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Depathologizing The Borderline Client - Page 4

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Internal Family Systems in Action

I recently began work with a 42-year-old client named Colette, who’d been in and out of several treatment centers for an unresolved eating disorder and diagnosed by the last two centers with borderline personality disorder. Like so many borderline clients, she’d been sexually abused as a child—in her case, by a neighbor. However, her previous treatments had focused mainly on getting her to examine and correct her irrational cognitions around the eating disorder.

She told me she’d heard that I was good at helping people with their traumas. I said I could help her with the parts of her that had been hurt and were stuck in the past. I added that we wouldn’t visit those parts until we’d gotten to know them and received their permission to approach those emotions and memories. In subsequent sessions, I helped Colette talk to and reassure several different protectors, including her eating disorder, so they wouldn’t be afraid of our contacting her exiles.

Once she got tentative permission to proceed, I encouraged her to focus on the memory of the abuse. She saw herself as a curious 5-year-old girl who’d been lured to the neighbor’s house to play with his pet bunnies. Colette became able to witness the ensuing abuse scene with compassion for her younger self. In her mind’s eye, she could then enter the scene and bring the girl to safety. Her protectors were relieved to see that this part was no longer so vulnerable and said they were considering taking on new roles. As Colette left that session, she said she felt hopeful for the first time in a while. I was moved by the intensity of the work and grateful for the privilege of being allowed to share in her journey.

In the next session, however, Colette was distant and shut down. She said she had no memory of what we’d done in the previous session and that continuing to work with me wasn’t a good idea. She added that she’d come in just to say that this would be our last session. There was no talking her out of it.

Despite knowing better, there are still young parts of me that get disappointed by such sudden downturns and others that feel pouty when I work hard to help someone who doesn’t appreciate it. So at that point, one of my own protectors took over, and I said with cool, clinical detachment that I was really sorry to hear this news, but if she was certain, I’d be happy to give her referrals. As we chatted a little longer, I had a chance to notice the reactive part of my own personality that had been triggered. I reminded it through inner dialogue that it didn’t have to take over. I know you think she’s ungrateful, I told my reactive part, but it’s really just her own protective parts that are scared. Just relax a bit. Let me handle this and I’ll talk to you after the session.

As my protective part receded, I sensed returning feelings of empathy and care for Colette and gained a clearer perspective on why she was being so distant. I interrupted our conversation and said, “I owe you an apology. Your wanting to stop surprised and disappointed me. I’ve been feeling really good about the work we’ve been doing and want to keep going. I get that our last session upset some parts of you that maybe we need to hear from, and I’m totally open to that.”

Colette thanked me for my time and said she appreciated my honesty, but she still wanted to stop. Then, during the week, she called to ask if we could meet again. At that next session, she said that my telling her that I wanted to keep going had meant a lot to her and she’d already negotiated with the part that had fired me to give me another chance. I told her I was glad for the second chance, but that I wasn’t sure what I’d done to be fired in the first place. She said she wasn’t sure either, so I told her to focus on the part that had pink-slipped me and ask it why. When she did, she said the part refused to answer and started swearing at her instead. I had her ask the part if it was willing to talk to me directly. The answer was yes.

Dick Schwartz: Are you there?

Colette’s Protector, in a harsh voice: Yes. What do you want?

DS: So you’re the part that fired me. Is that right?

CP: That’s right! She doesn’t need this bullshit. And you’re such an asshole!

(There’s a part of me that reacts reflexively to being called names. I had to ask this part to relax so that I could stay curious.)

DS: I appreciate your willingness to talk to me. I want to know more about why you think what we’ve been doing is bullshit or why you don’t like me.

CP: You’re no different than the last two loser therapists. You all get her hopes up and then shit on her.

(I sensed a part of me wanting to argue with her protector and convince it that I’m different, that I’m safe and won’t hurt her. I reminded it that this approach doesn’t work.)

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  • Comment Link Friday, 27 September 2013 18:02 posted by Sherry J. Zitter LICSW

    This is a moving, skillful and superbly helpful article to me. It ha shifted my relationship to 2 of my clients who have a huge amount of self-hate and a tough time holding onto the work we do in between sessions.
    The most useful part for me, of course, is the focus on noticing my own parts and how they can take over my natural compassion and wisdom. When I unblock my own heart, and open it toward any client is any situation with deep curiosity, miracles can happen -- as Dick shows us time and again.

  • 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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