In therapy for borderline personality disorder with disorganized attachment, transference intensification is a necessary and positive sign of healing, as it indicates the therapeutic relationship has reached the intensity needed for corrective experiences; clients must learn to 'power through' the pain of closeness rather than abandoning therapy when transference becomes overwhelming, as this process helps internalize secure attachment patterns over time.
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Borderline Emails #5 - Transference, Bad TherapyAdded:
Hey deserving listeners. So today's episode is the final episode in which I read the patron and YouTube member emails about borderline. And in these episodes, we end up touching on a lot of topics that aren't related to borderline because borderline is not this discreet thing in isolation. There's often associated things, you know, like other personality disorders or other kind of attachment ideas and theories and stuff.
But anyway, so in this final episode, I grouped all of the emails regarding therapy, what it's like to be in therapy, and what it's like to be a therapist. So, let's get into it. My name is Dr. Kirk Hana, and I'm a therapist and a professor. So, this first email is from annual anonymous patron. They say, "Hey, Dr. Kirk, the TLDDR of this is, would you happen to have any tips on how as a patient struggling with borderline and disorganized attachment, do you have any tips on how to push through and continue with therapy once transference starts to really intensify?
Okay, so let's read the rest of this email. It's it's a little long, but I I think it's important because it really describes well the conundrum that people with disorganized attachment and borderline. So, a little side note about disorganized attachment, borderline, not everyone with borderline has disorganized attachment and not everyone with disorganized attachment has borderline, but they often go hand in hand and the symptoms of each can uh overlap and blend together. So that's what I'll say about I've talked about that before, but just to be clear. So um and if you don't know what disorganized attachment is, just very briefly, when a child is being abused by a caregiver, particularly if there isn't a safe haven, you know, if you're being abused by one parent and the other parent is a safe person to go to, then you probably won't uh develop disorganized attachment. You develop disorganized attachment when uh there's no home base.
There's no secure place in a relationship. So either both parents or all caregivers are being abusive or one is being abusive and the other is being hands off. And the result emotionally for the child is that they naturally want to go to their caregivers when they're scared. But if uh you know when they're when some when a child is scared of a monster, they run to their parents typically, right? But what if the monster is the parent, the child doesn't know what to do. So they have this dual instinct. They have an instinct to run away from the monster, which is away from the parent, you know, physically actually run away, move away from the parent. But they al they also have uh the a diametrically opposed instinct to run toward the parent because that person has been dis you know is designated as the person who takes care of you you know who feeds you and this kind of thing. So the child doesn't know what to do and um even just see when we experiment in the lab we uh will uh uh evaluate families and we will discover that some children when they see their parents you know listen to my episode on attachment theory and on the strange situation but essentially uh we designed this exercise where the parent will leave the room and come back in is a is a very simple way of putting And with about 4% of children, what was observed is that when the parent would return, the child would freeze in place or just collapse or kind of run in circles in this agitated, terrified state. They don't know to run away from the monster because that's, you know, the parent is the monster, but they also don't know to run toward the caregiver because the caregiver is the monster.
And so the child has kind of a an internal mental breakdown where they don't know what to do. And so they just kind of and so this is a horrifying developmental reality for children developmentally and neurologically and personality-wise that for the rest of their life they desire closeness. They're desperate for closeness because they've never had it.
They have this at 35, they have the same intensity for needs and attachment and security and dependency that a one-year-old has. And you know, if you've ever parented a one-year-old or 2-year-old, three-year-old, they have intense needs for attachment, right?
Because age appropriate. Well, if you're 35 and you've never had that need met, then you have all of that need and you have a lifetime of unmet need around that. So you as a 35-year-old, you might even have a a greater intensity of attachment needs than a young child would. At any rate, you have a very intense primordial need. At the same time, as you develop and cultivate relationships with people, the closer you get to them, the more terrified you feel around them. So, as you're getting that need met, you know, say you do cultivate a good enough relationship with a romantic partner, as you get close and you get vulnerable and you get dependent and as the other person opens up to you, you start to panic and it is again primordial and unconscious and un it's not voluntary and you can't really even wrap your mind around it. It's instinctual. It's this it's in the bones, right? You can't will it away there. It it it it, you know, people that are aware of their disorganized attachment, you know, if you've listened to my episodes with Bob where we talk about this, um, you know, he's a therapist. He's been in therapy for 30 35 years, he he knows this forwards and backwards. And yet even today when he gets close to people he starts to feel that and he starts to have irrational perspectives and he overreacts and he becomes depressed and and uh it's really really hard and and he's been through a lot of therapy around this sort of thing. Anyway, so some people with disorganized attachment don't have borderline. Some people with borderline don't have disorganized attachment but but a lot of people have both. And well uh which makes sense, right? It's like a certain profile of someone with borderline. They're desperate for closeness like a the way a child would be desperate for closeness. And they're black and white in the way that a child is in terms of relationships. All good, all bad. But the close they that they get to someone, they will attack because they feel that you are harming them or you're about to harm them. And they're totally convinced of that because that's what it was like when they were growing up. And so they preemptively or uh becau or because they interpreted something you did as an attack even though it was an attack then they attack you because they feel wronged and harmed and betrayed by you. And so that's one profile of borderline where there's the push pull that they talk about the idealization devaluation. Anyway, so what annual anonymous patron is saying is how do I handle the the transference?
So, uh, when someone with disorganized attachment and borderline attempts to heal, which often can really only be done in therapy with a specialist that understands relational corrective experiences, uh, as you get closer to your therapist and you start to transfer, you're going to be desperate for that closeness and the way a child is. and all that's going to come pouring out and you're going to fall in love and you're going to want more and more time with that therapist and also you will be terrified and you'll start to interpret things that the therapist is doing as nefarious and bad and uh although so it's simultaneously like finding an oasis in a desert of no water. So you you have that feeling while at the same time the closer you get to the water as you're so thirsty you feel an increasing pain and terror like a deep terror for people that are preoccupied attachment which is different from disorganized attachment.
preoccupied attachment. At least there's an orientation.
There's an organization to the defense where the preoccupied person will engage in hypervigilance and pursuing and deferring or controlling or something.
It can be very dysfunctional, preoccupied, but at least there's a plan. There's a mode that you can depend on. For the disorganized person, there is no mode. There is no defense. They have nothing. They're just a raw terrified uh mass of emotion with no ability to soothe or to orient themselves. They're just like glitching. You know what I mean? And it it's like the worst thing you can imagine.
So, um but in order to heal, you got to get in therapy. You got to have that corrective experience. And through that, you start to have earned security and less disorganized attachment. But anyway, but it's hard and it takes years. Okay. So, anonymous patron says for context, you know, meaning, you know, they're asking about how do I manage that this transference with my disorganized attachment, my borderline with therapists. For context, I sought out my current therapist because years of DBT, dialectical behavior therapy, didn't seem to tackle my deeper wounding and existential despair. All right, just chime me in. Yeah, DBT isn't designed to be that corrective experience. It's designed for a lot of self-awareness and a lot of emotional regulation and perspective, but it's not designed to be a corrective experience that way. Okay, going on. I needed to do deeper relational work with a therapist where my attachment issues could come out through transference. The issue though is that this work takes an excruciating emotional toll. As I'm sure you know, sometimes between sessions, I am dragging myself through my week, completely fine one moment and then overwhelmed with shame, fear, and pain the next. I'm not actively suicidal, but it does trigger a deeply hopeless and exhausted part of me, which ended up causing my last therapist to drop me after 6 months. Okay. So, uh meaning I think that when you went to therap certain therapy anonymous patron, they choose not to work with people who have suicidal thoughts or who have suicide adjacent thoughts. And this is a troubling trend that okay so if if you're a therapist and you don't want to work with people that require the kind of work or oversight or um you know care that someone with suicide requires then okay but you can't work with any client that comes to you and then when they disclose to you that they have suicidal thoughts. You can't then terminate them. You have to screen them out initially and then you say, "Well, what about people who don't have suicidal thoughts at the beginning but develop it later?" Okay. Well, then you have to screen people out who might become suicidal in the future. Because if you take on a client who has abandonment issues and they open up to you and then they get mildly potentially suicidal, I mean, it sounds like an honest patron saying, "I'm not actively suicidal, but you know, getting close to a therapist, it does trigger deeply hopeless and exhausted parts of me, which is going in the direction of suicide." And then the nonopian says, "Which ended up causing my last therapist to drop me after six months."
So, you know, they don't go into more of that, but I think what that indicates is that the therapist doesn't work with people who are suicidal, which one, why would you not work with people who are suicidal? A lot of people are suicidal.
Where are people who are suicidal supposed to go for therapy if therapists aren't going to [ __ ] work with them? Plus, it's not hard to be competent working with.
[sighs] Again, if if that's your boundary, fine.
But you have to be hyper vigilant and screen people out, which means that you will screen people out of your practice before you even meet them. Uh that actually won't develop suicidal thoughts. But you have to screen out so many people. Like one of the various questions that you would need to ask if you're a therapist that doesn't treat suicide is you would have to ask someone who calls you up to hire you. You would have to ask them, "Have you ever thought about suicide or been close to it?" And uh try to get an honest answer out of this prospective client. And and if they say, "Well, yeah, I mean, I've never really thought about suicide, but I have thought I have been, you know, how did the patron put it? I have been deeply hopeless and exhausted when things get particularly tricky. Then you as a therapist, you have to say, I I can't work with you because that could develop into suicidal thoughts, which does happen sometimes. And I don't work with that. Let me give you a referral for the following five therapists that do work with people who are su I I'm reading into it. I I don't know why the therapist terminated with you, but it's irresponsible and I see this happening more and more because people are just like, well, you know, it's out of my scope and I don't have a facility to handle that kind of, okay, but you can't wait until it happens and then terminate people willy-nilly because you can harm people and you can waste their [ __ ] time because it takes a long time to develop a relationship with the with the therapist and anyway [sighs] [gasps] like I I when I first started out as for the first 15 years I was therapist I don't I from my memory I don't remember a single therapist who would even imagine saying I don't work with people who have suicidal thoughts I I just I don't remember that I don't remember seeing that until the last 10 years and I started hearing people say stuff like that I'm like what uh Okay. And they it's out of my scope. You know, I'm not trained or I don't have a facility or uh or it triggers me or something. I'm just like, what? Uh so many people have suicidal thoughts.
Why are you a therapist? Why did you become a the like there's anyway [sighs] now maybe some of you listening are like that, but and you know, so I've worked with people who have had these kind of boundaries. I've had uh I've gone down a road with some supervises who will conclude they don't want to work with people who have personality disorders or borderline. And I'm not happy about it when they do that because I think that therapists, you know, if therapists aren't going to treat these people, then who is, right? It's like your local hospital saying they're not going to treat cancer anymore. Well, where are you supposed to [ __ ] go, you know?
Uh a and uh it it's not hard to get the training and the supervision and support and the knowledge and the experience to be able to you know because the reason why people don't want to work with these things typically is because they had a hard time with it the first time they ran into it and it took a toll and as it always does you know because who said being a therapist was anyway going on it's such a catch 22 too says anonymous agent. I've absolutely been that patient who leaves therapy when the transference gets too intense mostly mostly because I didn't understand what was happening at the time. So just chiming in patron is saying that it's a well-known phenomenon that with borderline and with disorganized attachment as the transference intensifies which it always does. In fact, uh the way that I see it and other people in my camp see it is that it's a good thing that it happens because that indicates it it's not wonderful, right?
It when a a client is overdependent, overreactive on you, but uh if you don't see that with a disorganized or borderline client, then it means that the relationship hasn't gotten to that intensity where healing can really begin. Because as they transfer on to you and distort you and you don't meet that distortion repeatedly over time, then the distortion starts to go away because you know the world isn't agreeing with their distortion and they're internalizing a new experience. They're having a corrective experience. Anyway, so um what they're saying is I've absolutely been that patient who leaves therapy when transference gets too intense. Mostly mostly because I didn't understand what was happening at the time. meaning that in the past they didn't know about transfers. All I knew was a voice telling me to get away from the thing that's hurting you. Okay, so just show me. Remember I was talking about disorganized attachment that you're desperate to get close at the same time you feel that person is hurting you or that relationship is hurting you or closeness is hurting you.
So you're simultaneously desperately running to the oasis. Uh maybe the analogy is as the you know the closer you get uh the more of these spiky nails start to stick up out of the ground and you're like stepping on it.
Or maybe a a more realistic analogy would be the sand in the desert is getting hotter and hotter and it's singing your feet. You know, maybe that's a good metaphor. And so, uh, you're saying all I knew was there was a voice in my head saying get away from the thing that's hurting you and then I would terminate with a therapist going on. But I really don't want to do that this time with my current therapist. I have a great therapist who I trust as much as I am able to. And I know that even if I did quit, I'd only end up crawling back to therapy at some point when the lack of connection and alienation get too overwhelming again.
All right? So just join me. So this patron is uh describing the experience of disorganized attachment and this type of borderline very well. Right? Remember I was talking earlier about the the glitching and the back and forth. Right?
So what they're saying is the closer I get to the oasis, the hotter the sand gets where it starts to burn my feet. I I'm getting blisters and I and I have this voice in my head says turn around.
Get away. And sometimes I'll listen to that voice and I'll run away. But when I get away, I am dying of thirst and I I need water and I haven't drank in 40 years. And so there's water right over there. I got to get back there. And I vastly in this middle zone of going towards the oasis, feeling the heat, running away, going, but I have heard by listening to your podcast and maybe other sources that I need to, you know, power through that pain of the sand and get to the promised land and stay there because that's where the healing happens, right? If I don't do that, then I'm always going to be vacasillating back and forth in this mid zone between, you know, 40-year thirst and pain on my feet. You know, I just got to power through. Now, the analogy kind of breaks down because when you have an oasis, you get there and it's no longer going to burn burn your feet. But that isn't the case, unfortunately, with this type of borderline and this type of disorganized attachment. The closer you get, it's going to continue. There is no non-burning of your feet. But the more you burn your feet, even at when you're at the oasis and you're drinking the water, the the the the more the heat starts to go down, I guess, or you start to build up calluses on your feet. I don't know. Uh it hurts less over time is a thing, but it takes a long time. Anyway, so going on, I just can't get past the feeling that in the end it's going to be too much for one of us to handle, meaning them or the therapists. I can't get past this feeling that in the end it's going to be too much for one of us to handle and I'll have gone through all this pain just to be alone and lost again. All right, just chime in. So, uh, right, because you had a therapist that terminated with you after 6 months because you mentioned that you had psychological issues. Lo and behold, a client has psychological issues and you got ter. So, yeah. Uh, well, what I would do, anonymous patron, is ask a therapist prior to working with them how they feel about your issues, you know, and and how they feel about termination.
Because when I would get asked that question, I I learned this the hard way in the beginning of my career that I h I tell clients that once I take you on as a client, there's almost nothing that would cause me to terminate with you.
Even if you threaten me or something which has happened, I won't terminate with you because I consider the role and the mantle and the responsibility of being a therapist. I consider it sacred.
So I will fight tooth and nail to keep you. If you want to leave me, you're free to leave me. And I'll never fight you to, you know, if you want to leave me. But I will never leave you. I And I'm never I would also have to reassure people. I'm never moving out of Seattle.
I I I knew that when I was young, when I was, you know, 26, I was pretty sure I was never going to leave Seattle. So, with my borderline clients, I could even say that, you know, because they would have other therapists in the past or they would imagine, well, what if you get another job and you move? And I would say, I'm I love here. This is where all my friends and family have born and raised. I'm never leaving. So, I'm always going to be here for you.
Today you can do taotherapy if you move out of state and stuff but anyway uh this is a very important point and again why would a therapist take on someone who has disorganized attachment and borderline and then fire them when things get a little tough you're just causing more problems anyway so so yeah for you and not as patron you're just like [sighs] h I don't want to start something and invest all this time and go through all that pain for the little bit of gain over time if I'm just going to run away or the therapist is going to fire me. Anyway, um or uh so going on or I'm worried that the pain will keep getting worse and worse as I become more attached. I keep fighting to keep it at a manageable level, the pain. But maybe that's not right either. Maybe I'm just supposed to let it happen to its full fullest extent. Uh that just doesn't feel smart for either of us. Uh yeah, I've already talked about going on. I've been through a lot of treatment and I really try to be as fair as possible when considering my therapist's humanity, their boundaries, their emotions. Anyways, I would love any wisdom on how to muscle through these difficult stages of treatment if you can think of any any tips. I've heard you talk a lot about how it it's a common experience for borderline patients, but not a whole lot on how to manage it as a patient. How can I help my therapist help me? Thank you so so much for the work you do and for the compassion you hold towards cluster B patients. It means everything to me. End of email.
Yeah. Well, you're welcome. And you're not going to like this answer, an honest patron, but I I don't really have any good tips. I if I did, it would be trit and simplistic and overly optimistic.
Um the the best tip I guess I can tell you is probably something you already know which is with time it gets better because that's the idea is that as you withstand that anxiety and that pain uh you acclimate to it such that it feels less painful and you start to internalize that secure attachment and have earned security and less disorganized attachment. And as you experience a lack of exploitation and harm and abandonment, betrayal, you internalize the its opposite or the very least not that and that becomes your template for expecting the world to be a certain way and you feel a certain way.
There's less anxiety, there's less pain.
But it takes a long time and depending on the degree of your issue, um it can be a lifetime of therapy, you know. Uh, again, I this [ __ ] sucks, but let's say that you manage to find the perfect therapist and you work with that person for the next 40 years and you feel like leaving sometimes, but you never do. And your therapist is a real therapist who doesn't terminate because you're heading in the direction of suicidal thoughts.
and you work with that person for 40 years and and and you put effort into it and throughout the week you're having all the ups and downs. I hate to break this to you, but you might get 50% down the road and so you're still going to have 50%. But you won't have 50%.
Which is a lot better than having 100%.
Right now, I can't know that for sure.
You might if you did this fictional you know if you did this possible future maybe you would have only 10% or no or 0%. I don't know, but that isn't my experience. Unfortunately, the reality is that it's neurological and a lot can get better. And uh with getting down the road, it makes it easier to engage in relationships in your personal life that are insecure and less distorted because the same transference happens with partners, right? The closer you get to your therapist, you have transference and the closer you get to your partners, you're going to have transference. So, it can look different, but it's the same idea that, you know, the closer you get to an attachment figure, the more pain and the more terror. Anyway, and the more uh uh the more you want to run, right? And by the way, just side note, uh the that running thing that you highlighted so well and and described so well will sometimes be confused as avoidant attachment style. People will be on the heels of having run away from a relationship or a therapist or something and they'll be temporarily avoiding closeness and they will say, "Well, you know, when you describe preoccupied attachment, that's me in the past, but now I'm avoidant." And typically what I find is that I will characterize, you know, it's just a way of conceptualizing someone as being preoccupied and had become so overwhelmed by their preoccupied attachment triggers that they're temporarily avoiding relationships and and gaining distance, but but they're not embodying an actual avoidant attachment style. When you have avoidant attachment style, you're always avoiding attachment style. And um whereas when you're preoccupied having said that uh the opposite is also true when you're avoiding attachment style you can at times get close because avoiding attachment people want to get close and they manage to open up or someone manages to open them up and and all of their attachment needs comes pouring out the same attachment needs that are rawly uh expressed you know in a raw way by preoccupied people and they could become very dependent and very vulnerable, right? Or at least in their way. And when they're hurt or betrayed or dumped, right? Avoidant people can be dumped too, you know, and they will have their inner preoccupied person triggered and they will become unglued and they will look preoccupied as they like cry and pursue and oh my god, it's happening.
Like a classic indicator of preoccupied attachment is everyone always leaves me, you know, is is the schema and the assumption.
And underneath an avoidant person, often you will hear that same sentence, but it will be uh infrequently said out loud or felt because they avoid relationships.
But when they do open themselves up and they do get hurt, they will recall all the times that they've been rejected, including when they were very young and they were being neglected and rejected, you know, being treated in a cold way.
And they will have that same perspective. Everyone always leaves me, you know, insecure. Anyway, and if you're disorganized attachment, you have that a lot, too. All right, so let's take a break. We get back more emails.
All right, we're back from the break.
This this next email is related anonymous patron. She says, "Hi, my therapist has changed my life in 6 months of two sessions a week." All right, so two sessions a week, six months, and a great therapist changed her life. But he just told me today that he is moving and her only option is to go virtual. It's funny. I was just talking about this, right? That when I started out, you couldn't do that, but now you can. Um, so she says, "I'm on the borderline spectrum and I do feel abandoned already, even before he leaves. The thought that I will never see him again in real life once he moves made this made me sobb for an hour today at home after our session." Just chiming in. Yeah. Yeah. Uh, makes sense, right?
Going on. However, I also wonder if it could be a blessing in disguise. I'm kind of feeling obsessed with him, but I also wonder if this is the kind of really good transference that is needed for me to heal. I don't feel like virtual sessions are as good, but I also don't want to lose this connection, especially if it's what is needed by someone with my relational traumas. I platonically love him and he has raised the bar for humankind for me. But also, should I get out while the getting is good? Is virtual therapy just as good if I have this kind of connection? My personal history is so dense. If I have to start over with someone else, I might just not. Sincerely, confused. Anonymous patron. End of email. Yeah. Well put.
And yeah. Uh, okay. So, here's my advice from afar is that to come across a therapist that gets it is rare. So, hold on to them. Now, virtual online therapy might not hit the mark. It it might be such a downgrade that it it overall it you just have to try to find another therapist in your area that fits the bill, which is hard [snorts] to do, by the way. Like you you could go through 10, 20 therapists and not find someone that knows what they're doing when it comes to this thing and is a good fit for you. So I and this goes out to everyone. If you find a good therapist that even like 95% fits, you know, let's say that you really like the therapist, but there's a couple complaints.
Generally speaking, hold the [ __ ] on because, you know, it's hard to find that. Um, just ask uh other people as they're looking for therapists. It's it's hard. Um, the other thing I'll say, an honest patron, is although I can't really relate to this because I don't like to be virtual therapy as a client or a therapist, but I'm old and I have the [snorts] privilege of not having to do that kind of thing. But, uh, pretty much every therapist I know is at least half, if not 100% virtual therapy.
And everything seems to be working out fine. So, uh, one way to look at it is that if you started virtual, you might not have felt the transference and that depth as easily as quickly, but you have that foundation.
And as you head into virtual and online, that felt sense has been established and it's not likely just to go away when you're talking through a computer screen. You know, like another suggestion that I'm going to put out there to everyone, which is something that I tend to do, which is that we tend to think of online or or distant therapy. The the broader term is distance therapy because distance therapy includes talking on the phone as well. It even includes things like text and that sort of thing. But there's other ways of working with clients that can't come into your office or if you don't have an office, which a lot of therapists don't have anymore. And uh you can do it over video conference, but you can also talk on the phone. And most people think of that as a massive downgrade, right? Because you don't have the visual uh communication.
But uh through a computer screen, you're not getting all the 3D visual anyway.
You know, it's it to me through a computer screen is a lot different.
Plus, you can't have eye contact or it's hard to have eye contact through these uh you know, screens. They're working on that. And there I think there are even some products today like where they use AI to have your eyes move in a certain way. I don't know. I I I haven't used those. I've heard it. But uh there are options to do phone and I prefer phone that now I prefer in person as a client and as a therapist but if we can't have that uh I have found because you know 20 years ago before there was video conferencing I would occasionally have to do distance therapy and and you could only do phones. So I I got used to phone therapy a long time ago. So, the the pros and cons is that the con to phone is that you don't have the visual. And that can be pretty uh annoying actually to me in that I won't know if a client is crying sometimes and I'll just be forging ahead in the conversation and I'm thinking why aren't they saying anything? Uh because most people cry pretty quietly, you know, or at least they if they're tearing up. So I will have to get to know people pretty well in in their subtle u indicators over the phone if if they might be crying or I just ask are you crying you know in a therapeutic way. So uh the con to phone is that you can't see them which is a con. But there's a lot of pros I have to say [snorts] that you don't have to be upright and looking at a laptop computer there. There's something quite annoying about that for me. And you can be laying on the ground as a therapist or a client. Uh I like to pace. I'm a pacer.
I I just I walk in this circle in my in my office just I just pace around. Um and so uh I can look out my own window at the birds or something, you know, as as we're talking. So that's a con that it's physically I think more comfortable on the phone. The other thing is that I think re research even found this that when clients are talking on the phone they might feel more safe to talk. They might feel more free associative. It's similar if you've ever worked with kids and teenagers. It's a well-known phenomenon that at least we knew back in the day and would use that if you were having a hard time getting a kid or a teen to open up in therapy, you know, get in the car and drive them around.
There's something about driving down a road as long as you're you're not, you know, almost getting accidents and stuff and and of course you want to make sure you have insurance to drive clients around and our agency did. And there's something about uh looking at the same thing. You know, you have client and therapist, no eye contact, and you're both looking at the road. and the white noise and the kind of hypnotic nature, especially if you choose certain roads that just wind through the woods like in Seattle area, that kind of u it's a well-known phenomenon that kids and teens are much more likely to start talking and just open up. You know, it's similar to if you're trying to get your infant to fall asleep, you put them in the car and and they fall asleep.
There's something about the white noise and the womb aspect and the fact that you're um that you're driving. I think that might also play a role of like they're at your mercy, not like intimidation like Dennis like the implication, but it has a feeling of okay, I'm I'm symbolically in their hands and they're competent as a driver.
And I think it also simulates per parent and child. You know, if you're a teenager, you're used to being driven around by your parents and so it might facilitate safety or who knows. But the phone has a similar kind of thing where when there isn't that visual distraction, uh clients, especially if they're yammering, if they're exploring verbally, uh they might kind of forget that you're even there because they can't see you.
And so they're just journaling in a sense and they're freer and they're more honest. And I've seen, you know, like I I've had clients where I worked both.
I'd see them in person and I would work with them on the phone and I would see differences. It it was kind of a lateral move, right? Because there's pros and cons. But anyway, so for you anonymous patron with your client that's leaving, u if you find that the video isn't really working in terms of having that closeness that you feel, maybe try phone, you know. Uh so there's that. But yeah, my overall advice is that uh you found a good one and I [clears throat] would stick with it. So, let's read your description here. Let's see. I wonder if it could be a blessing in his size. I kind of feel like I'm obsessed with him.
Okay, so this is like, I wonder if I'm if I'm getting too attached, right? If it's becoming a problem. Like I said earlier uh to an earlier email, the general consensus among among experts with borderline and with disorganized attachment is that that obsessiveness, that transference, that dependency is necessary for therapy to actually work with people to for it to be a a corrective experience. And this has been known for decades. So, uh it's up to you, but um and it's not going to be easy, right? It it'll you you might uh feel betrayed, might you might get more sensitive.
Um but it's great that you know, so this raises another topic of how many sessions per week because people with borderline and disorganized attachment, but particularly people with borderline and preoccupi so there are people with borderline with disorganized attachment.
There's people with borderline with preoccupied attachment. There's not a single person with borderline and avoidant attachment or there's and there's not a single person with borderline and secure attachment, right?
That doesn't make any sense. I I imagine if you did um uh research on people that there would be a percentage of people that would test out as both having full-on borderline and secure attachment. But unless that person with borderline has recovered and healed and has a lot of self-awareness, I would be suspicious that the measuring methods were not capturing reality because you're asking people questions.
Anyway, um so with um session number per week, there's no reason why you can't have more than one session a week. And I would do this a lot. In fact, with my borderline clients, I I I wouldn't introduce it unless they were in crisis like with um suicidal thoughts and this kind of thing. But I'd be very careful because if I was committing to two or three sessions a week, I know because I've worked with borderline people before that unless I can sustain that for the rest of my career, then I shouldn't introduce that unless it's absolutely necessary because if I have to pull back from two sessions a week to one session a week and it's me that is doing that transition to the client, they are going to freak out and it's going to hurt them and they might not ever live the I mean that's that's a major move right like one of the main curative uh uh elements of therapy for people with disorganized attachment and particularly people with borderline is consistency is you start therapy at the exact same time you end therapy the exact same time we call this the frame of therapy you know meaning the picture frame you keep the frame of therapy. You keep the frame and you don't [ __ ] around with it.
You're never late and you're you always have the same mood. You always have the same coffee cup. You always have the same face. You're the same. There's no change. This is important.
And I see some therapists play around with this sort of thing, you know. And so, uh, if you're going to work with people like this, which I think we all should, it's not hard to have a consistent schedule. You know, you just have to be organized and commit to that.
And so, with the borderline clients that I worked with, if I ever did go to twice a week, I was uh telling myself, okay, I would ask myself, am I up for seeing this person two times a week in perpetuity? Now, often if you're doing it right, you know, years down the line, maybe two years, maybe seven, the client will naturally want to scale back because it'll work to the extent that they don't need that much therapy and it gets annoying to them to have to come to therapy twice a week or three times a week. So, they will do that transition, but you should not. Right now, if it's an emergency and uh you want to frame it as that, then you want to frame it as that. So you want to say, okay, given that you're going through this acute um period of time where you're suicidal, let's increase the session number to twice a week. But understand that it will only be for a month. Now, as I say that out loud, some of you might say, well, isn't that incentivizing suicidal thoughts because then they get more contact with you? Yes, and you have to think about that. So, you know, there are other ways of helping someone in between sessions regarding suicidal thoughts, but you but again, you have to be really careful with that too. Like I had a borderline client who was desperate for contact in between session and I didn't have the capacity in my schedule to do that and she just kept uh pestering and and I mean pestering is a bad word but asking and requesting and demanding and after years eventually I said okay well how about we just check in you know and because part of the justification was that uh Uh I would fight and fight and fight with her and then in the last couple minutes of the session, she would finally realize, oh, I can trust you and you are secure and you aren't the distorted version I have of you in my mind. And then she would go home and sleep well that night. She'd wake up the next day and she would slowly start heading towards the distortion. And and by, you know, 3 days later, she would be completely convinced that I hated her and I I rejected her and I was a horrible person and I was just like everyone else. And then she would get angry and she would, you know, almost cancel the appointment and then she would come in and she'd be pissed at me and she'd be hostile with me and and we'd start all over and we'd go again in the last two minutes. She would eventually get, you know, generally speaking, she'd be, "Oh, yeah, that's right. Okay. Thank you for, you know, working so hard." night. Oh my god, you must really hate me as a client. I'd be, no, no, you're good. You know, this is why I'm a therapist and we'll get down the road together. And we decided, and mainly she wanted this, was that, well, what if we checked in halfway through that week so that she could have some touchstone that would break through the distortion and sustain the reality that I am a secure relationship? because uh when she goes down that road and convinces herself that I'm not a secure relationship then that might and you know that's internalized right and that could keep her in a that could keep her from uh uh healing right because yeah when she meets with me and maybe the next day she's absorbing this new reality that I am secure but then for another four days of the week she's living a different reality you know, it's her own distortion, but it's a reality of being rejected and harmed and abandoned, and that is being internalized, too. So, what if midweek we could save that off a little bit by having a reality check where she talks with me on the phone for just a couple seconds, and just that little contact can remind her of the tangible me instead of the distorted projected me from inside her. And so, uh, we would schedule it. And at least that's my memory with this particular client that I'm thinking about. And um but the problem is is that uh we did this regularly for a long time. And you know I have this is when I was working at an agency. I had 35 other clients every Yeah. I I would see 35 clients a week or maybe 30 clients a week and she was just one of them. And I cared about her and I was dedicated to her but I was also dedicated to 29 other people. And and so when she would call uh at the a you know she'd call the agency the the landline and she would have to catch me in between clients which you know wasn't always easy but she but she would call she would try to call during that last 10 minutes and and everything seemed fine. But then one time I was running around the office, you know, cuz I'm seeing families and kids and there's all the other therapists that are in this small little building. It was a It was a small little Rambler house that was converted into an agency. Just so imagine that. Anyway, and I am stressed out. I'm trying to do my paperwork. I was also still addicted to cigarettes.
So, I'm running outside trying to choke down a a smoke uh to stave off the jitters from withdrawal from nicotine.
And then I get this call and I I pick up the phone and I knew to center myself, you know, to not just get on the phone.
What do you want? You know, I took a breath, took a beat, said, "Okay, calm down. You're you're going there's a lot of landmines here. So, you know, check in and have it go smoothly." And I did that, but I didn't do it enough. And uh I picked up, you know, line two and and I was actually behind the receptionist desk cuz that's where I happened to be in the building and there's all this chaos going around me, but you know, I tried to make sure to stay uh focused and uh and I got off the phone and thought everything was fine. The next session uh she laid into me and said, "I knew it. I knew you didn't care about me and I knew that you would uh abandon me and I I saw all I saw through the facade. You don't give a [ __ ] about me.
You know, I'm just one of many clients and I I you know, all that [ __ ] that you said that you're a secure relationship and that you care. I I saw through all of that [ __ ] crap and you're a horrible therapist, you know, and um I then I was like, "Oh, fuck." A and then I, you know, worked hard and maybe it took a few weeks to convince her that I did care. And then um we ended up talking about that phone call, that 3 minute check-in phone call for years. Every other session, it would be half the session. That's what we would talk about. It became what I found to just be a symbol, right? It was it was this totem for her of because I was so consistent otherwise, you know, in session. There wasn't any totem. There wasn't anything she could grab on to uh to to justify the way it felt to her, which is that I was abandoning and even abusive abusive to her. She had distorted that phone call in her mind and remembered something completely different. You know, I could hear it, the tone in your voice. And you know maybe I was a little frazzled but I did care deeply. You know I know that about myself [gasps] and uh for years that phone call would come up. So the frame of therapy you have so the frame is being broken in honest as he transitions to virtual. But whatever if you're a therapist out there you just have to establish a new frame and um yeah. So let's go on to another email. All right, this ne this next email is from listener Sarah from Ireland. She says, "Hi, Dr. Kirk.
Firstly, I think you're wonderful and I wish all the mental health professionals I come into contact with were as compassionate and understanding as you.
My question pertains to how clinicians perceive the borderline personality disorder label. I was misdiagnosed with borderline for a few years." Okay, so this isn't a question about someone who has borderline, but it the question does pertain to borderline. I was misdiagnosed with borderline for a few years, and I noticed a big difference in how I was treated when I had that label versus when I didn't. For example, when I would self harm, I would get questions from clinicians like, "Who were you trying to get attention from?" Yikes.
Also, I once got hit by a car and the first thing a doctor said to me when he read my notes was, "Did you walk out in front of the car on purpose?" By the way, I was hit at a pedestrian crossing.
Since having the label removed, I have noticed that clinicians ask more questions and make less assumptions about me. I wonder if you've seen this kind of thing in practice, or is it perhaps all in my head? Thank you. End of email. Yeah. [sighs] So, you know, I'm so divorced from this nonsense that I sometimes forget that this is still out there. But of course, it is. I think it's less hopefully less pre prevalent.
I don't know. But yeah, this is reminding me that in the past, uh, I would hear a lot of misinformation and a lot of stupid things about borderline.
Like in a previous episode, I talked about how the uh stigma among clinicians about borderline is like don't work with someone borderline because they're going to sue you. They're going to find some way to bring you into court and and sue you. And and and it's like huh what you know I I spe you know this is me telling I specialize in people with borderline.
I've never been sued by anybody. Um, so you know what?
Uh, maybe, but you know, uh, and and I, you know, I think in an earlier episode I talked about this one client who had borderline but never really worked on it and didn't have insight and didn't really want to work on it and it was really hard and every session it was just her yammering about all these lawsuits that she was involved in. And yeah, I thought, uhoh, am I going to be targeted with a lawsuit from her? Cuz she is to she does not give up for years, you know what I mean? And uh so, you know, I I'm really just tried to not step on any landmines with her, which when you're an expert, it's not hard to do anyway. So yeah, this is reminding me of another stupid stigma that Okay. So So there's a broader topic of what they call suicidal gestures. You've probably heard us talk about it before, but um okay. So uh you know, independent of borderline, but it's often associated with borderline, but independent of borderline, there is such a thing. And it some people don't some clinicians don't like to admit this or uh talk about it but some people do what they call gesture suicide in that they will use suicidal threats or behaviors to manipulate other people unfortunately. Now that is rare but it does happen and I've seen it. It can also be both. So, uh, which is more often the case with borderline that, um, yeah, I I totally forgot about this assumption, this misinformation. So, there are certain clinicians and maybe many clinicians, I don't know, it sounds like even physicians in your area, Sarah, that you have uh uh if you are if if you are labeled with borderline and it's in your chart, they will assume you're in a constant state of manipulating other people to care about you. Now, um the uh the the general uh uh statement that I would say is that people with borderline are manipulative, but it's out of desperation. They're not like he he I'm going to manipulate people. They uh they'll do anything to get attachment security, and they're desperate for it at all times. And and if they have transferred on to you, then they're really desperate for it. So, they will try anything. And so if you as a therapist are available and you keep the frame and you're consistent, then they learn they don't have to manipulate you, right? But if you're not consistent or it's a beginning, then they might engage in some manipulation. But what is the man manipulation actually look like?
Well, it's not psychopathic where they wake up and go, "He he, I'm going to use this person." It's um it's a often something that comes from their childhood where they learned in order to avoid abuse or to get some uh consistency and attunement from their caregivers. They learned that they had to signal more essentially. You know, all all children learn how to quote unquote manipulate is one word or how to garner love, how to get connection. If you're being raised by good enough parents, then the children will resort to a lot of things. You know, if if you're a good parent, you've raised kids, you know that sometimes they can be manipulative. You know, they can fake cry or I don't know, they can appeal in certain ways to you that are insincere because, you know, they want attention and we forgive them for that cuz they're kids, but they might also approach you in more direct ways like, "Hey, let's do this puzzle together or something, right?" So, sometimes they're direct, sometimes they're not. um they probably resort to the indirect ways or the manipulative ways, the deceptive ways when they feel like direct ways aren't going to work. Well, what if your parents are never responding to your direct ways? Well, then you're going to try anything. Now, the avoidant kid will just turn away and go into denial about their attachments. The preoccupied person and the borderline person, they lean in. They become hyperfixated on gaming the system. And [snorts] that can involve uh uh purposely manipulating but it's out of desperation. It's not just like he I'm going to um the the other thing is that neurologically so uh avoidant attached people will neurologically we can measure this turn off their attachment needs or or or ramp down attenuate their attachment. It never gets turned off, but they can sort of blunt it, numb it. And they also uh we find that attach attachment uh avoidantly attached people remember less about relationships.
We will test them in the lab and find that they remember things that happen with in relationships less often. And the idea is that they neurologically, you know, this is not your conscious mind. When they were two, they realized neurologically it was rewarding to their neurology for them not to encode memories that involved attachments. So that's why a lot of avoidantly attached, if you're in a relationship with an avoidantly attached person, you might find that they forget things about your relationship. They forget conflicts, they forget disappointments, they forget fights, they forget uh whereas preoccupied people are the opposite. They will remember, they'll hold on to a grudge.
They can recall fights that you had years ago and remember tiny details, right?
um they catalog you did this and okay so uh in the same way for the preoccupied borderline kid they neurologically will amp up their emotional expression even their facial expressions are more expressive because neurologically not consciously but neurologically they're being rewarded for having bigger emotions not not only just signaling and displaying their emotions more outwardly, but even feeling their emotions. So, borderline and preoccupied people scientifically, measurably feel the same emotion you five times more intensely or, you know, double the intensity or whatever you want to say in whatever metric. And from the outside, a simple way of dismissing preoccupied and/or borderline people is to say they're being manipulative. It's not real. They're overreactive.
And so when you Sarah had this label of borderline and uh you say, let's see, uh when you would engage in self harm, so I'm getting I'm guessing cutting and you would get questioned like who are you trying to get attention from? [laughter] Um one, why are they saying it to you?
Because you you didn't have borderline.
So that's a problem. But even if you did, why why is that? Um, you know, especially with cutting that is I said in an earlier episode, typically it's it's a way of coping with the severe psychological pain, right? They aren't doing it. In fact, 99% of people who engage in non-suicidal self-injury do everything to hide it from other people uh for a variety of reasons. But anyway, um, and then you got hit by a car and the physician says, "Did you walk out in front of the car on purpose?" I mean, my [ __ ] god.
[laughter] [gasps] Um, so getting to the suicidal gesture thing and this is a sensitive thing and I think you know even when I bring this up with Bob sometimes he he he doesn't like this perspective because the uh the sort of dumbest perspective is that borderline people will fake suicidal thoughts to manipulate people. Okay. Um and so this uh reaction to that which is justified where they swung the other way and said that never happens. There is no such thing as suicidal gestures. But uh there's a third uh mode I think of the vast majority of suicidal uh expressions or thoughts or communications from people with borderline are genuine but sometimes they're manip manipulative in a sense.
Um like uh a classic example you know earlier I was talking about the difference between men and women when it comes to borderline and one of the things that you will uh hear uh on this is just anecdotal that I from men who are borderline they will threaten suicide more often. This is just anecdote. Plenty of women and non-binary people will do this as well. But u men in their desperation to get you to come back to them or get you to listen to them or something will uh uh they might just completely make up that they're going to kill themselves later if you don't talk to them. This kind of thing. Some of you might have been the target of that sort of thing.
And it might have felt or at least in retrospect manipulative which it can be.
But here's the thing that it's both that uh you know the people with borderline are suffering right and suicide is a natural thought under that kind of suffering. It it's unfortunately just something about being a human that when we're hopeless and we're thwarted, you know, our belongingness is thwarted is the way they in in suicide theory they talk about it and we're experiencing psychological pain and we don't have any way that we believe will alleviate that pain. We will contemplate any way to get out of it and suicide for whatever reason pops in our head. And people who have borderline are suffering greatly if they don't get proper treatment support.
And naturally as anybody suffer from anything they will have that pop in their head and often it will become quite chronic. Now since borderline people are in a constant state of orienting toward other people to meet their attachment needs then that impulse that normal human impulse of suicidal thoughts that is popping into their head will uh be used by them to get people to pay attention to them. Right? They want attention. They want people to be close to them. They feel like they need to u coers people or manipulate people or um you know they uh they not this isn't all borderline people but for a lot it is where they believe that if they just approach people normally people won't really care or they won't uh or they might even harm you right but if you uh if the borderline person they might think in order for me to get love and attention I have to be so obvious viously suffering that they will take care of me. Right? The other thing is is that when you are suffering, [gasps and sighs] um [clears throat] you naturally want people to know and you want to alert people. You want care in the same way that if you were sick or you broke your leg or if you know someone died in your personal life and you met up with a friend later that day, you naturally would it would just come pouring out of you naturally, but also you just want some support. You want some love. Well, people who have borderline are suffering pretty much all the time. And they all the time want that. And and remember that contrary to narcissistic and avoidant attachment uh because those people uh will turn away from relationships. Borderline and preoccupied people the answer to all their problems is other relationships as people. So when they're suffering, they run to others and alert and neurologically because their emotions are felt bigger because that's the way their brain was wired when they were zero to five because they had to be they will come at you with their emotions big, [laughter] you know, and it'll be big. But if you're a therapist who specializes in a sort of thing, you specialize in it and you know it, you can interpret it and you have faith that if you stick with it, you know. So, uh, when people don't understand borderline and it's a very convenient way of looking at it, right? It's a way of dismissing the whole thing because working with borderline is very hard and it is very challenging personally and clinicians struggle with it naturally and uh and historically and today what will happen is the clinicians will talk amongst themselves and develop uh convenient excuses to reject people with borderline. And one of them in the past, which apparently is still present, is they're manipulative and they will sue you. And you know, I've even heard people say you can't treat it, right? In the same way that you can't treat people with narcissism, which is just not true.
That no scientific research demonstrates that narcissism and borderline or at least the consensus cannot be treated.
We have tons of data demonstrating that these two disorders can be treated over time and the symptoms will go down measurably. Anyway, so yeah. Wow.
Listener Sarah from Ireland, who were you trying to get attention from? And you know, and that just applies also to the sexist notions like independent of borderline misinformation.
A lot of people think of cutting which is associated a lot with teenage girls and this kind or young women, which is not necessarily the case, right? But uh since there's sexism and agism and mental healthism that we will as a society um figure out some way of oppressing further those people is just like well it's not real. You're just trying to manipulate people anyway. But to be hit by a car and to be asked by the doctor, did you walk out in front of the car on purpose? And then once the label is out of your file and you get treated differently, I mean that that's interesting, right? Like what an experiment because we talk about the stigma but if you have borderline one you're distorted in how you see the world you know not like completely all the time but you know there's that question mark but also uh you might just be interpreting things maybe everyone is dismissed by clinicians and therapists and and it's just more you're just more sensitive to it but for you Sarah you're saying there was your life before you had that label in your chart and and you were treated a certain way. You have that label put in your chart and suddenly everyone is reacting to you in a very different way. You have the label move uh taken out of your client file and everything goes back to normal. I mean, that [ __ ] says something. Now, that's Ireland, but I'm guessing it's a very similar thing in the States. All right, let's read another email. All right, this next email doesn't really have to do with borderline, but the emailer mentioned borderline and well, let me explain. So, I'll just answer this real quickly. So, anonymous patron says that they are training to become a therapist and they have borderline themsel and they appreciate my podcast because they've heard a lot of not so great perspectives from people including some clinicians who have stigmatizing misinformation perspectives about borderline. And then anonymous patron goes on to ask me about uh their experience as a novice therapist that uh they they're getting really nervous with some of their clients particularly as it goes deeper.
And she's saying how so she says um did you experience this anxiety and did it get easier? If so, is there anything you did to become more confident as a therapist or is it just a matter of experience and of email? Yeah.
[sighs and gasps] So briefly what I'll say is I absolutely felt that nervousness. In fact the very so uh the very first individual clients I worked with I was nervous for sure but not as nervous but the very first couple I worked with. I remember I was so panicky that I grabbed this textbook about couple therapy and was just leafing through it without the ability to process what I was reading. And and I was aimlessly searching for something written down in this book that would tell me what to do and pull me out of my terror. And I was such a bad therapist with this couple that they didn't come back to a second session.
You know, I must have just been staring at him in a cold sweat, you know. And every intern has to start somewhere and sometimes that means that some clients aren't going to get the best treatment.
And you know, sucks to be them, I guess.
I hope they got a better couple therapist than me. And uh that happens.
And it did happen. And that was a frequent occurrence for me in the beginning of my of treatment. And uh so that's me. Now you're experiencing maybe above average anxiety. The the key is is that when you're a novice therapist, you have a lot of supervision. You're hopefully in therapy yourself and you have a lot of colleagues and friends that you can talk to about this. So, I'm guessing a lot of other people have felt or are feeling this and you just talk it out and you get help and you get perspective and you let you just let yourself be anxious because you know I it's the anxiety is is um relevant or is um what's the is coherent in that a lot is at stake when you're a therapist.
It's a big deal. So you should be nervous and you're you're appreciating the significance of the ma of the matter and that's good you know and maybe depending and again talk to your supervisor about this but one of the things you will could contemplate is maybe if I'm particularly nervous in a particular moment I'll tell the client by the way I am feeling a lot of nervousness you know I'm a novice therapist and I really care about you and I care about your therapy and I want to do a good job and I just want to tell you up front that I, you know, I I've been kind of nervous and I've been thinking a lot about your case. You know, when we met last week and you told me this thing, I I realized, wow, you know, yeah, this is this is a big deal and I I'm feeling the weight of what you told me last time or at least I sense it and um I'm, you know, since I'm a novice therapist and I really want to help, I don't know, I'm just kind of nervous.
That's okay. you know, talk with your supervisor, they they might say, "I don't know if that's such a great thing.
It could undermine their confidence into you to such a degree that they would feel like they were flapping in the wind." But, uh, but yeah, uh, the other part of your question is, is it just a matter of experience? Yes, that's the answer. That's the answer to everything, right? The first time a fire, uh, fighter does their first fire, I'm sure they're all amped up with nervousness, and the 50th time they do it, they're less so, you know, so, you know, it works out. Uh, but if you're having excessive anxiety, then I would talk with your therapist and your supervisor.
And, you know, because there might be something going on with you about this, some kind of schema or uh, you know, another thing that could be here is you're emailing me about this. So, you know, were did you I didn't hear any mention of your clinical supervisor or your consult or your group supervision meetings. So, one of the reasons why I will hear people being nervous in this scenario in the beginning of their career, I I'll, you know, be I'll be going back and forth with them and then it comes out that they don't really have a supervisor or their supervisor is u absentminded or doesn't really pay attention to them or cancels appointments or something. And I'll be like, "Oh, well, that's why you're nervous because you're completely on your own." And your body is detecting the absurdity of that. You know, it's like the first time you're flying a plane and the instructor decides at the last minute not to get in the plane with you. So, of course, you're [ __ ] nervous. So, I I don't know what that scenario is, but anyway, let's read the last couple emails. All right. This next email, anonymous patron, she says, "Hi, Kirk. My boyfriend is a PhD psychologist with a with master's degrees in addiction psychology and psychoanalytic psychotherapy.
He also has ADHD and borderline personality disorder and has struggled with stimulant addiction which causes his borderline symptoms to become debilitating.
Okay. So, her boyfriend is psychologist with ADHD, borderline, and stimulate addiction, which causes borderline symptoms to become debilitating. He experiences significant jealousy and persecuto delusion centered on me, but he can be completely normal appearing with others and can continue to help his patients and students. So, just chiming in. So, this is the more common scenario. You know, earlier I I read an email about someone saying, "Hey," I think this is in the previous episode, and she was saying, "Hey, I tend to only have my borderline express itself through friends, not through my romantic relationships."
And that is a a profile that I've seen sometimes, but usually it's the opposite where the borderline triggering will occur in a close relationship or a set of close relationships but not outside. So this fits that profile that she's saying. He has borderline. He selfidentifies as having borderline. And with her, he is significantly jealous, has persecuto delusions, which is common for people being triggered and borderline. But with people outside, he's fine because he's not being triggered. He's not like holding it together outside. He just doesn't get triggered. So it it doesn't activate, you know, but going on. He is currently coming out of an episode of So it sounds like of that persecuto delusion towards her. He is currently coming out of an episode and your talks on borderline and on personality disorders and your theory deep dives have been so helpful as I try to take care of myself when he is struggling.
I'm wondering if you have any experience either as a colleague or a therapist with other psychologists with significant mental health illnesses or personality disorders. Thank you. And a female. Yes. So, I've worked with therapists with a variety of mental health issues, specifically borderline personality.
Uh, I had I'm thinking of one supervise of mine who selfidentified as having borderline and she said that her mom had borderline as well. And she had, you know, this student of mine and this supervise of mine, this therapist had been through a lot of therapy, but, you know, she knew that she had issues. Now from my memory her borderline triggering happened at home. She was actually in a polyamorous relationship with uh more than one partner that they lived in the house with kids and stuff. So it was a stable polycule but from my memory I think uh she had gone down the road fairly significantly. I I think what helped her recover prior to entering the program was that her mom was borderline and she could see from the outside what borderline looked like and then she could look at herself more objectively if that made any sense. Anyway, and as a therapist and you know, I would observe her and I taught her and interacted with her a lot and she didn't get triggered at work by clients. it. But I have also now that I mentioned that I have worked with colleagues and trainees who have borderline who do get triggered by their clients and you know uh it's the same topic for any therapists that we have to be aware of vulnerabilities and our triggers and our biases and when we are starting to lose it and we have to have a system of managing our counter transference. This is a scientifically f you know there's like 10 to 12 factors that are almost solely responsible for positive outcomes in therapy and counter transference management is one of those 10 to 12 factors. Others are empathy and self-disclosure and authenticity and feedback and rupture repair and this kind of stuff. But um having a system of counter transference management which not all therapists have uh in fact there are times when I will talk with people that I don't know very well in the field and we'll be consulting and I'll say they'll be you know talking about a case and and I'll say okay you know any counter transference that you have and they'll say no this person doesn't remind me of my family they'll say as if that's the only thing counter transference refers do. But when I'm asking and sometimes I'll explain, but when I'm asking for a counter transference, I I'm not asking if you have, I'm asking what because we all have reactions to clients, especially when we're struggling. And when I'm asking for counter transference in terms of my def and there's four major schools of defining counter transference and and I'm operating from one of them but I'm asking and I recommend therapists think this way of uh I'm you know you're always as a therapist having some kind of reaction big or small known or unknown uh problematic or helpful and you should have some awareness of it and if you become very practiced in this practice then you don't have to focus on it very much to notice it you know like with my uh fluttery adrenaline fear in the center of my chest that I feel when I first meet someone with borderline in the beginning of my career one I wouldn't notice it uh later on I would only notice it if I paid attention to it but with practice now when I feel it I uh oh oh another thing is in the past I would notice it, but I didn't know what it meant. Now, you know, later on, years into it, with practice, repeat, repeat, practice, practice. When I felt that feeling, I would detect it very readily and I didn't need to spend a lot of time thinking about what it meant because I had uh you know had a lot of experience which with each version of that flutteriness in the center of my chest such that eventually I I would immediately feel that feeling notice it and you know ask a very quick question like in a half second what what type of flutteriness is that? Is that indigestion? Is it borderline? Is it narcissism? It's something else. Is it, you know, some kind of just overt threat from this person or what's happening?
You know, and I with practice, you can do it very quickly. It's just like anything else, you know, like uh if you do something repeatedly, it becomes second nature. And that's that's what you have to do with counter transference, awareness, and management.
Anyway, so um with all therapists, they have to do that. With people with borderline then they have a particular version of this that they have to become very aware of how their borderline might get triggered by clients and how that feels and how that will distort. Now, there's ways of managing this as a therapist with borderline in that if you don't become overly attached to your clients, like you just make sure you monitor that, then uh you're less likely to get triggered, right? Or if you screen out clients that more closely resemble your person that you tend to transfer with, like, you know, if you were abused by your dad and someone comes in that has all the trappings of your dad, looks like dad or talks like that, um, then you might want to screen that out because it might be impossible to manage your counter transference.
Yeah. Um, now having said that, I've also worked with cases where people had disorders like borderline like narcissistic, you know, clinicians and it it screwed things up where they would distort and attack or in or exploit. You know, I I I've worked with cases where the therapist or psychiatrist had borderline and fell in love with their client and had sex and had a sexual relationship with their client and uh became overwhelmed with that relationship. So this is a borderline psychiatrist having an ongoing exploitative exploitative relationship with their patient and getting caught and then um you know so so it's not all fun and games but anyone of even people who don't have disorders right can engage in that kind of stupidity. So uh are people with borderline or narcissistic more likely? I don't know.
I I think so. often the kind of uh horrific cases that I've worked with, I often will see evidence that there's something characterological, some kind of personality disorder going on with that with that clinician, especially repeat offenders, you know, people who just don't really learn from, you know, because you would think if you get caught in a sexual relationship with a client, that you would steer clear of it, right? that you would detect it early and figure out some way of sublimating, you know, like if you start feeling that itch with a certain client that you instantly get on Tinder and start hooking up with or something, you know, and yet there are people that just repeatedly offend. And so there has to be something wrong with their personality, you know. Anyway, let's read one more email. All right, this last email is from anonymous patron and I will summarize her email. She is saying that she's aware that she has borderline and she's gone to therapy and she recently engaged in EMDR therapy and she is finding that uh some of her old symptoms of borderline are reemerging.
I'm trying to think uh like suicidal thoughts and alcohol and and marijuana use and that sort of thing. So, uh, her question is, could EMDR be making me more borderline? She asks. And the question is, yes. I mean, not everyone would word it that way. Another way of wording it is that as you uh go through trauma treatment, then there is an encouragement or at least the thought that you are probably going to be in EMDR. you don't talk about the trauma narratives, you think them. And uh and so when you're doing that, you're doing the eye movements or the bilateral stimulation or whatever. And so um when you engage in EMDR, that's usually explained to you and or you probably just know that that's why you're seeking out EMDR is that you want to work on your trauma. So, uh, even before because I think in your longer email you were saying that you haven't even begun doing the eye movement and the trauma narratives uh, remembering and yet you have these old symptoms that are coming back from borderline from before and you're thinking, "Oh my god, what's happening?"
Well, uh, who knows? And I would talk with your therapist about this, but the uh possibility is that your u you know mind and your soul are getting stressed out as it contemplates the idea of revisiting these traumas and that's natural but it has to be paced right you has to be at a tolerable pace and individuals who are heading into exposure types of therapy like EMDR you have to have a lot of emotional awareness and regulation and support and there can't be any risks like suicide right so or those have to be monitored quite closely so um hopefully your therap if you alert your therapist to this then there will be that monitoring and and that pacing you might be going at the right pace depending on what you and your therapist determine but that's the idea uh even before talking about the trauma your body kind of knows that's coming and So, you're having distress, that's PTSD, that's trauma, that's borderline, and your brain is starting to suffer. And so, you're starting to see those effects of suicidal ideiation, of drinking more to cope, you know, smoking weed. Um, it it also could just be a reminder, you know, as you head into the trauma, it might just cause regression to, which is another aspect of this that some of you might be able to relate to. As you go through trauma treatment, you you might just become more childish in a way or feel more of the age that you were when you were going through that. It's natural to have that happen, but again, I would talk with your therapist about that. All right. Well, I didn't realize it would take five episodes to go through all those emails, but I I don't know. It was a pretty rich experience for me. Was it for you? Was it good for you? Um uh yeah, I sat down uh last week to, you know, read emails because it had been a while and they'd been piling up and I always feel bad because I always want to respond at least to the patrons and YouTube members. And uh I noticed I was like, "Oh, there's a few uh uh emails about borderline. Maybe I should do a word search for BBD and borderline and lump these together." And and there were a lot of emails. Uh because there's a lot of questions and a lot of things to explore.
Um, I don't know if you all remember, but someone emailed in or DM'd me on Patreon or something and said, "Hey, do you hate borderline people now because you haven't talked about it in a long time?" And uh and it was sincere, you know, because if you have borderline and you're transferring on to me, which is natural, then if I'm not talking, if I haven't talked about borderline in a while, then you can start to distort or or wonder, right? Am I being abandoned by Kirk? And the best thing to do is to ask, right? And because that's what I one of my I'm not your therapist, but there could be a corrective element to any relationship that you're in, right?
Um, even if you don't have borderline, u some of you will email in and say that you now have some hope that you might find a man that isn't toxic and abusive because you have an example of a man who wasn't that way or you have a corrective like if you listen to my episode with my mom, some people emailed in and were were just like, "Wow, that felt corrective because I've I've never heard a mom so great as your mom, you know, loving [snorts] and caring. and attentive and and um you know so it I felt like I absorbed that feeling and and all of us whatever we're absorbing is going to have that effect on us whether it's podcasts or YouTube channels or movies or books or whatever friends therapists our spouses ourselves you know it's all an opportunity for affecting us in good and bad ways anyway so um someone emailed in and was um I I think pretty serious of just like, "Yeah, I feel I I I I'm pretty sure I'm distorting, but I feel like you must hate us now. Maybe even me because I've emailed in before about borderline and uh I just wanted to I'm pretty sure you don't hate me, but I'm starting to feel like you do and so can you let me know."
It wasn't me, you know, I'm pretty sure they weren't saying I hate me. I think it it was pretty sure it was like I think you hate borderline people now.
And I think what I said at the time, this was like I don't know six to 12 months ago, and I said something like, "Well, I get a lot of emails and sometimes I feel like I talk about borderline too much because it's a passion of mine and I get a lot of emails about it, but sometimes I wonder about the other people who listen to the podcast who might want other topics to be covered, you know." So, it had been a while about me answering any emails, let alone borderline. So, I hope that all the borderline parasocial transferring people on to me are satisfied at least for a while [laughter] and take care of yourself because you deserve it. You really Well, so the end here, I I'll say that um what can we say is the final word.
Well, I hope that through this deep dive or through it's kind of a deep dive, right? the emails and through the other deep tests that you know we can see that it's complicated that these are good people who deserve love and attention and support and some of them some people with borderline can be hurtful and so distorted that it can be kind of problematic and it's not their fault but it's also not our fault but with proper therapy I you know maybe I'll end on on that so one of the um early career borderline clients I worked with, she was intensely borderline, you know. So, without going into details, I'll just say, you know, she had all the the quintessential things and the transference and all and the distortions and the hostility and all that kind of stuff. And I worked my ass off with her. And then um slowly but surely you know year after year there were markers of change and eventually it wasn't every session that she was yelling at me it was every other session and then it was once a month and it was almost imperceptible because you know it was very slow over time and then eventually I started hearing that she was dating someone now this isn't always a marker of success. But with this client, it was new that she was dating someone before that point. Um I was the only man in her life romantically, you know, even though we didn't have a romantic relationship, but she didn't have any vague she didn't have any room in her heart for anyone other than me.
Before me, it was avoidance of relationships in general, uh, romantic relationships. But then I started hearing, you know, I, oh, I went on a date and I met this guy and and I'm like, oh, wow. You know, and you know, I have to say now that I remember it uh uh irrationally, counter transference wise, I felt a little abandoned. You know, I felt a little hurt like um the love and attachment from her, the obsession from her. Obviously, I saw clinically and it was u annoying at times, right? Just personally, it's like gh like let's get over this. But there's a part of me that liked it, right? You know, and that's a part of the counter transference awareness that you have to be able to admit that to yourself. And I'm admitting it now. And uh but you know, I manage it and uh don't let it affect what's happening. And um you know it it's not it's not even necessarily against my style to bring that up and to talk but typically I don't because I don't want to muddy the waters anyway.
So she uh slowly over time uh started to date and I think it was like the first guy she started dating it ended up working out and then couple years later they're still dating and now they're talking about getting married and and she uh eventually is telling me maybe she doesn't need therapy anymore. And the relationship from the outside to me looked really healthy. It didn't have the volatility and the all good all bad.
And I I cannot tell you how [ __ ] happy I was because it's one thing for her through our work together in the years of therapy to start to trust that I do in fact care and I'm not going to exploit her and I'm not going to reject her and that even in my mind I care. you know, not I'm not just acting like I care, but I I care in my mind and in my heart. For her to believe that consistently in between sessions even I, you know, was over the moon. But what does that mean? That just means her and me. That doesn't mean anything about her life or her actual needs in the world, you know.
And so to to hear her week in week out talk about this relationship and how it was carrying on normally, you know, normal ups and downs, but not volatile and not rife with distortions and projections and semi-delusions.
Um, and they had the normal triggering as anyone would. And I think he was just a really good find, you know, he was the he was a mellow dude, you know, very stable. And um so to see that and then eventually for her to terminate with me, I mean there was a time when that seemed like an absolute impossibility. It's like just she's never going to terminate with me, which is fine with me because I'm here to stay. But for her to say, "Yeah, I don't know if I need therapy anymore." You know what?
[laughter] And you know, like I said, you know, I have to admit it was sad. You know, I was grieving and so was she. And we say goodbye and I'll never forget it. And um that's the magic of corrective experiences. That's the magic of working with people like this, you know, and I was operating on faith in the beginning of my career cuz there was no success with borderline in the first few years or very little anyway. So I had to operate on faith and I had some guidance but you know not a lot. A lot of the knowledge and the faith that I had in my work at the time at the age of 28 was from literature was from psychonamic uh literature about borderline personality disorder and it was written in that psychonamic way that was hard to really grasp and and my supervisors and my mentors at the time uh went along with it but it wasn't really their specialty. I didn't have anyone in my life that could, you know, really guide me. They uh would hear me uh report about the literature and they go, "Yeah, that sounds about right." Um and you know, I wish I could tell you what literature I was reading.
Maybe Ogden, [sighs] maybe Kernburgg, um maybe McWills, uh maybe Milan, I don't know. But I uh was operating on faith. And so when I started to see success with people with borderline, I was like, "Ah, it's it's true." [laughter] You know, Kernburgg was right. [ __ ] Oh my god. It's happening. She's firing me.
What? She has a stable. What is hap? It works. Magic. And I'm crying right now thinking about it. It's wonderful. Take care of yourself because you deserve it.
You really, really do.
[music]
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