Borderline personality disorder (BPD) has always been considered an elusive and puzzling phenomenon. Concept and theory are indeed anything but straightforward. The ‘personality disorder’ construct appears to suggest a pathological condition located solely in the client. At the same time, the borderline dynamic is most famously associated with difficult or unstable relationships and evokes images of harassed and tormented therapists. But borderline relationships are challenging for clients and therapists alike. Both may feel attacked, invaded, helpless, misunderstood or unappreciated by the other. Borderline patterns of organisation are evidently active across the continuum of intrapsychic and interpersonal fields. The word borderline - ‘a line that indicates a boundary’ - incidentally names what is most lacking in the borderline dynamic. But the borderline dynamic is also particularly apparent as a bodily experience for both client and therapist. Hyperarousal and catastrophic anxieties, both cardinal features of BPD, suggest disturbances of very basic functions and indicate that the organism is in a state of somatic disorganisation. Body and psyche of the therapist are impacted by and respond to disorganized or dissociated psyche and body states of borderline individuals. In this chapter, I propose clinical perspectives to psychological and somatic phenomena and disturbances commonly experienced by borderline individuals and their therapists.

Abstract: This paper explores a therapeutic approach to BPD that integrates somatic and relational aspects. From a somatic perspective, the Borderline dynamic is characterised by chronic dis-regulation of the autonomic nervous system, inadequate muscular structuring and a lack of surface boundaries. In the therapeutic relationship with BPD clients we are confronted with episodes of catastrophic anxiety which the borderline body-ego is unable to contain or defend against. Such catastrophic anxieties constitute states of unintegration which manifest at times as despair, rage, clinging or self-destructive pathologies. The therapist is frequently experienced as either ‘too close’ or ‘too far away’. Somatic dimensions of BPD are equally evident in the transference relationship. The ruptures and dissonance typically associated with Borderline relationships reflect the extend of somatic dissonance, arousal and affect dis-regulation of the fragile Borderline structure. Our bodies constitute our primary means of dialogical engagement with the world and the complexities of BPD are best met by engaging with both dimensions. (Download as an Acrobat PDF file)