On the Borderline - Life With BPD

Usually I am given one "difficult" client to work with as case manager. But we've been short-staffed, so I have seven clients in all, and even though most of them are Level 3, which means they need to be seen only once a month and function relatively independently, I am kept more busy by case management than by what I came to do. Today I met with a client new to me, a young woman whose primary diagnosis is Borderline Personality Disorder. Look it up. Borderlines are the clients who make therapists roll their eyes and shiver. In sum, they feel that they have no existence unless someone is paying attention to them, so they demand an extraordinary amount of time and focus, requiring the therapist or anyone else who deals with them to be strongly vigilant about boundaries. If I didn't have six other clients I would be more eager to deal with Sally. It's hard to love a borderline because they take so much out of you, but right now I am still able to see how much in pain and doubt she is every day of her life and to feel for her.

Some weeks ago I said that it had been helpful for me to hear from my mentor that you can deal better with people diagnosed with Borderline Personality disorder (I refuse to capitalize "disorder") if you think of them as four-years-old. That was seen as insulting to some people. I believe, however, that people like Sally suffer from being emotionally arrested at about age four. Often, they are unable to really sustain being alone, and have an exaggerated sense of being alone and abandoned, as they are likely to have been as children. As a woman, Sally is certainly intelligent, presents herself well, is attractive, and is much more capable of sustaining herself independently than are most of our clients. But she has enormous emotional needs that can never be completely fulfilled. I don't know how much positive effect I can have with her, but I am glad to be given another chance at it. I like her, and care about her, whether she believes that or not.