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ABOUT SIX MONTHS AGO a colleague asked why I was particularly interested in treating borderline patients. Without hesitation I replied, "The intensity!" Working with borderlines is never dull. From one hour to the next, indeed, sometimes from one minute to the next, the content, process and accompanying affect of therapy are constantly changing. It is what makes the borderline's world chaotic and tumultuous, but can make the therapist's experience rich and varied. The analyst is intensely involved in the therapeutic process. Whether raged against or clung to there is never any doubt that the analyst matters. There is never the feeling of insignificance, or even non-existence which one may experience in treating schizoid or obsessive-compulsive patients.
Borderline patients' hypersensitivity, which can reach paranoid proportions and give therapists excruciating headaches, can also provide the patient with extraordinary facility for fathoming the unconscious depths of themselves, their analyst and others. This apparent access to their unconscious enables them to engage in treatment in a symbolic and metaphoric manner which proves to be crucially beneficial to them and very rewarding to the therapist. Searles (1986) writes about a borderline's "enthralling description" or about a "beautifully ambivalently-symbiotic session" and wonders "how much in the way of anxiety-lest-the patient-suicide, and anguish about the setting of limits … does an analyst realistically have to accept in order to pay … for the tremendous gratification one derives from working with borderline patients."
There is no question that working with borderlines is a chore that tests our analytic skills and our patience and that we all struggle with our anxiety lest the patient suicide, and our anguish about setting limits. For me, the work with borderlines is a constant