ABSTRACT: This paper describes in detail those as pects of trance that facilitate the ongoing therapy process with the borderline personality and secondly, the utilization of trance phenomena to directly work
with the borderline person's experience and particu lar ego deficits, elaborated from an object relations viewpoint.
The intent of this paper is to explore the use of trance in the treatment of certain ego deficits of the borderline patient. Psychoanalytic investigations based on the work of object relation theorists such as Guntrip (1969), Winnicott (1965), Mahler (1971), and Kernberg (1967) suggest that this pathological experience reflects a developmental fixation in ego development which initially occurs during the early childhood stage of separation/individuation. A number of factors —genetic, environmental, and interpersonal—may interfere with the child's progression from a symbiotic relationship with his mother to a position of relative separateness. This difficulty is suggested to occur following self-object differentiation, but prior to the development of object constancy and corresponding self constancy. Structural impairment during this period results in the pathological continuance of splitting as a defense, both in terms of self and object; "I am either all good or all bad—you are either all good or all bad." This continuous use of being split results in limited reality testing, ability to tolerate anxiety and frustrations and to sustain a stable and integrated sense of self. Phenomenologically, or experientially, this existential developmental dilemma is expressed in the dialectic and polarity of the fear of being abandoned and/or absorbed. One's inner experience of self is weak, empty and vacuous; and much acting-out behavior can be considered as attempts to avoid this desperate experience. In this paper I will first describe certain aspects of trance that facilitate the ongoing therapy process, and then secondly describe the use of trance to directly work with the borderline person's experience and particular ego deficits. Trance can provide for the "felt immediacy" of experiencing without reflective appraisal; thus, there is the paradoxical experience for the borderline person in trance to feel more real, more focused, more absorbed in, and more substance to his bodily felt feelings. Going into trance provides a time out from preoccupation with one's presentation of self. Going into trance can provide a time-out period from the internalized demands to act "as if" (to use Helene Deutsch's words) and perform to a prescribed role. As Winnicott (1965) and Guntrip (1969) point out, the borderline person, not having achieved an autonomous sense of self, borrows roles and behaviors (often of parental origin) which are not his and plays out that which he believes the other wishes him to be. Consequently, there is the internal experience that one's behaviors and one's roles are "not me", but just a game or a piece of theater. The border line person's publicly presented identity is not his internal identity—an identity which is felt to be hidden and secret. The experience of trance can, consequently, provide a patient with the novel experience of simply being without constant pressure to be performing, without the pressure to act out some fantasied image. Trance inductions that emphasize deep relaxation, bod ily awareness and the giving of suggestions within trance that facilitate disidentificafion with thinking and internal preoccupation, can facil itate the internal experience of substance and embodied feelings.
Secondly, the very ritual of entering into trance and coming out of trance can provide a metaphorical structure for the patient to tolerate subjective states that are painful and fearful. A major fear of the patient is to become stuck in the catastrophic and primitive experience (i.e., emptiness, rage) with no way out. Consequently, the patient is terrified of touching the earlier painful feelings and ego states. In a sense, the metaphor of going into trance to work on a particular experience or feeling allows the patient to set limits and boundaries on what will happen to him. He begins to see that the painful feelings can be touched upon and yet contained, and he is therefore more free to work with them.
I will now discuss the use of trance to directly work with some of the ego deficits that are manifested by the borderline personality.
As Guntrip (1969) and Eigen (1973) have pointed out, the core experience of the schizoid or borderline person is emptiness and the inner conviction of being nothing or hollow. Trance may be used (in the context of the relationship with the therapist) as a vehicle for the patient to go into and inward, and possibly discover the hidden or secret self (to use Winnicott's phrase).
Winnicott speaks of a true, silent, inviolable self, beyond all usual communication with the outside world (Winnicott, 1965). Elkin (1972) and Guntrip (1969) describe the schizoid retreat as a process in which an aspect of self retreats to a hidden, detached existence to preserve a sense of psychic freedom and safety from parental impingement and abandonment. Consequently, one goal of therapy is to facilitate contact with this aspect of self which has withdrawn beyond fear (Eigen, 1973). Once such contact has been established, the patient's viewpoint of himself, being intrinsically empty or hollow, may be reversed; and the possibility of his entering into the world of social life and embodied feelings increased.
I will present two representative cases illustrating this process. The first description of this process of entering inside and experiencing this, " I " Kernel, was written by Michael Eigen and published in The International Journal of Psychoanalysis (Eigen, 1973). Eigen describes how, over a number of months, his patient withdrew from social contact and was increasingly experiencing fear of disintegration. However, when the patient actively allowed or tried to bring about the disintegration he had feared when he was passive, he found it would not
happen. That he could not actively achieve what he passively feared was a discovery which helped lay the foundation for increasing the courage to face whatever he himself might bring forth. After this period, his fear of disintegration was replaced by an intense sense of emptiness, which he described as "the depression beneath depressions." The emptiness was like a cloudy medium through which he caught sight of " a hidden T which was drawing me into it . . . " More completely, "The emptiness is like a cloud .. . a vague cloud .. . I can almost see through it .. . sometimes I think I see something on the other side .. . a mirror perhaps .. . a mirror I can see through .. . but something is staring at me from it .. . I am already there .. . I am looking at me here . . . It's me, but more me .. . an T I feel I've always had . . . that I've always been moving toward . . . It's been directing me to it from behind somehow . . . like a transmitter ... " The patient aimed at this "I " and moved into the emptiness. As he entered the emptiness, it grew more intense, more alive with itself; still, like the eye of a storm. Though soundless, if gave the illusion of being loud. "It feels like it's about to give birth . . . "When the loudness reached its peak, the space became clear instead of cloudy. "It won't move .. . it stands in one place . . . like a light tower or a bright, dense stone . '. . black space endlessly around it .. . I want to touch and break it because it won't give an inch . . . but I'll break before it will .. . as though I'm breakable and it's not .. . I want to unite with it and make it part of me .. . It is .. . it's more me than me .. . the I-ness of my I ... " (Eigen, 1973).
Another representative example is that of one of my own patients, a 32 year old borderline male who has been experiencing the despair of his repetitious approaching towards and then rejecting the woman with whom he lived, and who he feared to get close to because he would either be absorbed by or eventually abandoned by her. In trance, he entered into his despairing feelings, giving up, so to speak, and then described the experience of falling—falling into a void. Eventually, the empty void became ice, and he felt himself to be surrounded and contained in ice. (His body at this point became ice cold.) He allowed himself to stay in the ice, "surrendered to the ice, " "gave up " and "lived it through" (to use his words), and then at the point where he had no feelings, other than being deeply cold and frozen and on the verge of disappearing, he began to experience cracks in the ice, began to see light and experience air coming into his compressed container. There was then a shift for him in which he began to experience warmth and energy from within, rather than from without; compressed, yet highly energized and alive. It was also at this point that he began to know that inside he was alive and not dead, and his constant preoccupation with being not quite real, of really being dead inside, of being only a moving body, left him and he began to experience laughter at the unwarrantedness and absurdity of his doubting and his self-critical examinations. He knew of his lively inner self, inside out, not reflectively from other's appraisals, but directly from his own inner experience.
This therapeutic event ought not be considered as a cathartic breakthrough, but rather it is the beginning of a reversal process. By going through the fear of despair, the void, emptiness, frozenness, the patient made contact with an inner bedrock sense of self and began the process of reclaiming the energy and aliveness which had been so constricted and hidden. After such an experience, the world appears to the patient to be different, less flat, more dimensional, more attractive. The experience provides a shift in perception that will give support for the concrete working on relationships with new hope and energy. Furthermore, this is not a once-and for-all event, but may reoccur with different nuances, variations; hopefully ever deepening and nourishing.
The pattern of the process of going inward to reclaim that part of one's self that was developmentally cut off may be described as follows:
1) disillusionment with the outer world and despairing over a meaningful life in it 2) withdrawing inside
3) panic and fear of disintegration
4) intense feelings of emptiness in which emptiness or void is eventually discovered to be alive and full
5) the experiencing of an underlying and indestructible sense of self—highly energized, although condensed
6) a reviewing of the world as being highly attractive, and the beginnings of feelings of generosity within one's boundaries. (Eigen, 1973)
r Although this process may and does take place spontaneously in ongoing interpersonal therapy, the patient within trance, within hypnosis, compresses the experience, seems to bypass defenses, and makes the trip more directly and more rapidly.
Trance can be used to facilitate the integration of the split and contradictory ego states. As was pointed out in the beginning of this paper, another major characteristic of borderline patients is being split—both in the sense of self and object.
In the borderline personality, self and object images with positive valence are maintained separate from self and object images of negative valence. This seems necessary to the person because the negative, being so intense, would seemingly destroy the positive. Often the split is experienced as being either all good, placating, dependent, and childlike, or, on the other side, being completely demonic, evil, destructive, rageful, totally independent (Masterson, 1976).
Normal development involves the coalescence of good and bad self images, which result in an integrated and sustained sense of self. Kernberg points out that the most important cause of failure in making this necessary coalescence is probably the predominance of the negative hostile introject, which is disowned or "not me," to use Sullivan's phrase (Kernberg, 1967).
The Gestalt techniques of dialogue, in which the patient gives a voice to his split parts/selves and then has the parts enter into a dialogue with each other, can be heightened and deepened in trance (Bauer, 1976). The adolescent whose be havior shifts erratically from being "lovingly dependent and placating" to suddenly "rageful, destructive and acting out," and who speaks of his mind wanting to kill his father and whose heart loves his father, can have these metaphorical representations of his split state enter into conversation. The young adult who seems frozen and all-placating and who intensely fears a vague demon-like creature within him (and yet feels clearly that it is not him) can give a voice to the demon and begin to re-own and reintegrate the split of rage and placating ego states. Both states are, in fact, pathologic and imbalanced. Being either all good or all evil is split. The dialogue in trance can facilitate re-owning of the split introject. The patient often consciously identifies with the placating good part and disidentifies, and consequently acts out impulsively the evil part. By consciously re-owning the evil part, balance and integration are increased. For a further description of this process of using trance experience to re-own the introject, I would recommend the paper by Beahrs and Humiston entitled "The Dynamics of Experiential Therapy" which appeared in the July 1974 issue of the American Journal of Clinical Hypnosis.
Trance and indirect suggestion can be helpful in the redefining of the phenomenologically felt to-be-evil bad introject; from evil-bad and "not me" to a possible ally and "for me." The early introjected and unassimilated bad parent object may initially be so fearful, overwhelming, and for that matter pre-conceptual (it is just a vague feeling without imagery) that the patient is unable to and terrified to give it expression as was previously described. The redefining of the evil part "witch-like and demon-like" (to use a patient's description) to a rather ferocious ally who arises when the patient does not take adequate care of himself (placating) is a useful way for the therapist to facilitate the patient experiencing the introjected state as manageable and containable; and thus enhancing the possibility of eventual assimilation and re-owning.
For example, Myra, a young 25-year-old female plagued with vague, ominous rage, was often frozen and speechless in regard to her destructive and self-destructive feelings. In trance, she was able to give form to these feelings as an
image of an evil woman bent on killing her. After numerous descriptions of her experience, both in and out of trance, it was suggested in an Ericksonian type of indirectness that the woman was an ally who would literally beat her on the head (the patient would do this to herself) when the patient did not take care of herself. The patient, therefore, began to reinterpret her experience of the hostile introject as a guardian, admittedly a frightening one, but one who she could listen to and take heed of. It was after such a hypnotic redefining that the patient could begin to become more efficient in her aggression and realize the adaptive aspects of the rage and the power within her.
Finally, I would like, to describe the use of trance and self-directed statements in dealing with borderline patients who have an obsessive defense structure. The obsessive defense style of certain borderline people is a useful way for the person to maintain structure and boundaries. An
obsessive adjustment is often a successful way for the borderline person to maintain himself in the world. Therapist attempts to remove such obsessive thinking may lead to poor results and possible personality regression. However, with the use of self-directed statements, the content of obsessive thinking may be changed. In a sense, the patient replaces an obsessive negative thought with an obsessive positive and nurturing thought pattern.
The patient learns to repeat, both in trance and out of trance, positive subvocal repetitions (i.e., I honor myself), and throughout the day does this internal speaking as he goes about his business. This technique is not unlike the Eastern use of
mantra repetition. The work of cognitive behaviorists, such as Meichenbaum presents research showing how what we say to ourselves internally does create mood states (Meichen baum, 1974). It may well be necessary to maintain the obsessive thinking style, but the content is changeable. Moreover, the self statements become an anchor point, and anxiety reducer during anxiety producing events.
In summary, I have attempted to describe the use of trance as a technique in working with the borderline person. Trance provides a ritual for the patient to become absorbed in his experiential world in an intense but contained way. Trance provides a ritual for the patient to give focus and defined expression to his chaotic and undefined experience. Although obvious, the uses of trance described in this paper are simply strategies that might be used in the ongoing therapist-patient relationship. It is the therapist patient relationship which is the fulcrum of change in the learning of trust in and love of one's self.
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EIGEN, M. Abstinence and the Schizoid Ego. The International Journal of Psychoanalysis, 54,493-498, 1973. ELKIN, H. On Selfhood and the Development of Ego Structures in Infancy. Psychoanalytic Review, 59, 389-416, 1972.
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