Creating Therapeutic Experiences for BPD

Several months into treatment, Julie began to reveal events in her family life that were extremely difficult for a highly sensitive, drama-prone child like her to navigate. She shared that her father had been unfaithful to her mother and distant from the rest of the family during Julie’s formative years. Her father and mother had separated for a year when Julie was nine years old. Julie’s mother had contracted cancer during that same year. As a doctor, Dad was away from home for long periods of time; when he was home, he was emotionally distant and critical. Dealing with the fear of death caused by her cancer diagnosis, Mom would draw close to her children; bouts of depression, however, would make her emotionally unavailable.

Julie thrashed about emotionally, as if anchorless in a sea of abandonment. A string of poor relationships with boyfriends as she grew into adolescence further confirmed what she feared: everyone she loved would leave her eventually. She was unlovable and destined to be lonely her entire life. One of the hallmarks of borderline personality traits is a fear of real or imagined abandonment—a fear that drove Julie to life-threatening acting out behavior. If she could find a way to leave everyone before they had a chance to leave her, she had reasoned, maybe it wouldn’t hurt so badly.

When Julie swallowed the painkillers, months earlier, it was her mother who found her and called the paramedics. Julie’s father arrived as his daughter was fighting with the paramedics. In an attempt to save his child, Julie’s dad removed the belt from his waist, looped it around one of her arms and helped the paramedics tie her to the gurney. He would later tell me that the look in her eyes as he strapped her down with his own belt still haunted him.

After Julie had made some progress in individual and group therapy, we began experiential family work with her. In one such experiential session Julie, her parents, and her therapist huddled around a bonfire for a special ceremony designed to symbolize the cleansing of the past and to celebrate the beginning of a hopeful future. The group watched in silence as Julie burned her black clothing, short skirts, CDs of dark-themed music and the straight-edged razors with which she’d cut her skin. The symbols of her abandonment were consumed by the flames.

Next, Julie’s mother reached into a pocket and pulled out an empty bottle of painkillers—the same bottle that had held the pills Julie used in her suicide attempt. She raised the bottle and held it over the flames. Her eyes shone with tears but her voice was strong and clear. “I’m burning this because I finally have confidence that Julie will never attempt suicide again,” she said.

When his wife had finished, Julie’s dad slowly removed the belt from around his waist, wound it around his fist then thrust it over the fire. He said that he was burning the “horror” of being forced to strap his oldest daughter to a gurney with his own belt. “I’m moving on,” he said, looking at Julie, “and I invite you to do the same.” Then he threw his belt into the burning cherry logs. Julie ran to embrace her father.

The treatment team created many such experiences for Julie and her family in order to foster emotional communication and create a bond of shared experience. It is very difficult for a young woman struggling with the fear of abandonment to feel connected. But when she participates in an emotionally powerful event with those most important to her it is difficult to deny that connection in the future.

These experiences were powerful, positive bonding events which could never be taken away from the family because they had lived it – together. The burning ceremony and other therapeutic experiences like it addressed the issue of abandonment at the core of Julie’s borderline traits; these experiences were central to her healing process. At a recent four year follow-up, Julie’s parents report that they are happily married and that Julie is successfully completing a bachelor’s degree.

Dustin Tibbitts, LMFT, has been a therapist at InnerChange for fifteen years and is the executive director for New Haven, RTC, a treatment center for adolescent girls with two campuses in Utah. You can contact Dustin at [email protected].