Chapter Ten

Understanding and Healing

Now here, you see, it takes all the running you can do to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that.

—From Through the Looking-Glass, by Lewis Carroll

 

 

 

“I feel like I have a void in me that I can never quite fill.” Elizabeth, an attractive, witty twenty-eight-year-old woman, was originally referred for therapy by her family doctor. She had been married for six years to a man who was ten years older than her and had been her boss at one time. Five months before, she had given birth to her first child, a daughter, and was now severely depressed.

She yearned for something she could call her own, something that would “show that the rest of the world knew I was here.” Inside, she felt her “real self” was a swamp of childish emotions, and that she was always hiding her feelings, which were “ugly and bad.” These realizations turned into self-hate; she wanted to give up.

By her count, Elizabeth had engaged in nine extramarital affairs over the previous six years—all with men she met through work. They began soon after the death of her father. Most were relationships that she totally controlled, first by initiating them and later by ending them. She had found it exciting that these men seemed so puzzled by her advances and then by her sudden rejections. She enjoyed the physical closeness, but acknowledged she dreaded being too emotionally involved. Although she controlled these relationships, she never found them sexually satisfying; nor was she sexually responsive to her husband. She admitted that she used sex to “equalize” relationships, to stay in control; she felt safer that way. Her intellect and personality, she felt, were not enough to hold a man.

Reared in a working-class Catholic family, Elizabeth had three older brothers and a younger sister, who had drowned in a swimming accident at age five. Elizabeth was only eight at the time and had little understanding of the event except to observe her mother becoming more withdrawn.

For as long as Elizabeth could remember, her mother had been hypercritical, constantly accusing Elizabeth of being “bad.” When she was a young girl, her mother insisted that she attend church with her, and forced her father to construct an altar in Elizabeth’s bedroom. Elizabeth felt closer to her father, a passive and quiet man, who was dominated by his wife. As she entered puberty, he became more distant and less affectionate.

Growing up, Elizabeth was quiet and shy. Her mother disapproved of her involvement with boys and closely watched her friendships with girls; she was expected to have “acceptable” friends. Her brothers were always her mom’s favorites; Elizabeth would kid with them, trying to be “one of the guys.” Elizabeth achieved good grades in high school but was discouraged from going to college. After graduation, she began working full-time as a secretary.

As time went on, the conflicts with her mother escalated. Even in high school, Elizabeth’s mother had denounced her as a “tramp” and constantly accused her of promiscuity even though she had had no sexual experience. After a while, having endured the shouting contests with her mother, she saved enough money to move out on her own.

During this turmoil, Elizabeth’s boss, Lloyd, separated from his wife and became embroiled in a painful divorce. Elizabeth offered solace and sympathy. He reciprocated with encouragement and support. They began dating and married soon after his divorce was finalized. Naturally, her mother berated her for marrying a divorced man, particularly one who was ten years older and a lapsed Catholic.

Her father remained detached. One year after Elizabeth married, he died.

Five years later, her marriage was disintegrating, and Elizabeth was blaming her husband. She saw Lloyd as a “thief” who had stolen her youth. She was only nineteen when she met him, and needed to be taken care of so badly that she traded in her youth for security—the years when she could have been “experimenting with what I wanted to be, could be, should have been.”

In the early stages of treatment, Elizabeth began to talk of David, her most recent and most important affair. He was twelve years older, a longtime family friend, and the parish priest. He was someone known and loved by her whole family, especially by her mother. He was the only man to whom Elizabeth felt connected. This was the only relationship that she did not control. On and off, over a period of two years, he would abruptly terminate the affair and then resurrect it. Later, she confessed to her psychiatrist that David was the father of her child. Her husband was apparently unaware.

Elizabeth became more withdrawn. Her relationship with her husband, who was frequently away traveling, deteriorated. She became more alienated from her mother and brothers and allowed her few friendships to flounder. She resisted attempts to include her husband in therapy, feeling that Lloyd and her doctor colluded and favored “his side.” So, even therapy reinforced her belief that she couldn’t trust or place faith in anyone because she would only be disappointed. All her thoughts and feelings seemed to be laden with contradictions, as if she were in a labyrinth of dead-end paths. Her sexuality seemed the only way out of the maze.

Her therapist was often the target of her complaints because he was the one “in control.” She would yell at him, accuse him of being incompetent, and threaten to stop therapy. She hoped he would get mad, yell back, and stop seeing her, or become defensive and plead with her to stay. But he did neither, and she railed against his unflappability as evidence that he had no feelings.

Even though she was accustomed to her husband’s frequent business trips, she started to become more frightened when left alone. During these trips, for reasons not yet clear to her, she slept on the floor. When Lloyd returned, she raged constantly at him. She became more depressed. Suicide became less an option than a destiny, as if everything were leading to that end.

Elizabeth’s perception of reality became more frail: She yearned to be psychotic, to live in a fantasy world where she could “go anywhere” in her mind. The world would be so far removed from reality, no one—not even the best psychiatrist—could get to her and “see what’s underneath.”

In her daydreams she envisioned herself protected by a powerful, handsome man who actively appreciated all of her admirable qualities and was endlessly attentive. She fantasized him as a previous teacher, then her gynecologist, then the family veterinarian, and eventually her psychiatrist. Elizabeth perceived all these men as powerful, but she also knew in the back of her mind that they were unavailable. Yet, in her fantasies, they were overwhelmed by her charm and drawn irresistibly to her. When reality did not follow her script—when one of these men did not aggressively return her flirtations—she became despondent and self-loathing, feeling she was not attractive enough.

Everywhere she looked she saw women who were prettier, smarter, better. She wished her hair was prettier, her eyes a different color, her skin clearer. When she looked in a mirror, she did not see the reflection of a beautiful young woman but an old hag with sagging breasts, a wide waist, plump calves. She despised herself for being a woman whose only value was her beauty. She longed to be a man, like her brothers, “so my mind would count.”

In her second year of outpatient therapy, Elizabeth experienced several losses, including the death of a favorite uncle to whom she had grown close. She was haunted by recurring dreams and nightmares that she could not remember when she awoke. She became more depressed and suicidal and was finally hospitalized.

With more intensive therapy she began recalling traumatic childhood events, opening up a Pandora’s box of flooding memories. She recalled severe physical beatings by her mother and then began to remember her mother’s sexual abuses—episodes in which her mother had inflicted vaginal douches and enemas and fondled her in order to “clean” her vagina. These rituals began when Elizabeth was about eight, shortly after her sister’s death, and persisted until puberty. Her memories included looking into her mother’s face and noting a benign, peaceful expression; these were the only times Elizabeth could remember when it appeared her mother was not disapproving.

Elizabeth recalled sitting alone in the closet for many hours and often sleeping on the floor for fear of being molested in her bed. Sometimes she would sleep with a ribbon or award she had won in school. She found these actions to be comforting and continued them as an adult, often preferring the floor to her bed and spending time alone in a quiet room or dark closet.

In the hospital Elizabeth spoke of the different sides to her personality. She described fantasies of being different people and even gave these personality fragments separate names. These personae were independent women, had unique talents, and were either admired by others or snobbishly avoided social contacts. Elizabeth felt that whenever she accomplished something or was successful, it was due to the talents of one of these separate personality segments. She had great difficulty integrating these components into a stable self-concept.

Nonetheless, she did recognize these as personality fragments, and they never took over her functioning. She suffered no clear periods of amnesia or dissociation, nor were her symptoms considered aspects of dissociative identity disorder (multiple personality)—although this syndrome is frequently associated with BPD.

Elizabeth used these “other women” to express the desires and feelings that she herself was forced to repress. Believing she was worthless, she felt these other partial identities were separate, stronger entities. Gradually, in the hospital, she learned that they were always a part of her. Recognizing this gave her relief and hope. She began to believe that she was stronger and less crazy than she had imagined, marking a turning point in her life.

But she could not claim victory yet. Like a field officer, she commanded the various sides of her personality to stand before her and concluded that they could not go into battle without a unifying resolve. Elizabeth—the core of her being—was still afraid of change, love, and success, still searched in vain for safety, still fled from relationships. Coming to accept herself was going to be more difficult than she had ever imagined.

After several weeks Elizabeth left the hospital and continued in outpatient care. As she improved, her relationship with her husband deteriorated. But instead of blaming herself, as she typically did, she attempted to resolve the differences and to stay with him. She distanced herself from unhealthy contacts with family members. She developed more positive self-esteem. She began taking college courses and did remarkably well, achieving academic awards. She slept with her first award under her pillow, as she did when she was a child. Later she entered law school and received merit awards for being the top student in her class. She developed new relationships, with men and women, and found she was comfortable in these, without having to be in control. She became more content with her own femaleness.

Little by little, Elizabeth started to heal. She felt “the curtains raising.” She compared the feeling to looking for a valuable antique in a dark attic filled with junk—she knew that it was in there somewhere but couldn’t see it because of all the clutter. When she finally did spot it, she couldn’t get to it because it was “buried under a pile of useless garbage.” But now and then she could see a clear path to the object, as if a flash of lightning had illuminated the room for a brief instant.

The flashes were all too brief. Old doubts reared up like ugly faces in an amusement-park fun house. Many times she felt as if she were going up a down escalator, struggling up one step only to fall down two. She kept wanting to sell herself short and give credit to others for her accomplishments. But her first real challenge—becoming an attorney—was almost a reality. Five years before, she wouldn’t have been able to talk about school, much less have had the courage to enroll. The timbre of her depressions began to change: her depression over failing was now evolving, she recognized, into a fear of success.

Growing and Changing

“Change is real hard work!” Elizabeth often noted. It requires conscious retreat from unhealthy situations and the will to build healthier foundations. It entails coping with drastic interruption of a long-established equilibrium.

Like Darwinian evolution, individual change happens almost imperceptibly, with much trial and error. The individual instinctively resists mutation. He may live in a kind of swamp, but it is his swamp; he knows where the alligators are, what’s in all the bogs and marshes. To leave his swamp means venturing into the unknown and perhaps falling into an even more dangerous swamp.

For the borderline, whose world is so clearly demarcated by black-and-white parameters, the uncertainty of change is even more threatening. She may clutch at one extreme for fear of falling uncontrollably into the abyss of another. The borderline anorexic, for example, starves herself out of the terror that eating—even a tiny morsel—will lead to total loss of control and irrevocable obesity.

The borderline’s fear of change involves a basic distrust of his “brakes.” In healthier people these psychic brakes allow a gradual descent from the pinnacle of a mood or behavior to a gentle stop in the “gray zone” of the incline. Afraid that his set of brakes won’t hold, the borderline believes that he won’t be able to stop, that he will slide out of control to the bottom of the hill.

Change, however gradual, requires the alteration of automatic reflexes. The borderline is in a situation much like a child playing a game of “Make me blink” or “Make me laugh,” struggling valiantly to stifle a blink or a laugh while another child waves his hand or makes funny faces. Such reflexes, established over many years, can be adjusted only with conscious, motivated effort.

Adults sometimes engage in similar contests of will. A man who encounters an angry barking dog in a strange neighborhood resists the automatic reflex to run away from the danger. He recognizes that if he runs, the dog would likely catch up with him and introduce an even greater threat. Instead, he takes the opposite (and usually more prudent) action—he stands perfectly still, allows the dog to sniff him, and then walks slowly on.

Psychological change requires resisting unproductive automatic reflexes and consciously and willfully choosing other alternatives—choices that are different, even opposite, from the automatic reflex. Sometimes these new ways of behaving are frightening, but they typically are more efficient ways of coping. Elizabeth and her psychiatrist embarked on her journey of change in regular weekly individual psychotherapy. Initial contacts focused on keeping Elizabeth safe. Cognitive techniques and suggestions colored early contacts. For several weeks Elizabeth resisted the doctor’s recommendation of starting antidepressant medicine, but soon after she agreed to the medication, she noticed significant improvement in her mood.

The Beginnings of Change: Self-Assessment

Change for the borderline involves more of a fine-tuning than a total reconstruction. In rational weight-loss diet plans, which almost always resist the urge to lose large amounts of weight very quickly, the best results come slowly and gradually over time when the weight loss will more likely endure. Likewise, change for the borderline is best initiated gradually, with only slight alterations at first, and must begin with self-assessment: before plotting a new course, one must first recognize his current position and understand in which direction modification must progress.

Imagine personality as a series of intersecting lines, each representing a specific character trait (see Figure 10-1). The extremes of each trait are located at the ends of the line, with the middle ground in the center. For example, on the “conscientiousness at work” line, one end might indicate obsessive over-concern or “workaholism,” and the other end “irresponsibility” or “apathy”; the middle would be an attitude somewhere between these two extremes, such as “calm professionalism.” If there were a “concern about appearance” line, one end might exemplify “narcissistic attention to surface looks,” and the other end, “total disinterest.” Ideally, one’s personality makeup would look like the spokes of a perfectly round wheel, with all these lines intersecting near their midpoints in the wheel “hub.”

Of course, no one is completely “centered” all the time. It is important to identify each line in which change is desired and locate one’s position on that line in relation to the middle. Change then becomes a process of knowing where you are and how far you want to go toward the middle. Except at the extreme ends, no particular locus is intrinsically “better” or “worse” than another. It is a matter of knowing oneself (locating oneself on the line) and moving in the adaptive direction.

FIGURE 10-1. Personality as a series of intersecting lines.

For example, if we isolate the “caring for others” line (see Figure 10-2), one end (“self-sacrificing over-concern”) represents the point where concern for others interferes with taking care of oneself; such a person may need to dedicate himself totally to others in order to feel worthwhile. This position may be perceived as a kind of “selfish unselfishness,” because such a person’s “caring” is based on subconscious self-interest. At the other end (“don’t give a damn”) is a person who has little regard for others, who only “looks out for number one.” In the middle is a kind of balance—a combination of concern for others and the obligation to take care of one’s own needs as well. A person whose compassion trait resides in this middle zone recognizes that only by taking care of his own important needs first can he hope to help others, a kind of “unselfish selfishness.”

FIGURE 10-2. The “caring for others” personality trait line.

Change occurs when one acquires the awareness to objectively place oneself on the spectrum and then compensate by adjusting behavior in a direction toward the middle. An individual who realistically locates his present position to the left of the midpoint would try to say “no” to others more often and generally attempt to be more assertive. One who places himself to the right of the midpoint would compensate toward the middle by choosing a course of action that is more sensitive to the needs of others. This position reflects the admonitions of the ancient scholar Hillel—“If I am not for myself, who will be for me? But if I am only for myself, who am I? If not now, when?”

Of course, no one resides “in the middle” all the time; one must constantly adjust his position on the line, balancing the teeter-totter when it tilts too far in one direction or the other.

Practicing Change

True change requires more than experimenting with isolated attempts to alter automatic reflexes; it involves replacing old behaviors with new ones that eventually become as natural and comfortable as the old ones. It is more than quietly stealing away from the hostile dog; it is learning how to make friends with that dog and take it for a walk.

Early on, such changes are usually uncomfortable. To use an analogy, a tennis player may decide that his unreliable backhand is in need of refinement. So he embarks on a series of tennis lessons to improve his stroke. The new techniques that he learns to improve his game initially yield poor results. The new style is not as comfortable as his old stroke. He is tempted to revert to his previous technique. Only after continuous practice is he able to eradicate his prior bad habits and instill the more effective and eventually more comfortable “muscle memory.” Likewise, psychological change requires the adoption of new reflexes to replace old ones. Only after persistent practice can such a substitution effectively, comfortably, and therefore permanently occur.

Learning How to Limp

If a journey of a thousand miles begins with a single step, the borderline’s journey through the healing process begins with a single limp. Change is a monumental struggle for the borderline, much more difficult than for others because of the unique features of the disorder. Splitting and the lack of object constancy (see chapter 2) combine to form a menacing barricade against trusting oneself and others and developing comfortable relationships.

In order to initiate change, the borderline must break out of an impossible catch-22 position: To accept himself and others, he must learn to trust, but to trust others really means starting to trust himself, that is, his own perceptions of others. He must also learn to accept their consistency and dependability—quite a task for someone who, like a small child, believes others “disappear” when they leave the room. “When I can’t see you,” Elizabeth told her psychiatrist early in her treatment, “it’s like you don’t exist.”

Like someone with an injured leg, the borderline must learn to limp. If he remains bedridden, his leg muscles will atrophy and contract; if he tries to exercise too vigorously, he will reinjure the leg even more severely. Instead, he must learn to limp on it, putting just enough weight on the leg to build strength gradually, but not so much as to strain it and prevent healing (tolerating leg pain that is slight, but not overwhelming). Likewise, healing in the borderline requires placing just enough pressure by challenging himself to move forward. As Elizabeth’s therapy progressed, cognitive interventions gave way to a more psychodynamic approach, with more attention focused on connections between her past experiences and current functioning. During this transition, the therapist’s interventions diminished and Elizabeth became responsible for more of the therapy.

Leaving the Past Behind

The borderline’s view of the world, like that of most people, is shaped by his childhood experiences in which the family served as a microcosm of the universe. Unlike healthier individuals, however, the borderline cannot easily separate himself from other family members, nor can he separate his family from the rest of the world.

Unable to see his world through adult eyes, the borderline continues to experience life as a child—with a child’s intense emotions and perspective. When a young child is punished or reprimanded, he sees himself as unquestionably bad; he cannot conceive of the possibility that mother might be having a bad day. As the healthy child matures, he sees his expanding world as more complex and less dogmatic. But the borderline remains stuck—a child in an adult’s body.

“There is always one moment in childhood when the door opens and lets in the future,” wrote Graham Greene in The Power and the Glory. In most borderlines’ childhoods, the responsibilities of adulthood arrive too early; the door opens ever more widely, but he cannot face the light. Or perhaps it is the unrelenting opening that makes facing it so difficult.

Change for the borderline comes when he learns to see current experiences—and review past memories—through adult “lenses.” The new “vision” is akin to watching an old horror film on TV that you haven’t seen in years: the movie, once so frightening on the big screen, seems tame—even silly—on a small screen with the lights on; you can’t fathom why you were so scared when you saw it the first time.

When Elizabeth was well into her journey in psychotherapy, she began to look at her early childhood feelings in a different light. She began to accept them, to recognize the value of her own experience; if not for those early feelings and experiences, she realized, she would not have been able to bring the same fervor and motivation she was bringing to her new career in law. “Feelings born in my childhood,” she said, “still continue to haunt me. But I’m even seeing that in a different light. The very ways I have hated I now accept as part of me.”

Playing the Dealt Hand

The borderline’s greatest obstacle to change is his tendency to evaluate in absolute extremes. The borderline must either be totally perfect or a complete failure; he grades himself either an A+ or, more commonly, an F. Rather than learning from his F, he wears it like a scarlet letter and so makes the same mistakes again and again, oblivious to the patterns of his own behavior, patterns from which he could learn and grow.

Unwilling to play the hand that is dealt him, the borderline keeps folding every time, losing his ante, waiting to be dealt four aces. If he cannot be assured of winning, he won’t play out the hand. Improvement comes when he learns to accept the hand for what it is, and recognize that, skillfully played, he can still win.

The borderline, like many people, is sometimes paralyzed by indecisiveness. Various alternatives seem overwhelming, and the borderline feels incapable of making any decisions. But as she matures, choices appear less frightening and may even become a source of pride and growing independence. At that point the borderline recognizes that she faces decisions that only she is capable of making. “I’m finding,” Elizabeth noted, “that the roots of my indecisiveness are the beginning of success. I mean, the agony of choosing is that I suddenly see choices.”

Boundary Setting: Establishing an Identity

One of the borderline’s primary goals is to establish a separate sense of identity and to overcome the proclivity to merge with others. In biological terms, it is like advancing from a parasitic life-form to a state of symbiosis and even independence. Either symbiosis or independence can be terrifying, and most borderlines find that relying on themselves is like walking for the first time.

In biology the parasite’s existence is entirely dependent on the host organism. If the parasitic tick sucks too much blood from the host dog, the dog dies and the tick soon follows. Human relationships function best when they are less parasitic and more symbiotic. In symbiosis two organisms thrive better together, but may subsist independently. For example, moss growing on a tree may help the tree by shading it from direct sunlight, and help itself by having access to the tree’s large supply of underground water. But if either the moss or the tree dies, the other may continue to survive, though less well. The borderline sometimes functions as a parasite whose demanding dependence may eventually destroy the person to whom he so strongly clings; when this person leaves, the borderline may be destroyed. If he can learn to establish more collaborative relationships with others, all may learn to live more contentedly.

Elizabeth’s increasing comfort with others started with her relationship with her psychiatrist. After months of testing his loyalty by berating and criticizing him and threatening to terminate therapy, Elizabeth began to trust his commitment to her. She began to accept his flaws and mistakes, rather than see them as proof of the inevitability of his failing her. After a while, Elizabeth began to extend the same developing trust to others in her life. And she began to accept herself, imperfections and all, just as she was accepting others the same way.

As Elizabeth continued to improve, she became more confident that she would not lose her “inner core.” Where once she would squirm in a group of people, feeling self-conscious and out of place, she could now feel comfortable with others, letting them take responsibility for themselves and she for herself. Where once she felt compelled to adopt a role in order to fit into the group, she could now hold on to her more constant, immutable sense of self; now she could “stay the same color” more easily. Establishing a constant identity means developing the ability to stand alone without relying on someone else to lean upon. It means trusting one’s own judgment and instincts and then acting rather than waiting for the feedback of others and then reacting.

Building Relationships

As the borderline forges a distinct, core sense of identity, he also differentiates himself from others. Change requires the appreciation of others as independent persons and the empathy to understand their struggles. Their flaws and imperfections must not only be acknowledged but also understood as separate from the borderline himself, part of the process of mentalization (see chapter 8). When this task fails, relationships falter. Princess Diana mourned the loss of her fantasy of a fairy-tale marriage to Prince Charles: “I had so many dreams as a young girl. I wanted, and hoped . . . that my husband would look after me. He would be a father figure, and he’d support me, encourage me. . . . But I didn’t get any of that. I couldn’t believe it. I got none of that. It was role reversal.”¹

The borderline must learn to integrate the positive and negative aspects of other individuals. When the borderline wants to get close to another person, he must learn to be independent enough to be dependent in comfortable, not desperate, ways. He learns to function symbiotically, not parasitically. The healing borderline develops a constancy about himself and about others; trust—of others and of his own perceptions—develops. The world becomes more balanced, more in between.

Just as in climbing a mountain, the fullest experience comes when the climber can appreciate all the vistas: to look up and keep his goal firmly in view, to look down and recognize his progress as he proceeds. And finally, to rest, look around, and admire the view from right where he is at the moment. Part of the experience is recognizing that no one ever reaches the pinnacle; life is a continuous climb up the mountain. A good deal of mental health is being able to appreciate the journey—to be able to grasp the Serenity Prayer invoked at most twelve-step meetings: “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Recognizing the Effect of Change on Others

When an individual first enters therapy, he often does not understand that it is he, not others, who must make changes. However, when he does make changes, important people in his life must also adjust. Stable relationships are dynamic, fluctuating systems that have attained a state of equilibrium. When one person in that system makes significant changes in his ways of relating, others must adjust in order to recapture homeostasis, a state of balance. If these readjustments do not occur, the system may collapse and the relationships may shatter.

For example, Alicia consults a psychotherapist for severe depression and anxiety. In therapy, she rails against her alcoholic husband, Adam, whom she blames for her feelings of worthlessness. Eventually she recognizes her own role in the crumbling marriage—her own need to have others become dependent upon her, her reciprocal need to shame them, and her fears of reaching for independence. She begins to blame Adam less. She develops new, independent interests and relationships. She stops her crying episodes; she stops initiating fights over his drinking; the equilibrium of the marriage is altered.

Adam may now find that the situation is much more uncomfortable than it was before. He may escalate his drinking in an unconscious attempt to reestablish the old equilibrium and compel Alicia to return to her martyred, caretaking role. He may accuse her of seeing other men and try to disrupt their relationship, now intolerable to him.

Or, he too can begin to see the necessity for change and his own responsibility in maintaining this pathological equilibrium. He may take the opportunity to see his own actions more clearly and reevaluate his own life, just as he has seen his wife do.

Participation in therapy may be a valuable experience for everyone affected. The more interesting and knowledgeable Elizabeth became, the more ignorant her husband seemed to her. The more opened-minded she became—the more gray she was able to perceive in a situation—the more black and white he became in order to reestablish equilibrium. She felt that she was “leaving someone behind.” That person was her—or, more closely, a part of her she no longer needed or wanted. She was, in her words, “growing up.”

As Elizabeth’s treatment wound down, she met less regularly with her doctor, yet still had to contend with other important people in her life. She fought with her brother, who refused to own up to his drug problem. He accused her of being “uppity,” of “using her new psychological crap as ammunition.” They argued bitterly over the lack of communication within the family. He told her that even after all the “shrinks,” she was still “screwed up.” She fought with her mother, who remained demanding, complaining, and incapable of showing her any love. She contended with her husband, who professed his love but continued to drink heavily and criticize her desire to pursue her education. He refused to help with their son and after a while she suspected his frequent absences were related to an affair with another woman.

Finally, Elizabeth began to recognize that she did not have the power to change others. She utilized SET techniques to try to better understand these family members and maintain protective boundaries for herself, which could shield her from being pulled into further conflicts. She began to accept them for who they were, love them as best she could, and go on with her own life. She recognized the need for new friends and new activities in her life. Elizabeth called this “going home.”