By Margherita Spagnuolo-Lobb in Gestalt Therapy in Clinical Practice: From Psychopathology to the Aesthetics of Contact (Gestalt Therapy Book Series 2). Gianni Francesetti, Michela Gecele, Jan Roubal, and Leslie Greenberg
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Fears of Abandonment and Borderline Personality Disorder
By Margherita Spagnuolo Lobb
5.2. Fears of Abandonment
Diagnostic criterion (loc: 14,422)
The frustration and disorientation that the child feels in no longer finding the mother where s/he had left her when s/he drew away to explore the world, are at the basis of the borderline’s (loc: 14,423)
fear of being abandoned and of the consequent acting-out (loc: 14,426)
Patient’s experience (loc: 14,426)
“intolerance of solitude” (loc: 14,427)
a symptom of precocious insecure attachment by Fonagy (1991). what emerges is acting out, (loc: 14,432)
the anger with which the patient manages (loc: 14,433)
fear of abandonment, (loc: 14,433)
therapist’s reaction is often a consequence (loc: 14,433)
rather than of the feeling at its basis. (loc: 14,436)
the therapist considers fragility constitutive of borderline experience and the attempt to rediscover the sketch of the self so effortfully constructed by defending it (loc: 14,437)
with anger against whoever fails to protect her/him (loc: 14,438)
her/his reaction will be to ally her/himself with the patient’s defense of the self. (loc: 14,650)
6. Preserving the Sketch of the Self with Harmonious Dignity: the Gestalt Model of Work with BPD (loc: 14,653)
If the aim of treatment of borderline disorder shared by the psychodynamic approaches is the integration of the split parts of the self (moving from a borderline pathology to a neurotic organization, Clarkin et al., 2000, p. 9), Gestalt therapy is not far from this perspective, but, in line with the phenomenological perspective, it is focused on the support of what there is already, i.e. the patient’s intentionality to protect that sketch of the self constructed with difficulty. (loc: 14,658)
what can resolve it is not the consciousness of the defenses activated, but rather the support of the intentional movement to reach the other wholly, not split, not damaged, but whole. (loc: 14,660)
is for Gestalt therapy the fundamental reference, the fulcrum of its model of operation. (loc: 14,670)
All clinical approaches agree (loc: 14,670)
treatment of borderline patients (loc: 14,671)
patient-therapist relationship is fundamental. (loc: 14,674)
For Gestalt therapy, (loc: 14,675)
the way the patient lives the therapeutic relationship re-proposes a suffering has remained open in fundamental relationships. the task (loc: 14,676)
is to complete, in as relaxed a manner as possible, the intentionality that was interrupted in the primary relationships, (loc: 14,678)
If the object-relation theories are focused on the analysis of the patient’s transference in the here-and-now of the therapeutic session, Gestalt therapy we focus on the counter-transference, (loc: 14,679)
use of the therapeutic sensitivity to intuit the manner in which, in the patient’s perceptive field, the significant other (in this case the therapist) maintains the borderline relational pattern. (loc: 14,681)
permits to intuit what the significant other may do to support the interrupted intentionality of contact (loc: 14,691)
focused on counter-transference becomes, in the case of the BPD patient, almost an ethical norm. (loc: 14,692)
background, ethical, contractual elements are more important than those of content. (loc: 14,693)
create the basic security the borderline patient needs in order to slacken the mistrust ()
The therapist’s anger, frequent with borderline patients, must be transformed into containing strength by the Gestalt therapist, instead of being naively brought into the setting with trust (in this case misplaced) in the value of the therapist’s authenticity, a crucial value for Gestalt therapy. (loc: 14,699)
borderline patients induce us to set in action the most split parts of our self (loc: 14,705)
6.3. The Gestalt Therapeutic Process with the Borderline Experience (loc: 14,709)
domains of the therapeutic relationship. (loc: 14,717)
the progress of patients suffering from BPD may be very various and an effective therapy does not always end positively. (loc: 14,717)
the patient may need to separate her/himself abruptly and/or with negative feelings (“I’m going because even you have disappointed me”). (loc: 14,719)
patients with BPD readily change therapist. (loc: 14,720)
the first stage they idealize the relationship, (loc: 14,720)
faced with the concreteness of the necessary separations, anger dominates and they devalue the therapist (loc: 14,721)
This is a protective move for the patient, who avoids becoming to intimate with the therapist, (loc: 14,723)
five domains that form the Gestalt competence to treat the patient (loc: 14,729)
basic competences to treat borderline suffering. (loc: 14,733)
Table 2. Specific competences and therapeutic goals in the different domains. (loc: 14,736)
Domain 1 Secure, clear, non- manipulative attitude (loc: 14,744)
Domain 2 Accepting the now-for-next in the patient’s relational difficulties (loc: 14,752)
Domain 3 Making explicit the elements of shared reality (loc: 14,758)
Domain 4 Supporting self-regulation in the face of the primitive defences (loc: 14,763)
Domain 5 Containing the borderline suffering through counter-transference (loc: 14,769)
6.3.1. First Domain The ethical attitude is secure, clear and not manipulative. (loc: 14,776)
6.3.2. Second Domain Grasping the now-for-next, the tension to preserve the sketch of the self, in the relational difficulties the patient suffers. (loc: 14,797)
6.3.3. Third Domain Elucidating the elements of shared reality (both the moon and cheese are yellow). (loc: 14,818)
patient says: “When I was little my mother tried to poison herself, and I stopped her. What was I saying or doing to make her do such a thing? Was I so bad? Was I the murderer or the victim? I wasn’t a child, but I had to be grown-up, if I can put it that way. I had to wipe myself out and humiliate myself, let myself be humiliated. Terrible things. I wanted love, normality, and yet I touched so much pain. (loc: 14,825)
Borderline patients seem strong when they talk about painful facts, but since talking about them is not cathartic for them (as it is for neurotics), it rather relights a fire that had been quenched; what comes after is not easy for them; it exposes them to loneliness and anger. For this reason, the therapist must always be one step behind as regards expressing painful feelings, must let the patient self-regulate, and never overvalue the BPD patient’s ability to contain her/his anxiety. (loc: 14,831)
6.3.4. Fourth Domain Supporting self-regulation in the face of the primitive defenses. (loc: 14,842)
6.3.5. Fifth Domain The use of counter-transference to contain borderline suffering. (loc: 14,872)
I hold that the aim of treatment is not to change the style of contact, but rather to experience this style with less anxiety. (loc: 14,930)