Holding Environment for the Borderline

by Kathi Stringer

With this discussion I hope to elaborate on the conceptualization and aesthetic fundamentals of the empathic holding environment when applied in the treatment of the borderline patient. When treating the borderline, the therapist is working with primitive defense mechanisms (spitting & projective identification covered earlier) in most lower level clients. To draw from an analogy, the best paradigm leads to the environment of the toddler. This would be a good place to begin since the first three years of life are crucial in the human development of how we relate to the world.

The newly ambulatory toddler struggles daily with the conflicting components of independence / individuality verses dependence / enmeshment with the primary caregiver. The toddler, testing limits in his expanding world retreats periodically to mother for emotional refueling. If the mother is unavailable in this critical phase, the toddler will be reluctant to develop his growing autonomy. Rather, he interprets the event of leaving mother as abandonment since on his return, she is unavailable. The toddler’s response is clingy behavior. Yet, not to enlarge his budding world means engulfment by her. 

The ambiguous thoughts of the toddler become overwhelming in the splitting format of independence verses dependence. Unable to articulate his thoughts and bridge both dynamics into a comprise, the toddler gives in to rage often seen as a temper tantrum. Unable to make a decision in his confusion, the parent would do well to hold the child. This would demonstrate to the child even in his rage, he cannot destroy the parent or the empathic holding environment provided for him. This then, leads to the emergence of a consistent constant object in his mental structure, which is similar to the (Erikson) theory of trust Vs mistrust. It is irrelevant the source of the frustration, real or imagined. The point is, it is real for the toddler and must be addressed as such. A parent that will provide a consistent empathic holding environment will pave the way for trust and object constancy (Winnicott).

The therapist’s office, the milieu of a hospital setting or worst case, restraints in a therapeutic hold, all are sufficient to maintain this environment with the borderline patient. The borderline longs for the perfect caregiver. Patients may well come to feel that they are with someone who is strong enough to withstand their destructive impulses (Cohen & Sherwood) and interested enough to engage them even in their painful state. Since Adler and Buie believe that the core of the borderline pathology is a failure in the development of holding and soothing introjects, they argue that the early stages of therapy must offer patients the experience of being empathically held. Cohen and Sherwood (1996) go on to say, "The borderline will emphasize the therapist’s coming to be seen as a stable, consistent, and caring person who survives the patient’s rage." Like the toddler, the borderline will incessantly test limits hoping to find consistent boundaries.

Compliments of Kathi Stringer
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