This is a really interesting thread from @JonathanShedler and I'd really encourage people to read critically to get an understanding of the splitting associated with BPD/EUPD. Some things to think about.... https://twitter.com/JonathanShedler/status/1355207666025459714

It talks about the black and white thinking that all people can experience, but locates it uniquely within those with the 'borderline personality'. This means that when...

...they "see the clinician as a 'bad person' and attack them for their callousness or incompetence" this can only be their flawed thinking...

...As a clinician who has probably been both dismissive and not good enough, its a relief to know that a reaction to this was due to the pathology of the patient...

"Split, disavowed representations of self and others and the feelings associated with them are projected wholesale onto other people with conviction and certainty. The projections often involve intensely negative emotions such as anger, spite, hate, envy, and disgust."

"The person regards their projections as facts, not perceptions. It can be disorienting and maddening to others, including clinicians, to be seen and treated repeatedly as someone they are not." But what if they are?

Surely all relationships are co constructed? Is it not possible that anger, spite, hate, envy or disgust might be in the clinician? If not, surely this mirrors the black and white thinking we are accusing the patient of?

"the person works to induce and evoke the feelings they have projected with such vehemence, until the other person begins to feel and act in accord with the projection. Borderline patients are masterful in bringing this about (not deliberately)"....

"Clinicians describe experiences of not being able to think their own thoughts or feel their own feelings—as if their minds have been colonized by something alien"

Lets imagine a patient saying this about staff...

'The staff are psychically making me act in a way I dont want to. They have taken away my thoughts and feelings. My mind has been colonised by something alien.'

These are first rank symptoms of schizophrenia.

There must be black and white thinking at work if a statement is either clinical reasoning or psychosis depending on who says it.

"Observable behavior on the part of the patient pulls, pushes, coaxes, and bullies the clinician into their assigned role, although the clinician may be unaware of this as it is occurring"

Can we get rid of this nonsense that traumatised young women are using mind control to rip apart previously high functioning teams?

"the transfer of thoughts and feelings from patient to clinician that occurs in projective identification is not mysterious or mystical" it really is from the way I'm reading it.

How can we prepare staff to work empathically with those who have lived through abuse if we sell the notion that they have powers to insert thought and make you act in ways you do don't want to? Its like saying there's a banshee or siren coming to stay on the ward.

All relationships have something from both people. We cannot locate all problems in the patient. As the ones being paid, staff might need to have the responsibility for managing their feelings. We need to stop blaming traumatised women for how we are thinking & feeling. End