chapter  31
10 Pages

Family Therapy and the Borderline Patient

ANYONE WHO RELATES to a "borderline" person is likely in due course to experience powerful reactions to that person's personality. Over time at least some of the following behaviors are likely to occur: sharp oscillations of expressed feelings, a peculiar emotional intensity alternating with what at times can be a chilling indifference to the feelings of others; radical shifts from clinging and controlling behavior to cool disdain; submissiveness shifting to accusatory disparagement; disarming directness giving way within moments to vague ambiguity; personal forcefulness and contemptuousness coupled with brittle defensiveness; and sometimes a mysterious elusiveness. These behaviors evoke confusion, fascination, awe, sympathy, withdrawal, anger, ambivalence, guilt, outrage, and even violent reactions in those with whom the borderline person lives and works. This may well include those of us who take on a therapeutic role with such persons. "Us" includes personnel in institutional treatment settings and psychotherapists of whatever background - behaviorist, humanist, psychodynamic-psychoanalytic, etc. The range of behaviors through which borderline patients may move in a fairly short time can be extremely varied - often excitatory or dramatic in quality and even spectacular in scope. Perverse sexual practices, heavy reliance on alcohol or drugs, involvement in deviant social groupings and, not infrequently, secret deviations from conventional living may be a part of the borderline person's life. Inevitably, complicated and often fairly chaotic interpersonal and family relationships result. These can end disastrously. Suicide attempts, self-mutilative acts, or violence against others is not unusual; and the threat of these events results in guardedness, distancing, retaliatory anger, and other reactions in those who have significant relationships with the borderline person. Certainly there are borderline persons who are less provocative and who live quieter lives. But, once confronted

with the stresses of intimate relationships, even they reveal some of the variations and shifts I have listed.