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Depathologizing The Borderline Client - Page 2

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The Internal Family Systems Perspective

These struggles can result just as much from therapists’ reactions to their clients’ behaviors as from the clients’ intrapsychic extremes. How therapists react is largely determined by their understanding of what’s happening. The Internal Family Systems (IFS) approach, a model that I’ve developed over the past 30 years, offers an alternative to conventional ways of working with borderline clients. It can make the therapist’s task less intimidating and discouraging, and more hopeful and rewarding. From the IFS perspective, borderline personality disorder symptoms represent the emergence of different parts, or subpersonalities, of the client. These parts all carry extreme beliefs and emotions—what we call burdens—because of the terrible traumas and betrayals the client suffered as a child.

The central task of IFS therapy is to work with these parts in a way that allows the client’s undamaged core self to emerge and deep emotional healing to take place. If each part—even the most damaged and negative—is given the chance to reveal the origin of its burdens, it can show itself in its original valuable state, before it became so destructive in the client’s life.

Suppose that you were sexually molested, repeatedly, as a child by your stepfather and could never tell your mother. As an adult, you’ll probably be carrying parts of yourself stuck back in those scenes of abuse, isolation, and shame. Those parts remain young, scared, and desperate, and when they surface in your consciousness, you’re pulled back into those dreadful times. This cycle raises the same terrible memories, emotions, and sensations that you swore decades ago never to think about again. I call these parts your exiles because you try to keep them banished and locked away, deep inside. However, when not actively hurting, these parts are sensitive, trusting, playful, and imaginative, so suppressing them stifles some of your capacities for love and creativity.

Much of the time, these exiles remain hidden. They’re kept buried by protective parts, which use various strategies to prevent you from experiencing them. One strategy is to prevent the exiles from being triggered in the first place. These protectors organize your life so you avoid anyone who reminds you of the stepfather and remain at a safe distance from people in general. They constantly scold you, forcing you to strive for perfection to keep you from being criticized or rejected—which would bring up the feelings of shame, fear, and worthlessness carried by the exiles. Despite these protective efforts, however, not only does the world still manage to trigger your exiles, but the exiles themselves want to break out of their inner jail so that you’ll deal with them. Their breakout strategy comes in the form of flashbacks, nightmares, panic attacks, or less overwhelming but still intense and pervasive feelings of anxiety, shame, or desperation.

To escape the bad feelings generated by the exile states, other parts of you develop an arsenal of distracting activities, to be used as needed. You feel the urge to get drunk, or you abruptly go numb and find yourself feeling confused and flat. If those efforts don’t work, you may be both comforted and terrified by thoughts of suicide. If you qualify for the borderline personality disorder diagnosis, it’s likely that you also have two sets of protective parts that specialize in handling relationships: the recruiters and the distrusters.

Suppose your mind were a house with lots of children and no parents. The younger children are badly hurt and needy, and the older ones, overwhelmed with the task of caring for them, have locked them in the basement. Some of these older ones desperately want to find a grown-up to take care of these basement orphans. These are the recruiters. They search for likely prospects—therapists, spouses, acquaintances—and make use of your charm to recruit those people into the role of redeemer. However, these recruiter parts share with your exiles a sense that you’re basically worthless, that as soon as people see how vile you are, they’ll bolt. They believe you have to prove yourself special in some way or manipulate people so they’ll continue to play the redeemer role. The recruiters also believe that caring for your exiles is a full-time job, so they try to invade the life of whomever they target.

Among the older kids in this house of your mind is a faction that tries to protect the basement kids in a different way—by trusting no one and keeping them away from people who might falsely raise their hopes of liberation. These protectors have seen in the past what happens when the exiles attach too strongly to a potential redeemer. The exiles become infatuated with the supposed redeemer, who inevitably lets them down by never helping enough, or even by becoming repulsed by their neediness. The protectors have seen how the redeemer’s distaste and rejection devastates the basement children, so these “big brothers” make sure you remain isolated, detached, completely engrossed in work, and emotionally unavailable. They remind you that the redeemers flee because you’re truly repulsive—and that if others are allowed to get close enough to see you as you really are, they’ll be disgusted, too.

Whenever your recruiters override the distrusters and succeed in getting you close to someone, these distrusting protectors watch that person’s every move for signs that the person is false and dangerous. They scan everything about your therapist, for instance—from his taste in clothes and office furniture to perceived shifts in his mood or lengths of his vacation. They then use these imperfections as evidence that he doesn’t really care or is incompetent, especially if he ever does anything that reminds you of your perpetrator. If your therapist uses a similar phrase or wears a similar shirt, he becomes your stepfather. So your therapist innocently enters the house of your mind and quickly finds himself caught in the crossfire between these sets of protectors: one set will do almost anything to get him to stay, and the other set will do almost anything to get him kicked out. If the therapist lasts long enough, he’ll be subjected to the suffocating needs of your basement children and exposed to the disturbing methods the older children use to keep them contained. A therapist unprepared for this inner war or untrained in approaching these various internal factions will become embroiled in endless battles.

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  • Comment Link Monday, 18 November 2013 18:45 posted by OLAF HOLM

    Magnificent article from Dr. Schwartz; for us IFS people it´s a big plus for our daily work

  • Comment Link Monday, 04 November 2013 19:48 posted by Jeff Kayes, LPCC

    I don't think I will apply for sainthood anytime soon! Your article was humbling for sure. I found that I had to remind myself (quickly!) that I do succeed with some of my clients. Thank you for your brutal honesty with your internal reactions in working with these two women.

  • 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.

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