When you suffer from Borderline Personality Disorder (or complex trauma) one person’s constructive criticism or negative response is another person’s life-threatening narcissistic injury. I received a narcissistic brain hemorrhage this week when my challenging and authoritative therapist decided it was not relevant to our therapy to watch a video link I had emailed her.

My borderline reaction went to DefCon One in less than a nanosecond and I thought my brain would implode.

To be fair to myself, my thoughts remained relatively mindful (she’s said no before for the same reasons and yet I continue to email her things; it could be said that an idiot does the same thing all the time and expects a different response. If that is the case, then I am that idiot) but my body was transported instantly back to the mid-seventies where school bullying and parental fighting had finely tuned my fight, flight or freeze response.

At what point does a therapist decide to terminate a client because their relationship has broken down? Over the past three years writing my blog I have received many emails from therapy clients telling me that their therapists terminated them, either for no reason or for a small infraction within the relationship.

Are therapists being over-sensitive or are clients diagnosed with borderline personality disorder unaware of their own personal lack of empathy towards someone who is on their side? Being terminated for relationship issues with the therapist does not make sense to me. The entire reason we are in therapy is because we have huge external relationship problems and this plays out in the therapeutic relationship and the therapist should be aware of this.

Dear XXXXX,

I thought it was safe to let you know how I was doing. I thought it was safe to email you about what my thoughts were regarding brief psychosis –v- depression (which is something I have finally made sense of and wanted your opinion on because I trusted you). I told you what my current working life was like and I felt as though I got a rubber stamp response because nothing in your email referred specifically to what I had actually said or achieved.

In therapy once, you asked me to always let you know how I was doing because you didn’t want me to move on and disappear out of your therapy life. You also once told me you loved me and trusted me deeply and that you would never abandon me.

With those bold statements comes a considerable amount of post-therapy responsibility to clients, even to the most adjusted but vulnerable client who has left your therapy and your rooms. With that comes a duty of care to accept that sometimes the client who wants to move on feels much dissonance, ambivalence and an overwhelmingly disproportionate sense of obligation and responsibility to her former therapist to keep her informed lest she feels abandoned by her.

Sometimes, the smallest things in life can cause the greatest pain and physical reaction.  A bee’s sting is almost invisible to the naked eye and yet can easily kill someone when they have an allergic reaction.  A mere critical stinging comment can just as easily send a person suffering Borderline Personality Disorder into “emotional anaphylactic shock.”

When a person has a life-threatening reaction to the poison from a bee sting, an ambulance is called and the person is taken to hospital where they receive treatment for their illness as well as respect and dignity but when someone suffering an emotional reaction to life circumstances presents at emergency, they are sometimes treated with rejection, intolerance and disdain.  People can die from a bee sting and Borderlines can “die” from their own personal rage and self-hatred.  If you present at emergency with a swollen face and throat unable to breathe with all your body organs shutting down, is some doctor or nurse going to say, “OMG, it’s a tiny bee sting, how bad can that be, look at you, get over yourself,” like they sometimes do when Borderlines present at hospital with similar symptoms.

Yet both types of people are in much pain and danger. 

At last, someone who is giving Borderline Personality Disorder a new image, a new spin, a positive focus and dispelling all of the myths surrounding this socially constructed disorder.  Thank you, Marsha Linehan, for coming out of the closet.  What a breath of fresh air you are!

I have read Marsha’s book on Dialectical Behavioural Therapy and since then I have been recommending this type of one on one therapy, based on Cognitive Behavioural Therapy, radical acceptance, Buddhist meditative practice and mindfulness with the adjunct of group therapy and inter-session therapist phone-calls, to many people.  It proves beyond a shadow of a doubt that there is life beyond this subjective, patronizing, ineffective, degrading and destructive diagnosis, generally given out by the psychiatric industry. 

We all know good therapy when we experience it, that warm fuzzy feeling where we are heard, understood, validated and start healing from the inside.  But what about bad therapy, what does that feel like?  And what if bad therapy turns ugly and ends in termination?  Here are five reasons why good therapy turns bad and ends in termination.

1.  Countertransference – when a client triggers the therapist’s issues.

It has been a long established rule of good therapists never to take on a client who will trigger personal issues.  The therapist who has been raped may not be able to cope with the raped client.  The therapist with children who finds out her client is a paedophile or the client who triggers off mother-issues with the therapist who has not resolved her own childhood.  These well-meaning people can sometimes unwittingly do more damage than good if they have not received their own therapy or supervision.

Nancy McWilliams admits in her book Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process that she can sometimes be a masochist with a depressive personality, which can gear itself up towards rescuing her clients from themselves.

In her section “Therapeutic Implications of the Diagnosis of Obsessive or Compulsive Personality,” she says “… by accepting compulsively self-harming people into analytic treatment unconditionally, the therapist may unwittingly contribute to their fantasies that therapy will operate magically, without their having at some point to exert self-control …”

This is known universally in Therapy World as “rescue fantasies.” Sometimes there is a repeat pattern of trauma in therapy where the obsessive, compulsive self-harming client with abandonment issues regresses and imploringly begs the therapist for extracurricular activities, and the therapist panics and enables the client to regress further by trying to pull them out of their regression with a magical cure, trying to rescue the client by crawling into their fantasies and merging with them. This can cause the client to withdraw and disintegrate or verbally attack the therapist in a sadistic manner due to feelings of overwhelming engulfment. This is where the cure can be worse than the disease.