When a borderline client suddenly pushes away their therapist, it can be a challenging and delicate situation. Borderline Personality Disorder (BPD) often involves intense emotions, fear of abandonment, and difficulty with interpersonal relationships, which can manifest in therapy as well. Here's how therapists may respond in such situations:
Validate and empathize: The therapist should acknowledge the client's feelings and fears, letting them know that it is okay to have these emotions. They should express understanding about why the client may be feeling overwhelmed and reassure them that they won't be abandoned.
Maintain boundaries: Even though the client may be pushing the therapist away, the therapist should consistently maintain professional boundaries. They must resist the temptation to rescue the client or engage in unhelpful behaviors that may perpetuate the client's fear of abandonment.
Reflect and explore: The therapist can gently explore with the client why they are feeling this way and what might be triggering their reaction. Encouraging open communication can help the client express their concerns and fears more explicitly.
Be patient and consistent: Therapists should recognize that it might take time for the client to trust and feel safe again. Being consistent and reliable in their approach can help rebuild trust and create a sense of safety.
Use therapeutic interventions: Depending on the client's needs and progress, the therapist may employ various therapeutic interventions such as dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), or psychodynamic approaches. These therapies are often effective for individuals with BPD.
Reevaluate treatment plan: If the client's reaction persists or worsens, the therapist may need to reevaluate the treatment plan. They could consult with supervisors or colleagues for guidance or consider referrals to other professionals who may be better suited to handle the client's specific needs.
Set realistic expectations: It's crucial for the therapist to set realistic expectations for therapy progress and acknowledge that setbacks are a normal part of the therapeutic process. Progress in therapy might not always be linear, and there will be ups and downs.
Encourage self-compassion: The therapist can help the client develop self-compassion and self-soothing skills. These skills can be particularly beneficial for individuals with BPD, who often struggle with self-worth and self-acceptance.
Remember, therapy can be a challenging journey, especially for individuals with complex emotional struggles like BPD. In these situations, a therapist's patience, empathy, and skillful handling can play a vital role in helping the client work through their issues and develop healthier coping mechanisms.