Ethical Conundrums with Borderline Patients


Note: This live virtual workshop took place in October 2020. If you’re interested in seeing this topic presented again, please contact us at !

Program Description:

We often struggle with our Borderline patients’ love-hate states and the bonding-ruptures during intense treatment moments. Research data show that more than 90% of Borderline patients have insecure attachment styles and unresolved social trauma. Our patients tend to lose perspective when emotions get conflicted and then “spit out”, i.e. project, these unbearable emotional states onto us and/or take to impulsive actions. In our patients’ minds, we often become the representation of parental abuse and neglect. This leads to particular challenges to our own emotional composure.

The ability to maintain a balanced notion of oneself is an outcome of early social biofeedback, and in the first part of this workshop, we will explore the core attachment dynamics that lead to successful mentalization and emotional self-regulation.

As we all carry our emotional baggage into therapy and repeat how the social biofeedback from our families formed us, we tend to get into the same familiar power plays and emotional abuse we grew up with. That is just as true for our patients as it is for us, and when we get trapped in transference struggles, we tend to leave our therapeutic neutrality in favor of unethical power plays or unethical actions towards the patient. It can show as deliberately and revengefully withholding a compassionate response to a patient who puts us down, or we can take to physical closeness as a misguided attempt at bonding. We will take a look at how therapists can cross the fine line between helping and hurting a patient, from sticking to patient-focused, verbal explorations to acting out.

In the second part of our workshop we will focus on common treatment conundrums with Borderline patients. We will use material from three published or fictional cases that capture unethical boundary violations, but we also welcome you to bring your own treatment experiences to our discussion.

Learning Objectives

  • Name the basic principles of Attachment Theory and understand the role of a parent for a child’s capacity for Mentalization and future Self-Regulation.
  • Identify insecure Attachment styles and discuss Borderline patients’ key difficulties with separation, affect-hunger, idealization, destructive rage, and interpersonal boundaries.
  • Understand revengeful, unethical boundary-violations during therapy, when our patients are going through intense affect storms, in particular when the practical rules of treatment, such as absences, fee, phone calls, etc. are being discussed.
  • Gain awareness of appropriate and professional use of compassion and the role of firm and harm-preventing boundaries.

Continuing Education Credit – 3 Hours

  • APA – Avant Training is approved by the American Psychological Association to sponsor continuing education for psychologists. Avant Training maintains responsibility for this program and its content. This workshop qualifies for Ethics CE hours for Psychologists.
  • LCSW –  This workshop is approved for Ethics CE hours through the Georgia Society for Clinical Social Work.
  • LPC, LMFT- Related hours

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