‘Hello you really understand me’ is suddenly replaced with, ‘Hell you have never understood me, ever’. The professional is a pale shadow or their former glowing self, an imposter, a fraud who pretended to care.

Unfortunately the professional will also see the truth in this accusation as they experience the fragility of their supposed alliance with the patient, seeing how thin the veneer of connection actually was.

The loss of the idealised object (the angelic professional) will not be felt by the patient as a product of their own mind. They will see the destruction of their cherished professional to be a wanton act of badness by the professional. They will feel that the professional has killed off the loving and good feelings to replace them with cruel and toxic bad feelings, symbolised in poisonous envy being sprayed.

Two patients emerge when the split breaks down, a tyrannical entitled patient who accuses the professional of betrayal and failure ‘like all the rest’ and a terrified embattled victim who fears retaliation by the professional.

The aggrieved patient, both the aggressor and victim, occupy a territory in the country of the mind where grieving and loss have no place.

The problem for the professional is that the country of their mind will also be war torn after a borderline battle and as the patient divides their mind, they divide the minds of others.

It is often too much to anticipate integration in the mind of the patient in the aftermath of such conflict but it may be possible for some integration to begin between the fragmented, disintegrated colleagues who find they each share a burden of hopelessness and yet may believe it is the other colleague who is inadequate and has failed.

The kind of regular reflective space that is not directed to articulating a plan but is concerned with articulating the emotional impact of working with borderline patients is a vehicle for the interpersonal task of working towards a realistic perception of what has happened and what can happen.

Limits are the casualty of borderline experience and though lost, regaining sight of the limits of what is possible can begin to mitigate the excitement and despair that accompanies the limitless expectation of the patient and professional relationship.

.