhood abuse! Well to be a bit teenage….DUH. Then maybe…it’s not BPD. Maybe….it’s complex ptsd! Since knowing this…I have witnessed countless multitudes saying they’ve been diagnosed with BOTH. Every time I see that…I have to wonder which came first? Because in this case…the chicken or the egg matters. Not all individuals with BPD have a complex traumatic history. So I don’t dismiss the entire established dx. But many BPD’s do have the trauma history. Thankfully…there are increasing sources (legitimate ones, not from people like me)….who have stated that in many cases of BPD….the diagnosis is inaccurate. That the complex trauma would be more correct. Someone might not get why….or care. I do. For several obvious reasons (if you’re someone whose been diagnosed with either you understand) but perhaps most importantly….because of the accepted treatment modalities that seem to dominate complex trauma now….vs. the BPD. There are wonderful resources out there on complex trauma….and a few of them are agreeing that using the DBT…just as you would for the BPD….will certainly be beneficial for those symptoms that do overlap, but that for complex trauma patients it falls short…..just as ‘J’ stated above. (Thank you ‘J’ for bringing this up!) Because people who were severely traumatized in childhood (or later for that matter) cannot be ‘handled’ the same way that others might be. I’m learning that the hard way myself. I went to therapy thinking I could go…and somehow learn everything that my therapist spent years in higher education to learn…so that I could keep my distance, take notes, say thank you very much, walk out and fix myself by outsmarting myself. Doesn’t seem to be working that way(sigh). Seems I could have all the DBT in the world…but that wouldn’t be enough and I’d still need to work it (trauma) through in some ‘relationship’. (uugh) I find that interesting…since having to face nightmares, daymares, memories, feelings, beliefs, thoughts, perceptions surrounding all the abuse….both mine and ‘hers’….was terrifying enough. But this relationship stuff? Exponentially more terrifying. I had to ask why I went to work on ptsd….and have to end up being pulled into some relationship. But then who is gonna unload all their deepest, darkest secrets…their smoldering shame and excruciating pain on someone they cannot trust and have no relationship with? Especially someone who just sort of sits there telling you all the wrong ways you think…but seems to not care anymore about you than the check out lady. May even clearly be frustrated with you and want to avoid you because your one of those ‘BPD people’. THAT’S gonna help a trauma survivor! pfftt Guess all I’m trying to say is…..anytime I see a discussion on BPD….I almost always see undertones or themes that sound a lot more like complex trauma to me. They ARE two different things….most obviously that one has a definitive source….which now has more definitive treatment offerings. So shall I give my little PLUG….for the powers that be to PLEASE include that DESNOS or complex trauma code in the DSM? I have plead with my therapist not to dx me as BPD. Not because I myself villainize, resent or look down upon them (hey, I think I can understand better than the average Joe (not you Dr. Burgo)….but because so many others still do, including professionals (still not you Dr. Burgo….I hope) who should be able to discern better. ;> If it doesn’t matter for any other reason….I think it matters for the exact reasons that ‘J’ laid out above……effective treatment to help the people who suffer from EITHER of these conditions. It’s friggin hell livin with either of them….at least give us the best chance at some form of improvement in life. ‘J’…..go with your gut. DBT does seem to miss the ‘nurturing’ if that’s what ya wanna call it (though it makes me feel a little childish…and I hate that)….and is it not painfully obvious that borderlines and trauma survivors alike could use a little of that? Or do we still not have that right? (sigh) OK…sorry…that was more than a couple cents. (quickly sweeps off table) :<

    I’d say let’s get rid of the diagnostic labels and not worry whether it’s BPD or complex PTSD. How is the person suffering? What is the meaning of his or her pain? Is it possible to build a relationship between client and therapist where you can bear the pain together and make it more comprehensible, less toxic? I know that CBT and DBT skills have value, but it feels to me as if you’re giving up on the possibility of fundamental transformation, only possible (in my view) through a long-term psychotherapy relationship.

    Yup….pretty much. Don’t think anything horrifies me more. I’m simply not capable of it. But….maybe I can still learn at least something. Maybe.

    I once terminated a relationship with a therapist by screaming and swearing at him. I was 19 at the time and a college student living independently – I confided in him that I had suicidal thoughts and he responded by calling my university, informing them I was suicidal, and I was literally pulled out of class by a college counselor without warning! I tried to explain the situation but they ignored me and I was informed that until I sought treatment I would no longer be allowed to return to classes. They were all convinced I had a plan to kill myself when I had said no such thing. I tried to contact my therapist but he ignored all my calls/emails for days. Finally I stormed into his office and told him off to his face. I’m sure I made him feel terrible, but honestly, I intended to. I think a lot of therapists deserve the rage they get and it’s a shame they blame it on the client instead of reflecting on themselves and their unethical behavior. That said I do regret yelling and swearing at him, I should have told him off in a more polite way, but I exceptionally angry.

    Maureen, your anger seems justified. We therapists are required by law to act when a client is suicidal, but not every person who mentions having suicidal thoughts is an actual danger to him- or herself.

    I find this very interesting, but it brings up a question for me – well actually a couple of questions.
    First – can the anger or rage in a theraputic relationship be justifiable? And second, is it possible to display significant BPD symptoms during the interaction with one therapist only but not with any others?
    Firstly – a very long story – I’ll try to keep it as brief as possible – During my first major episode with depression I was confused and frightened and angry about what I was going through, I had also just come through an experience of being virtually homeless with a 13 month old baby- living in house(s) that were virtually empty of furniture and appliances – ‘nough said about that. Anyway, I think the majority of my anger at the time was from these difficult times. Although I didn’t know it at the time and clearly wasn’t ready to deal with it. 20 years later I still have difficulty with it and it can spiral me into a depressed mood very easily. So I felt very angry most of the time.
    My therapist listened to my history and said that I had a right to feel angry. Actually, he allowed me to take my anger out on him which I could never understand, and, he never asked me why I was angry. Did I put him on a pedistal? Initially. Did he fall from it – of course he did. (I eventually met someone who put me on a pedistal from which I fell and I had an “ahha moment) But I stuck with the therapy because I was motivated to get better and I would do whatever I was told in an effort to overcome my deep despair. I was told by him that all I needed to do was replace the negative thoughts with positive ones and I would get better. I worked very hard on this for years. It’s not the entire solution.
    One time I saw notes – Borderline Personality Disorder. I asked him what it meant – his reply “A lot of work”. He never explained anything to me, never told me that what or how I was thinking was part of my depression or BPD for that matter- I couldn’t find a “normal” anywhere – I felt like a freak, that I was the only person in the world who thought like me.

    He wrote notes and corrected mistakes with white out rather than look at me when I was talking. The only time he ever looked at me was when I was feeling suicidal.

    He often would redirect my attention from something that I was talking about that was really emotional for me – it would have been better for me if he had let me carry on. He would look at one lamp shade and then another and say “huh, I didn’t notice that those lamp shades are two different colours of pink.” Another time he noticed a bird flying by the window. He pulled crap like that all the time.

    I saw him for a long time – the first 2 years were with some frequency – the last 5 years I saw him about 5 times a year. In the last weeks that I saw him something changed. I was severely depressed, feeling suicidal and it was definitely darker than my first episode. I told him that I was feeling worse than the first time and he gruffly replied “you never feel as bad as the first time.” So I guess he knew better than I did about how I was feeling – NOT. He went on to me out about my journalling was compulsive – so I now thought that journalling was wrong. It was winter during this episode – as it often is -so I had my winter coat on and was sitting in the chair hiding under it. “Why are you under there?” I meekly replied “because it’s safer.” He didn’t even realize that there was a person in tremendous pain sitting in front of him. At the end of that session he stood up and asked “What’s your family history again?”
    So I ask – was my anger justifiable in all these moments? Was I a pain in his butt? Ya, I was. I would ask the same question over and over again because I never recieved an answer. I learned to push his buttons because I was smarter than he was. There was a part of me that wanted to push him to the point of giving up on me so that I could confirm what I knew at the time to be true. “I wasn’t worth the effort.” (I don’t think that way anymore)

    The last time I ever spoke to him he said that I was the most difficult person he had ever worked with. So now I have that belief shadowing me – that I am a difficult person to deal with. However, when I look at the relationship that I have had with other therapists over the years (Provincially covered – another long story) I find that the behaviour that I displayed with my first therapist has never been repeated with any others. None of them have really ticked me off – except for one – again, long story. The only reason I have had to end with other therapists is either because they were government funded and the time ran out or because I could not afford to continue with a private therapist.

    So riddle me this, is it possible to just display BPD symptoms with one person only?
    Was he just a crappy therapist?

    No I’m not asking for theraputic help here – just trying to understand the behaviour then and now.

    Your post has provided me with the best info so far regarding BPD – it is a difficult thing to understand and I thank you for writing it.

    Feeling angry is not the same thing as displaying borderline behavior. Your therapist sounds like a fairly insensitive, clumsy guy and you have every right to have felt angry.

    Thanks for your reply, Joe.
    I have tried for many years to let this experience go. I reach a point when I think that I have successfully done so – until I have another depressive episode and then it all comes flooding back to me. I think that it hurts so terribly much because of the trust I had in him. I was also in a most vulnerable state and his words spoke to a core belief that I had (or still have) about myself and so it has strongly stuck there in my brain. He also had an air about him that because he went to University, he had to know more than I did about how I felt, etc. He was arrogant. However, until a person is strong enough, emotionally developed enough, we can’t always see the reality of a particular relationship.
    I never yelled at him, but I definitely got angry with him on paper – but there always seemed, in my memory, to be justifable cause. I may have exhibited more BPD traits at that time, but when you look at the trauma of being homeless without anyone in our family really wanting to help us all that much, there was a good reason for my anger, sometimes rage – but at the time (22 years ago) I didn’t understand any of it – and my therapist didn’t really try to explain it to me either. Yes, I may have had a reason to be angry, but who or what was I angry at? Myself I think.
    Thanks again,

    No question here so I hope it’s okay I’m not in possession of the book.

    There is absolutely no question that (many) therapists can be patronizing, I find they sometimes confuse therapeutic expertise with other forms of knowledge. I sought therapy in the past for being a bit of a “doormat” you could say, and in sessions where there would be some discussion of my interests (which were on hold due to my problems) you would be amazed at the presumptions and outright patronizing nonsense they trotted out about art/literature/philosophy, ie my “fields”. I can laugh about it now, almost, because of how dumb they look in retrospect: there’s no way they were basing their sense of authority in these matters on their own knowledge, they were assuming that because I was emotionally troubled, I had no real knowledge whatsoever.

    Unless you were really really sure that Nick had no real interest in writing or speaking on philosophy, he might have had a point. You mentioned elsewhere that writing and publishing are very meaningful to you in an “ego” sense.

    Thanks for clarifying below, it certainly seems you made the right assessment of the fellow. I wish I could find a way to “shift” my past experiences with my therapists, but it’s hard to see a way, I remain angry for now! There are really big differences from one therapist to another it seems.

    Your client’s “You think I envy you?” sneer reminds me of times when I’ve told my therapist that I deeply envy him. Specifically, I envy what I see as his psychological health and level of wellness while mine seems to be completely shattered beyond repair (major shame and frustration). Thankfully, I am also able to experience gratitude and a burgeoning kind of love for him, too, especially when he says something humorous.

    Your ability to recover from these kinds of brutal attacks is admirable.

    Thanks, RC. I think that the ability to acknowledge envy and still feel gratitude is a very good thing. He sounds like he’s doing you some genuine good.

    Hi Joe,
    Firstly, I have bought your book on Kindle and am just starting to read it. Thank you for writing it!
    I am sure I must have BPD although therapists say no. I feel tremendous anger towards my therapist sometimes and I know it affects him although when I apologise later he says there was never a problem. So I winced when you wrote so eloquently above about what a toxic experience it can be for the therapist to experience borderline rage.
    However I never set out to cause pain. I’m always deeply ashamed of the extent of my rage and later can see clearly that it is excessive, but at the time it controls me. I can understand the bitterness expressed by family of people who have BPD, but please understand that we are in pain as well.

    That it the truth that I always hang onto — that someone who lashes out in rage is suffering deeply. I know from personal experience that there are few things as painful as feeling that kind of rage.

    Have you ever been fired angrily by a patient who is not borderline? Or is the expression of profound anger in an abrupt termination by a patient ipso facto borderline behavior?

    I’ve been thinking about how to answer some of the angry and dissenting responses to this post and finally decided the best thing to do was to give readers the room to express there opinions and leave it there. My own experience has led me to the views I hold, but other people have had a different kind of experience that leads them to believe otherwise. We don’t need to persuade one another and we don’t have to agree.

    But on one thing we can all agree — people who struggle with borderline rage are in deep pain and would give anything not to behave in the ways they do. It helps to keep this in mind.

    At the risk of being wrong, and I can be, but I have at least read all of the posts and have a point or two to add. Who reads a blog about Psychotherapy? Many people, but a good portion of them will take an interest either because they are in therapy, thinking about going into therapy, or were once in therapy: people who will have read, thought or verbally picked up some ideas about themselves and their psyche. The trouble with popularizing psychotherapy, everyone becomes a ‘lay’ expert. Someone’s sad- they’re depressed, someone laughs loudly-they’re hysterical. The back lash of popularizing psychotherapy sometimes means that the ‘worried’ well’ can over question their emotions and see them as a symptom of something that needs and ‘deserves’ a label. Have we not all looked at a medical textbook and by page five given ourselves three days to live- ergo the psyche and psychotherapy. I mean no disrespect to people who do have B.P.D, and for those of you who do serious battle with it you have my admiration and respect. But many people who have commented hear are just plain angry, B.P.D will serve as well as any label, we have a need to name things that make us uncomfortable. But seriously, being angry is not B.P.D.

    I fully agree with your point that we don’t have to agree about this topic, but I still find myself asking why your feelings about people with borderline symptoms are so different in this post from those you expressed in your post “Working with Borderline Personality Disorder,” in which you say working with borderline clients is “the type of work I find most rewarding, despite its challenges, and where I do my best work.” And despite your stated preference for avoiding labels, here you refer to “borderline clients” several times, in fairly stereotypical terms. I felt stung by your post and had to go back and read your earlier post just to remind myself why I enjoy and respect what you write so much. Thanks, as always, for the opportunity to discuss these issues, which clearly matter a lot to your readers.

    Now I understand better — I didn’t realize you were feeling stung. I guess what hasn’t come across in the post is how much I feel for this man, and how painful I know his shame to be. I had been watching and listening for months, hearing very similar comments from him of a comparing nature. I had seen him go through several enthusiasms, jumping on board a new idea and carried along by a kind of manic energy as if he were going to do something “all at once,” only to find he couldn’t follow through and ending up in despair. When I finally spoke to him about the shame he felt at not being able to realize his potential, I misjudged his readiness to hear it as well as the strength of the connection between us.

    I have a lot of empathy for people who rage because I know how painful it is. My strength as a therapist is that I can take your rage and not hate you back, but that doesn’t mean you won’t hurt me. I have been hurt many times by my clients and gone on to do good work with them. As for the “borderline” label, I don’t know what to say about it. I don’t believe in the label, but at the same time, there is a set of features that, in my experience, do go together; foremost among them is a kind of hypersensitivity to perceived criticism which can lead to a self-righteous, no-holds-barred assault on the person who was “insensitive.” For me, the word “borderline” is short-hand for those features, not a diagnostic, label. Like many other terms that started out neutral and became loaded with pejorative connotations, the word borderline now sets people off when they hear it, conjuring all sorts of insults and accusations where none is intended.

    The reason why I find working with “borderline” people so rewarding is that, over time, once they understand the value of a person who can bear their rage, envy and hatred and continue to give, they become profoundly grateful and appreciative clients.

    About that “bearing their rage….” thing. When my therapist allowed me to take my anger out on him I lost a certain amount of respect for him. I think the idea for me was “How can a mentally healthy person allow such behaviour to be cast on them.” I thought that he didn’t value himself and therefore allowed me to be angry without explaining the “why” behind it, or work on reducing the anger. Maybe that was also part of pushing him, not only for him to give up on me, but for him to say “enough” – that he respected himself enough to put an end to me, basically, disrepecting him.

    Good point. I never just “take it.” I’m always trying to help my clients understand the “why” — usually to do with excruciating feelings of shame or smallness. And there has come a time with some clients where I had to set some limits. I’m talking years into the treatment, after a history of abusive rage, when I felt the client had gotten to the point where he or she could control it but was choosing not to make the effort.

    I’ve also been reading all of the comments, and have held back from commenting on all of the comments until now!

    I think it’s important to remember that as a therapist (and a person), it’s possible to genuinely enjoy working with people who display traits of bpd, and want to help them, while also, at times, feeling incredibly frustrated and hurt by their actions. These two emotions can co-exist…one emotion doesn’t cancel out the other emotion.

    I say this because this is one of the patterns that repeats over and over with my mom. I love her deeply. Sometimes she rages at me, trying to confirm that I won’t “always stay.” I become incredibly hurt and frustrated, which, to her, she says, confirms that I don’t really love her.

    Love and frustration can co-exist.

    Dr Burgo, I am so glad that I finally made it to the end of this thread and read the concluding comments. I also felt unnerved by what I was reading but had no clarity. Martyn above talked about needing to know more about the context of your relationship with Nick and I agreed with that.

    By offering more of that context, you helped me better understand what happened and I am most grateful.

    Your honesty – that you had misjudged Nick’s readiness to hear your observations as well as the strength of the connection – is wonderful. Mistakes are made in therapy, but not always admitted. I once asked a therapist in an initial interview what mistakes she had made in practice and what she had learned from them. She almost had a fit and refused to answer.

    It may be hard for the borderline to tolerate others mistakes but it’s a very important skill to learn. One has to learn that there are some mistakes that are reasonable and arise out of good will gone wrong, and others which are damaging and destructive and arise out of cruelty. Given how damaged the borderline is, that can be a difficult distinction to come to terms with.

    I have learned a little bit about that here – so thank-you for your largesse in making your time and effort and skill available to many. Best wishes…

    And thanks for hanging in there, giving me the benefit of the doubt long enough until we could all get clear on what happened.

    As someone currently in both psychotherapy and DBT (as is the reccomendation), there are a couple of aspects of DBT that seem to be overlooked and misunderstood that I think are important to clarify. The first is that DBT does not and should not exist without individual psychotherapy similar Joe’s and Nick’s. And it’s very helpful to have the group and individual therapist work together. Second is that the skills training is exceptionally helpful in preventing serious outcomes of short term pain (I.e. cutting or suicide). Finally, one of the best gifts I’ve received from DBT is gaining the knowledge that I am not alone in my thoughts, behaviors and feelings. That, in and of itself, is a huge way to find relief from constant shame. To know there are others like me has been so amazingly helpful!

    I have BPD, and my therapist terminated with me three months ago. I feel hopeless as to any hope for a cure, and rightfully so. The feelings that you and other therapists are feeling are just the tip of the iceburg for what I carry around daily. It takes you a couple days to recover? You have a choice. Imagine having it inside of you, having to build defenses around it, going to therapy and trusting someone, who then unburies this, and terminates you because of your toxicity? I get that we have no right to hurt anyone else, I have no desire to do so. What happens when we can’t cope or interact? Should I just give up? Every time I feel a little self-acceptance, it is gone with the wind. This is all so futile. Lock me up with the criminals where I belong, please. My mother was enmeshing while my angry father was either angry or distancing. No csa at a young age, but being enmeshed and having a mother control who you are and a father who could care less, well , is fertile ground for BPD. Does this explanation excuse me for having an illness I didn’t chose to have? No. And it shouldn’t. Trust me, I’m not worth it.

    When I say I’m not worth it, I am frustrated about how to deal with myself. I hate myself, and reading things about how horrible I am to therapists, is true but upsetting. My BPD is not ego syntonic, and I feel trapped in here with myself.

    Hey J,
    My heart goes out to you. That must have been devastating to lose your therapist that way. :-( This therapist was probably not the best one for you, though, if s/he terminated. Maybe s/he didn’t have the right skill set. If that was the case, then finding someone else may be better anyhow, in the long run because you will save time and money trying to get better.

    But I’m sure that does little to console the loss, however, especially if it was transference-based therapy. I can’t even imagine how painful that would be. Keep in mind that I’m pretty sure that your therapist has an ethical responsibility to avoid patient abandonment–like by offering referral/s (hopefully to someone more helpful).

    I phone interviewed and then consulted with at least a dozen therapists before finding the psychoanalyst that was ultimately able to help me. There is hope. It took time, but it was pretty intense, so I’m kind of glad it wasn’t faster!

    It took around three years of weekly psychodynamic sessions (now I’m in a sort of ‘maintenance’ mode going once a month). I do feel significantly better than I did before therapy. I don’t know if I can say 100% “cured”… but at least 70-75%. I’m sure there’s lots more like me out there and others that are 100% cured. There’s DBT too. So don’t give up hope :-)

    I know this topic is probably dead but since I’m new here, I just came across it. I read most of the comments and have been mulling it over in my mind as I had very strong reactions to things that were said. I don’t know if I have anything different to say than has been said already.

    I did envy my therapist for a long time. He has done some awesome things with his life that I would like to have done. If he called me on it, though, it would have scared me away. A huge part of that, for me, is not wanting to be seen. Not wanting to be seen because I had no boundaries for a long time and being seen felt like I was being violated. As I get stronger, I’m able to share more of my emotions but let me tell you, it’s been a long process.

    For me, there would also be an element of resentment. Of someone telling me how I feel – something that was done for me my whole life.

    I’ve guarded my emotions because I have had to. It became a self-protective type of thing because at times as though they’d been twisted and turned and mutilated and stomped on by others. Until I felt as though I understood myself more, had more compassion for myself and had some kind of a handle on my emotions, I couldn’t share them with anyone else.

    I don’t know much about the psyche but I couldn’t help but wonder if Nick needed to merge? with you and that, that, in fact, is how he would develop positive feelings for himself? Sort of like, emotional adoption? I guess I think of it in terms of what our parents should have done for us when we were little but somewhere, somehow it went awry.

    I say this because I had to merge as well with my therapist. Now I am stronger, actually have some positive feelings for myself and I’m able to separate and see us as two distinct individuals.

    Just some random thoughts.

    I have a couple of more things I want to say. Dr. Burgo, I hope that you will truly consider what I say and not get defensive. However, I will understand if you do and will gracefully bow out.

    The first is a message to J: Don’t give up. You have to find someone who believes in you and understands you. It’s NOT hopeless.

    The second is that I think part of the backlash here might not be the use of labels but more from the way Nick was described, which was as a deeply troubled individual. In my opinion, that characterization right there is more dismissive and hurtful than anything else considering the story led to a treatment failure. It was like a “connect the dots” game. It implies a justification for the treatment failure. It was Nick’s “fault”. I’m sure you didn’t mean to say that but why couldn’t you have described Nick perhaps as someone with identity and substance abuse issues or however else you could have described him?

    I also have some comments for Warren:

    “The trouble with popularizing psychotherapy, everyone becomes a ‘lay’ expert. Someone’s sad- they’re depressed, someone laughs loudly-they’re hysterical. The back lash of popularizing psychotherapy sometimes means that the ‘worried’ well’ can over question their emotions and see them as a symptom of something that needs and ‘deserves’ a label.”

    What I can’t help but wonder here is if you would say the same thing about us if we were learning about plumbing or should we just blindly rely on every plumber that comes to the house? I think it’s commendable when people educate themselves. There are a lot of incompetent people in EVERY field. Knowledge is power. It just hurts when you get criticized and that’s understandable. I also know you were standing up for Dr. Burgo.

    “But many people who have commented hear are just plain angry.”

    You bet, Warren. The problem here is that it has become the professionals vs. the laymen. I do detect a certain arrogance here. How could a layperson know any better than you? Then there is the total and complete dismissal of any validity to the comments that were made. Have you read David Wallin? Have you read what he said about what people say about us? That they probably are, in fact, picking up on things we are unaware of in ourselves and/or have disowned? The more anybody denies our point of view, the angrier anyone would get. That just seems like common sense.

    I think what Sioux quoted up above is really on point here and with Nick, as well:

    “In analytic work, it is therefore vital for the analyst to be demonstrably open to the possibility of alternative meanings in any exchange between analyst and patient, rather than trying to impose a particular view of the patient’s unconscious intentions on him. Otherwise an analytic impasse is inevitable, in which analytic work deteriorates into a battle in which both analyst and patient are fighting for survival, the analyst for survival of the analytic function and the patient for his or her very psychic existence. Indeed, the analyst’s countertransference feeling that his own survival as an analyst is at stake can alert him to the fact that, for the patient, the analyst is another parental figure who requires total subjugation to his needs and the annihilation of the patient’s own self-agency.

    “In spite of the fact that some degree of enactment of this impasse may be inevitable, an analyst who is open to exploring multiple symbolic meanings and to understanding the material from the patient’s perspective, rather than imposing his own, offers a new experience within which the patient can gradually relinquish her defensive mindlessness. The projection of the controlling, devouring parent can gradually be withdrawn as the analyst demonstrates again and again his own reflective function, the awareness of the patient as a separate psychological and emotional being.”

    Hi Sarabi,
    I wasn’t actually sticking up for Joe, well perhaps a little, but he’s also no stranger to my (sometimes undue) criticism. My interest in psychotherapy was born out of three years on the couch, and dabbling with psychoanalysis in my M.A. before I went on into philosophy proper. I actually find much of psychotherapy’s suppositions and contexts problematic. However, when one plays chess, two players sit down in observance of the rules. In the context of psychotherapy, there is a law maker/advise giver; and a subaltern subject whose principle function is to accept a new set of prohibitions. As you rightly say, one can be an auto-didactic, but within the context of psychotherapy, the object is part of your own subjectivity, the role of the ‘skilled helper’, is to lift it from you and place it before your gaze for your own examination. Again, all of these terms and processes I find are highly problematic, far too little room here to elaborate even the briefest of arguments.


    Thank you for taking the time to reply and explain what you meant. I really appreciate it. I misunderstood your statements to mean that you weren’t open to feedback from the laypeople and how what was written affected them.

    I was also having a hard time figuring out who the audience is here. The borderline blogpost appears to have been geared towards professionals but it seems like there are a lot of people readers who have been told they were borderline and have had difficulty finding a therapist who will work with them. It seems understandable to me that some people might feel hurt by things that were said. Dismissing the comments that were made by laypeople by saying both that that’s the problem with popularizing psychology and “the people commenting here are just plain angry” is certainly not going to foster an open dialogue but rather a hardening of the sides, so to speak. Best of luck to you.

    Some people are more comfortable than others with more exploratory therapeutic
    style. I found overly-supportive therapy fairly unhelpful, while the more challenging
    interpretations lead to growth and change. Maybe Nick just wasn’t quite ready for that level of change.

    I think I was also a little premature in bringing up these issues. He wasn’t quite ready and I should have seen that more clearly.

    “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.”

    I don’t even have a personality disorder and yet I winced inwardly when I read this. If a therapist ever said this to me, I would probably think he was trying to intentionally make me feel worthless by comparing me negatively to himself.

    I think the so-called borderline rage isn’t necessarily a defense only against their own core shame, but can also develop as a defense against other people’s projected shame. When you think about the kind of environment a BPD-sufferer survived growing up, it’s kind of a battleground for who can project their shame onto whom first, and sometimes this shame can come in veiled or sugar-coated forms or mixed with elements of truth. In the moment, it can be VERY hard to sort out which parts or communications if any are valid and accurate and which are projections and subtle manipulations. If there’s any doubt about the content, it can actually be better to simply fly into a rage and reject everything wholesale than to risk absorbing whatever part of the message may essentially be poison. Rather than swallow the shame pill you are being offered, you puke it back in the other person’s face. The problem arises when you do this reflexively whenever you get the slightest whiff that someone may be trying to shame you, even when that isn’t actually what’s going on. So I don’t know if this might have been part of what was going on with your client or not, but it’s something that comes to mind for me.

    You make some interesting points about shame-trading, and how it gets handed around in borderline families. I think you’re onto something about the rage reaction in those cases.

    I know this is an old post, but I came here today and saw it, so maybe someone else will too. I felt compassion for you as I read this. I think you described the shame and rage so well. I cringed though, when I read: “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.” Right or wrong on my part, it kind of felt like a bit of psychotherapist retribution on your part when you addressed him. I felt your pain, and the pain he must have felt when you said it.

    I can understand why it strikes you that way but it didn’t feel like that to me. It’s our job to tell the difficult truths and I believe that psychological/emotional growth depends upon facing the truth, however painful it might be.

    Hi Joe, as a colleague, I really appreciate your post here and empathize with your struggles as a therapist in relation to a BPD client. I personally had to have 3 consultation sessions with a seasoned colleague to terminate a very toxic and shame-dumping client who was consistently disparaging and dismissive, would not follow any treatment recommendations and would come in and lecture me about my incapabilities as a therapist. Having a severely borderline client can really drain a therapist and divert his/her attention from other clients in need. It’s totally a lose-lose situation; since then, I have come to the conclusion that for the sake of other clients and my own mental health, I will not take a severely borderline client into my practice; I refer them to DBT therapists/centers.
    Thank you again for this piece; it really resonated with me.

    You’re welcome. I know what you mean — the transference with this type of client is often immediate and very toxic, unless you can make interpretations that return the client’s shame to him or her so you’re not left with it. I don’t know whether “enjoy” is the right word, but it’s a kind of work I don’t mind undertaking.

    Myself I am a patient with Borderline issues and I felt the shame and embarressment in a so called therapy. After four years it ended badly. I presume the therapist wanted to get rid of me, and said he did not have the tools for me and send me to another team for personality disorders. I cried in front of him and it was terrible for both of us.
    I never met the new therapist. I was not done with the first one, don’t want to have another ‘threapeutic relationship full of illusions again, so I withdrew. But do not tell me I could not witness my own failures and hidden narcism. Even though it was shamefull I always went through all the pain and wittnessed myself. But I did not understand what the therapy was (or wanted). He was not very polite with me. Now I think he wanted to stand up for myself, but I couldn’t.
    Yes, from the moment I came in a stumbled into a strong transfer, now I would describe it as a mini psychose. I became a baby like it was real, not just regression. I told everthing, was honest, not so much I did ‘wrong’ really. Only once I made a mistake; I left therapy after two years, because I felt he was backing out emotionally. It was more like a test. Did not mean it, but they never show they care.
    Anyway, I feel devastated. Five months have passed and I guess in a few years the pain will still be there, because this is actually the whole issue. My father told me at age nine, not to come anymore in his life.(He remarried)
    My therapist told me, that sending someone away is normal in the whole of Europe. I don’t think this is normal in the whole world! Even though in a bureaucratic way, he is right, he should not have thrown me away so ‘cold turkey.’ I feel very bitter and never go back to the falsehood of Mental Care.


    Seems that sometimes, it is easier for clinicians and therapists to brand people than it is to understand their behavior. I would wholly support spending time looking at symptoms as opposed to classifications. It does seem that with ommittance from the DSM 5, a complex trauma or PTSD diagnosis, then psychiatrists/psychologists are more likely to give a bpd label because that is the one that closely fits from the pages. The helper looks and becomes more like a perpetrator and the person in question is most likely to be on the receiving end of confirmation bias…which leaves very little room for therapeutic gain.

    There is a growing field in trauma informed healthcare practices that is long overdue. There is actually a very serious risk of retraumatising people when their experiences are seen but not understood. The mode of questioning is far more helpful to not say what is wrong with you, but what happened to you? I like this site for trauma informed care..http://www.asca.org.au/WHO-WE-ARE/Our-Documents/Practice-Guidelines

    I’m speaking from personal experience and really, I’m still trying to process alot of trauma from medical fields. Coming from a background of being constantly criticised, what do you do when you are then criticised by professionals who label you with the most insulting stigmatising and alienating label that exists-bpd.

    I pretty well lost the plot that was significantly gaslighted by parents who created a reality for me that I didn’t agree on but I got lost in what reality was true because I was convinced by them I needed hospitalisation for my sickness…except I wasn’t sick, I was extremely confused by the reality they presented and as I tried to make sense of it, I spiralled into a maze of confusion. Being a trauma victim, I began to beleive that it was in fact a plot to get rid of the burden they felt I was.[yes, my father actually strangled me during one of his abusive episodes. He really did want me dead. He viewed me as the cause of his drinking and now has liver problems, no doubt he claims I am to blame. His view was that he already had the perfect family and he didn’t need me-just to put things into context] My anxiety then mimicked a psychosis that didn’t exist but I couldn’t explain my way out of it. Psych wards are a huge stress factor for me and so I tried to disappear, only then to fear the police would come for me and again, I have been traumatised by them also. I then sank deeper into the two realities. The one that I was being presented with and the one I beleived. Within the psych hospital, psychiatrists held the same opposing views which further served to confuse me. The first saw me as something that didn’t need medication, that didn’t respond to medication. That doctor claimed that it was through her own personal experience that she knew what I was going through and that it was rare and you would only know it if you knew what to look for. I was so relieved to be under her care, despite the mysterious diagnosis given. I am completely against being forced antipsychotics [could write a book on the facets of why I disagree with them] and I don’t need to be retraumatised by being manhandled, exposed and injected. However, my doctor changed within a couple of days, and the new one held a completely different view of treatment. The new one prescribed anti psychotics and used her power to threaten what I was already scared of. She however did not have a diagnosis for me, or at least with held one. What was I being treated for? I felt like a lab rat. I felt that because they saw something rare, they were tempted to flood me with their own tests to test my behaviour. Eventually, I began to feel as if I would have a stroke. I began to feel like I was fighting for my life every day. I could not be in a less therapeutic environment..the trick was how I was going to handle what really was stress and maintain my sanity. I played good so they wouldn’t hurt me..I had to submit to a process that was inhumane and I had to get out of there. I did and here I am and they diagnosed PTSD after I was released, saying this is what I would be “labelled” with when I followed up outpatient. They also oddly said that the new support did not need to know the rest..but I wasn’t told either. What occurred next was that when I reached out to the outpatient services after my discharge, I was now in another state of my country and the professionals there thought I was psychotic. At first, I just met with them and it was amicable. They expressed doubt, but naturally I was nervous and so I was asked to return, for which, I agreed, but then, the interviewing Psychiatrist changed in all manner of expression and decided to not let me go. I was taken and locked up in the local hospital.
    I don’t know if you can comprehend this as a reasonable response, but I was tired from my last admission and that was too much for me to handle despite hospitalisation being called therapeutic, safe and in the care of health professionals.
    My reaction was that I kept telling them to let me out. I really changed my behaviour and carried on in a way that is quite unlike myself but here I was again in the same boat and I could see no way of maintaining my composure any further. The last hospital had me in tears and begging to know what more they wanted from me. When really sick people werebeing discharged and staff questioned me how it felt to see such sick patients go before I could. Frankly, nothing made sense and it is absolutely terrifying. How could I face another round? Two Psychiatrists interviewed me after admission and they didn’t know what was going on, but the senior one said to the other, we have to get to the bottom of this. For me, I could explain my previous admissions and they all were equally bizarre, but o them they didn’t know why I was suddenly having this new meltdown..out of the blue in their eyes. because i had seen a Psychiatrist before and he’d not diagnosed PTSD, they were unwilling to accept that as an option despite me just being through what I described above which detailed close observation over 6 weeks. I can tell you that I have been now labeled by them as borderline and as the Psychiatrist gave me this advice, he said I wasn’t going to like it. He gave me the opportunity to say why I wasn’t, but how could I have such knowledge on the fly like that to really be able to defend the label and my character. True, that I was difficult but that should be comprehended and I mirrored what they gave. I could no longer be polite to those who were rude, but I just shut them off. I showed respect to those who showed me respect and for the others who still struggled to understand why I was refusing medication, labelling me as non compliant and difficult, it was never easy. I watched as their attitudes towards me grew negatively. I felt their impatience. They saw me as disruptive..difficult. None of that was out of proportion but for them, it was. Nobody looked at the circumstances. I too had gained weight in the former hospital, with a history of ED’s it was not something I ever liked to share but it became knowledge via questioning. I ate because I thought they would kill me because I was stuck in a flashback triggered by a multitude of things. I ate because I had been tired of the whole restrictive cycle I had been in. And then the nurse I was assigned openly disclosed to my friends I had an ED. The way she did it was by looking me up and down and saying, you don’t look like you have an ED, right in front of them. So traumatised was I by this, I began a bulimic cycle that I still have a year later, many days, I think and fear it will kill me. That started upon weekend leave whereby the hospital Psychiatrist came to me and said he didn’t think I had a psychotic illness..exactly what I had been saying, hence they let me home for the weekend. Fuelled by all the things that went on, the bulimia was terrible over that weekend. It wasn’t until i returned on the Monday to the hospital that the Psychiatrist gave the bpd diagnosis. I cannot help but think that they are wrong. I don’t relate to the diagnosis. I wish I did in some ways but what I really do feel is that it was like an insult tossed at me for being difficult, when really, nobody there was owning their own behaviour. I find that there are many a closed mind within health professions and fear of my future in some ways should I fall onto the radar in some way again. I really wish I had the freedom to know that at least I was safe and cared for in those environments. Trauma does not need to be perpetuated and it certainly should not attract a diagnosis that describes one that seeks attention because really, I just want to be left alone. I don’t make threats that I will carry out suicide for the sake of attention, I don’t manipulate, i don’t have reckless sex..or even feel the need to be loved the way it is described in the DSM. I learned to be alone, I learned that I could self soothe. I do dissociate alot..I do just get creative basically as my outlet. I am quiet. I lived a life thinking and wishing I would just be mute. I stuttered at a late stage. I pulled my eyelashes at an early age and my favourite colour was black. I am far too logical to be borderline because I need and do see things from a multitude of analytical angles. i am not content to label and I am open to more honest discussion without drama than any person I know[well not everyone of course]I have simplified the criteria but should I list all that I don’t identify with, I would list many. Do I have some solid emotions that seem really heavy..yes I do, but can anyone not see that they are in context to what is actually occurring? I was accused of saying that everything I say gets twisted and I am still at a loss as to where that came form.
    I didn’t intend on writing so much, so just honestly i am sorry. I am posting this with the idea that it is written and maybe I just need some validation that my reactions were warranted. I tried to only quote facts and to leave bias out of it but inevitably I guess I am biased that my experience is not a OK one at all. There is an intense need for my disownership of the bpd label to be validated, I admit that I would like that.

    I also found out that the Psychiatrist that changed and admitted me is actually a Urologist and so it really just demonstrates that there was alot in question regarding the second admission. I don’t see anyone else taking the initiative to say, actually, we as healthcare providers got it wrong. I am all for ownership but how much of this should I be owning? Do I really have bpd? How can I now access help for it if I got a diagnosis that alienates me. I went to my GP and when I couldn’t get a word in edgewise and finally did, tactfully I thought, he brought out the, so hows the personality disorder going.

    I am now seeing a psychologist but struggle really. I do live in hope, but how long can that go on for? To be defeated is difficult. I really would not like anyone to go through my experiences and have the borderline tag..there’s something much different, but maybe that’s just my hope I cling to.

    I read this blog and respect the content. It’s not bookmarked but I found it again today..I guess I lurked a while before posting, so forgive that I take up so much space. I was labeled borderline and disagree with the diagnosis and I have written quite a bit, maybe it is of value to a discussion that I see was started some time ago, I see that so hope this is still valid? I’ll let you decide, thanks in advance.

    Seems that sometimes, it is easier for clinicians and therapists to brand people than it is to understand their behavior. I would wholly support spending time looking at symptoms as opposed to classifications. It does seem that with ommittance from the DSM 5, a complex trauma or PTSD diagnosis, then psychiatrists/psychologists are more likely to give a bpd label because that is the one that closely fits from the pages. The helper looks and becomes more like a perpetrator and the person in question is most likely to be on the receiving end of confirmation bias…which leaves very little room for therapeutic gain.

    There is a growing field in trauma informed healthcare practices that is long overdue. There is actually a very serious risk of retraumatising people when their experiences are seen but not understood. The mode of questioning is far more helpful to not say what is wrong with you, but what happened to you? I like this site for trauma informed care..http://www.asca.org.au/WHO-WE-ARE/Our-Documents/Practice-Guidelines

    I’m speaking from personal experience and really, I’m still trying to process alot of trauma from medical fields. Coming from a background of being constantly criticised, what do you do when you are then criticised by professionals who label you with the most insulting stigmatising and alienating label that exists-bpd.

    I pretty well lost the plot that was significantly gaslighted by parents who created a reality for me that I didn’t agree on but I got lost in what reality was true because I was convinced by them I needed hospitalisation for a sickness…except I wasn’t sick in a psychotic sense. I had embarked upon an online PTSD course that brought back to my mind more than one bad experience. As I explored what I felt was a positive step with the online CBT course, I headed into dangerous territory of flashbacks, fear, nightmares and then I encountered some family abuse. I was extremely confused by the reality they presented and as I tried to make sense of it, I spiralled into a maze of despair that I tried to correct by overworking, therby distracting me from what was surfacing. I then decided that I needed to get away and think things over. I really