Another Chance to be Real: Attachment and Object Relations Treatment of Borderline Personality Disorder PDF
Preview Another Chance to be Real: Attachment and Object Relations Treatment of Borderline Personality Disorder
Another Chance to Be Real Another Chance to Be Real Attachment and Object Relations Treatment of Borderline Personality Disorder Donald D. Roberts and Deanda S. Roberts JASON ARONSON Lanham • Boulder • New York • Toronto • Plymouth, UK Published in the United States of America by Jason Aronson An imprint of Rowman & Littlefield Publishers, Inc. A wholly owned subsidiary of The Rowman & Littlefield Publishing Group, Inc. 4501 Forbes Boulevard, Suite 200, Lanham, Maryland 20706 www.rowmanlittlefield.com Estover Road Plymouth PL6 7PY United Kingdom Copyright © 2007 by Jason Aronson All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the publisher. British Library Cataloguing in Publication Information Available Library of Congress Cataloging-in-Publication Data Roberts, Donald D., 1939– Another chance to be real : attachment and object relations treatment of borderline personality disorder / Donald D. Roberts and Deanda S. Roberts. p. ; cm. ISBN-13: 978-0-7657-0553-2 (cloth : alk. paper) ISBN-10: 0-7657-0553-2 (cloth : alk. paper) ISBN-13: 978-0-7657-0554-9 (pbk. : alk. paper) ISBN-10: 0-7657-0554-0 (pbk. : alk. paper) 1. Borderline personality disorder—Treatment. 2. Attachment behavior. 3. Object relations (Psychoanalysis) I. Roberts, Deanda S., 1942– II. Title. [DNLM: 1. Borderline Personality Disorder—therapy. 2. Object Attachment. 3. Psychotherapy—methods. WM 190 R643a 2007] RC569.5.B67R62 2007 616.85’852—dc22 2007022381 Printed in the United States of America ∞ ™ The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI/NISO Z39.48-1992. Contents Introduction: Attachment 1 1 Normal Development and the Real Self 9 2 Borderline Personality Disorder Development and the False Self 31 3 Compassionate Attunement: Igniting the Self 51 4 Stance, Neutrality, and Frame With the Borderline Patient 65 5 Listening and Speaking to the Borderline Patient: An Invitation to a Secure Separation 77 6 Psychotherapy: Another Chance to be Real 97 7 Terri: Destitute and Desperate for Help 117 8 Susan: Immobilized, Helpless, and Hopeless 125 9 Laura: Tormented and in Trouble 145 10 Practical Considerations 153 11 Now and Then, Here and There, Change Happens 163 References 167 Index 175 About the Authors 179 v Introduction Attachment Seven or eight years ago, we came upon an article in a mental health journal.1 It was written by an ethologist, Helga Fischer-Mamblona (2000), and it was the story, the developmental journey, of a goose. Feli was one of the flock whose social behavior was being investigated by Konrad Lorenz’s team of researchers; the geese lived in a seminatural environment at the Max Planck Institute, Seewiesen, Germany. Feli was separated from the flock at birth and lived the first 10 days of her life sequestered away from visual and auditory stimulation. She then spent 8 weeks in a pen con- structed so that she could see through the top but not make visual contact with the other geese. Stimulation during this period was limited to the heat- ing lamps in her pen and by the replacement of her food and water bowls. As we understand it, goslings from birth onward vocally “greet” their mothers, fathers, and siblings and repeatedly seek proximity and contact with them. According to Fischer-Mamblona’s article (2000), this process of initiating contact and becoming attached in the first days of life is the most critical stage in a goose’s social development. Even in isolation, Feli engaged in a gosling’s normal greeting and complaining behaviors. But unlike her peers, she had no social context. There were no other geese within her visual field at all, no mother goose to interact with. As the author describes it, Feli seemed confused by this situation. She began to scurry around in a disorganized and directionless way, making weak and pathetic sounds into the vacant space of her pen. At first, she was unresponsive to any changes in her environment. But in time, she came to “greet” any changes that she observed, like the replacement of her food dish or the ons and offs of the warming lights. 1 2 Introduction At the end of 8 weeks, when she had acquired her feathers, Feli was allowed to leave her pen and explore her environs. She was frightened when she first saw the other geese, and if one approached her, she hur- riedly returned to the safety of her pen. The researchers began to move her feed bowls progressively closer to the other geese; with this help, she gradually became desensitized to them. Eventually, she became able to eat in the presence of the others, although if one approached her, she still took refuge in her pen. According to the article, goslings during the second spring of their lives typically leave their families and are attracted to their peers, seemingly looking for company and making social contacts. Feli observed this be- havior and was fascinated by it. In fact, she sometimes shed her anxiety and ran to join in. But the other geese didn’t recognize her as a member of the flock. They considered her behavior a violation of good goose man- ners and, as the observers expected, promptly chased her away. As this re- peatedly happened, Feli’s fear and anxiety intensified, and her tendency to flee the other geese increased. Feli was faced with a knotty dilemma. If she approached another goose, she was aggressively rejected; but if she withdrew to her pen, she lived in complete isolation. Both her attachment and separation behaviors had negative consequences. Apparently in response to this quandary, when a goose approached, Feli began to groom her feathers, an expression of her desire to engage socially. But, simultaneously, she vigorously shook her head, a manifestation of her dread of being close to another goose. Her observers thought that these incongruous behaviors served to regulate the anxiety stimulated by her predicament. At first, she preened and shook every time that a goose approached her, because this elicited her conflict between approaching and fleeing. But over time, the dilemma resolved itself after a fashion; the urge to flee, stimulated by her fear of attachment, overpowered her desire to attach, and Feli seemed to resign herself to being alone. She became increasingly with- drawn and apathetic. In their second year of life, geese become sexually mature, and this intensifies attachment urges. But in Feli’s case, advances by other geese merely caused her to withdraw. On occasion, a shy male would court her from a distance, but instead of reciprocally approaching him, her re- sponse was only to shake and preen. Her odd behavior discouraged the other goose from coming nearer. This pattern persisted for 2 years. But in Feli’s fourth year, something curious happened. A particularly shy and cautious male approached her. This time, she did not retreat or resist, and she mated for the first time and produced a nestful of eggs. Observers noted that although she appeared to provide all of the usual maternal ministrations, she still tended to flee when another goose came Introduction 3 near, and she would (if necessary) vacate her nest. But she did manage to tolerate the 4-week incubation period, and one gosling hatched. Feli’s gosling immediately attempted to seek proximity to her mother. But Feli did not respond to the gosling’s approach behavior. She with- drew physically, preening and shaking and ignoring the gosling’s cries of distress. The next day, the gosling was found dead. Feli laid eggs again the next year. This time, the eggs were sterile. The observers replaced them with fertilized duck eggs, which are less sensitive than goose eggs and require a shorter incubation period. The ducklings hatched, but once again, Feli did not respond to their approach behavior, preening and shaking instead. Again, she abandoned the nest in response to their pestering. Even after she returned, she was unrespon- sive to the distressed appeals of the cold and hungry ducklings. A few days later they, too, died. In her sixth year, Feli once more laid sterile eggs; again, these were replaced with ducks’ eggs. When the ducklings hatched, she again re- sumed her preening and shaking and—a familiar sight by now—seemed altogether apathetic to her “offspring.” But this time, the outcome was quite different. These ducklings were relentless in their efforts to be close to their “mother.” Several times a day, they would greet her and snuggle up to her. Feli responded with her preening and shaking ritual, but these ducklings could not be deterred, and they persisted in nibbling her feath- ers and making efforts to get close. Feli tried to bite them—unanticipated behavior in a mother goose, according to the author. For a while, even these persistent ducklings resigned themselves to the situation and got through the nights by keeping each other warm. Inexplicably, though, during this time, Feli’s ritualized preening waned. One rainy night, the ducklings returned to their mother for warmth—and this time, she gave it to them. This was a pivotal event. From then on, Feli responded, albeit hesitantly at first, to her ducklings’ greetings. In fact, she began to demonstrate most of the typical maternal behaviors of geese: She accompanied the ducklings down to the water to feed; she bathed them; she tended to their feathers. In response, the ducklings pursued her when she left them to graze, and they approached her for warmth and protection. In short, an attachment was realized—for the first time in Feli’s life. This account has a bittersweet conclusion. An older gander approached Feli, who this time did not retreat into ritual or distance. She actually obliged, and the two remained a pair long after the ducklings had become independent. During the 4 years that Feli and her gander were together, they had their own goslings and reared them successfully. When the flock moved to Konrad Lorenz’s lab in Austria, the pair lived together there for 2 more years. But one day, Feli mysteriously disappeared. Shortly after
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