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
Order
   

The Rapprochement Child

Written by Kathi Stringer

April 27, 2004

This paper addresses the fixated child that resides within the adult psych of individuals with borderline personality disorder in the treatment environment.  A writer's question is answered in 2 parts.  Part 1, a review of relevant theory and part 2 is a response to her concerns. 

The Letter - QUESTION:

Dear Kathi,

I'm hoping you might be able to help me with something.  My therapist thinks I am always being manipulative with her, but I'm not.  I've taken in articles to her from your web site and others that explains exactly how I feel when I say or do things, and why I say and do them.  But she takes it that I am purposely and with intent trying to "get my way" by attempting to anger her, attempting to cause guilt, trying to make her feel bad - but I've never ever thought those things when I say or do something with her.  I actually don't tell her a lot of things because I know she thinks I say them to manipulate her.  I know it appears I am manipulative, but I don't tell her things to make HER feel a certain way to get the response I want.  If I tell her I feel suicidal, it's because I truly do feel suicidal and want her help.  I don't tell her that because I just want her attention.  Since she thinks so strongly that I try to manipulate her all the time, I don't tell her things I should - such as, when I am feeling extremely suicidal.  I know suicidal ideation is prevalent in those with Borderline Personality Disorder, (I've attempted suicide several times).  Is it likely I'll commit suicide?  No.  But that's not what I'm thinking when I'm feeling suicidal.  I don't have rational thoughts - manipulating my therapist most certainly isn't one of the top things I'm thinking when I'm in crisis - wanting and needing her help and guidance is what I'm after, not making her mad, pushing her buttons, trying to "get my way" against her wishes, trying to convince her I'm feeling something I'm not just to elicit a response, etc. 

How do I get her to understand my point?  How do I get her to realize that although it may appear I am being manipulative, I'm not - it's not even a thought.  I'll write her and tell her how I feel and ask her to help me understand what's going on - she thinks I'm writing to elicit email from her.  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.  It takes a lot for me, given I'm a perfectionist and hate feeling and appearing unintelligent, to tell her "I don't understand what this statement means," and her not respond or respond with a tone, talking to me like I'm a baby.  I HONESTLY don't know - if I'm asking, it's because I DON'T KNOW, but she doesn't see it that way.  I'm SO frustrated about this.  It hinders me from telling her things I need and want to tell her - both good and bad.  I tried to explain this to her several times, but she won't listen.

To give a perfect example: I had an appt with her and I arrived about 6 minutes before my appt time.  Before I knew it, it was 5 minutes, then 10 minutes, 13 minutes, 15 minutes past my appt time - I was in a panic, my anxiety level was sky high, I had nicked my hand 6 times till it began bleeding, I was getting dizzy, having trouble breathing, and all that was going through my head was what was going to happen once I got in there.  I was calm when I arrived, but after waiting about 16 minutes, the calm ocean wave was out to sea and I couldn't focus anymore.  So I left after waiting about 20 minutes -  I had to change my focus and direct it to something else, seeing a different view, moving, etc.  When I came back, she was still busy with her current client, and since I wasn't feeling much calmer, I left again for a few minutes.  This time, even though the other client still hadn't come out, I felt much calmer.

When I got into the office I told her I left because I just couldn't sit anymore, I had to refocus, I was too anxious, etc., etc.  She kept making gestures and facial expressions giving the indication "yeah, right...sure that's why."  She went into this big whole explanation of what she "did for me" to keep the rest of the afternoon free and to tell me several more times what she gave up to keep my appt.  It was pissing me off that she sat there and repeatedly was trying to make me feel guilty.  She basically told me that I left to manipulate her into ending her session with the previous client.  That never, ever, EVER, crossed my mind - getting calm was my objective for what I did.  When I walked in, I was shaking so bad, I nearly fell trying to sit in the chair.  I was still having difficulty breathing - she finally told me it was okay and to calm down, as I was breathing way to shallow.

We slightly discussed manipulation as she was reading a manual - when she got to the manipulation part, it was just pissing me off and she knew it.  She looks up and says, "Ooooo - there's that nasty word again."  I said, "that's because I'm not manipulative."  She snickers and looks down at her book and then looks up with her eyes and says, "yeah....right."  OMG - I wanted to lunge forward!

Anyhow, do you have any suggestions on how to get her to see things from my eyes, from my mind, from my experience, from my abuse, from my beliefs and realize that even IF it appears I'm being manipulative, I'm not???

Thanks!


Theory – Part 1

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