Listening and Meaning in the Pyschotherapy of Borderlines

Abstract

Current conceptualizations about the borderline condition, derived from object relations theory and self psychology, point to an arrest in the separation-individuation phase of development as the source of the central emotional and cognitive dysfunctions of borderline patients. Consequently, several lines of development are truncated at the point, around age two, at which the separation-individuation process has been arrested. Some of the implications of this developmental failure are explained, with particular attention to deficits relating to communications between patient and therapist. Borderline transferences manifest issues similar to parent-child interactions in the practicing and rapprochement subphases of the separation-individuation process. Borderline patients attend to messages in the transference related to certain key issues around which they must protect themselves, namely, abandonment by the therapist, judgments about the self, the therapist's holding function, and the therapist's narcissistic needs. Understanding the way borderline patients communicate and how this differs from the therapist's communications helps improve treatment direction, planning, and optimism. An important therapist stance is to view the patient's disturbed relatedness as having positive adaptive roots. That is, the patient is expressing unmet developmental needs or protecting the self from injury. This view of the patient as manifesting arrested developmental needs and acting similarly to his or her developmental age at the point of arrest supplements an earlier view in which borderline behavior is viewed as only a psychopathological outcome of conflict. This new perspective permits a more hopeful vision of possibilities for communicating in a helpful way.