I Hate You--Don't Leave Me - Jerold J. Kreisman [68]
Some treatments are usually avoided. Strict behavior modification is seldom utilized. Classical psychoanalysis on the couch with use of “free association” in an unstructured environment can be devastating for the borderline whose primitive defenses may be overwhelmed. Because hypnosis can produce an unfamiliar trance state resulting in panic or even psychosis, it is also usually avoided as a therapeutic technique.
Goals of Therapy
All treatment approaches strive for a common goal: more effective functioning in a world that is experienced as less mystifying, less harmful, and more pleasurable. The process usually involves developing insight into the unproductiveness of current behaviors. This is the easy part. More difficult is the process of reworking old reflexes and developing new ways of dealing with life’s stresses.
The most important part of any therapy is the relationship between the patient and therapist. This interaction forms the foundation for trust, object constancy, and emotional intimacy. The therapist must become a trusted figure, a mirror to reflect a developing consistent identity. Starting with this relationship, the borderline learns to extend to others appropriate expectations and trust.
The primary goal of the therapist is to work toward losing (not keeping) his patient. This is accomplished by directing the patient’s attention to certain areas for examination, not by controlling him. Though the therapist serves as the navigator, pointing out landscapes of interest and helping to re-route the itinerary around storm conditions, it is the patient who must remain firmly in the pilot’s seat. Family and loved ones are also sometimes included on this journey. A major objective is for the patient to return home and improve relationships, not to abandon them.
Some people are fearful of psychiatry and psychotherapy, perceiving the process as a form of “mind control” or behavior modification perpetrated on helpless, dependent patients who are molded into robots by bearded, Svengali-like mesmerists. The aim of psychotherapy is to help a patient individuate and achieve more freedom and personal dignity. Unfortunately, just as some people erroneously believe that you can be hypnotized against your will, so some believe you can be “therapized” against your will. Popular culture, especially cinema, frequently portrays the “shrink” as either a bumbling fool, more in need of treatment than his patients, or a nefarious, brilliant criminal. Such irrational fears may deprive people of opportunities to escape self-imposed captivity and achieve self-acceptance.
Length of Therapy
Because of the past prominence of psychoanalysis, which characteristically requires several years of intensive, frequent treatment, most people view any form of psychotherapy as being extended and drawn out, and therefore very expensive. The addition of medications and specialized treatments to the therapeutic armamentarium are responses to the need for practical and affordable treatment methods. Broken bones heal and infections clear up, but scars on the psyche may require longer treatment.
If therapy terminates quickly, one may question if it was too superficial. If it extends for many years, one may wonder if it is merely intellectual game playing that enriches psychotherapists while financially enslaving their dependent and helpless patients.
How long should therapy last? The answer depends on the specific goals. Resolution of specific, targeted symptoms—such as depression, severe anxiety, or temper outbursts—may be accomplished in relatively brief time spans, such as weeks or months. If the goal is more profound restructuring, a longer duration will be required. Over time BPD is usually “cured.” This means that the patient, by strict definition, no longer exhibits five of the nine defining DSM-IV