analyze this information:

Susan and Ken, who are both in their late twenties, met at a bar. When she met Ken, Susan shared intimate details of her life with him. She also flattered Ken in a way that made him feel terrific about himself. Ken and Susan left the bar and returned to Ken's apartment, where they had sex. Afterwards, Susan began telling Ken that she believed she was in love with him, and that she was in awe of being "in a relationship" with Ken. Ken finally persuaded Susan to leave his apartment by stating that he would call her the next day. When he did not do so, Susan called her. Ken was uneasy about the level of intensity Susan had infused into a non-existent "relationship," and he informed Susan that he did not believe that they should continue to see each other. Susan began yelling at Ken, calling him names, and further upsetting Ken. She left repeated messages on his phone, alternately screaming at him and apologizing for screaming at him. She began to threaten and insult Ken in some of the messages. Susan stalked Ken until he applied for an order for protection against her.

The DSM-5 names nine criteria for a diagnosis of borderline personality disorder (BPD). If a person has borderline personality disorder, they will meet at least five of these criteria. (American Psychiatric Association, 2015, p.663)In the case study outlined above, the reader is not privy to all of Susan's symptoms. However, she does demonstrate intense anger and difficulty with keeping her anger under control. Additionally, she attempts to avoid being "abandoned" by Ken by continuing to contact him and seek his attention. Susan's willingness to have sex with Ken a few hours after meeting him in a bar indicates that she is impulsive. Depending on how much she imbibed alcohol, she might be impulsive in her substance use, too. One can surmise from the context that Susan also has difficulty forming and maintaining relationships, being that she becomes aggressive if the other person's behavior is not as she wishes it to be.

"Splitting" is a shift into black and white thinking, and it is one of the characteristics of BPD. A person engages in shifting when they believe that they cannot handle the emotions they are facing, such as the feelings one experiences when one feels abandoned. ("What is BPD splitting?" 2021)Susan's split occurs when Ken tells her that he does not want to continue seeing her. While the night before Susan expressed her love for Ken and determined that she and Ken were in a relationship, Susan's behavior the next day diametrically contrasted with her actions of the night before. Feeling abandoned and rejected, Susan began yelling at Ken, insulting him, stalking him, and leaving an abundance of messages. The shift disturbed Ken to the point that he eventually filed for a restraining order against Susan.

When a person with BPD receives empathy, they will behave as Susan did on the night she and Ken met. They will latch onto the person who shows them empathy. Susan began imagining that she and Ken were in a relationship almost immediately after they met. She flattered Ken, expressed her love to him, and became obsessed with this man whom she had known for a matter of hours. People in Susan's situation will attempt to manipulate the person who shows them empathy. Manipulations often involved threats of suicide, descriptions of real and imagined mental health issues and trauma, and flattery. If the person believes that the individual who shows empathy is subsequently withholding empathy, the person might split and become abusive toward the individual to whom they were recently expressing devotion.

As a practitioner, I believe that working with individuals with BPD is frustrating and defeating. My experiences with people with the diagnosis of BPD were like that of Ken's experiences in the case study. Clients with BPD will tell me that I am "the best therapist they ever had." They will give me compliments and praise my abilities, at times indicating that I am the "only person who ever understood" them. If, however, I withhold giving them attention, or if I delay giving them attention, they respond with hostile language such as, "I knew you didn't really care about me. Nobody cares about me. You're just like the rest of them." One rarely sees the person who exists separately from the mental illness, and this creates a tremendous challenge for the therapist or the assessor.

People with BPD form bonds at astonishing speeds. They might initially form what appears to be an authentic therapeutic relationship. They will cooperate with treatment, praise the practitioner and their work, and present a happy and enthusiastic aspect. (Ackley, et al., 2010, p. 99) If, however, the client feels slighted by the psychologist, they will become verbally aggressive and accuse the psychologist of not understanding or caring about their needs. The person with BPD might eventually return to the original behaviors if their anger abates, or if the practitioner begins to meet their needs again.

Practitioners are challenged to stabilize the therapeutic relationship enough to discern the nature of the client's authentic self. Furthermore, working with people with BPD is extremely exhausting, and practitioners are further challenged to do their best work when the client shifts between extreme emotions, repeatedly fracturing any genuine alliance that might have existed between the client and the practitioner. The baseline state of a person with BPD is one of elevated emotions from the start, and if a psychologist unwittingly triggers a negative feeling in the client, the client will become aggressive. A practitioner might become frightened that the client will hurt the practitioner. If a psychologist is afraid of their client, their fear will obfuscate their ability to focus on the client and attempt to discern the client's genuine needs. Eventually, a practitioner might refer the client to another psychologist to escape the fear, exhaustion, and frustration of working with someone with BPD.

In a forensic setting, providing therapy or assessments to a person with BPD is no less frustrating than it is in a clinical setting. The difficulty a psychologist experiences in determining the client's true personality could result in the psychologist inadvertently making errors in judgment regarding therapeutic progress or psychological assessments. If the client is incarcerated, the practitioner need not worry for their own safety. Nevertheless, the continuous splitting of emotions and the exhaustion one incurs from operating in an environment of constantly elevated emotions could result in the practitioner becoming too tired and too frustrated to continue to work with the client.

References

Ackley,C.N., Mack,S.M., Beyer,K., & Erdberg,P. (2010).Investigative and forensic interviewing: A personality-focused approach. CRC Press.

American Psychiatric Association. (2015).DSM-5 classification. American Psychiatric Publishing.

What is BPD splitting?(2021, February 8). Verywell Health.https://www.verywellhealth.com/bpd-splitting-5101493#:~:textLinks to an external site.

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