An Early Wake-Up Call
Early in my career, before developing IFS, I began seeing Pamela, an obese, 35-year-old office manager who came to the mental health center where I worked complaining of depression and compulsive eating. In our first session, she said she thought her dark moods might be related to having been sexually abused by a babysitter when she was 10 years old, but that she also felt alone in life and stuck in a job she hated. She liked that I was young and seemed kind, and wondered if she could come in twice a week. I, in turn, looked forward to working with her, appreciating how eager and articulate she was compared with the sullen adolescents who made up much of my caseload. For a number of sessions, I coached her as she debated leaving her job and developed an eating plan. I felt confident that her trust in me was growing, and I was enjoying the work, which seemed to be progressing nicely.
Then came the session when she began talking about the abuse. She became frightened and weepy and didn’t want to leave my office at the end of the hour. I extended the session until she seemed to recover and could leave. I was bewildered by this shift, but understood that we’d hit on an emotional subject.
In her next session, Pamela was apologetic and worried that I wouldn’t work with her anymore. I reassured her that I thought the last session had been the beginning of something important and that I was committed to helping her. She asked if she could come in three times a week, in part because she was having some suicidal thoughts. I agreed.
This pattern repeated in the following session: she began talking about the abuse, then became mute, started to cry, and seemed increasingly desperate. I tried to be empathically present, trusting my Rogerian instincts. The subsequent session began in the same way, and then someone knocked on my door. Although I ignored the knock and encouraged Pamela to continue, she erupted furiously, “How could you let that happen? What’s wrong with you?!”
I apologized for forgetting to put the in-session sign up, but she’d have none of it and bolted from the office. I tried futilely to reach her several times that week, grew increasingly panicked as she missed all her appointments, and was about to call the police when she showed up unannounced at my office, repentantly pleading for me to continue seeing her.
I did continue, but no longer with an open heart. Parts of me had felt powerless and frightened during the week she was missing, and other parts resented the way she’d treated me. I should have had the sign up, but her reaction was way over the top, I thought. I began resenting all her requests for more of my time.
I’m now certain that the work with Pamela didn’t go well in large part because she sensed this shift in me and my feelings about her. There were further suicidal episodes and escalating demands for reassurance and more time. She even began running into me on the street. I suspected she was stalking me—which made my skin crawl. Try as I might to hide it, I’m sure my exasperation and antipathy leaked out at times, making her recruiters more desperate to get me to care and her distrusters more invested in driving me away.
After about two years of working with her in this way, she died suddenly of a heart attack related to her obesity. I’m ashamed to admit that I mostly felt relief. I’d never developed any real awareness of my role in her downward spiral and had been feeling increasingly burdened by this “hopeless borderline.”
After many years of learning from clients like Pamela about their inner systems, my style of therapy has changed radically. From that experience with her, I understand why so many therapists retreat to their own inner fortresses, hiding their panic and anger behind a façade of professional detachment. If you don’t have a systemic perspective on what’s going on, you’re faced with what seems like the wildly oscillating expressions of different, often contradictory, personalities.
From the IFS perspective, however, the shifts in demeanor that signal the appearance of different subpersonalities aren’t bad news. Far from necessarily being evidence of extreme pathology on the client’s part or incompetence on the therapist’s part, the emergence of these subpersonalities signals that the client feels safe enough to let them out. In IFS land, things like flashbacks, dissociation, panic attacks, resistance, and transference are the tools used by the different parts and, as such, are useful signposts indicating what needs to happen in therapy.
If therapists understand borderline personality disorder in this way, they’re more comfortable with jarring shifts, personal attacks, desperate dependence, and apparent regression, as well as controlling and coercive behaviors. Because these behaviors aren’t signs of deep pathology, they shouldn’t be taken personally. They’re part of the territory. The attacks are coming from protective parts whose job it is to make you feel bad and force you to retreat. The regression isn’t a crossing of the border into psychosis: it’s a sign of progress because the system feels safe enough to release a hurting exile. The manipulation and coercion aren’t signs of resistance or character disorder: they’re just indications of fear. The self-harm and suicidal symptoms aren’t signals of scary pathology: they’re attempts to self-soothe.
This perspective can help you remain the “I” in the storm—grounded and compassionate in the face of your clients’ extremes. It’s like having X-ray vision. You can see the pain that drives the protectors—which helps you avoid overreacting to them. The more accepting and understanding you are of your clients’ parts when they emerge, the less your clients will judge or attack themselves or panic when they feel out of control. The better you get at passing the protectors’ tests, the more they can relax, allowing your clients’ calm, confident, mindful self to separate from the protectors and emerge.
A hallmark of IFS is the belief that beneath the surface of their parts, all clients have an undamaged, healing self. At the beginning of therapy, most borderline clients have no awareness of this inner self, so they feel completely unmoored. In the absence of self-leadership, parts become scared, rigid, and polarized, like the older kids in the parentless house. As the therapist perseveres with his or her calm, steady, compassionate self, clients’ parts will relax, and their self will begin to emerge spontaneously. At that point, clients will start to feel different, as if the stormy waves of life are more navigable.