Psychoanalytic Approach to Borderline Personality Disorder

     Those with a diagnosis of BPD typically struggle with maintaining constant representations of others and themselves in regard to mental states and intentions, they also tend to fear rejection, mistreatment and abandonment in relationships and have difficulty forming and maintaining relationships in general (Bradley & Westen, 2005). Furthermore, these individuals often attribute false representations of the motivations and intentions of those around them (Bradley & Westen, 2005). Those diagnosed with BPD tend to have difficulties with integrating good and bad characteristics of themselves and others and keep separate memories of positive and negative memories and attributes (Bradley & Westen, 2005).   

    Any dynamic psychoanalytic approach to treatment for those with a diagnosis of BPD include these goals: to identify and alter negative relationship paradigms and emotional regulation patterns and to increase the complexity and integration of one's representation of self, others and relationships (Bradley & Westen, 2005). To do so, a clinician must focus on the patients' individual fears of rejection, abandonment and victimization, as well as identify, confront and help the patient integrate the good and bad while addressing aggression and manipulation (Bradley & Westen, 2005). Focusing on these treatment goals requires employing an object relations theoretical approach. 

    While object relations theory is based on the psychoanalytic theory of Freud, it de-emphasizes the focus on biological drives and instead focuses on early relationships as a foundation of personality (Cervone & Pervin, 2023). Freud was the original object relations theorist; however, his theory does not completely align with the more contemporary theorists (Bollas, 2017). However, Bollas (2017) posits that Freud's theory of unconscious thinking is central to many aspects of our personality development and he explains that we are constantly impressed upon by the object world. Furthermore, while this may not be apparent to the individual, the repressed unconscious becomes a mood (Bollas, 2017). According to Bollas (2017) a person represents various experiences of their relationship with their mother and father and their infant-self and posits that anyone is an object of their own self-management and how one manages is always up for scrutiny of others. Due to this, the process of transference and countertransference becomes incredibly important during the psychoanalytic process (Bollas, 2017). 

    For those diagnosed with BPD, it is important for a clinician to help the patient identify thinking errors, such as all-or-nothing thinking, to help the individual integrate the good and bad characteristics (Bollas, 2017). It is also crucial for the clinician to work with the patient to determine where their fears of rejection, abandonment and victimization stem from and alter their current approach to mitigating those feelings in current relationships (Bollas, 2017; Bradley & Westen, 2005). In addition, clinicians need to pay close attention to transference and countertransference during therapeutic interactions, so that these can be addressed in a healthy environment with the patient (Bollas, 2017; Bradley & Westen, 2005). 


References

Bollas, C. (2017). The Shadow of the Object: Psychoanalysis of the Unthought Known (1st ed.). Routledge. https://doi.org/10.4324/9781315437613

Bradley, R. & Westen, D. (2005). The psychodynamics of borderline personality disorder: A view from developmental psychology. Development and Psychopathology, 17, 927–957

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