1. Sexual Abuse and Borderline Personality Disorder: The Process of Therapy M. Sc. Teja Bandel Psychologist

2. Borderline Personality Disorder & Sexual Abuse BPD: Pervasive pattern of instability of interpersonal relationships, self-image, affects, and marked impulsivity Begins by early adulthood and is present in a variety of contexts. Frantic efforts to avoid real or imagined abandonment. The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior. Very sensitive to environmental circumstances Trauma (sexual abuse) plays a significant role in the psychogenesis of borderline states.

3. Characteristic of the client Woman, 36 years old Reffered to Vocational Rehabilitation Centre (URI-Soča) from Employment Agency (ZRSZ) for an assessment of the level of work ability, knowledge, work habits and vocational interests. Efficiency in working environment was unstable and under an influence of health problems. Sexual, emotional and physical abuse from childhood (still occuring, different persons).

4. Dealing with numerous physical health problems, of which many of them only partially explained. Numerous mental health problems (BDP, depression, anxiety, eating disorders) & hospitalizations in psychiatric hospital. Oscillating intake of medication (“self-treatment”) Engaged in numerous treatments, blaming others for the failures. Shy, reserved, non-assertive, uncommunicative but at the same time revealing the most intimate contents in first contact.

5. Disorganized type of attachment. Low self-esteem, self-confidence, self-image. Impaired body image. Prone to self-injuries, suicidal behaviour, impulsivity. Mood lability, constant fear of abandonement. Cognitive impairment/dissociative symptoms (memory). Manipulative behaviour. Family characteristics.

6. Reporting unstable and harmful relationships characterised by alternating idealisation and devaluation (when she is “betrayed”). Defense mechanisms: regression, multiple decompensations Type of communication: repetitive and simple sentences, irrelevant topics were exposed, usually starting with “I want to say goodbye, I can’t handle it anymore”. Changing mind all the time, without reasons.

7. Process of therapy Individual therapy 1x per week Intense countertransference: feelings of anger, hatred, disgust and reluctance toward the client. Projections often positioned me as agressor and her as a victim, I felt exposed and vulnerable,

8. Constant presence of fear of abandonement and clinging to therapist Manipulative behaviour, “threatening” with suicide No progress in 6 months, eventhough she was expressing a desire for it Without specific goals Double-bind communication Transmition of responsibility for change on therapist Basic affects: anger, fear, shame, guilt

9. What was efficient? Importance of providing secure attachment and predictive environment with the purpose to decrease feelings of abandonment through the constant presence regardless of client's behavior. Goal setting was not successful at the beginning. Client as well needed to feel that her narratives was believed. Revealing how the therapist felt.

10. Addressing the manipulative behaviour (double-bind communication) all the time. Client was out of touch with her feelings, affects, thoughts, beliefs, sensations. This steps were significant to take before it was possible to address affects as anger, fear, shame and guilt.

11. Results Decline of suicidal ideations. More stable mood. Trying to move from the unsafe environment. Capable of talking about feelings and events more sistematically.

12. Thank you for your attention and interest. Please feel free to ask questions. teja.bandel@ir-rs.si +386 1 47 58 181