Transference

During therapy, both therapist and patient develop intense feelings called transference and countertransference.  Transference refers to the patient’s unrealistic projections onto the therapist of feelings and attitudes previously experienced from other important persons in the patient’s life.  By itself, transference is neither negative or positive; but it is always a distortion, a projection of past emotions onto current objects. 

Borderline transference is likely to be extremely inconsistent, just like other aspects of our life.  We will see the therapist as caring, capable, and honest one moment; deceitful, devious and unfeeling the next.  These distortions make the establishment of an alliance with the therapist most difficult.  Yet establishing and sustaining this alliance is the most important part of any treatment.

In the beginning stages of therapy, we both crave and fear closeness to the therapist.  We want to be taken care of but fear being overwhelmed and controlled.  We attempt to seduce the doctor into taking care of us and rebel against his attempts to control our lives.

As the therapist remains steadfast and consistent in withstanding our tirades, object constancy should develop- we begin to trust that the therapist will not abandon us.  I myself have never been able to achieve object constancy because of the many times my therapists have terminated treatment without warning.

As someone with BPD progresses in therapy, we should be able to settle into a more comfortable, trusting dependency.  We may pine for our previous ways of functioning and resent needing to proceed onward.  At this point we must also deal with our separateness and recognize that we, not the therapist, has elected change.  And we must develop new coping mechanisms to replace the ones that no longer work.  As we improve, the intensity of transference diminishes.  The anger, impulsive behaviors, and mood changes- often directed at, or for the benefit of, the therapist- become less severe.  Panicky dependency may gradually wither and be replaced by a growing self confidence.

Countertransference refers to the therapist's own emotional reactions to the patient, which are based less on realistic considerations than on the therapist’s past experiences and needs.