The individual tries to integrate the good with the bad aspects of the internalized caregiver. This is the optimal condition where the child experience what Bruno Bettelheim (Bettelheim, 1987) describes as the “good-enough parent” who is supportive yet supplies optimal frustration. Faced instead with a binary choice between engulfment and abandonment, the child can’t integrate the good and bad. It should be noted that earlier, from a much less forgiving perspective, Bettleheim posited the existence of the schizophrenogenic mother who would create the binary choice.. Under these conditions, risking being either engulfed or abandoned, the child loses the possibility of ever having the good-enough mother. Better to forever delay integration of good and bad in a single, ambiguously real individual than to lose the possibility of an integration which is always, tantalizingly, just out of arms’ reach. This perennial threat of loss keeps the patient in a state of anticipatory mourning that is incomplete. The patient must always be in search of a new, potentially all-good object. The knowledge of the bad mother must be sealed off from the knowledge of the good mother. By knowing what we know we don’t know, we split off and project the all-bad or persecutory object onto actors out in the world.
BPD patients protect the introjected all-good mother at the cost of their own individuation. As a result, these patients are never wholly adult nor wholly child. This split in their psyche is played out among their “treatment teams.” These patients often bond instantly and with seeming irrevocability to one member of their caregiving team. They cast this team member in the role of savior, while casting other members in the role of the “bad cop.” The savoir will, without sufficiently strong boundaries, be subjected to continual barrages of unscheduled contact and emergency situations. The patient’s emotional lability can lead, ultimately, to caregiver burnout.
The savoir/villain dynamic will fluctuate over time. Roles will be re-assigned in what seem to be random and wholly unexpected fashion. This mirrors the arbitrariness of early caregiver interactions and the internal split of the all-good and all-bad primary attachment figure. Such patients will often maintain diametrically opposed narratives of their treatment, once again mirroring their internal split representations of caregivers. They tend to create chaos in inter- and intra-agency settings where coordination of care is required. They also create intense counter-transference issues in the individuals who work with them therapeutically. Therapists struggle with the sense of unreality that is projected onto them by borderline patients, as well as the resultant emotional ambivalence that emerges in the transference.
Transference may create a feeling of discomfort as the therapist is idealized and overvalued. The sense of being unable to live up to the patient’s idealized version of the therapist can result in powerful feelings on the part of the therapist. These feelings range from embarrassment, guilt and shame to a sense of outright hostility or feelings of disparagement toward the patient. The therapist must alternatively inhabit idealized all good and devalued all bad projective identifications. In this way, these patients impede and overwhelm the very people upon whom they often depend for their most basic needs. The internal split is thus reinforced and the projection of this internalized world onto the outer world to which they go for help becomes exactly what they believed it would be. There is vindication of their worst beliefs about themselves and the world. The failures of the people meant to protect them are abundantly manifest..
