ANSWER:
Borderline personality disorder is an emotional developmental fixation that would be age appropriate to the toddler. Before I get into the meat of your letter; lets review relevant theory to set my response into perspective.
Vestiges of theory
components were annexed from a paper titled: “An Object Relations Approach to
Understanding Unusual Behaviors and Disturbances – K. Stringer”
Source
This paper has
applied widely accepted models grounded in object relations. The main
source of this material was lifted from the observations, conclusions and
scholarly work of Margaret Mahler and her dedicated collages. Mahler had
secured grants that funded a major project that setup a natural framework to
observe mothers interactions with their children as they moved through their
developmental phases. Mahler’s carefully arranged setting for
observations (one-way glass) included an infant’s room and a transitional
hallway that led into the toddler’s room. “Thus, we had an
observational situation that provided many opportunities for the observation of
mother-infant separations and reunions. [4] Mahler arranged experiments to
measure the infants and toddlers frustration toleration when separated from
mother at different time intervals. Data was collected based on the
degree of attunement in which mother and infant were able to communicate.
Mahler and her collages observed passive separations as well as deliberate
separations, i.e. when mother would leave the room for an interview with staff.
Symbiosis Phase
Symbiosis in the real
sense is a mutual beneficial relationship between two different
organisms. Mahler’s symbiosis is a metaphor to explain the infant’s
innate perception that he resides within the nuclear orbit with mother, and
that their mutual beneficial relationship is omnipotent, from which he is the
center. The infant now perceives mother as a powerful extension of
self. Mahler explains the symbiotic relationship between mother and
infant in this way “The infant
behaves and functions as though he and his mother were an omnipotent system – a
dual unity within a common boundary [4]. The infant’s delusional concept suggests that he is much greater and
grandiose then really he is. In other words, the infant cannot
conceptualize mine from not mine, and I from not-I. It is as though there
is a fusion that reverberates between mother and infant. For example: The
infant’s feels tension and cries. The cry is routed though the symbiotic system
(mother-infant dyad) from which he is the center, and the tension is relieved
by his ‘wish’ (mother is an extension of himself).
(Note: it is this
nexuses dream like state, this blissful belief of tranquility that imprints a
powerful symbiotic magnetic pull (SMP) in the newly formed structures within
the infant’s pathology. Gradually this pathology is repressed into the
unconscious, but remains a force, a
regressive pull to return to oneness-with-mother (a magnetic pull to be
one-with-creation).
Rapprochement
This is perhaps the most critical stage of the separation
individuation process.
The toddler is becoming acutely aware of his separation from mother; compared
to his early delusion that mother was an omnipotent extension of himself.
As the symbiotic safety net diminishes, his separation anxiety gains momentum.
The toddler is more concerned with mother’s whereabouts and demonstrates his
anxiety through active approach behavior (rapprochement). To make
things for difficult for the toddler, he is not able avail himself as easily to
his ‘contact supplies’ in mother as he was in the past. There is a mutual
realization between mother and toddler that he can do more and more for
himself. Consequently, mother’s response to the toddler’s anxiety and
frustrations are at greater and greater intervals, and the toddler’s defense
to this crisis is an active approach. We call this rapprochement.
Separation is more
pronounced due to the onset of verbal progress. Separation becomes
further apparent due to nouns “mine” and “me” and especially ‘no.’ Of course
the pervasive and intrinsic component of ‘no’ is ‘my way and not your way,
which establishes a continual awareness ‘self’ that is splitting away from the
symbiotic orbit of ‘us’, the dual unit.
In other words, repetition of “no” is a way of practicing the individuality of
“I am.” What seems negativistic may actually be positive process toward
developmental growth.
Often
theorists suggest that rapprochement is specifically vulnerable in the
separation individualization sequence because of possible unaligned growth
spurts. For example, if the toddler’s gains access (growth spurt) to his
upright locomotion (individualization through new experiences) before he is
developmentally ready to emotionally separate from mother (separation) then the
toddler is at risk for overwhelming anxiety. Because mother is not as
available to metabolize and modulate the toddler’s intolerable affect (mood,
feelings), he is subject to the perils of abnormal pathology. This observation
suggests that is helpful and a benefit to the toddler when individualization is
aligned with separation from mother. A considerable acceleration or lag
in either environment can manifest as disturbances throughout the life cycle.
Shadowing and Darting
Away.
This dynamic operates
like a push-pull behavior. In essence, the child runs away from mother and
expects to be swooped up in the safety of her arms. Ambivalence is
striking and evident since the child wishes for dependence on mother (shadowing)
and then independence (darting away). It becomes a flirtatious game of
play, of testing new capacities toward independence. It can also become
an ambivalent nightmare. However, there are times the junior toddler may
not wish to be swooped up and may react with rage on contact. Other times
the child is permitted greater expansions that may lead to the engulfment of
the void, and this emptiness may also cause rage. To the observer it
appears as a no-win situation. During this period the child is in an
emotional crises and cannot tolerate ambivalence.
Abandonment
When
a child becomes separated from mother before he is emotionally ready, his
libido reserves may not be sufficiently in place to overcome separation
anxiety. This anxiety engenders insecurity and neediness.
The
rapprochement toddler is peculiarly vulnerable due to his increasing autonomy
along with his elevated cognation. He can no longer contain the illusion
of the symbiotic orbit that he and mother operate as one. As the
rapprochement toddler separates, his individualization is more apparent because
reality is gaining ground. There is a growing realization that mother
will not share in his quest for new discoveries at his beck-and-call. We
now have a clash. The toddler has gone from a ‘high’ to a ‘low’ in a
short time during the shift from one phase to the next. Some theorists
speculate that resolution of the rapprochement phase sets toddler’s ‘base mood’
for life. This model suggests that is it prudent that good-enough mother establishes attunement
with her toddler to survive the rapprochement crisis.
A child that is
deprived from being emotionally refueled can be haunted with pervasive
emptiness and a lack of identify, or a loss of self. This is how
one fixated adult put it:
It’s
hard to be a child in a grown up world. It’s a feeling of being
lost. It’s sad sometimes because when I see other children they don’t
look lost. They have parents, structure and guidelines. This helped
them grow and form into an adult. They went through the maze and arrived
at the other end. It was a maze I have never had the opportunity to
enter. What is structure? I remember at 6 being on the other side
of town in the blackness of the night. No one cared where I was.
What are parents? I can’t ever remember being loved, rocked, cuddled or
held. I have no memory traces of this. What are guidelines? I
had none and made them up as I went along in life. I’m afraid my
guidelines are not very stable since I didn’t have a measuring stick that was constant
in my life. Is it any wonder that
I am still a lost child that is pretending to be an adult?
The Rapprochement Crisis
As the child becomes
psychically and cognitively aware of his new budding world, he becomes
increasingly conscious that he can no longer maintain his delusional symbiotic
orbit with mother. Mahler states that “While individuation
proceeds very rapidly and the child exercises it to the limit, he also becomes
more and more aware of his separateness from mother.” The crisis of
the rapprochement subphase heightens as the child realizes mother is not an
extension of himself, but he is rather a small, helpless diminutive
individual. In contrast to the practicing phase when the child’s
narcissism was at its peak and the world was his oyster sort of speak, the child is now overwhelmed with
narcissist injury on a daily basis. The world that seemed as a
treasure trove for new opportunities to conquer with his new ambulatory
locomotion during the practicing phase is now being delineated by the harsher
psychical boundaries of reality. He cannot do as he anticipated. It begins to dawn on him that he is
not as grandiose or powerful as his first imagined.
The failure to reach
a resolution during the developmental phase can have far reaching
implications. “As old, partially unresolved sense of self-identity and
of body boundaries, or old conflicts over separation and separateness, can be
reactivated (or remain peripherally or even centrally active) at any and all
stages of life…”
Symbiotic Magnetic
Pull (SMP)
Matterson found that treating certain patients was
difficult because there “is still a strong internal regressive pull to
maintain the old familiar rewarding object relations unit” [11]. The Symbiotic
Magnetic Pull (SMP) derives from the unconscious attraction to the
symbiotic orbit of the mother-infant dyad that was experienced when mother was
conceptualize as an extension of the self (symbiotic phase), as a container
that resolved and metabolized anxiety through her affect modulation. The strength of the SMP is a regressive
force, an energy, a ‘pull”. SMP is conceptualized as a nexuses, a oneness with creation, a
completeness. For example, this force to return, to regress is
exemplified with the rival of baby into the family unit in the face of an older
child.
Here
we see “another form of attempted adaptation was identification with the rival baby. Matthew showed signs
of wanting to be a baby himself; like this baby brother, of instance, he would
climb into the playpen [4]. Mother was intolerant of his regressive
behavior and Matthew; the happy radiant child began to adapt aggressive conduct
by throwing objects out of frustration.
It was observed that Matthew had lost his spark for life in service of the
mother, the influence of the false-self, “all of which on superficial
observation seemed to be in compliance with mother’s wishes that he be
independent and remain her happy little “big” boy [4].
The influence of the
SMP will vary depending on the progress on the separation – individualization
phase. The greater the symbolic pull,
the more likely the individual is developmentally conflicted with
unsatisfactory object constancy. If the individual’s development is
static and held in abeyance because insufficient maternal reserves are absent
or not fully integrated, the individual may become fixated and employ primitive
defensive mechanisms (regressions, splitting and etc.) to relieve anxiety.
SMP, Anxiety and Defense Mechanisms
To
simplify, anxiety derives from three sources (pressures) of conflict. To
simplify, they are (1) pleasure seeking (impulsive) and the aspects needed to
survive, (2) morals and perfection, formed out of punishment and rewards, and
(3) the external world (reality). Depending on the source of conflict,
defense mechanisms are automatically activated to prevent the individual from
the harshness of reality. Defense
mechanisms distort or distract an individual from the full impact of reality.
If the defense mechanism(s) is successful, a compromise has been reached between
the opposing forces toward a decision that enables the discharge or
displacement of anxiety. However, when defensives are primitive or
ridged, and the personality is rendered with inflexibility, then there is
likely a disturbance in the Separation – Individualization phase that is
yielding to the SMP. In other words, the inability to defuse anxiety
renders the individual prey to the regressive, symbiotic magnetic pull of
oneness with creation. Primitive defenses closely orbit the SMP due to
its greater gravitational pull, then the more distant orbits of sophisticated
defenses.
Primitive Defenses
(Close orbit to the SMP)
Regression: Return to an
earlier developmental level of functioning prompt by anxiety. For
example, an individual overtaken with losses collapsed into a fetal
position. An adult clutches a stuffed bunny (transitional object) to ease
anxiety. A child temporarily reverts to dependence as a relief from the
new responsibilities of independence.
Splitting: Separation of
internal objects that create anxiety. For example individuals that cannot
tolerate ambivalence (shades of gray) will split a person as ‘all-good’ or
‘all-bad.’ It creates less anxiety to completely hate a person that is
‘all bad.’
Projection: Decrease
anxiety by deferring responsibility onto others. It is easier to tolerate
‘You made me do it’ rather then ‘I did it.”
Denial: Stops anxiety dead
in its tracks. “How can I be upset if it didn’t
happen?”
Maturity
vs. Fixation and Object Constancy
After
separation – individualization has been sufficiently resolved; a more mature
defense against the SMP has evolved. The child is able to internalize a
consistent, available image and the essence of mother though repeated
satisfactory (good enough) interactions with her. The child’s integrated
conceptualization of mother satisfies the demands of the SMP and helps regulate
anxiety. We call this object constancy.
As the child matures
and the SMP is adequately satisfied with the constant internalized mother
object, a new dynamic begins to take shape reaching into youth and adulthood.
The constant object within the youth/adult reverberates with the SMP to form a
more integrated sense of self, a new dual unit. The self becomes integrated within the self, no longer seeking
the maternal nurturing though the original symbolic mother - infant dyad.
What has emerged is an individual that has separated from the unconscious
nexuses of mother. The individual is now ready to enter into a more
mature libidinous relationship with ‘other’, a life partner.
In the absence of the
more mature (integrated) sense of self due to disturbance in the separation
individualization phase, manifestations to recreate and replay a failed
situation in hopes of a better outcome can become chronically and compulsively
intrinsic with the individual’s pathology. Treaters find this especially
difficulty according to Matterson and Chathan “They bring nothing into the
treatment that will disrupt the symbiotic fantasized relationship with the
therapist and thus activate depression [11].
Symbiotic
Magnetic Pull (SMP) and Manifestations
Because SMP is a
regressive force, its vicissitudes may become apparent though the manifestation
of unusual behaviors. These behaviors are the result of mechanisms that
were created to satisfy the unconscious demands for emotional
equilibrium.
Borderline Personality Manifestation
Individuals with borderline personality disorder are
fixated at an emotional developmental age of 1 1/2 to 3 years. Mahler
delineated this span as the rapprochement subphase within her widely accepted
model. The hallmark traits of borderline personality disorder (BPD)
are a lack of identity, pervasive emptiness, excessive anger and the inability
to regulate emotion. The sources of these symptoms were caused by the
dynamic, ambivalent and powerful struggle between the SMP vs. individualization
during the rapprochement subphase. “The rapprochement subphase is
where the fixation becomes apparent, with the point of origin in the symbiotic
phase [11]. Here we see dependence vs. independence.
Emptiness – lack of a maternal constant object
Since the subphase of
object constancy has not developed within the borderline individual, he resides
predominately within the rapprochement subphase. There is a constant
reverberation of the push-pull behavior. A sort of “I hate you, don’t leave me’
or ‘I run away, come rescue me’ dynamic. We see this because a borderline
individual has not internalized the ‘all-good nurturing maternal object’
(emptiness) and when his fleeting maternal supplies diminish, there is a
run-away behavior to prompt the chase. We can sum it up in this way, “If
you catch me, you love me, if you don’t catch me, you hate me.” When
‘captured’ the borderline individual’s maternal supplies are replenished for a
time. We can see this clearly when the borderline patient tries to woo
and extract maternal attention from the treater. If the treater fails,
like the toddler, the borderline patient will up-the-stakes, sort of
speak. Note this observation in the toddler. “It is quite impressive
to observe the extent to which the normal infant-toddler is intent upon
extracting, and in usually able to extract, contact supplies and participation
from the mother, sometimes against considerable odds; how he tries to
incorporate every bit of these supplies into libidinal channels for progressive
personality organization [9]. Here we see that the borderline
individual is behaving as the normal toddler through rapprochement with his
treater. The problem a treater faces is that active approaching
(rapprochement) and the ‘catch’ appears as chronic, and therefore draining on
the reserves of the therapeutic relationship. Sooner or later the
therapeutic relationship with the borderline individual will take the normal
course into a rapprochement crisis that is age appropriate with the
toddler. What may appear to a treater as ‘regression’ is actually a
resuming course of development that was fixated in childhood.
Response – Part 2
Now that theory is
out of the way, lets address your letter.
Projection vs. Containment
Lets
turn things inside-out for a moment to understand how the treater viewed the
situation. After she gave up her lunch to squeeze in the client,
she was saddled with additional anxiety when the client disappeared and then
later reappeared in the waiting room. And, once the client entered her
office (the holding environment), rather then containing the situation, the
treater projected the ungrateful and impatient client that resided within her
back on to client. In the treater’s unconscious mind, through the
mechanism of a countertransference reaction, the treater’s impulse was to rid
herself of the unappreciated object, as if to say, “These are your yucky
emotions, not mine.”
On
the other hand, with insight to dynamics of pseudo-manipulation and an
understanding of the symbiotic magnetic pull (SMP), the main and active force
of rapprochement complex, she would have been better equipped to
therapeutically handle the situation. In this case, rather then
taking it personal, (I gave up so much for you and you don’t appreciate it), it
would have been more advantageous if she had provided a ‘container’ to ‘hold’
the raw and toxified objects (Bion) until they could be soften and handed back
in a more attractive form. For example, when the client entered into the
treater’s office, the treater was holding the toxic objects of frustration, (I
changed my schedule to get you in), and anxiety, (you walked out on me, what is
going on?) in their raw form. However, at this point if the treater
‘continued’ to hold these unattractive objects (frustration, anxiety) while the
client conveyed her feelings…i.e. “I feel out of control”, “I feel suicidal,”
“I am not manipulating” etc., then the client would have had an opportunity to
expressed herself. At this point, the treater can begin to detoxify the
objects and make them more attractive for the client to handle. For
example, the treated could say, “Yes, I understand this can appear as
manipulation, but we understand that is it not (validation). Individuals
with borderline personality disorder often behave as children when they are
unconsciously reaching out for a parental figure (the all good object) and in
many cases; this causes them more problems (validation again). We
need to figure out the dynamics you have toward me as a parental figure and
explore additional resources for you when you feel overwhelmed.” Here, the
treater had acknowledged herself as a perceived parental object (validation)
and offered to look for ‘more’ resources, rather then abandoning the
client…i.e. “This is a manipulation tactic and you are trying to control
me.” This sort of a response invites problems because it has the
undertones of an invalidating environment (repeated from past childhood
[Miller]), meaning there is a risk of the therapeutic alliance would get put on
hold until the misunderstandings are cleared up, if at all.
Ideology
of INvalidation
Individuals
with borderline personality disorder and need structure. What may ‘appear’
to be the craving of constant reassurance, is really a sincere attempt to
delineate some sort of solace of consistency. When you think about it,
many of the borderline symptoms are intrinsic of their shifting perception and
instability. For example, splitting is a defense that changes perception
with rapid and marked opposites (poor stability). Lack of identify also
signifies poor interpersonal boundaries and an empty sense of self (the
abyss). When we blend instability within the abyss, we see an individual
that questions their emotions on a regular basis. It is not
uncommon that these confused persons seek clarification on the simplest
terms. As one client shared, “When I ask her
a question about feelings or emotions, which is pretty simplistic to those who
weren't traumatically abused, she thinks I'm asking her something I already
know the answer to just to get an answer. It just infuriates me.” This statement is reflected in the material and work of
writer Alice Miller. Her studies reflect that children who survived an abusive
childhood, ended up doubting their simplest emotions. Since as
children, they hadn’t experienced a constant role model, they lacked the gold
standard in which to compare their emotions. For example the child says,
“I’m thirsty.” And then came the invalidating response, “You are not thirsty,
you just had a drink of water.” This underscores the paradigm of an
invalidating environment. The child is taught not to trust their
most basic emotions by what they view as almost God-like role models.
You
Echoed It, Therefore It Is.
A
times treaters are perplexed when the client asks them to explain the
appropriate feelings for a given array of circumstances. At other times the
treater may interpret the client’s request as a manipulation tactic to elicit a
pathetic response (the despised and needy provoker). When in reality,
what sits before the treater is an emotional child fixated in the rapprochement
sub-phase of separation-individualization. The fixated individual is unsure and
confused as to how to experience appropriate emotions on a consistent basis.
Therefore, it is not unreasonable that the treater offer a supportive ego as a
new model of object constantly for the individual with borderline personality
disorder. And, this is ‘not’ a short time, I said it once, there, we are
done with it, procedure. As with the rapprochement child, the renewed
process begins with constancy, repetition and proper empathy.
SMP
vs. Validation, Reality, and Limits
Imagine,
being an intellectual adult governed by rapprochement fixation. The
symbiotic magnetic pull (SMP) is relentless; to be one again with the Nexus
(the all nurturing embodiment) is ever pervasive. Yet, the force of the
SMP can be counterbalanced with validation, reality and boundaries. For
example, we state, “Total surrender to the SMP equates to decomposition of
acute regression or psychosis. This path may lead to locked inpatient
long-term custodial care at a state hospital. Any chance you have at a
real life to experience joy would be put on hold. How would you feel
about that?”
To
counterbalance the pervasiveness of the SMP, we use intervention, i.e.
validation, reality and limits. First, we began with validation, “Yes, it
makes perfect sense that you need/want me to mother you, and take care of you
(validation/reflects understanding). You deserve that. You deserve a ‘do
over.’” This improves the clients sense of being understood. Now we
attach truth. “Yet, in reality, this would be impossible. I can’t be a
real mom and take you home and start all over again. I know that on some
level that is sad to hear, but to say something else wouldn’t be
truthful. There is something I need to teach you, and that is how to
grieve in our work together.” Next, we move to empathic boundaries. “One
of the reasons I became a treater is to help you. It will be important in
our work together that you finally have emotional stability that you can count
on. I have learned that there are some things that I need to explain in order
to protect you from additional loss and abandonment. I have set up a
program. I will need to work with you x days a week, and want you call when you
are in a crisis. I limit the number of calls to x times a week to help
encourage you to tolerate unpleasant feelings while I am with you in
spirit. I hope in our work together that you can learn I am there with
you, supporting you, even when you cannot see me. This framework will
help provide the consistency you need and relieve your fears of abandonment.
To
help you feel this structure is real and to help you feel a sense of
containment, we need to have an agreement/contract between us. When I
sense that you are confused and need help in making decisions for your safety,
you promise to follow my instructions or crisis plan to the best of your
ability. I say this because there may be times when it will not be in
your best interest for me to personally handle the life-threatening
situations. In those cases another qualified individual/agency will handle
the emergency. In order for me to help you best, I must maintain a
certain level of objectivity, and I can’t do that if I’m part of the problem
because I’ve crossed the lines. I must keep both my feet on the shore if
I’m to throw you a life raft and pull you in.
Summary
It
is not unusual for an individual with borderline personality disorder to seek
direction and validation for their emotions. Nor is it unusual for these
conflicted individuals to unconsciously experiment with the new holding
environment provided for them. Stark (1994) reaffirms, “Intrinsic to
the patient’s relentless pursuit to infantile gratification is a wish to be
stopped. Intrinsic to the patient’s compulsive reenactments of his
internal dramas is also a wish to be contained.” Since these individuals
are rapprochement fixated, they will test and retest, ask and reask. To
ameliorate the treatment prognosis, the treater will need to validate and
revalidate. The treater must role model consistency (the constant object), i.e.
when limits are tested; a matter-of-fact response is carried out AND carried
out as empathic discipline (to learn) rather then as punishment (punitive – the execution boundary). There is reassurance and
comfort in this since it provides consistency with structure. The client
over time will begin to formulate an image of the empathic and validating
treater in the absence of the treater’s physical presence. Basically, the
insightful treater begins at the client’s rapprochement emotional arrest RATHER
then with the intellectual false self, which is of little substance. Constancy
equates to progress, and inconstancy equates to stagnation, or worse, concretes
the belief that the self is without a membrane, and the client is eternally
doomed to reenact their tragedy in hopes for a better outcome. In
succinct, it is parliament the therapeutic holding environment is imbued with
Constancy, Empathy, Validation, Reality and Limits.
References:
2003
- An Object Relations Approach to Understanding Unusual Behaviors and
Disturbances – K. Stringer http://www.toddlertime.com/general/disturbances.htm
2001
- Effective Inpatient Treatment And the Amelioration of the Therapeutic
Alliance For
Resistive Individuals with BPD K. Stringer http://www.toddlertime.com/borderline/alliance.htm
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