Why Therapists Fear Borderlines

Borderline Personality Disorder (BPD) is essentially an extremely rational set of beliefs given the premise that all love inevitably ends with betrayal or abandonment. Such is the world in which the borderline lives.

Therapists who do not specialize in treating BPD (and many who do) may have a staunch defense against treating borderlines. This is largely because the nature of the illness itself involves emotional volatility while the therapists’ hands are essentially tied. What do they fear?

• Suicide. Repeated suicide threats. Hospitalizations. Self-harm and threatened self-harm are in fact diagnostic criteria for BPD. Whenever I would look at my caseload, I would ask myself, ‘If someone were to suicide today, who would it be?’ This is the therapist’s nightmare: to lose a patient. It’s not entirely unlike an oncologist losing a patient to cancer, only, a suicide can feel more personal, and more like a failure on my part.
• Harassment. A few of my borderline patients threatened to suicide in front of me. They may not only be hurting you; they may also be communicating a need for help. How can I explain this pain besides sharing it? Another patient told me that Satan had made me. This was her actual belief. The more outlandish the insult, the less personally I would take it.
• Licensure. Borderlines can be passive-aggressive when feeling unsafe. Though this usually involves self-harm, they can also write to your licensing board and say the most sordid things imaginable. Ironically, the extremity of what they say may in fact help the board to realize this is a borderline reaction and not a credible complaint. That is what you hope as your career hangs in the balance.
• Countertransference. This is what we project onto our patients. Therapists usually have had rough childhoods as reasons for entering this field. When a patient tramples on our self-esteem, we are suddenly surprised to remember that not everyone is easy to help, easy to love, easy to heal.

It helps to remember that compassion is most meaningful when it’s least rewarding to give. It helps to remember the borderline is suffering more than the therapist. It helps to remember that the borderline wants what everyone does — love — and fears what everyone does — loss of love.

Read the other half of this narrative: Why Therapists Fear Narcissists.

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