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Depathologizing The Borderline Client - Page 5

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DS: I get that you have no reason to trust me. She’s been betrayed by lots of people who told her to trust them, and she’s gotten her hopes up and been disappointed lots of times. I also get that you’re determined to keep those things from happening again, and you have a lot of power to do that. You’re the boss, and we’re not going to do anything more with her traumas without your permission.

CP: You’re an asshole! I know what you’re doing right now with this caring therapist bullshit. I see through you, asshole!

(Now a part of me was saying that this was a pointless and tiresome waste of time and it was sick of being insulted. I asked it to step back.)

DS: OK. As I said, I don’t expect you to trust me until I’ve proven myself to be trustworthy. I do appreciate that you let her continue to see me even though you have these feelings about me, and I want to check in with you frequently to see how we’re doing. Now I’d like to talk to Colette again. Are you there, Colette?

Colette: Yeah. That was weird! He’s always been so mean to me that I never realized that he’s trying to help me. While he was talking to you, I could feel his sadness.

DS: So how does that make you feel toward him?

C: I feel sorry that he has to act so tough when he’s so sad himself.

DS: Can you let him know that? See how he reacts?

C: (after a pause) He seems softer. He’s not saying anything, and just seems sad.

As Colette listened to me talk to her protector, she got a different sense of that part. When I asked how she felt toward it afterward, it was clear that her self was more present. Her voice was calm, and she exhibited a confidence and compassion that had been missing in earlier discussions about this part.

She still felt sorry for that protector in the next session, so I had her convey her new compassion to the part through inner dialogue. Initially it reacted with the same kind of contempt for her that it had shown toward me, telling her that she was a worthless fool to trust me. But as I helped her keep her heart open to it, the part disclosed that it liked that she’d finally realized it had been trying to help her.

Later in the therapy, after Colette had unburdened many more exiles, she began with my support to make big changes in her life. She stopped bingeing and purging and left a relationship in which she’d been recreating some of the original abuse patterns. I’d become fond of her and reveled in her growth and in my ability to help her. Then one day, I got a phone message from her that gave me chills. The voice on the message was deep and menacing. “You can’t have her. She’s mine!” it said, and then hung up.

I called back and got no response. Suddenly I felt a knot of panic in my belly similar to the one I’d felt with Pamela. Here was a client who might be in danger, and I couldn’t reach her. Fortunately, I had a few days to work with my distress before our next session. I asked a colleague to help me with a part of me related to a time in my early life when I felt powerless to help someone. This work turned out to be revealing and valuable.

When Colette came to the next session, she looked downtrodden and reported that she was back to square one, bingeing again and attempting to reignite the relationship she’d left. She was having suicidal thoughts for the first time in years. She remembered calling me, but couldn’t recall what she’d said. Because I’d gotten so excited by her progress, I sensed my heart drop and a familiar inner voice question whether we’d achieved anything at all in our work together. I asked this part to let me stay present. I connected to her and felt the shift toward more spaciousness that comes when my self is more embodied.

I told her to focus on the suicidal impulse and ask the part of her that feared it to step back, allowing her to simply be curious. Then she was able to ask the other part why it wanted her to die. The scary voice from the phone message replied that its job was “to take her down.” I got my own nervous parts to step back and helped her stay curious about why that part wanted to do that. It told her that she deserved to die, and it was going to make sure she did. Colette looked at me and said that it seemed like pure evil. I told her to just stay calm and curious so she could talk to it and we could see if that was true.

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  • Comment Link Tuesday, 06 August 2013 15:03 posted by Terri

    I am a Borderline. I have been having a terrible time adjusting to a new therapist, after the retirement of a much loved and cared for counselor. The feelings of abandonment and loss have been horrible. Thanks for a great article that has helped me understand more about myself than years of therapy ever have.

  • Comment Link Sunday, 30 June 2013 13:03 posted by Stana Paulauskas PhD

    Excellent article and highly attuned compassion for self and client!!

  • Comment Link Wednesday, 19 June 2013 23:49 posted by Cecille del Gallego, LCSW, CEAP

    So spot on and very well articulated....I think the article captures the complexity of working with those who have had enormous pain and who have been violated on so many levels. It gives voice to the deepest yearning that is essentially in all of us - to be seen, heard, accepted and believed in. Great job humanizing this "population"...

  • Comment Link Sunday, 16 June 2013 20:57 posted by Jake Eagle

    Dick, I really appreciate your article this month, Depathologizing the Borderline Client. The specific details you shared about using IFS—both in dealing with parts of your client as well as dealing with parts of yourself—were illuminating.

    This may not surprise you, but I recently experienced remarkable success using IFS with a client struggling with multiple parts—I don't label my clients—but she most certainly would be labeled with multiple personalty disorder by most in our profession.

    I think what may have be unique in my approach is that I had her read the first 60 pages of Internal Family Systems after our first session. I asked her not to read any more of the book because I didn't want her to get caught up in the details, but the first 60 pages provided a context for our work. She immediately recognized herself reading your book and felt hopeful for the first time in her life. No one had previously been able to explain her confusion and internal conflict, but after reading your book she felt seen.

    During the six months of working with my client she has identified all of her parts, engaged in conversation with all of them, and now talks openly about her family and how they are learning to live together and love each other. It's been a remarkable and relatively quick transformation. I don't think it would have been possible without your IFS model.

    Hope you're well and maybe I'll see you again in Tulum.


  • Comment Link Monday, 10 June 2013 16:23 posted by Kimberly April (not my real name)

    Thank you for humanizing the reality of the results of adult survivors of childhood abuse, and for specific ways to help therapists effectively relate to, treat, and heal those affected by this senseless horror. I am a survivor, and yes, I saw parts of myself in your dialogue. I am almost finished with my therapeutic journey of 4 long and sometimes painful years, yet also colored by unequivocal joy encontered through the ability to finally feel and deeply connect to another human being, my therapist. I appreciate all of your research and practical steps with parts work designed to help heal a shattered self. Doing parts work was one of the most painful yet healing parts of therapy after the much feared phase of establishing safety and trust, which took a very long time, and was filled with a lot of acting out in many forms.
    Thanks again for this article and your work which has given those of us who have survived destructive secrets of the past much hope for unibiased treatment and point us to a live worth living, full of connecting with others. I am not out of the woods yet as the termination part of therapy seems to be a difficult one full of loss and pain, because although I intellectually realize that my therapist is not my father, all my little girl wants to do is take her blankie and climb up on the couch and sit next to him, because he helped me feel safe and finally alive. (This definitely is embarrassing for me because I am older than he is, and part of the baby boomer generation.)I am sure I will get through this because my therapist has given me coping skills, and I know he will walk with me to show me the way. Although he will not walk for me, he will walk with me, and that for me makes all the difference!

  • Comment Link Monday, 20 May 2013 18:22 posted by toni aguilar

    this article has excellent advice for the therapist whose "parts" get too reactive and take things personally. (one of my clients taught me the term "QTIP"--quit taking it personally.) the rage (coming at us or simply to us)that some of these clients can exhibit is very difficult for some of us to handle w/o getting weary, no matter how compassionate or skilled we are. i DO believe in and use the idea of internal family systems, and i teach all my clients that all human behavior is purposive, geared toward whatever the subconscious THINKS it needs for survival. so i try to hang onto curiosity and that compassion at my core....but whew! i find it to be very hard work sometimes, choosing just the right words, the right tone, the right demeanor to help those protectors accept all of us who are in the room! thanks for running the article.

  • Comment Link Saturday, 18 May 2013 22:02 posted by Gary Brown

    though I am not a therapist, nor a phsychologist or anything like that, I have been reading and enjoying this magazine for five or six years. I found this article to be very interesting and if I might dare to say, insightful. I talk with a lot of people and many of them ask me questions similar to those a therapist might receive.
    I like to relate back to different articles I have read in this magazine to suggest things to those people. Many times I find that those to whom I speak find the way we interact to be thoughtful and insightful, I suspect this article will lead to further insights I might be able to share with those who ask for my input.
    Thank you for the article, I feel it was a very worthwhile read.

  • Comment Link Wednesday, 15 May 2013 16:14 posted by Suzanne Watts

    As a therapist treating survivors of sexual abuse, this article was very informative for me. Therapists can be very nervous about treating clients who have been diagnosed with Borderline Personality Disorder, especially if they are described and identified with that label. Viewing these clients as trauma survivors enables therapists to reframe their own countertransference reactions and possibly see the clients in a different light, as you so elequently pointed out.

    However, as the article concluded it appeared as though you might have been referencing a client with Dissociative Identity Disorder (Colette in your article). It is difficult to tell given the brief summary of your interactions. I found that internal family systems therapy is very effective in treating DID and am interested in learning more about it.

    In any event, all trauma therapists can benefit from helping clients speak to their inner "parts" which may have opposing messages at first glance.

    Thank you for the informative article!

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