MHM Magazine

Issue 3 | 2024 | MENTAL HEALTH MATTERS | 23 MHM Medical and mental healthcare practitioners are often filled with a sense of dread and despondence when working with patients who have been diagnosed as having Borderline Personality Disorder (BPD). These patients frequently face prejudice and are spoken about in pejorative ways by many health care providers. This is unhelpful for both the patient and the healthcare provider. Borderline Personality Disorder symptoms • Instability of affect, self, relationships and behaviour • Pathological coping mechanisms including self destructive behaviour (self- harm, suicide attempts, substance abuse, promiscuity and recklessness) • Impulsivity • Black and white thinking • Co-dependency • Fear of abandonment BPD is marked by profound difficulties in interpersonal relationships, that are exacerbated by their central conflict, fear of abandonment. To protect themselves from the pain of perceived abandonment BPD patients engage in push-pull dynamics in relationships. They form close intense connections with others pulling them close, then become overwhelmed and feeling impinged upon, which results in them pushing the other person away. This dynamic often occurs through manipulative actions and attacking words, leaving the other person bewildered and hurt by the sudden, unpredictable changes in their behaviour. This pattern is unfortunately played out with people who are working therapeutically with BPD patients, not just close family and friends. Treating a person with BPD, doesn’t stop them from repeating their relationship difficulties with professionals. It’s a pervasive problem that they struggle to recognise, control and address. Practitioners can feel frustration and powerlessness to be effective in these volatile relationships. Splitting- idealisation vs denigration Initially practitioners might be idealised by the patient, being seen as their rescuers but the pendulum can easily swing to denigration, blaming and attacking the practitioner for “giving up on them, not doing enough, saying “no”, maintaining boundaries”- all of which leave the person with BPD feeling abandoned. This vacillation between idealisation and denigration is referred to as “splitting”. It is a common defence By Vanessa Hemp Clinical Psychologist vanessah@global.co.za NAVIGATING THE THERAPEUTIC RELATIONSHIP IN BORDERLINE PERSONALITY DISORDER: STRATEGIES FOR BUILDING TRUST AND FOSTERING PROGRESS MHM | 2024 | Volume 11 | Issue 3 | Navigating the Therapeutic Relationship in Borderline Personality Disorder MHM