Because many sufferers of BPD have been so betrayed and hurt by their childhoods they may frequently have developed psychological defences that do not immediately endear them to others such as deep mistrust of people in general and, in particular, of authority figures and a propensity to display rage in situations that, to those who are unaware the BPD sufferer’s overwhelmingly traumatic childhoods and how both conscious and unconscious reminders of traumatic events that occurred during that childhood can trigger dysfunctional responses in adulthood that may be difficult to understand and tolerate.
And, of course, those responsible for the psychological care of adult BPD patients, being all too human, are not immune to having negative feelings towards those suffering from this severe psychiatric disorder (notwithstanding the fact that their understanding of the patient should, we ardently hope, be better than the average person’s). Some psychotherapists describe these negative feelings that the psychiatric carer (e.g. psychiatric nurse, psychotherapist etc..) may harbour towards his/her patient as negative countertransference.
Negative countertransference occurs when the therapist’s emotions become entangled with the patient’s emotions in a way that leads the therapist to feeling antipathy towards the patient such as contempt, irritation, annoyance, hatred and anger. And, as would be expected, such feelings, if not entirely resolved via professional insight, can potentially seriously undermine the therapeutic relationship and greatly damage treatment outcomes.
The term malignant alienation refers to a deterioration in the patient-therapist relationship (Morgan, 1979). Patients affected by the process of malignant alienation may be seen as ‘difficult’, ‘manipulative’, ‘hostile’ and ‘demanding’. However, it is imperative to note that such patients are frequently severely ill (Neill, 1979)The process of alienation which may occur is described as malignant because the process often precedes the suicide of the patient (Modestin, 1987) or severe relapse.
SUSCEPTIBILITY OF SECTIONED PATIENTS AND THOSE CAUGHT UP IN THE CRIMINAL JUSTICE SYSTEM:
Patients who have been sectioned or have been caught up in the criminal justice system (e.g. due to impulsive and/or anti-social behaviour) are particularly susceptible to experiencing the process of malignant alienation as their interaction with the therapist may be mandatory (e.g. part of a court order or obligatory treatment plan).
REDUCING THE LIKELIHOOD OF MALIGNANT ALIENATION OCCURRING:
Chiswick and Cope (1995) stress that to reduce the probability that malignant alienation will occur the therapist should strive towards being non-judgemental,, non-moralistic and minimize the extent to which his/her emotions cloud his/her professional judgement.
David Hosier BSc Hons; MSc; PGDE(FAHE).