Relational Healing for the Borderline Personality – with Dr Ruth Birkebaek (September 2021)

For the third time, we were afforded another excellent live seminar by Dr Ruth Birkebaek and learned how she works with “borderline” clients using her clinical experience as well  as a training with Richard Erskine’s theoretical model of integrative, relational psychotherapy. 

I felt that Ruth’s explanation of Richard Erskine’s re-wording of the word “borderline” to “Early Affect Confusion” was so much more helpful and relevant in describing clients/patients with these issues and symptoms. 

“People suffer from relationship disruptions, not psychopathology.”   

This statement set the tone and basis for how Ruth works with patients, keeping in mind the core of the patient’s difficulties, the suffering from extreme fear of abandonment, the fear that others will control them and then abandon them.   

The ways that patients cope, using addictive behaviours of all types and learning to manipulate others to manage their deep fears.

Ruth spoke about how patients are often confused about their own life stories, the axis of fantasy and reality and how the therapeutic process can assist in understanding the patient in more depth.

Ruth shared her thoughts on how neuropathy and psychology blend in explaining how the little traumas in early years trigger increased levels of cortisol which affects the development of the hippocampus.  Patients can often experience being unable to recollect memories, as they lack the storage of explicit memories.  She talked about the presence of patient’s physical and medical presentations which can be connected to their psychological condition.

Patients with Early Affect Confusion can often feel suicidal, display emotionally and behavioural impulsivity, acting out as the patient is unable to think. Projecting into others and feeling shame afterwards.  Self-harming and mood swings indicate the depth of psychological pain and fear being felt by patients. 

Ruth presented the seminar to the delegates with care and patience, offering plenty of time and space for the group to think and express.   It became clear that Ruth’s manner and approach is the same as with her patients, allowing connection, understanding and expression in a safe, contained, non-judgmental way. 

She spoke about the core of the therapeutic connection, making phenomenological enquires of the patient, keeping attuned to their thoughts and feelings, helping the patient to make new neurological pathways to develop the bridge between the feelings and cognition. 

Ruth shared her knowledge on how patients can be unsure of their core identity, sexual identity sometimes and often don’t know who they are and feel that they are a fake.

She spent time sharing her own clinical cases and experiences when working with the patient’s fantasy worlds, their thoughts and stories, which Ruth suggests can provide rich and important insights into helping the patient understand themselves and is often where the patient’s shame is uncovered and able to be explored.    

Working alongside the patient in a slow, consistent way, attuning to the patient to assess what is enough and tolerable in the moment, as the patient is likely to try to push the therapist away by minimising, projecting or attacking, to protect themselves from their pain. 

Ruth helped our group to understand that insufficient attunement by mother/caregiver in childhood (9 – 24 months) can result in Early Affect Confusion.

We were given a wealth of knowledge, experience and theoretical referencing during our seminar, some of which I’ve precised in this short blog. Thank you again, Ruth and we look forward to seeing you next year for another thought provoking and most helpful seminar.