Paranoid-Schizoid and Depressive Positions And Recovery from BPD

Last week in my session with T, she said something about “paranoid-schizoid and the depressive position“. At the time, all I heard was the word “schizoid” and I momentarily freaked out that she was trying to tell me I had a personality disorder (which I probably do, but she has never actually told me that), then last night I was Googling Borderline Personality Disorder and it lead me to this page which I now realise was what she was referring to!

I found this VERY interesting and enlightening and what’s more, it has really helped me to understand the process of rupture and repair.  I am hoping it may also help some of you too.  I was planning to summarise these notes and make some comments on them but I think it is a bit too complex for me to do that accurately, so whilst I am tempted to sit here and make comments on everything, I will just attach a few links and if you have time/are interested, please do read them and let me know what you think, I would love to talk to someone about this!

A very brief summary is as follows:

The paranoid-schizoid position

Anxiety is experienced by the early infant’s ego both through the internal, innate conflict between the opposing life and death drives (manifested as destructive envy) and by interactions in external reality.

A child seeks to retain good feelings and introjects good objects, whilst expelling bad objects and projecting bad feelings onto an external object. The expulsion is motivated by a paranoid fear of annihilation by the bad object.

Klein describes this as splitting, in the way that it seeks to prevent the bad object from contaminating the good object by separating them via the inside-outside barrier.

The schizoid response to the paranoia is then to excessively project or introject those parts, seeking to keep the good and bad controlled and separated. Aggression is common in splitting as fear of the bad object causes a destructive stance.

The child’s ego does not yet have the ability to tolerate or integrate these two different aspects, and thus uses ‘magical’ omnipotent denial in order to remove the power and reality from the persecuting bad object.

This splitting, projection and introjection has a frighteningly disintegrative effect, pulling apart the fragile ego.

Projective identification is commonly used to separate bad objects whilst also keeping them close, which can lead to confused aggression.

 

The initial depressive position

The initial depressive position is a significant step in integrative development which occurs when the infant discovers that the hated bad breast and the loved good breast are one and the same.

The mother begins to be recognized as a whole object who can be good and bad, rather than two part-objects, one good and one bad. Love and hate, along with external reality and internal phantasy, can now also begin to co-exist.

As ambivalence is accepted, the mother can be seen as fallible and capable of both good and bad. The infant begins to acknowledge its own helplessness, dependency and jealousy towards the mother. It consequently becomes anxious that the aggressive impulses might have hurt or even destroyed the mother, who they now recognize as needed and loved. This results in ‘depressive anxiety’ replacing destructive urges with guilt.

The general depressive position

In the more general depressive position, projective identification is used to empathize with others, moving parts of the self into the other person in order to understand them.

To some extent, this is facilitated when the other person is receptive to this act. The experience that the projecting person through their identification is related to the actions and reactions of the other person.

When the thoughts and feelings are taken back inside the projecting person from the other person, they may be better able to handle them as they also bring back something of the other person and the way they appeared to cope. It can also be comforting just to know that another person has experienced a troublesome part of the self.

The depressive position is thus a gentler and more cooperative counterpoint to the paranoid-schizoid position and acts to heal its wounds.

 

My understanding of this is that children (or adults if they have been emotionally neglected and wounded and didn’t have a “good-enough” caregiver to help them develop through these phases successfully), tend to see people as all good or all bad due to using splitting as a defence mechanism.  In the therapy setting, this happens because a child is desperate for a good enough parent substitute (this is 100% true for me as I have written many times on here).

As therapy continues, the aim is that the therapist helps us to move through this phase as we should have done as children and in turn, we are more able to view the therapist as a whole person made up of good bits and bad bits and not one or the other.

I guess that when my T referred to me having “moved out of the paranoid-schizoid and into the depressive position” on Thursday she meant that I have moved out of the entirely “bad” projecting place and was then in a place where I was feeling guilt and worry about HER feelings and the damage that I may have caused to HER and our relationship. I think this is evident if you read my latest blog post.

Klein says “If the confluence of loved and hated figures can be borne, anxiety begins to centre on the welfare and survival of the other as a whole object, eventually giving rise to remorseful guilt and poignant sadness, linked to the deepening of love.”. I think I speak of this poignant sadness in my post “Drunk Thoughts“.

I guess when I went to my session Thursday and told T I couldn’t relax, was crying a lot and didn’t really know why and was feeling utterly helpless it was because I was feeling the guilt and grief of my projection onto T, the worry that I had damaged her/us.

 

AANNNDDDDD……

On top of this wonderful new information, I then came across the following blog:

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

which explained the 4 phases of therapy when recovering from BDP – being

(1) The Out-of-Contact Phase

(2) Ambivalent Symbiosis

3)  Therapeutic Symbiosis

4)  Resolution of the Symbiosis (Individuation)

The blogger explains these amazingly well and so I won’t copy her blog but please read it if you are interested.  I wonder now if this is what my T meant when she told me last week that we were now entering into the phase of my therapy where rupture and repair was common.  (Phase 2 perhaps? The ambivalent phase?).

I then read this:

“…. the dominance of the all-negative images during ambivalent symbiosis result in the patient distrusting the therapist and using projective identification to reject them. The patient distorts the therapist, turning him “all bad” in their mind in order to block the development of a positive relationship. In other words, the patient sabotages himself by actively attacking his potential positive relationship to the therapist“.

Oh dear.. well that feels worryingly familiar doesn’t it? Our entire rupture was formed on me asking to go from 2 sessions to 1 and her reaction being that I was sabotaging my therapy……… GULP!!  What followed? a huge rupture where I turned her “all bad”………….

 

4 thoughts on “Paranoid-Schizoid and Depressive Positions And Recovery from BPD

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