Therapeutic relationship in Borderline personality disorder

Therapist provides a holding relationship to the person, where it is difficult for the client to trust the availability and continuity of therapist's presence. once the hope is gained in the relationship and therapeutic work, an understanding of therapist is established, there is a reduction in the intensity of aloneness which the patient stays with. The patient is able to hold the therapist's presence, voice inside himself without destroying it and losing it. Until and unless the therapist has been internalized as a person who contains, provides space, helps the patient in creating an understanding, the split which is present in the patient's world of black and white thinking will be hard to reduce. There needs to be correction of projections which has increased the negative side of the split. Slowly, there is a recognition that loved and hated object are the same. There needs to be a reconciliation of both these parts.

in a paper, while working with a patient, author writes about his patients experience of being raised by a mother who was intensely loving but then would suddenly withdraw from him in disgust, as the therapy progressed with this patient, he grew very attached to the therapist, with an urgent sense of needing him between the hours and the sessions. He would find him helpful but then would be increased angry at him for deserting him and not taking care of him properly enough. The rage at the therapist grew where he wont even look at the therapist for a gaze felt could shatter the therapist like a piece of glass. the client would maintain distance from the therapist and if he would lean forward, he would withdraw. There was mention of a cannibalistic dream of eating the therapist. As the rage with the therapist mounted, he started acting out in self-destructive ways visiting unsafe places, drinking heavily, getting into accidents. It was during these times that he could not recall even a vague image of therapist, as if he did not exist. During this period, therapist encouraged him to call or schedule extra sessions to check if the therapist is there or not. In this way, therapist was helping the patient understand the unbearable aloneness, rage and feeling that closeness meant mutual destruction expressed in cannibalistic fantasies.