Friday Keynote Address
How do people with borderline personality disorder communicate?
Implicit communication in the therapeutic relationship.
Stephan Doering, MD
Chair of the Department of Psychoanalysis and Psychotherapy
Medical University of Vienna
Watch this interview with Dr. Doering on YouTube!
People with borderline personality disorder (BPD) are characterized by an impairment of mentalizing capacity, i.e., it is difficult for them to find symbols, metaphors, and words for their experiences from the past and present. Instead, implicit memories are stored, mostly in the form of unconscious emotional-sensory, embodied states. This results in a way of interpersonal relating that is less characterized by a cognitive analysis of internal processes inside the self and others, but rather by an acting out of implicit relational experiences. The therapist is assigned a certain role and drawn into a dramatic re-enactment of early relational experiences of the patient. The challenge for the therapist is to “read” and understand what is being enacted, and to find metaphors and words to express what is going on – in a way that the patient can accept as related to his/her own experience.