by Margherita Spagnuolo-Lobb in Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact (Gestalt Therapy Book Series 2). Gianni Francesetti, Michela Gecele, Jan Roubal, and Leslie Greenberg
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Borderline: The Wound of the Boundary (Ch30) (loc: 14,150)
1. Borderline Personality Disturbance and Society (loc: 14,158)
Borderline personality disorder faces a human drama (loc: 14,171)
It pertains to a more delicate experiential field, in which uttering one’s emotions leads to an expansion of the self which is always dramatically conflictual: a profound sense of split leads the sufferer to desire and at the same time loathe contact with the other. (loc: 14,172)
the difficulty of defining oneself solidly (loc: 14,176)
of defining the movement of the self in relation to the environment, (loc: 14,176)
I in relation to the You. (loc: 14,176)
The strong boundary, in which “I am I and you are you”, is the soul of Gestalt therapy but it is also the most delicate point for the borderline experience. (loc: 14,190)
Yontef (1993, p. 456 ff.) the first significant study. (loc: 14,196)
Yontef (loc: 14,197)
clarifies the differing styles of personality (loc: 14,197)
he compares the borderline style with the narcissistic style, (loc: 14,199)
Yontef’s openness to diagnosis and to psychopathology marks the beginning of a series of studies (loc: 14,199)
1.1. BPD in Post-Modern Society (loc: 14,211)
Going back to the generation that grew up between 1970 and 1990, on the one hand they nourished the illusion (brought on by parents from the narcissistic society) that they were exceptional; on the other they concealed the sense that they were a bluff. Unable to grow up in the concreteness of their mistakes, they developed a borderline relational modality: ambivalent, dissatisfied, incapable of separating themselves in order to affirm their value. (loc: 14,211)
In the first years of the new century, up to the present day, this need to feel oneself in solitude through the body has been transformed into a still more radical search, almost a cry provoked in the body as a sign of nonexistence, of non-relationship. We may say that, in some respects, today cutting has taken the place of drugs: a form of self-harming more inherent in the body, in the flesh (loc: 14,222)
the globalization of communications and the desensitization of the body, have influenced and caused to develop the borderline disorder, in which the “liquidity” of social feeling and the absence of a primary relationship are declined as angry demand for concreteness, for bodily containment, (loc: 14,233)
This peculiarity of the diagnosis and treatment of the BPD patient is also linked to the development of the social feeling. (loc: 14,243)
Vaillant (1992) actually maintains that this diagnosis is substantially adopted by the clinicians in order to label the patients they do not like. This reflection not only alerts us to the risks of not questioning ourselves about ourselves in the case of unpleasant reactions (and on the importance of doing supervision), (loc: 14,255)
2. The Diagnosis of BPD (loc: 14,260)
appeared in 1980, with the DSM III (APA 1980). (loc: 14,262)
in 1994, it was perfected, (loc: 14,263)
Kernberg (cf. Clarkin et al., 2000, p. 5 ff.) speaks of “borderline personality organization” (BPO) (distinguishing it from true borderline “disorder”), (loc: 14,268)
He distinguishes three macro-types of personality organization: (loc: 14,270)
borderline organization, psychotic organization and neurotic organization (loc: 14,270)
especially useful for us Gestalt therapists, because it considers the patient’s experience (rather than simply the behavioural manifestation) (loc: 14,271)
a cluster that includes both the inner representations of the primary relationships (loc: 14,272)
and the specific character (loc: 14,273)
the socio-environmental conditions (loc: 14,274)
as well as the relational patterns the patient puts into effect. (loc: 14,275)
borderline experience is characterized, according to Kernberg, by three features (loc: 14,276)
1) the syndrome of diffusion of identity; 2) primitive defense mechanisms centered on the split; 3) continuity of the examination of reality. (loc: 14,277)
neurotic experience is (loc: 14,279)
1) solid identity of the ego; 2) defense mechanisms centered on removal; 3) excellent examination of reality. (loc: 14,279)
structure of the psychotic experience is (loc: 14,280)
an examination of reality that is constantly disturbed. (loc: 14,281)
1. By syndrome of the diffusion of identity (loc: 14,284)
means the lack, in the patient’s experience, of an integrated concept of the self and of an integrated concept of the significant others. (loc: 14,285)
patient’s reflective ability is damaged (loc: 14,286)
what is missing in these patients is the ability to integrate the satisfactory with the frustrating experiences, maintaining an experiential continuity between the good and the bad. (loc: 14,287)
for the borderline patient it is impossible to forgive the bad other or to consider that the good other may have moments of badness. (loc: 14,288)
2. The primitive defenses, (loc: 14,292)
split and projective identification. (loc: 14,292)
the child’s experiences of satisfaction and frustration are linked to the caregiver: when this person is able and willing to satisfy the need, s/he nourishes a bond of love, (loc: 14,293)
at other times this willingness is absent, the frustration of the need generates anger and hatred in the infant. (loc: 14,294)
gratifying other and the frustrating other are experienced as separate and distinct, (loc: 14,295)
The borderline patient may pass from the feeling of omnipotence and omnipotent control and of idealization of the other, to her/his devaluation and painful rejection. (loc: 14,297)
3. The examination of reality (loc: 14,302)
the borderline (loc: 14,303)
is often impulsive, chaotic, affectively unstable, and in stressful conditions experiences relationships in paranoid manner. (loc: 14,304)
lack of perceptive stability, united with impulsiveness, may lead to the risk of suicidal behaviors, or of serious eating disorders, predisposition to abuse, addiction to drugs and/or alcohol and antisocial behavior. (loc: 14,304)
Kernberg (Clarkin et al., 2000, p. 6), places the various possibilities of borderline experience along two relational dimensions, (loc: 14,308)
the borderline patient may relate to others in a more or less introverted manner (loc: 14,309)
and to a greater or lesser degree damaged by the infusion of aggressiveness: (loc: 14,311)
3. The Contribution of Gestalt Therapy to the BPD Construct and its Treatment: the Reading of Isadore From (loc: 14,315)
Isadore From, (loc: 14,320)
read borderline suffering in the key of the primary relationships, but framed by Gestalt epistemology. (loc: 14,320)
the borderline’s primary intentionality in contact is to preserve a laboriously constructed sketch of the self. (loc: 14,322)
the behavior of borderline patients and their “now-for-next”. Isadore brought out the borderline patient’s tension towards an anxiety developed in the primary relationships, (loc: 14,323)
faced by the adult’s attempt to define it in intrusive/abusing terms (loc: 14,324)
In order to define her/himself against the invasion of the adult in her/his (fragile) boundaries (loc: 14,325)
the person develops an incomprehensible language. (loc: 14,326)
“The moon is made of cheese”, is the example he gave in his teaching, (loc: 14,327)
the language of the person with borderline suffering (loc: 14,328)
misleading for the adult. (loc: 14,328)
the therapist (loc: 14,329)
must read the misleading language (loc: 14,329)
with such profound interest, free from evaluations that would objectivize (and so cool) the vitality that animates it, (loc: 14,329)
with such lucidity of the boundary that he will be able not to feel attacked (loc: 14,330)
This therapeutic operation can give the patient with BPD the experience s/he desires of the “I am I and you are you”. (loc: 14,331)
Here is an example I often use (Spagnuolo Lobb 2011a, p. 152). Faced with the patient who – angry with the therapist because she did not answer when he called her several times in the middle of the night, after a session that had (loc: 14,334)
been particularly full of human closeness – says to the therapist: “I’ll never trust you again”; the therapist – more attentive to the way he says this than to what he says, and bearing in mind the patient’s attempt to maintain a sketch of the self – answers: “I’m touched by the dignity with which you say that”. (loc: 14,336)
Isadore From provides a phenomenological reading of contact, (loc: 14,339)
brings out two fundamental aspects of the borderline (loc: 14,341)
the sense of having built up a sketch of the self, (loc: 14,341)
object-relation theoreticians link borderline behavior to failures of the process of attachment (loc: 14,343)
and to the impossibility of introjecting secure relationships and figures of reliable nurturing. (loc: 14,345)
result is the lack of a self perceived as trustworthy, (loc: 14,345)
confusion as to whom the experiences belong to (they might belong to someone else too), anger at what one has not had, recourse to primitive defenses such as split (in order not to feel the anxiety of the loss of the other) and anger, the alternation of opposing states of mind, relational ambivalence, momentary distortion of reality (yet without ever losing the sense of reality, (loc: 14,346)
As Gestalt therapists, we find ourselves perfectly in line with the reading of the object-relation theoreticians (loc: 14,352)
Gestalt therapy, however, adds a further value, (loc: 14,355)
The intentionality to maintain a sketch of the self (loc: 14,356)
enables the therapist to focus attention on the next of the borderline experience, (loc: 14,356)
This Gestalt perspective, with the relative therapeutic strategy, makes it possible to fulfill the processes of individuation needed by the borderline patient in order to emerge from the painful mechanisms of split, of insecurity and ambivalence, (loc: 14,358)