Learning to Manage Our Fears
By Richard Schwartz
Inevitably, given their history of trauma, many borderline clients will trigger their therapists from time to time. But forgoing the urge to blame these clients and taking responsibility for what’s happening inside you can become a turning point in therapy.
I’ve specialized in treating survivors of severe sexual abuse for many years, which means that many of my clients fit the diagnostic profile of borderline personality disorder. Therapists typically dread these clients since they can be among their most difficult, unpredictable, and unnerving. My clients have often been highly suicidal—some threatening suicide to manipulate me, and others making serious attempts to kill themselves. Many have been prone to self-harm, cutting their arms or torsos and showing me the raw, open wounds. I’ve known them to binge on alcohol to the point of ruining their health, to drive under the influence, and to show up drunk for sessions. Sometimes they’ve acted out by stealing and getting caught or exploding into such rage in traffic or on the street that lives were actually in danger.
At times, they’ve formed a childlike dependence on me, wanting—and sometimes demanding—not only my continual personal reassurance, but also my help in making even small decisions, like whether to get a driver’s license. Some have had tantrums when I’ve left town. Others have wanted regular contact between sessions and asked to know in detail how I felt about them and what my personal life was like. They’ve continually tried to stretch my boundaries by demanding special treatment—such as free sessions and extra time on the phone to talk about every detail of their lives—or violating my privacy by finding out where I live and dropping by unannounced. When I’ve set limits on my availability by telling them when or if they could call me at home, some have responded by implying or stating outright that they might cut or kill themselves.
Sometimes I’ve been idealized—“You’re the only person in the world who can help me!" Other times, I’ve been attacked with head-spinning unpredictability—“You’re the most insensitive person I’ve ever known!” During therapy, some clients have suddenly shifted into behaving as if scared young children had just taken over their bodies; others have erupted in almost murderous rage at seemingly small provocations. Repeatedly, progress in therapy has been followed by self-sabotage or a backlash against me that’s made treatment seem like a Sisyphean nightmare.
Early in my career, I'd react to such behaviors as I'd been taught: correct the client’s misperceptions about the world or about me, firmly enforce my boundaries by allowing little contact between our weekly sessions and refusing to disclose my own feelings, and make contracts for them to help them refrain from harming themselves or acting out. Not only did this rational, impeccably “professional” approach typically not work, it usually made things worse. My careful, neutral responses seemed to turbocharge client dramas, and I spent large chunks of my life preoccupied with clients who never seemed to get better.
In retrospect, I can see that despite my best intentions, I was subjecting too many of my clients to a form of therapeutic torture. By interpreting some behaviors that scared me as signs of severe pathology and others as forms of manipulation, I often made matters worse. I hardened my heart against these troubled clients, and they sensed it. They felt that I’d abandoned them emotionally, especially during crises, when they most needed a loving presence. My well-intentioned attempts to control their risky behaviors frequently convinced them that I didn’t get it, and even that I was dangerous, no different from their coercive perpetrator.
Of course, I’m not alone in having these experiences. Many therapists become detached, defensive, and directive when confronted with the extreme thoughts and behaviors of their borderline clients. It’s hard not to have these reactions when you’re responsible for protecting someone who seems out of control. Alternatively, some therapists react by trying to be even better caretakers, expanding their boundaries beyond their comfort level until they grow so overwhelmed and resentful that they end up unloading their clients onto someone else.