This article is published in the book:

"Psych 101 -
What you didn't learn in nursing school."

by Kathi Stringer
Paperback: 320 pages
ISBN-13: 978-0615193137

The Treater Blinks!

Written by Kathi Stringer

Working with Clients That Have
Borderline Personality Disorder

The Holding Environment

During the formation process of the therapeutic alliance a dual interview is taking place. The treater is gathering intake information to assess the symptomlogy of the client. The client however is looking for clues to determine the strengths and weaknesses of the treater. A client’s unconscious preverbal structure may be inquiring whether or not the holding environment is defective.

Winnicott who coined the term ‘holding environment’ felt it didn’t need to be perfect but ‘good enough’. He felt the failures of the holding environment would help adjust and acclimate the client to the difficulties encountered in reality.

Too Much, Too Soon

The traumatized and resistant client usually has an acute ability to size up the container that resides in the treater. If the treater’s container presents itself as defective, clients may more then likely withhold information and unconsciously resist disclosure. A client may sense ‘vibes’ that to disclose sensitive material may be met with rejection. These ‘vibes’ may take the appearance that the treater is not qualified to contain the formless identity of the client’s interpersonal dimensions.

Capitalize on Effective Defenses

It is not uncommon for some treaters to capitalize on the developed defenses of the false self that have enabled the client to function and meet the demands of their environment. However, the false self presents a problem when the client wakes up one day and asks, “Who am I? Have I simply been a pretender all along?”

When left with the haunting questions that one is a pretender, then the next line of thought may lead the client directly into the abyss, or as the DSM equates as ‘emptiness’. Which brings us back to the fear of the defective container that resides in the treater.

In the early development of the therapeutic alliance, the client’s distorted, formless and fragmented identity searches for a consistent and delineated personality structure in the treater. Hopefully the treater can present as the constant object and as an available template from which the client may investigate and examine their feelings without fear of overwhelming the treater.

A Protective Mistake

A novice treater may error on the side of caution hoping to protect the client and say something like this, “Perhaps these feelings are too painful for you, and perhaps it may be in your best interest to stop treatment.” The treater in the client’s mind has ‘blinked’ meaning that the holding environment is defective and cannot contain the painful organizations that dwell within the client. The client is back-handedly validated that the false self is healthier then the tormented true self that yearns for acceptance, nurturing and empathy. This suggestion from the treater may circumvent the true self back into the abyss under the guise of keeping the more sophisticated defenses intact. A gain of this type is nothing but smoke and mirrors that dilutes motivation for further investigation and the client may be left with the impulsive recoil to go along with the treater’s suggestion and ‘quit’.

You’re Right, I Quit.

The client may quit out of hatred because the treater has exposed the treater’s defected container. The disappointed client is now in a foolish and humiliated light induced by the sham of hope. After all, it was suggested by the treater that the true self could be written off and barred in favor of more useful and adaptive false self. The whole scenario may come off as being used again, “You don’t like me, only who I am able to pretend to be.”

The Alternative

In the genesis of the new holding environment, a highly defended client must be able to internalize that an alternate supportive structure from the treater can maintain some measure of protection. This invites the client to view the world without the safety of the armored false self. It stands to reason, before one can venture out into a dangerous situation, the partner must provide a sense of protection. Akin to the ole western movies, that when one makes a break for it, the other will provide cover.

Basically, when a traumatized client’s pain presents as ‘non-adaptive’, remember…

Don’t Blink and Cover!