1. Discuss the early development of borderline personality disorder (from an American Ego Object Relations perspective). This condition is developed during the first two years of a child’s life. The normal autism stage is from 0 to 2 months old, and this is when the child is about self and is totally dependent on others. Between 2 months and 6 months, the child develops a symbiotic relationship with the mother (or caregiver), and this is referred to as the symbiotic stage. Between 6 months and 25 months is the separation-individuation stage, and this is when the child begins to break away from the mom or caregiver. From 6 months to 10 months, the break away is in the form of a differentiation phase, where the child learns that he or she is separate from the caregiver. Between 10 months and 16 months is the practice phase, and this is when the child walks away from the caregiver and practices independence. Between 16 months and 25 months is the rapprochement phase, and the child becomes discouraged with independence and tries to revert back to the symbiotic stage. The correct procedure at this point is for the caregiver to encourage the child and gently push him or her back into independence. However, if the mom pulls the child back in or even punishes the child for trying to gain independence, then this disorder is developed.

2. Discuss the theoretical causes of borderline personality disorder. This problem occurs within the rapprochement phase of the separation-individuation stage. In most instances, the mother does not have her separation-individuation issues resolved. The child has not and cannot individuate. The natural forces of development make the child want to separate, but the mother holds and punishes him or her. When the child tries to be symbiotic, the mother rewards him or her. Therefore, the child has a conflict between natural psychic urges and social restraints. If problems develop during the early autism stage or the symbiotic stage, they can also be serious and last a long time.

3. Make an assessment of the borderline personality disorder. This disorder probably develops during the rapprochement phase because the mother is usually a borderline personality, too. She has a problem with separation, so she will not let the child individuate. She punishes individuation but rewards symbiosis. Incidentally, the mother was probably never diagnosed because knowledge about this disorder is relatively new.

The client enters into therapy presenting complaints. He or she usually suffers from recurrent and current depression and has a history of interpersonal problems (no friends, betrayal, loneliness, no long-term relationships, and family conflict). A borderline child, which is usually a girl, will almost always have a borderline mother and will also have difficulty in relationships. One way to assess this disorder is through an MMPI sawtooth profile. The 2 (depression), 4 (psychotic deviation and manipulative), 6 (paranoic), and 8 (psychotic schizophrenia) scales will show elevation, and this is an indication of the disorder. Elevation of the "F" scale is a cry for help, so this one can also occur.

The borderline personality disorder patient shows evidence of a push-pull for separation-symbiosis. They feel pushed to grow up but pulled back into an unhealthy situation (relationships) when they try. Ego object relations say that this person will be split between all good and all bad, either all on one side or the other with no middle ground. They will also fluctuate back and forth between the two extremes. In terms of self, they will feel either bad, guilty, inadequate, and ugly, or they will feel passive, compliant, and obedient. In terms of others, they will either be cruel, destructive, critical, and hostile, or they will be approving, all-giving, supporting, and comforting. In emotional state, they will either feel rage, anger, venom, and despair, or they will feel good, cared for, and desire for extreme closeness.

4. Describe the treatment for borderline personality disorder. The therapist should try to: (a) fuse with the person in a positive way with a positive transference to promote a positive identification with the therapist, (b) confront and limit negative destructive behavior within an atmosphere of support (they actually think that negative behavior is good for them), (c) avoid technical and methodological rigidity in an attempt to control, (d) not confront when the client is out of control and not support if the client is in control, (e) set up new object relations with positive affect associated with growth and a positive representation of self, (f) work for insights (interpret transference and severe defenses when the client is "together"), (g) link insights to parenting as time passes, (h) avoid the trap of being the only one who can help, and (I) deal with termination over a long time (usually about 1/3 of the total number of sessions).

				Tom of Bethany

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