Читать книгу Schema Therapy for Borderline Personality Disorder - Hannie van Genderen - Страница 19

When the patient is in the detached protector mode, the patient seems relatively mature and calm (See ST step by step 5.08). A therapist could assume the patient is doing well. In fact, the patient uses this protective mode in order to avoid experiencing or revealing her feelings of fear (abandoned/abused child), inferiority (punitive parent), or anger (angry/impulsive child).

The patient also doesn't look happy or relaxed (happy child). Underlying assumptions that play important roles here are those of: it is dangerous to show your feelings and/or desires and to express your opinion. The patient fears losing control of her feelings. She attempts to protect herself from the alleged abuse or abandonment. This becomes particularly evident as she becomes attached to others. The protector keeps other people at a distance either by not engaging in contact or by pushing them away (the detached protector can become an angry protector (see ST step by step 5.11) or a bully and attack mode (see ST step by step 5.13 and 5.14)) or belittle them by denigrating them (self‐aggrandizer see ST step by step 5.12)). Should others discover her weaknesses, the patient would face potential rejection, punishment, and/or abandonment. Moreover, if the patient would allow to fully feel emotions and emotional needs, the dysfunctional modes to the right of the “wall” in Figure 2.2 might get activated, which is a frightening prospect for the patient, as she does not know well how to deal with that. Therefore, it is better to not feel anything at all and keep others from getting too close to her, and to prevent emotions to be felt.

Figure 2.3 Borderline personality disorder: an example of a case conceptualization linking modes with the origins in youth, schemas, and current problems

The therapist should try to find a special name for the detached protector of Nora. A lot of patients call their protector a wall or a shield. This helps to make clear what the function of this mode is.