I Hate You--Don't Leave Me - Jerold J. Kreisman [67]
During her third week in the day hospital, another patient hanged himself while home over the weekend. Frightened, Julie flew into a rage: “Why didn’t you and these nurses know he was going to kill himself?” she screamed. “How could you let him do it? Why didn’t you protect him?”
Julie was devastated. Who was going to protect her? Who would make the pain go away? I finally realized that it would have to be Julie. No one else lived inside her skin. No one else could totally understand and protect her. It was starting to make some sense, to me and, after a while, to Julie.
She could see that no matter how hard she tried to run away from her feelings, she could not escape being herself. Even though she wanted to run away from the bad person she thought she was, she had to learn to accept herself, flaws and all. Ultimately she would see that just being Julie was okay.
Julie’s anger at the staff gradually migrated toward the suicide patient, who “didn’t give himself a chance.” When she saw his responsibility, she began to see hers. She discovered that people who really cared about her did not let her do whatever she wanted, as her parents had done. Sometimes caring meant setting limits. Sometimes it meant telling her what she didn’t want to hear. And sometimes it meant reminding her of her accountability to herself.
It wasn’t much longer before all of us—Julie, the staff, and I—began working together. I stopped trying so hard to be likeable, wise, and unerring; it was more important to be consistent and reliable—to be there.
After several weeks, Julie left the hospital outpatient program and returned to our office therapy. She was still lonely and afraid, but she didn’t need to hurt herself anymore. Even more important, she was accepting the fact that she could survive loneliness and fear but could still care about herself.
After a while, Julie found a new man who really seemed to care about her. As for me, I learned some of the same things Julie did—that distasteful emotions determine who I am to a great extent and that accepting these unpleasant parts of myself helps me to better understand my patients.
Beginning Treatment
Therapists who treat borderline personality often find that the rigors of treatment place a great strain on their professional abilities, as well as on their patience. Treatment sessions may be stormy, frustrating, and unpredictable. The treatment period proceeds at a snail-like pace and may require years to achieve true change. Many borderline patients drop out of therapy in the first few months.
Treatment is so difficult because the borderline responds to it in much the same way as to other personal relationships. The borderline will see the therapist as caring and gentle one moment, deceitful and intimidating the next.
In therapy, the borderline can be extremely demanding, dependent, and manipulative. It is not uncommon for a borderline patient to telephone incessantly between sessions and then appear unexpectedly in the therapist’s office, threatening bodily harm to himself unless the therapist meets with him immediately. Angry tirades against the therapist and the process of therapy are common. Often, the borderline can be very perceptive about the sensitivity of the therapist and eventually goad him into anger, frustration, self-doubt, and hopelessness.
Given the wide range of possible contributing causes of BPD, and the extremes of behavior involved, there is a predictably wide range of treatment methods. According to the American Psychiatric Association’s “Practice Guideline for the Treatment of Patients with Borderline Personality Disorder,” “The primary treatment for borderline personality disorder is psychotherapy, complemented by symptom-targeted pharmacotherapy.”1 Psychotherapy can take place in individual, group, or family therapy settings. It can proceed in or out of a hospital setting. Therapy approaches can be combined, such as individual and group. Some therapy approaches are more “psychodynamic,” that is, emphasize the connection between past experiences and unconscious