http://www.angelfire.com/biz/BPD/Gunder.html The 3 Levels of Emotions found in Borderline Personality
Pages 32-37 of John G. Gunderson's _Borderline Personality Disorder_
This formulation emphasizes the degree to which the borderline
person's manifest psychopathology can be understood in terms of
relationships to major objects.
The term major object will be used to refer to any significant
current relationship perceived as necessary . In the following
section, the borderline person's current relationships to the three
levels of psychological functioning are observed. Lower levels of
psychological function emerge regressively and act to preserve a
sense of contact with and control over major object relationships.
LEVEL I
When a major object is present and supportive, the depressive, bored,
and lonely features predominate. Here the borderline person is at the
first and best level of function. It is characterized by considerable
conscious longing for closer attachment but considerable passivity
and failure to initiate greater sharing within the context of the
relationships. There is a capacity here to reflect on past failures
and to identify conflicts and resistances realistically. There
remains, however, considerable concern about the object's fragility
and concurrent fears of being controlled by becoming dependent. As
Kernberg (1975) has pointed out, such concerns reflect fears of
projected hostility. the wary expectation of being controlled can be
used as an active attempt to gain control over others. The result is
that a dysphoric stalemate exists in relationships, which is
periodically disrupted by regressive efforts to provoke reassurance
from the other or by progressive initiatives to acknowledge what they
want and feel they need from that person more fully. Two major
organizing and sustaining beliefs are "Should I want more from you,
or should I be angry with you, you will leave" and "If I'm more
compliant, something will be given to me that will make me
invulnerable and less destructive." The nature of this "something" is
generally not well defined. Behind these conscious beliefs are
concerns with the destructiveness of their own aggressive wishes and
wishes to find a powerful protector. In any event, the basic tension
between wanting more from the object and fearing that less will be
received accounts for the sustained dysphoria characteristic of
borderline functioning at this level. Within treatment contexts,
these features of the borderline's personality disorder will be
evident during uninterrupted phases of therapy (even more evident in
the middle of hours, and likewise when such patients are offered
considerable autonomy within supportive residential treatment
settings. During these periods, patients will generally be able to
work collaboratively with an active therapist toward fuller affective
expression and insight i.e., accept interpretations). The resistances
most commonly encountered are the patient's passive compliance,
accompanied by failure to initiate contact, bring in new material,
and so on. This often occurs in response to activity by the therapist
that is experienced as directive or helpful. Such compliance and
failures to initiate often contain a covert demand that the therapist
do more. Another resistance arises after having shared new material
or affect; then the patient withdraws and becomes defiant. Such
sharing is accompanied by fears that there will be a loss of control,
that they will give in to their passive wishes, and that, if either
of these fears is actualized, the therapist will then respond
exploitatively. These represent threats to the illusion of control
over the therapist which sustains the patient on this level. The
overt expression of these concerns is an increased fear of being
controlled and an openly defiant posture. Within residential
settings, impatience and fears of giving much gratification
(secondary gain) are common feelings among staff working with
borderline patients who are functioning within this level. Treatment
personnel are likely to overestimate a patient's strengths and try to
stir patients into better social functioning and more independence.
There is frequently a failure to recognize and interpret, especially
to less verbal patients, the degree to which their passivity reflects
fears of loosing control over their affects and the degree to which
their compliance silently hides their belief that their object is
under their control. Under such circumstances, it is difficult to
appreciate and anticipate the extreme sensitivity to rejection that
becomes evident when either greater autonomy or separation is
encouraged.
LEVEL II
When a major object is frustrating to borderline persons or when the
specter of their loss is raised, a second level of psychological
functioning and a different constellation of clinical phenomena are
evident. The angry, devaluative, and manipulative features
predominate. Although the affective tone of anger is pervasive, it is
only occasionally expressed as open rage. More frequently, it takes a
modified form such as biting sarcasm, belligerent argumentativeness,
or extreme demands. The anger is modified to alleviate fears of
losing the object (in reality as well as its mental representation),
while it still communicates the wish to maintain a hold on the
person. Failing this, the patient can attempt to deny the fear of
loss by dismissing the felt need for the object (i.e., devaluation)
or attempt to prevent loss by dramatizing the object need.
Manipulative suicidal gestures are frequent under these
circumstances. At its extreme, when there is danger of the anger
becoming too uncontrolled, the rage gets projected onto the object
and paranoid accusations occur. All of these reactions are best
understood as efforts, often conscious, to control or coerce the
object into staying. These issues - to feel the need for a reliably
available other and to feel able to control that person - have not
changed from the higher level. Rather it is the repertoire of
defenses and their behavioral expression that undergo regression and
are most specific to the borderline patient. These reactions continue
as long as the object is still perceived as accessible or retainable.
The disabling effects of anticipated loss can frequently be seen as
the patient struggles to find some acceptable expression of its
attendant affects. This can take the form of rather elaborate and
poorly connected affective states - giggling, bland dismissals,
sudden rages, and, of course, extreme lability. The distinctive
feature is the dissembled unsustained quality of the affects. Within
treatment contexts, these features of the borderline's
psychopathology become evident only when the treating person, or
institution, has assumed the role of a major object (i.e., is felt as
needed by the patient). When the object is felt as needed, these
regressive phenomena emerge whenever separations are imminent (i.e.,
terminations, vacations, and end of hours). They also take place
within the psychotherapy hours themselves whenever the inaccurate.
The borderline patient's elaborate efforts to prevent separations and
sudden anger at or withdrawal from frustrations are critical features
in the treatment of borderlines. These features have been a focus of
most authors who have primarily been concerned with analytic therapy
(Adler 1975; Giovacchini 1973; Kernberg 1968; Masterson 1972.) Under
these circumstances, borderline patients will frequently dismiss a
therapist's interpretative or clarificatory efforts (i.e., to one).
The therapist's primary task is to interrupt the patient's anger
enough to draw attention to the provoking incident. This often
requires confrontation or limit setting. Such responses address the
change of feeling and attitude as a regressive retreat from some
reality that the patient wishes to avoid. It preserves and calls on
the patient to utilize still intact ego functions of reality testing
and self-observation. It is not that the expression of anger at the
therapist's failure are not critically important in themselves; it is
that the transformed rage (i.e., devaluation, manipulation, or
paranoid accusations) utilizes defenses of denial, acting out, and
projection, which prevent the patient's recognition of the feeling
response and its reason. I believe this helps understand why many
experienced therapists have found it futile to allow borderline
patients to spend much time in this preferred mode of angry
expressiveness. Once the regressive efforts are interrupted,
interpretative work directed at the devaluation ("You're working hard
not to know what you want" or "You're afraid to want things from me
which you can't control"), the manipulation ("You're trying to exert
control over me without risking that it will provoke my anger"
or "You want to prevent me from being unavailable"), or the
projection ("You're mad at me for not always being available"
or "You're afraid of how enraged you might be with me") can be
accepted and worked with. An insistent examination of the importance
a patient places on the therapist's presence brings to fears of
experiencing the important helplessness that are a psychological
function occurs within the therapeutic context, and while the object,
the analysis of its purpose and form is a critical part of
psychotherapy.
LEVEL III
When a borderline person feels an absence or lack of any major
object, then a third level of psychological function becomes
predominant. The phenomena during such periods include the occurrence
of brief psychotic episodes, panic states, or impulsive efforts to
avoid such panic. These phenomena each represent efforts to ward off
the subjective experience of aloneness (Adler and Buie 1979a) and, I
would add, total badness. Under ordinary circumstances, this aspect
of the borderline around - even if without any evident emotional
contact, in using radio and television as hypnotics, or in heavy
reliance on transitional objects (Arkema 1981; Morris et. al. 1984).
Under the more extreme circumstances when there has been a loss of a
specific and essential object relationship, dangerous impulsive acts
occur that most commonly consist of taking drugs or alcohol. These
serve both to numb the panic and to initiate social contacts. Fights
and promiscuity occur under these circumstances - often assisted by
the disinhibiting influence of alcohol - and reflect desperate
efforts to establish contact with and to revive the illusion of
control over some new object. A second major type of reaction against
the experience of aloneness is a prolonged dissociative episode of
either the depersonalization or derealization types. These detach the
borderline person from either the reality of bodily distress or the
reality of the environmental situation that evokes that intolerable
distress. During dissociative episodes, nihilistic fears occur ("am I
dead, has my body dissolved"), and these may give rise to self-
mutilation in order to confirm being alive by feeling pain.
Frequently, such self-mutilation is accompanied by restitutive
fantasies in which the absent object is either believed to be
performing the act or is being punished by the act, but in either
event, is still involved. These self-mutilative actions are quite
different in their intent and subjective experience from the suicidal
gestures that occur when ongoing contact with a specific object is
still being sought. Sometimes nihilistic ideas slip from dystonic
fears to become beliefs; they then take on aspects of psychotic
depressions. The conviction of being evil and nihilistic beliefs are
two extremes that the borderline patient achieves when the usual
defenses of action and substitutive objects are not that Kernberg
(1967) refers to the borderline's very primitive underlying,
generally avoided, abandonment depression as central to his
formulations. Perhaps because of the amount of interpersonal
involvement and the borderline person's dramatic responsivity to such
involvement, sustained depressions of psychotic proportions are
unusual in borderline patients, particularly for those who are in
treatment settings. Occasionally, bizarre imagery, simple
hallucinatory phenomena, or transient somatic delusions occur. The
object restitutive aspect patient who developed the belief she was
pregnant, or the patient who developed anal and urethral
retentiveness requiring emergency room care). The most common
delusional experience is ideas of reference. Not only do these
project unacceptable self-judgements, they sustain a sense of
involvement with nonspecific others where none exists. The general
point here is function (desperate impulsivity, substance abuse,
dissociative episodes, brief psychotic episodes, and ideas of
reference) represent efforts to manage the fear of aloneness and the
sense of badness. This badness is related to beliefs that they have
failed or wronged their object. These experiences of alone-badness
and the panicky reactions to it are seldom seen within the hospital
or psychotherapeutic context. As described subsequently (Chapter 7)
they do, however, often come to the attention of clinicians as a
reason for seeking treatment or as phenomena described
retrospectively by borderline patients. Understanding the context in
which they occur is important so that their recurrence can be
anticipated and avoided.
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