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doctor into taking care of him and rebels against his attempts to “control his life.” As the therapist remains steadfast and consistent in withstanding his tirades, object constancy develops—the borderline begins to trust that the therapist will not abandon him. From this beachhead of trust, the borderline can venture out with new relationships and establish more trusting contacts. Initially, however, such new friendships can be difficult to sustain for the borderline, who, in the past, may have perceived his formation of new alliances as a form of disloyalty. He may even fear that his mate, friend, or therapist may become jealous and enraged if he broadens his social contacts.

As the borderline progresses, he settles into a more comfortable, trusting dependency. As he prepares for termination, however, there may again be a resurgence of turmoil in the relationship. He may pine for his previous ways of functioning and resent needing to proceed onward; he may feel like a tiring swimmer who realizes he has already swum more than halfway across the lake, and now rather than return to the shore must continue on to the other side before resting.

At this point the borderline must also deal with his separate-ness and recognize that he, not the therapist, has effected change. Like Dumbo, who first attributes his flying ability to his “magic feather” but then realizes it is due to his own talents, the borderline must begin to recognize and accept his own abilities to function independently. And he must develop new coping mechanisms to replace the ones that no longer work.

As the borderline improves, the intensity of the transference diminishes. The anger, impulsive behaviors, and mood changes—often directed at, or for the benefit of, the therapist—become less severe. Panicky dependency may gradually wither and be replaced by a growing self-confidence; anger erupts less often, replaced by greater determination to be in charge of one’s own life. Impatience and caprice diminish, because the borderline begins to develop a separate sense of identity that can evolve without the need for parasitic attachment.

Countertransference

Countertransference refers to the therapist’s own emotional reactions to the patient, which are based less on realistic considerations than on the therapist’s past experiences and needs. An example is the doctor who perceives the patient as more needy and helpless than is truly the case because of the doctor’s need to be a caretaker, to perceive himself as compassionate, and to avoid confrontation.

The borderline is often very perceptive about others, including the therapist. This sensitivity often provokes the therapist’s own unresolved feelings. The doctor’s needs for appreciation, affection, and control can sometimes prompt him into inappropriate behavior. He may be overly protective of the patient and encourage dependency. He may be overly controlling, demanding that the patient carry out his recommendations. He may complain of his own problems and induce the patient to take care of him. He may extract information from the patient for financial gain or mere titillation. He may even enter into a sexual relationship with the patient “to teach intimacy.” The therapist may rationalize all these as necessary for a “very sick” patient, but in reality they are satisfying his own needs. It is these countertransference feelings that result in most examples of unethical behavior between a trusted doctor or therapist and patient.

The borderline can provoke feelings of anger, frustration, self-doubt, and hopelessness in the therapist that mirror his own. Goaded into emotions that challenge his professional self-worth, the therapist may experience genuine countertransference hate for the patient and view him as untreatable. Treatment of the borderline personality can be so infuriating that the term “borderline” has been inaccurately used sometimes by professionals as a derogatory label for any patient who is extremely irritating or who does not respond well to therapy. In these cases “borderline” more accurately