"Borderline" patients

[PATRICIA DESERT]

Dear Bud--I appreciate your sensitivity to the connotations of "borderline" 
and I agree that it inaccurately describes what is going on.    I hold the 
view that "borderline" symptomology has all to do with attachment disorder 
and that "borderline" is an unfortunate choice of words for this painful 
disorder.  And so in this way I reframe the name of the diagnosis for my 
clients while educating them to the reality that in medical circles 
"borderline" is still the recognizable word of choice to describe the 
symptoms.  Even among us professionals though "borderline" is the 
recognizable word to use when we want to succinctly communicate with each 
other.  Perhaps one day the DSM will remove "borderline" and replace it with 
a more accurate description.  Certainly attachment disorder is not a new 
concept, particularly in relation to the borderline diagnosis, and certainly 
it describes the primary wound.  Patti

>From: BARNETT WEISS <budweiss at verizon.net>
>Reply-To: list at grouptalkweb.org
>To: list at grouptalkweb.org
>Subject: "Borderline" patients
>Date: Tue, 5 Sep 2006 05:33:18 -0700 (PDT)
>
>I think this is a very important string and hope that we can follow it up 
>further as persons in this "Category" are some of the most difficult to 
>work with especially in a group setting as they tend to split the group.  
>My mentor in doing community building will take them aside privately and 
>basically advise them not to participate in the community building sessions 
>as it would not be a good process for them due to their "extraordinary 
>sensitivity." He will instead direct them toward a therapist he knows who 
>has been very successful with moving these persons along.
>
>   While the approach mentioned by Ann, written up in the journal,  makes a 
>lot of sense to me and I will see about looking it up for all the details,  
>there is still something that bothers me about the label "borderline."  On 
>the border of what comes the logical question and knowing someone who is 
>showing many of the intense symptoms, it is easy to say on the borderline 
>of insanity altogether or about to be a victim of another abandonment or 
>worse.  I think the primary issue is the abandonment issue and that 
>resonates far more with the persons who are called "borderline" in my 
>experience.  Moreover, persons of this nature would probably enter into 
>therapy more easily if in fact the calling to the group was more along this 
>lines.
>
>   Another person who is highly successful with persons in this category is 
>Jeffrey Young with his Schema Therapy http://www.schematherapy.com/  which 
>he created after many years of being one of the primary trainers in 
>Cognitive Therapy. In Young's work, he actually does some psychodrama as 
>well as using EMDR and even moves into some spiritual work which many 
>"borderline" persons tend to be drawn to. This latter I think is a coping 
>strategy for them in dealing with the abandonment issues.
>   Other's thoughts?
>   Blessings, Bud
>
>Ann Hale <annehale at swva.net> wrote:
>           Patti, Stephen Sidorsky presented on, and wrote for the Journal 
>an excellent article on the Psychodramatic Treatment of Borderline 
>Personality, vol 37, no 3 (Fall, 1984) pp. 117-125.  There has also been 
>some succcess in treating a group of about six-8 who are entirely 
>borderline. They spend time in group getting to know their diagnosis 
>backwards and forwards, and prt of the sessions is identifying aspects of 
>it when it is occuring. The therapists (four) work in tandam of twos, and 
>the facilitators trade off, in sequence.  And, each person sees their own 
>therapist. It is an interesting approach. The purpose of the group is to 
>dilute dependency on the primary therapist.
>     ----- Original Message -----
>   From: PATRICIA DESERT
>   To: list at grouptalkweb.org
>   Sent: Monday, September 04, 2006 2:24 PM
>   Subject: Re: client or trainee
>
>
>     Hello Everyone--Adam hit on an area that deeply resonates for me at 
>this time--that is, characterological disorders.  I am in the midst of 
>working with two clients exhibiting classical symptoms of Borderline 
>Personality Disorder.  It continually manifests in rage at me for not 
>fixing them, for caring more for my other clients, for holding to time 
>boundaries of sessions when they are late, for not giving them 2 hr 
>sessions whenever they want them, for long phone message between sessions 
>criticizing all that I haven't done, for not remembering exactly what was 
>said last summer, last month, last week, etc., etc.  These criticisms are 
>relentless.
>
>   I have had 18 years of enormously rewarding work with clients, mostly 
>Axis I disorders and some with mild to moderate Axis II.  Until this year, 
>after working with these two for over a year, I have never felt this sense 
>of frustration, anger, or at times inadequacy.  And for the first time in 
>my 18 years as a therapist I acted out my anger at one client and told her 
>with no compassion or empathy that her behavior was both rude and 
>disrespectful to me and to the other client whose session she attempted to 
>interrupt.
>
>   Obviously my stuff got triggered big time and I recognize that I need 
>supervision around this and am getting it.  However, I'm curious to hear 
>from anyone else who has had their own similar responses to these kinds of 
>clients and some action methods that were helpful, besides the TSM 
>Containing Double and mindful breathing, both which are definitely 
>powerfully helpful at times.   Private practice is sometimes a lonely 
>place, with little peer connection, and hearing from you all about your 
>experiences is helpful.  Thanks.  Patti
>
>   ----- Original Message -----
>     From: Adam Blatner
>   To: list at grouptalkweb.org
>   Sent: Tuesday, August 29, 2006 2:11 PM
>   Subject: client or trainee
>
>
>   Hello All, Responding to an excellent professional question: Can a group 
>member join a training group: And responding further to Bud's response 
>(attached after this below):
>
>   Bud's attitude is understandable and somewhat compatible with many 
>directors and perhaps even Moreno's generous spirit, but it is also I think 
>mistaken for the following reasons. Part of this emerged with the 
>difficulties emerging with the encounter group fad of the 1970s:
>         There are many people who are clearly mentally ill and just want 
>to get better, have no aspirations to being a therapists.
>        Some people, on the other hand, are vibrantly healthy and 
>self-sufficient, and while they have some mild issues that need to be 
>worked on, they basically have the character to train and be therapeutic 
>for others, should they be interested in taking on that task.
>          A significant number fall between the two, and their problems are 
>associated more with their interpersonal style. In the APA's Diagnostic and 
>Statistical Manual, the problems they encounter are noted in the category 
>called personality disorders, also known as "Axis 2" disorders.
>           Many people who have depression, anxiety, and other Axis I 
>diagnoses are also co-morbid, meaning they have more than one problem--not 
>just their anxiety, but also character or personality tendencies that set 
>them up for the defeats that then eventuate in depression and/or anxiety, 
>or other symptoms.  (Another example of co-morbidity is the way people with 
>mild PTSD--perhaps not fulfilling all the criteria for full diagnoses-- 
>and/or addiction problems may also come crashing into more clearly Axis I 
>types of symptom clusters.)
>           The second and most important thing that wasn't much recognized 
>before the mid-1960s is the pervasiveness of varying degrees of Axis II 
>tendencies, which can be mild, moderate, or severe, and more, the key here 
>is that these folks don't have primary anxiety--i.e., feeling ego-alien or 
>uncomfortable with their own symptoms; rather they are ego-syntonic with 
>their life style, whether it be passive-aggressive, obsessive-compulsive, 
>hypomanic, hystrionic, borderline, narcissistic, etc. What this means is 
>that they become upset when people get tired of their behaviors, abandon 
>them, divorce them, fire them from their jobs, but they don't see what they 
>did that got people so riled up!  Folks with character problems tend to 
>deny it, minimize it, and so forth. Now we're getting closer to the games 
>people play in wanting to become "therapists."
>         It doesn't matter if you buy the diagnostic categories I've 
>mentioned--they're just tools, and I'm not all that attached to them in 
>their specifics. What we're talking about is, in Eric Berne's Transactional 
>Analysis language, the "games people play."
>          I will confess that I have some mild characterological 
>tendencies, and I haven't met anyone yet who doesn't have a bit, so we're 
>talking about how much, and whether a person is really committed to 
>cleaning up his or her act. Lots of folks don't really get down.
>
>        Perhaps another factor here is whether much significant therapy can 
>happen in a group--especially a training group. The problem is that there 
>is a dual relationship: On one hand, there is the deal with my problems 
>goal; on the other hand, there's a bit of do you respect me as a therapist, 
>can you? I confess, there are people with patterns of behavior that are 
>intense enough, and lack of insight deep enough, and a kind of resistance 
>to really looking just thick enough, or lack of mental agility, so that 
>while I might find them okay to work with as clients, I would never ever 
>consider them capable of actually helping others. We have to really get 
>clear about this.
>         I am afraid that there is a kind of humanistic egalitarianism-- in 
>California it used to be called "woo woo," that is post-Hippie "whatever" 
>"it's all good" blind to the actual range of issues in people. It would be 
>nice to assume that all can be wonderful, but there is absolutely no 
>evidence that supports this assumption.
>
>       So back to the problem: I've been in groups, sometimes with people 
>who were in counseling programs, and it was clear to me that they were not 
>only miles from being ready to help others, or even begin to; but were 
>fairly blind to the deficits in their personalities that would be 
>problematical: Some were painfully inhibited, passive, reticent, highly 
>defended; others were "drama queens," seeking emotional catharses and 
>tending to dominate and exhaust the group. And so forth. Experienced group 
>leaders could make a list of their most trying group members.
>
>        We must also remember that the desire to graduate, to be seen as 
>being good as the group leader, to be a trainer, is a common desire of 
>people whether or not they have the talent, ability, experience, maturity, 
>or other role requirements for the job. To accede to such desires is only 
>one step away from letting any teenager do brain surgery without having to 
>go to medical school, much less residency.
>
>            So, yes, trainees who have more than the mildest of problems 
>should indeed have as their primary therapist someone who is out of the 
>stream of their own vocational guidance, someone who can confront their 
>manipulations, and someone to whom they don't have to hide those 
>manipulations. They also need someone outside the group to whom they can 
>complain about the group leader. (This observation is a variation on the 
>saying, "No man is a hero to his wife's psychotherapist.")
>
>           So it's not the "rules," that are the problem, but the actual 
>principles that acknowledge the reality that transferential problems will 
>emerge, they are common, and they are made almost impossible to address if 
>the group has any other agenda than the commitment to explore the 
>interactions themselves, with a view to clearing up blocks and blind spots. 
>A secondary hope to be appreciated, admired, respected, to prove 
>competence, to gain final approval for vocational advancement, is a 
>significant dual relationship. Add the financial element: What is the group 
>member paying for, therapy or training? This further muddies the water.
>
>       Well, sorry, but I want to indicate to the group members that the 
>more conservative practitioners aren't just defending their guild status, 
>but trying to address actual complexities in dual relationships.      I'm 
>open to your thoughts. Warmly, Adam Blatner
>
>
>     ----- Original Message -----
>   From: BARNETT WEISS
>   To: connie at souldrama.com ; list at grouptalkweb.org
>   Sent: Tuesday, August 29, 2006 11:52 AM
>   Subject: Re: Question
>
>
>   Of course, I am not a TEP so I can only answer from my perspective 
>having trained many persons in the past in some of the work in many venues. 
>  I really don't see what the problem is in welcoming a person from one of 
>your groups into a training program. If there is to be a distinction drawn 
>about this, I am not at all clear as to why there should be.
>
>   Psychoanalysis to begin with and many other psychotherapeutic approaches 
>have implicit rules about the relationship of the therapist to the client 
>that exclude such conversions and even those are somewhat murky decisions.  
>In most of the training programs, you have to go through the therapy 
>yourself to be more completely aware of what your clients are going to be 
>experiencing when you work. So the trainee has to find someone else to do 
>the therapy with them.
>
>   In the training groups that I have lead, I was doing the therapy for 
>everyone at first and then working with the more advanced students 
>co-directing the psychodrama's of other members of the group as we went 
>along with greater and greater hands off as they built their skills and 
>confidence. I really don't quite see the distinction here. I also made 
>myself vulnerable at times and became a protagonist briefly choosing my 
>director and working with it.
>
>   I remember a time at Beacon when Zerka asked me to direct her in her own 
>psychodrama as she needed to get some clarity about some things. I was 
>happy to do so while others in the group were quite fearful and actually 
>reacted very intensely when Zerka was working as it brought up a great deal 
>for them. While dealing with the group became quite a challenge, I was 
>quite confident in working with this protagonist since I knew that I had 
>one of the best co-directors ever...Zerka!!
>
>   In fact, I see everyone's psychodrama as being co-directed by the so 
>called designated Director and the protagonist themselves. If you are not 
>following the direction of the protagonist, in my estimation, you are 
>moving in the wrong direction. Words similar to those from Zerka are 
>emblazoned in my memory.
>
>   So again, I don't get why a client couldn't become a trainee at any 
>time.
>
>   Blessings, all, Bud
>
>Connie Miller <connie at souldrama.com> wrote:
>     Dear Adam:
>
>    Muddy?? This is a swamp!
>
>   Ultimately it is the decsion of the trainer.  My groups are for 
>"Training in Aciton Methods"  and they also comprise those wanting 
>psychodrama certification.  This in fact stimulates those in training to 
>want to get certification later in psychodrama.  Otherwise I feel like we 
>will never have those certified to do psychodrama increase and  
>psychodramatists will then become a special and exclusive group and will 
>die.  Also this is why I agree with you about teaching different parts of 
>psychodrama separately to help spread psychodrama.  And of course I would 
>never allow anyone in the group who was not using the group methods in 
>thier own work but only wanted to use the group for therapy.
>
>   I however am studying for the written part of the tep exam where it asks 
>under the ethics part,,, what do you do if someone in your therapy group 
>wants to join your training group?  Technically I guess the right anser is 
>not allowing duel relationships but is this what the all the traianers are 
>actually doing?? Right now, I have only met one.  this is why I am looking 
>for group feedback.
>
>   Thanks Connie
>
>
>   -----Original Message-----
>From: Adam Blatner [mailto:adam at blatner.com]
>Sent: Monday, August 28, 2006 08:39 AM
>To: list at grouptalkweb.org
>Subject: Re: Question
>
>
>   Dear Peter, Connie, and group.
>          Peter, your open-hearted attitude is commendable, but I wonder if 
>you have considered the potential for less-than-worthy motivations. There 
>are people who want the status of professionalism, but are yet unwilling to 
>take on the full responsibility for self-management that this implies. What 
>I'm referring to is the role of "patient" or "client," in which the 
>therapist has a more non-judgmental attitude of "I'll try to help you at 
>the level that you are functioning." Some of these levels can be quite 
>immature, entitled, un-self-modulated, dependent, passive-aggressive, and 
>so forth. Many people are not willing to live up to the simplest 
>requirements of being responsible enough to pay regularly and in good 
>faith, to show up regularly and on time, of refusing to be civil under the 
>excuse of victimhood or the right to emotional expressiveness, and so 
>forth.
>          To move to a training group is a kind of graduation into a 
>recognition by peers and group leader that one has moved into a full 
>process of taking charge of one's life. Not all issues are resolved--I 
>quite agree with Peter about this-- but there has been a graduation of 
>sorts that is the equivalent of finishing therapy in the sick or 
>dysfunctional role.
>
>        The problem is tricky, and it is a dual role-- clients wish for 
>unconditional regard, but this term is misleading. It confuses the 
>archetypal maternal unconditionality--I'll draw you forth however you may 
>be, age 1, age 3, age 8, age 80...
>             and the archetypal paternal conditionality: You are recognized 
>as being qualified to swim, do brain surgery, take 2nd level geometry, only 
>when you have clearly demonstrated your mastery of the first level or other 
>realistic requirements.
>
>      Alas, the actual requirements for training as a counselor have become 
>hopelessly muddy, and it is quite possible to be excessively immature and 
>still get into a training program somewhere, and even graduate. This is 
>because there are significant financial incentives to accept all comers, to 
>keep people in rather than wash them out, to blur and overlook 
>deficiencies. Arguments that the number of training programs and trainers 
>should be limited evokes counter-accusations of being elitist and 
>guild-like.  Arguments that call on the belief in the innate goodness of 
>people confuse the reality of people being a nexus of hundreds of roles and 
>role components, some of which are more talented, and the ways strengths 
>often compensate for, and not infrequently disguise weaknesses. So 
>significant discrimination is needed.
>
>       In some universities, this graduation - acceptance into a graduate 
>school - problem of transference, dependence, and approval is circumvented 
>by a general policy that there be a period in which graduates must travel 
>elsewhere and perform for supervisors who have not been in the nurturing 
>role, the object of parental transference.  Perhaps later, having 
>demonstrated clear competence and maturity, they may be re-considered for a 
>position in the upper graduate or even lower faculty level.  It's an 
>interesting challenge--perhaps one that requires a hard look at the limits 
>of good feeling, tele, etc.
>
>         I hope I haven't muddied the issues too much. Warmly, Adam
>     ----- Original Message -----
>   From: Peter Howie
>   To: connie at souldrama.com ; list at grouptalkweb.org
>   Sent: Sunday, August 27, 2006 10:49 PM
>   Subject: Re: Question
>
>
>Hi Connie,
>
>It is often a natural step. The psychodrama groups are developmental. The 
>training is developmental. Not all work can be done in a training groups 
>and hence experiential groups are required as well for trainees. Not all 
>development can be done in experiential groups and hence training is 
>available. What does the training do? It expands a persons functioning, 
>their capacity for warming themselves in a spontaneous fashion, their 
>capacity to role reverse with others and creates mental models for the 
>process of doing so. While I run the groups differently the larger purpose 
>is the same - a more spontaneous world.
>
>Cheers
>
>Peter Howie
>Brisbane, Australia
>
>
>
>
>At 12:19 PM 24/08/2006, you wrote:
>   I was wondering what other trainers do when  a group member wants to 
>join the psychodrama training group. what are your feelings on them being 
>in both?
>ConnieGrouptalk mailing list
>List at grouptalkweb.org
>http://grouptalkweb.org/mailman/listinfo/list_grouptalkweb.org
>
>
>---------------------------------
>
>Grouptalk mailing list
>List at grouptalkweb.org
>http://grouptalkweb.org/mailman/listinfo/list_grouptalkweb.org
>
>---------------------------------
>
>No virus found in this incoming message.
>Checked by AVG Free Edition.
>Version: 7.1.405 / Virus Database: 268.11.7/437 - Release Date: 9/4/2006
>
>
>Grouptalk mailing list
>List at grouptalkweb.org
>http://grouptalkweb.org/mailman/listinfo/list_grouptalkweb.org
>


>Grouptalk mailing list
>List at grouptalkweb.org
>http://grouptalkweb.org/mailman/listinfo/list_grouptalkweb.org