I read this article and OMG this is me. I tell people all the time (those who know about my BPD), that I go through emotional cycles. I’ve described these very “modes” in the cycle that I’ve noticed within myself. I didn’t necessarily realize that they were very real and consistent among those with the disorder. I’ve pasted the significant section below, but here is a link to the article itself if you’d like to read the whole thing.
To assist the therapist in maintaining appropriate engagement with borderline patients, a psychologist at Columbia named Jeffrey Young has developed an interesting way of categorizing the ego states commonly seen in borderlines. In his experience, the borderline patient will normally present four ego states, which he calls MODES:
1. The patient normally presents for therapy in an ego state which Young calls The Vulnerable Child Mode – in this mode, the patient is compliant and seeking assistance. This is a continuation into adulthood of behavior patterns used by most children to secure caring and assistance from powerful adults. The therapist will be idealized by the patient in this mode, often leading to a breakdown in normal therapeutic boundaries if the therapist’s grandiosity or guilt can be hooked by the patient. Since the borderline’s need for emotional nurturance exceeds the capacity of even the most giving therapist to satisfy, the therapist who lacks good professional boundaries will often begin to experience anxiety and resentment about the patient’s escalating demands. This will cause a failure of empathy on the therapist’s part, leading to the emergence of
2. The Angry Child Mode – in which the therapist is harshly devalued by the patient. If the therapist reacts defensively, an even more dysfunctional ego state will emerge:
3. The Punitive Parent Mode – since the child was punished for expressing normal needs and emotions, the adult knows that she is wrong to have these needs and emotions, and deserves punishment for expressing her feelings. Because she has internalized her parents’ dysfunctional attitudes and behaviors, she will begin to punish herself for having needed the therapist so much, and for having expressed her anger at the therapist for not satisfying those needs. In the punitive parent mode, the patient will derogate herself during internal dialogues, will experience herself as defective, worthless, and contemptible, and will often punish herself through self-mutilating or self-poisoning. Her attempt to regain a position of emotional equilibrium will often lead to the fourth and last of the common ego states seen in borderlines:
4. The Detached Protector Mode – in which feelings are disavowed, and the patient appears passively compliant and placid. This particular ego state is often overvalued by naive therapists whose personal insecurity leads them to prefer the appearance of calm to the turbulence of the patient’s other ego states.
The Detached Protector Mode is actually the least workable of the four ego states commonly seen in borderline patients; the only appropriate therapeutic technique for this mode is to encourage the Vulnerable Child mode to reemerge. One can do this by reminding the patient how she felt in a previous session.
You may then have to work through eruptions of the Punitive Parent Mode by assuring the patient that her need for nurturance is normal and acceptable. In general, your goal is to extinguish the Punitive Parent Mode by presenting yourself as a more accepting and appropriate parent for the patient.
The Angry Child needs help learning how to express that emotion in nondestructive ways. A therapist who is personally secure will encourage the patient to verbalize even more anger at the therapist, but actual verbal abuse should be redirected into more authentic emotional expressions. In this regard, the patient can be helped to use “I” statements rather than “you” statements – “I felt abandoned by you” rather than “You’re a cold, uncaring, heartless bastard”. You may have to assist the patient to understand that “I think you’re a cold, uncaring, heartless bastard” is really a “you” statement disguised as an “I” statement. The payoff for the patient in learning how to verbalize anger more appropriately is that the patient can then be angry without sacrificing connection with potential sources of emotional nurturance.
The Vulnerable Child Mode is the most workable ego state in borderline patients.