PTSD/Borderlines in Therapy: Finding the Balance

This book critically examines the relationship between childhood sexual abuse and adult borderline personality disorder, with a particular focus on symptoms of post-traumatic stress disorder (PTSD). Taking into account the many ambiguities in the current understanding of the complex relationship between childhood abuse experiences, formation of self-destructive personality styles, and subsequent psychotherapy for these problems, the author presents a working model that is useful without straitjacketing the practitioner or foreclosing the opportunities for new perspectives. The legacy of childhood abuse establishes a pattern in which the past influences the patient's present life in profound ways, from symptoms such as dissociative episodes to relationship styles such as victimization. Kroll describes the PTSD/borderline person as suffering first and foremost from a disorder of the stream of consciousness, "an inability to turn off a stream of consciousness that has become its own enemy, comprised of actual memories of traumatic events, distorted and fragmented memories, intrusive imageries and flashbacks, dissociated memories, unwelcome somatic sensations, negative self-commentaries running like a tickertape through the mind, fantasied and feared elaborations from childhood of abuse experiences, and concomitant strongly dysphoric moods of anxiety and anger". Much of the person's behavior is in response to this intolerable stream of memories, sensations, and thoughts. In therapy it is seen in patterns centering around destructive pursuit of gratification of needs and repeated playing out of old hurtful traumas and interactions. The challenges of working with PTSD/borderlines areillustrated in over twenty cases, many of which point out the pitfalls that frequently undermine the therapy of abuse victims. However, whether examining research or presenting his own cases, Kroll remains ever the skeptic, questioning not only the grand "Truths" that curtail useful discussion in the field but also his own small truths. In a style that is provocative and pragmatic, that moves from the grand schemes of theory to the specific nuances of single therapeutic comment, Kroll presents an extraordinarily useful model for working with PTSD/borderlines.