Borderline Personality

Some therapists will not work with a Borderline (ooh that's bad we are not supposed to do that), I mean someone suffering from a Borderline Personality Disorder (BPD). However, I love it. They can be the nicest, most reaffirming clients out there. However, if you challenge them or say the wrong thing, they will turn on you in a second. As long as you realize that when they say they hate you, they just mean that you are not pleasing them, right now, you will get along fine. Although, some therapists can have great difficulty with a person with BPD because they have their authority challenged and boundaries trampled.

From Wikipedia, the world's most foremost guide to everything (sarcasm in italics), "As a result, people with BPD often evoke intense emotions in those around them. Pejorative terms such as “difficult,” “treatment resistant,” “manipulative,” “demanding” and “attention seeking" are often used, and may become a self-fulfilling prophecy as the clinician's negative response triggers further self-destructive behaviour.[107] In psychoanalytic theory, this stigmatization may be thought to reflect counter-transference (when a therapist projects their own feelings on to a client), as people with BPD are prone to use defense mechanisms such as splitting and projective identification."

What does this mean? A therapist that does not have a good ego can get his or her feelings hurt by a BPD patient. I would call the technical term counter-transference, but the lay name would be butt-hurt. When the client that shows up late, doesn't pay, stays late, calls the therapist at all hours, doesn't do their homework, and wants to only discuss their latest "crisis," all of a sudden reveals that they hate you and no longer want to come to therapy, it can be hard for a therapist to take. Of course one only has to realize that the patient will most likely show up next week and think you are the greatest therapist in the world to have a little patience and empathy for the client and understand that you are heading in the right direction. And expect the unexpected, and keep on your toes. I like to keep scrupulous notes so that I can keep up some days.

The DSM-IV-TR requires that at least five of the following criteria (or symptoms) be present in an individual for a diagnosis of borderline disorder:

• frantic efforts to avoid real or perceived abandonment
• pattern of unstable and intense interpersonal relationships, characterized by alternating between idealization and devaluation ("love-hate" relationships)
• extreme,persistently unstable self-image and sense of self
• impulsive behavior in at least two areas (such as spending, sex, substance abuse, reckless driving, binge eating)
• recurrent suicidal behavior, gestures, or threats, or recurring acts of self-mutilation (such as cutting or burning oneself)
• unstable mood caused by brief but intense episodes of depression, irritability, or anxiety
• chronic feelings of emptiness
• inappropriate and intense anger, or difficulty controlling anger displayed through temper outbursts, physical fights, and/or sarcasm
• stress-related paranoia that passes fairly quickly and/or severe dissociative symptoms— feeling disconnected from one's self, as if one is an observer of one's own actions

If you see any 5 of these symptoms in yourself please call a therapist and make an appointment.