The material you'll be reading here has been over two decades in the making, as looking back over the years I worked to help people heal, I'd used a core trauma approach with my acutely depressed clients. Even as a Marriage and Family Therapy intern in private practice, I seemed to comprehend what was at the heart of these people's suffering, which was well over a decade before I'd learned anything about borderline personality pathology.

Miraculously enough, my schooling never touched on this pervasive universal disorder, and yet my understanding of it cumulatively expanded through assisting clients who'd never forged healthy, enduring attachments, nor been able to tolerate or endure darker emotions without compulsively analyzing them. If you're wanting to help emotionally underdeveloped people grow, heal and recover, it can feel much like navigating a very complex and challenging labyrinth. In my view, until you've become so familiar with a Borderline's defenses and patterns of behavior that were cultivated in order to survive their inescapable, excruciating pain as children, you're incapable of accompanying them on a road trip to the familiar place you've visited thousands of times before.

In short, only when you've gained intimate understanding and knowledge though years of working with BPD clients directly, can you can anticipate and expect how they'll emotionally react and what they'll do, before they even think of doing it. You might think of this facet kind of like what a good parent senses in their child and expects they'll do, based on their own childhood experiences. It's that level of experiential knowing to which you want to strive, if you're welcoming Borderlines into your practice to do emotional development work with them.

A few clinicians have contacted me seeking guidance with particularly challenging patients, after reading some of my articles. The core of their difficulties with these people, was they invariably wrestled with a significant amount of counter-transference during these client sessions. With a bit of digging, it became clear the therapist had almost identical feelings as a child in response to a volatile, yet fragile parent.

The unique struggle this can present to clinicians is monumental, as their natural priority is to be gentle with the patient/client, but this may entail dangerous disregard of the Self, to where a professional can literally feel like a deer in the headlights while treating some of these individuals. In my opinion, until the therapist seeks qualified help to dismantle their own unresolved childhood issues, they should avoid accepting people with BPD into their practice, as they're not equipped to help them.

Whether you're a Borderline or a clinician who's attempting to assist one, this literature may give you deeper insights into BPD, and perhaps help you revise some long-standing beliefs and/or assumptions you've held about this disorder. That at least, is my hope for you.

Let me be perfectly clear; I have not 'treated' Borderline Personality Disorder. I've merely helped clients resolve underlying difficulties like disconnection from emotions/senses and poor self-worth, which in my opinion, have spawned and perpetuated this very destructive and debilitating personal obstacle, and made it impossible for them to build and maintain mutually loving, harmonious relationship dynamics.

Having worked for nearly three decades to heal core-damaged people, my sense of their inner-wounding starts within the first days and weeks after their birth. I've always held, that the etiology of Borderline Personality Disorder is due to the lack of emotional attunement and adequate bonding with his/her birth mother in the earliest stages of life. If an infant cannot come to rely on a sound, consistently loving, safe connection with his/her first object of attachment beyond the womb, and he or she cannot experience a nourishing, trusted bond with Mother, how is it remotely possible to build a bond of trust with anyone, for the duration of his/her life?

Borderlines are not "bad people." Their lifelong struggle with fear and anguish have made it necessary to develop a self-protective, tough outer shell or armor that's helped them avert further harm to themselves during a time when they were very young and defenseless, and had to survive. Unfortunately, learned survival instincts and defenses prompt disruptive acting-out episodes and distancing behaviors in even potentially close relationships.

In truth, when core damaged individuals are helped to resolve their self-worth issues, and connect with all their emotions without compulsively analyzing or judging any of them, personality disorder features are eliminated. It's surely not 'rocket science,' but it definitely requires an unconventional and unique type of approach that falls outside the realm of standard or traditional therapies.

Resolving Borderline Personality Disorder isn't a head issue, and there is absolutely nothing wrong with a Borderline's mind. In my view, BPD is a heart issue, which seems to be why psychotherapeutic treatment has for many, remained a disappointing, unrewarding endeavor.

BPD MYTHS, MISCONCEPTIONS AND FANTASIES

Borderline Personality Disorder is not a "mental illness." Yes, it's listed in the DSM-IV and V~ but so are a lot of other clinical issues, such as ADD/ADHD, Bipolar Disorder, Anxiety Disorder, etc., that have nothing whatsoever to do with mental illness or incapacity! Borderline pathology is never caused by a genetic or biological abnormality, and it cannot be "inherited." BPD is solely an environmentally induced 'nurture' issue, which is passed along through a diffuse, inadequate maternal connection from each generation to the next. In short, if we've never been able to receive nourishing love, warmth and affection within a stable, trusted bond, we never get to learn what the experience of real love actually feels like, and we're not equipped to give it, either.

The B orderline personality is constructed from a cumulative, complex group of emotional injuries to one's sense of Self. The first year of life is a critical time for an infant, but core injury begins in the first weeks of life outside of the womb, due to deficits in affection, holding, nurturing and emotional attunement with the birth mother that inhibit/derail a baby's ability to retain the nourishing attachment we forged with her during our gestation period.

We form an intimate bond of oneness with our mothers in-utero. We hear her rhythmic breathing and constant heartbeat (which often lull us to sleep), and share her oxygen and blood supply. We hear the tone of her voice, and grow very familiar with her language style, the cadence of her speech and how she uniquely enunciates her words. In addition, we co-experience her emotions, so when Mother is sad, so are we. If she's anxious, angry or discontent we feel those emotions at the very same time she does. We can easily acquire what I've coined, "womb anxiety" if we're born to a woman who often felt worried or unsafe during her pregnancy with us, for this was often the predominant sensation we experienced in-utero.

By the time we are born, we're already in-love with this woman. From our point of view as a fetus, there is no separation between us~ she is us, and we are her. It's after we leave her womb that our trouble often begins, if she is not emotionally sound and whole. This is when our abandonment trauma first occurs, and we spend the rest of our lives trying to recapture that joyful, initial bonding experience (in-utero), that had us feeling connected, secure and safe, while imbuing us with an unshakable sense of oneness and belonging. Many Borderlines who've contacted me for help have named this painful inner craving, "Love Addiction." While I fully understand the emotional association we humans make if we can find a salve to help distract from or soothe our pain, there's no such thing as "love addiction." It does not exist.

The initial Honeymoon phase in a new romance with a BPD lover replicates the initial bonding period we had with our mothers in-utero. When he/she starts pushing away or finding fault with us, we begin to re-experience the core shame and despair we felt soon after birth when this bond was broken, and we feared it was our fault that we couldn't get our love for Mother, reciprocated.

Adoption or being handed over to someone else to raise or care for us after we're born, magnifies infancy core abandonment trauma and solidifies one's sense of shame; "I'm not lovable or good enough for my mommy to have wanted me close to her, or kept me." I'm sensing the same could be said for babies born prematurely, having to spend their early days or weeks in a hospital's incubator, separated from the only sense of security and safety they've ever known.

This child will go through his or her entire life with a troubling question that subconsciously inserts itself into all relationship endeavors: "If my own mom can't love me, who the hell can??" We might begin to comprehend why under these conditions a borderline personality experiences profound difficulty in terms of trusting others, or even being willing to depend on and embrace the emotion of love, itself (beyond a few fleeting moments, that is).

Any separation during the very early part of a baby's life greatly impacts his sense of lovability. Even well meaning parents who have prepared a beautiful nursery for their newborn and leave him to sleep alone in a separate room, have undermined their infant's sense of connection, security and well-being. A newborn hasn't developed a sense of object constancy, that takes months to acquire. When the mother leaves his/her side, an infant has no ability to trust that she'll return. No wonder, so many babies succumb to inexplicable SIDS (Sudden Infant Death Syndrome). I think of this all too common "phenomenon" as an infant's fatal heart attack.

Many core injured people presume there was some sort of "major trauma" that occurred during childhood that left them impaired, but what's far more accurate is that there were dozens, maybe hundreds of little emotional betrayals and disappointments that cumulatively derailed this child's capacity to trust someone with their care. "Death by a thousand cuts," is how one of my clients aptly described his experiences as a child with his mother.

THE BORDERLINE'S CRUCIBLE - DEEP DENIAL

Borderlines beget Borderlines. Anyone who grew up with a BPD mother cannot help but acquire survival defenses during infancy and early childhood, which leave them with abandonment fears and attachment difficulties. You might think of these defenses as a suit of armor, which protects the Borderline from incurring more trauma. This outer protection is very stiff and cumbersome, and it keeps them upright when they're feeling a bit vulnerable or fragile. The problem with a suit of armor though, is it also keeps others from getting really close. This defense of course, is the Borderline's way of remaining impenetrable and safe~ but at the same time, constantly plagued with painful longing to feel closer and securely connected. This is literally the root of their come here/go away dance.

Even the slightest sense of distance from a lover or spouse can catalyze profound abandonment terror in Borderlines, because he/she assumes it's their fault. They scan their inner terrain to determine what they might have done wrong to bring about this painful outcome, and imagine all sorts of scenarios to codify the wild stories they're making up about themselves, and You~ their "Abandoner."

Because of inadequate/defective primal experiences that kept the Borderline from retaining a solid bond of attachment during his/her earliest years, he/she was never able to forge real trust in Mother. As a result, learning to trust oneself has been elusive, at best. If you've never been able to rely on your own senses to discern who's trust-worthy, how can you ever trust anyone not to hurt you??

Trust issues have serious ramifications within a potentially solid and meaningful therapeutic endeavor. A Borderline will resist helpful intervention, especially when it interferes with their need to 'change the channel' on what they're feeling during episodes of duress. The characteristic of BPD impulsivity can make working with a Borderline feel considerably more challenging. You're put in a position of having to reign them in, and all you can do at these times is damage control and crisis intervention, which are antithetical to growth work.

Even when acting-out behaviors self-destructively catalyze excruciating pain beyond that with which they're already struggling, the temptation for someone with BPD features is, at least they've orchestrated those changes~ and there's a subtle sense of relief and power in this. Now, their familiar life-long agony envelops them like a familiar old blanket that's oddly comforting.

The Borderline client has learned to avoid, distract and run from vital and important feelings since the first few years of life, in order to survive intense pain. This has left them emotionally underdeveloped, which is always at the baseline for people with personality disorders. They must be taught how to experience and tolerate all their emotions (even light, good ones), so that growth can be accomplished. Only then, are they equipped to surrender their acting-out behaviors and BPD features.

It's not at all uncommon to see pathological levels of borderline disorder and Codependency within the same individual~ in fact, this combination is way too prevalent among psychotherapeutic professionals.

Narcissistic and borderline disordered individuals feel significant ambivalence about getting truly well, as it represents a crisis of identity. Their resistance to surrendering a malfunctioning sense of Self is palpable to the trained clinician. A dysfunctional identity feels familiar to the NPD/BPD client, and it's far more comfortable to retain, than exploring a healthy and wholesome new one. You might think of this element of resistance in the Borderline as a "devil you know" kind of issue.

Some Borderlines cling to the ideation that they've fallen victim to a "mental illness," but if that were true, BPD would only be treatable, not curable~ and I have assisted Borderlines who've worked hard at growing and healing, and fully recovered.

A solid therapeutic dynamic allows that the Borderline client's interpersonal struggles will manifest within their clinical dyad as well. In a sense, there exists a permeable membrane between a Borderline's private life, and the relationship he/she shares with any practitioner who is dedicated to doing healing and growth work with them. In short, how they've behaved with others, is precisely how they'll eventually behave with their therapist. This is inevitable, and should be anticipated if you have these people in your practice.

DIAGNOSIS IS JUST THE BEGINNING.

Most BPD individuals are never diagnosed, and there are myriad reasons for this unfortunate reality~ but here are just a few: 1) The clinician has not recognized their own borderline personality traits. 2) He or she is afraid of the emotional fallout that might occur during their client's session, if they reveal this diagnostic impression. 3) Psychotherapeutic professionals are afraid they'll lose a client, if they confront them with this information. 4) Too many psychotherapists/psychologists have accepted the layman's very narrow and stereotypical notion of how BPD presents in impaired individuals, and what Borderline Personality Disorder actually looks like or entails! Because of their lack of independent research and/or experience working successfully with core trauma issues, their very limited, biased and stigmatic view of people with borderline traits renders many professional caregivers afraid to accept them as clients.

Sadly, many clinicians seem under-informed about the etiology of this disorder, intimidated about how to work with it effectively, and have no idea what a Borderline client needs from them, in order to embark on their journey toward authentic wellness. Real recovery from emotional pain can feel intimidating or scary for someone with BPD features, because the absence of pain brings with it brand-new sensations the client has no familiarity with or frame of reference for, which feel foreign and unnatural to them.

The Borderline's core abandonment wounds make it difficult for them to trust a clinician with their care, but it's a mistake to tell someone with BPD that you will never abandon them! The BPD Waif inspires these assurances from you, but they'll test you at every turn, and keep acting-out their ambivalence surrounding this attachment, just as they do with their lovers. Some can be abrasive and abusive~ and while you might tolerate or encourage their rage, you should not agree to be their whipping post. Ever.

Promising never to leave a Borderline does not mitigate their abandonment trauma, and it's foolish to presume it will. I did this at the very start of my career as an MFT intern, as I thought it would be helpful. It wasn't. No matter how patient, tender and warm a 'surrogate mother' I was to these clients, they made some strides, but didn't actually recover.

Be certain to keep your counter-transference in check while working with a BPD client, for he/she can easily trigger your own unresolved core trauma issues. My book, DO YOU LOVE TO BE NEEDED, OR NEED TO BE LOVED (linked to on this website's main page) was written for psychotherapists who have difficulty establishing healthy boundaries, and putting their own needs first.

While you may fear you're replicating their childhood trauma by even hinting at separation, the Borderline knows no limits or boundaries, and you must be willing to end treatment, if they're not willing to be compliant. In short, don't make promises you may not be able to keep, for this is more injurious to them, and imprisoning both professionally and personally, to you.

The BPD client might alternate between being seductive and abusive or diminishing during treatment, with a Dr. Jekyll and Mr. Hyde temperament. Some weeks, the therapist is "brilliant," and he's ecstatic he has found him or her. Other sessions, he's petulant, argumentative, devaluing, etc. This all good/all bad reflex is central to borderline pathology, and is referred to as splitting. You could feel as though you need a shower after those sessions, to wash off the toxic residue that's left in his/her wake. Burning a scented candle during their visits can be helpful for diffusing some of that intrusive, negative energy and helping you at least be present for your other clients the rest of your work day.

Because Borderlines have such terribly diminished self-worth, they cannot fathom that their therapist actually cares about them; it simply doesn't show up on their radar. This issue contributes to abrupt departures even from long term treatment, as if the therapeutic bond never existed. Emotional cut-off is very common within their interpersonal world as well, which of course has made for a catastrophic romantic history. The BPD patient enters therapy feeling ashamed and unlovable, so it's difficult to imagine that anyone might view him/her more favorably.

Frankly, the Borderlines I've assisted have been some of my favorite clients, even though the work can be very demanding at times. They are bright, engaging and affable. Most are extremely talented, and you can't help but like them~ but at the start of contact or during treatment, they may come across as combative and belligerent. Some may have navigated years or decades of psychotherapy and a litany of recovery programs which have all proven disappointing. Their anger about these tragic outcomes is palpable and quite understandable, as I'm seen as just another person who'll let them down.

I do not view anger as a 'bad' emotion, and I encourage it during this work. It never dissuades me from accepting somebody into my practice, unless I sense we'll have a continuous power struggle, which will deter him/her from making substantial gains here. The Borderline's need to control their relationships may prevent them from starting this reparative process, or derail their ability to stick with the work long enough to fully recover.

Crisis and chaos addiction is typical among borderline disordered clients, so as you help them begin to surmount immediate struggles and their pain lessens, they lose impetus/motivation to continue with and complete their emotional development work, and progress is effectively derailed.

Non-compliance with treatment is common for Borderlines. Aside from their fear of change which feels frighteningly destabilizing, they tend to rebel against useful, meaningful intervention~ especially if there are BPD Waif features present. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted.

Unfortunately, very little in undergraduate and graduate course work prepares future clinicians for working with this type of client, or understanding how pervasive a problem BPD is within societies all over the globe. My own life experiences brought me a rich, working knowledge about core pain associated with poor self-worth, entitlement issues, and a litany of other obstacles caused by defective parenting. I've called on this cumulative wisdom to help people grow, and together we have worked to repair and restore the Self.

THE SEEDS OF AN INTRICATE GARDEN

As stated earlier, Borderline Personality Disorder begins within the first year of life, and if you want to get even more specific, the first weeks of an infant's life outside his mother's womb critically shape and mold how he views and relates to himself lifelong. Any psychic and/or emotional wounds incurred thereafter, reinforce one's sense that he/she isn't lovable, or worthy of genuine affection, protection and care. This faulty assumption must be corrected within the framework of a steady and solidly nourishing, but firmly boundaried therapeutic relationship~ or the client remains unwell.

A client with borderline or narcissistic traits can enter treatment with a "fix me" demand, but never comprehends the need and importance for an interactive experience within a process that must allow for the gradual growth of trust. Their impatience is palpable, and they're always speeding ahead of themselves and the work, due to the daily anguish they have to endure. This type of client seldom stays in treatment long enough to achieve their wellness goal, and typically blames this failure on even the most gifted practitioner.

A great number of females who contact me for help, say: "I've done a lot of work on myself!" Their statement instantly alerts me that they've been tireless seekers of healing that has always eluded them. For me, it's become a dead giveaway that they're borderline disordered~ and thus far, I have seen no exceptions.

These people often try to control what happens during their time with you, by filling it up with chatter about themselves that you do not require and haven't solicited, which wastes their precious time and money (if you've allowed it) within effective, solution-focused treatment. It's mostly this client's manipulation tactic~ so try to resist indulging them by giving into it.

You cannot allow the BPD client to gain the upper hand in your therapeutic dynamic. If he/she did not require sound, reliable adult guidance and sensible, concrete direction, they would not be struggling with this disorder! In short, there are times you'll have to play The Heavy. It's called 'tough love,' and it's often the only way you'll get their attention and keep them on track with the progress you're wanting to help them make. Their tendency is to confuse Recovery Methods with psychotherapy~ and there is virtually no similarity between the two.

A common misconception is that all Borderlines were molested or incested as children. Sexual abuse does not cause BPD! The Borderline may try to elicit your sympathy by telling you stories about rape or sexual abuse, but that doesn't mean it happened. Even if abuse by a father, family friend or relative did occur, the mother's failure to guard/protect her child from such atrocities or believe his/her reporting of these incidents, is a much deeper wound, because it represents emotional betrayal and neglect.

I've seen tremendous defenses in these clients, as to idealization of one parent and devaluation of the other, based on which one they've come to believe inflicted the least or most emotional or psychic injury, but their perceptions are usually heavily biased by stories and accounts they've heard from one resentful parent (typically, the mother). These views are mostly inaccurate, which tends to foster and perpetuate poor partner selection, while setting them up for for the same type of relational strife they frequently observed as kids, between their parents.

It's not unusual for t he offspring of this type of coupling to have been brainwashed/coerced into sympathizing with and relating to the passive/victim parent, while despising and rejecting the other parent's dark or "negative" traits from their own emotional repertoire. We then have discarded or split-off facets of the Self which results in a fragmented or partial personality structure, instead of a whole one (fertile soil for BPD seeds to grow).

Borderline clients often pedestalize their mother and see her as "perfect." They identify their relationship with her as sacred/holy and vehemently want to defend her, regardless of how neglectful or noxious that maternal connection was or is for them.

Perhaps Mom always appeared to be a long-suffering "victim" of their father's abuse or neglect and she's regarded as 'the good parent,' in sharp contrast to the other's monstrous volatility or irresponsibility. I always challenge this stance, for there are two sides to every coin, and children seldom get to see who's holding the flame that has ignited their father's fuse.

Significant lapses in childhood memory are silent clues as to how much abuse, neglect and emotional betrayal the Borderline had to endure and dissociate from as a child, in order to survive. Kids who cannot develop defenses and coping strategies to ameliorate their anguish, often orchestrate their own exit plan, and suicide by traffic incident or catastrophic fall is not uncommon among these tragically unhappy children.

Many survivors have enlisted psychotherapy, which has spanned decades of their life and/or tried numerous other "healing" modalities, self-help venues, DBT, etc., in an effort to ease their pain, but none of these have brought about significant or lasting change. Still, they continue to hope that a 'magical cure' will one day relieve their lifelong anguish, and cling to the ideation that they are essentially well.

The Borderline lives with such a profound level of core shame, they're compelled to regard themselves as perfectly brilliant, skilled, talented, beautiful, successful, etc. Their 'affirmations' may episodically override self-loathing, but these grandiose defensive strategies are purely compensatory, which keeps the false-self actively refuting/rejecting the type of help they really need, in order to discover, accept and finally embrace the whole Self.

The Borderline may develop 'roles' they've come to use within their everyday life, which allow them to navigate on 'auto-pilot' and perform spousal, parental or professional tasks, while being disconnected from any genuine emotions and needs. In a sense they're sleepwalking, but their role-play gives them a much needed sense of containment, and helps them adhere to socially acceptable limits and boundaries, so they can maintain some semblance of order and functionality. I've noticed this trait most prominently among hyper-religious clients who appear to need rigid parameters or disciplines set forth by a church, synagogue, yoga or Buddhist practice.

The Borderline in treatment could be 'A Lifer' in long-term care, particularly if he or she has tried to get their needs met with standard therapy or analysis. They're heavily armored and their defenses are thick, and often impenetrable.

BETWEEN A ROCK AND A HARD PLACE

Psychotherapists with BPD features are especially challenging to treat. Most have been over-therapized or have undergone no useful treatment whatsoever, and they want to run the show.

The borderline disordered therapist hyper-analyzes every single feeling, rather than learning how to experience it in the body. It's a shame that their cerebral brilliance works against them during true recovery work, and they fall (or jump) off the grid. Healing work is very different from psychotherapy. Some just can't make the bridge from thinking to feeling their way along~ and the mind is antithetical to one's journey toward emotional wholeness and wellness.

Therapeutic practitioners who treat Borderlines or anyone who's suffering from core trauma issues for that matter, must constantly remind themselves that they're dealing with someone who is emotionally underdeveloped--in essence, a very young child in an adult body. If this isn't routinely on the forefront of a healing professional's mind, helping this individual will feel daunting and extremely frustrating. In short, you'll regularly experience therapeutic burn-out.

Effective treatment of clients with BPD might be very similar to doing child psychology, and requires just as much mindfulness and patience.

I don't believe in withholding diagnostic impressions from my clients. Issues of core shame ("I'm not good enough") make it difficult to accept personality disorder features, but how can we effectively work with a problem, unless we understand what it is? If you went to a physician complaining that you were hurting, wouldn't he/she need to discern where you felt pain and the nature of that discomfort, to assist you? Learning we have BPD traits is a hard pill to swallow, but it's not a death sentence~ and it is possible to recover with the right kind of help, and one's serious dedication to getting Well.

A dual diagnosis must always be considered, as a fair number of Borderlines also struggle with chronic depression or Bipolar Disorder, and balancing brain chemistry with medication is often a crucial adjunct to helping them hold the work, and make good use of it. Untreated ADD issues can inhibit solid BPD recovery outcomes as well.

I'd say the primary issue with the Borderline in treatment, is their resistance to trusting someone/anyone with their care, due to painful disappointments and setbacks throughout childhood, that undermined their ability to feel protected and emotionally safe with their parental units. Many of these people have been physically beaten as kids, but most were emotionally brutalized.

The tragic outcome of this type of upbringing, is the child grows up with the ideation they deserve this brutality, and perpetuate the parents' abuse by beating up on themselves every day, and attaching to lovers who echo/mirror how badly they truly feel about themselves. Their self-defeating narratives have become reflexive and automated, and they're the toughest to dismantle, while trying to help the Borderline client move toward healthier self-care and positive self-regard.