Fragile Selves: Working with Narcissistic and Borderline States of Mind

Borderline and Narcissistic Clients in Cognitive Analytic Therapy

In this interview, Elizabeth Wilde McCormick explains the characteriztics of the borderline personality within the framework of Cognitive Analytic Therapy (CAT). Grounded in the cognitive revision of object relations theory, a central tenet of CAT is that from birth we all internalize a complex web of relationships which CAT names as reciprocal roles. Until revised these roles may dominate our adult relationships and are likely to be acted out in therapy, which is where the valuable work of noticing and choosing to change may be invited. Patients who are described as borderline tend to have reciprocal roles related to neglectful early care such as abusing/attacking in relation to abused and attacked. The resulting deep emotional states may shift suddenly in response to perceived threat and this is likely to be enacted during a therapy and is an essential form of communication. It is the therapeutic work to contain and name the different states and create safety and this is challenging for therapists who often feel deskilled, confused, afraid or angry.

Elizabeth elaborates her understanding of how these states operate within the psyche as ways of managing difficult feelings that cannot be otherwise described. In the early stages, the therapeutic work is simply that of recognition of what is being felt or enacted. By developing an observer-self, who learns to recognize these emotions, it becomes possible to find language for them – the key to containment. Ultimately, clients become more able to tolerate relationships, to be less reactive and more responsive.