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Insecure attachment and borderline personality disorder:

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 Body, Movement and Dance in Psychotherapy, 2014
Vol. 9, No. 2, 93–105, http://dx.doi.org/10.1080/17432979.2014.891261

Insecure attachment and borderline personality disorder:

Working with dissociation and the ‘capacity to think’
Bethan Manford*

Homerton University Hospital, London, UK

(Received 8 September 2013; accepted 19 January 2014)

This article explores time-limited dance movement psychotherapy (DMP) with a

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female offender diagnosed with borderline personality disorder looking

particularly at the development of the therapeutic relationship and attachment
theory. DMP can help increase the ‘capacity to think’ and provide alternative
approaches for managing emotions opposed to ‘acting out’ difficulties in
relating. The therapeutic relationship in DMP can provide a containing, holding
environment in the absence of healthy attachments, early experiences of
deprivation and trauma. Laban Movement Analysis, psychodynamic and
mentalisation approaches were used to underpin the assessment, formulation and
therapeutic interventions.
Keywords: dance movement therapy; attachment; forensic; mental health;
mentalisation; firesetting; dissociation; borderline personality disorder;
violence; trauma

Introduction
Bowlby (1982) established the link between a child’s development and the quality of
the relationship with caregivers. An absence of feeling held in mind and a lack of
secure attachment can have a traumatic impact on body and mind (Bartenieff &
Lewis, 1980). ‘The mother infant relationship is mediated through eye contact,
rhythm, sound, reciprocity, synchrony and the sensory-motor experience of holding’
(Meekums, 2002, p. 33). Nurturing behaviour from a caregiver helps to preserve a
child’s emotional and physical balance. Rothschild (2000) suggests that the impact
of trauma on psychophysiology can lead to an avoidance of eye contact between the
child and its caregiver and may be linked with feelings of shame and separation
distress.
Loewenstein (1993) states that dissociation is the mind’s attempt to flee when
the body freezes; movement, therefore, may provide a healing path for clients who
have experienced trauma (Steckler, 2006). Movement work can enable clients to
engage with flow in effort (Laban & Lawrence, 1947), improving their capacity to
think and stay in contact with their emotional experience.
This article reflects on my experience of working as a dance movement
psychotherapist with an individual diagnosed with borderline personality disorder

*Email: bethanjanedmp@gmail.com

q 2014 Taylor & Francis

 94 B. Manford

(BPD) in a forensic setting. This required me to respond compassionately and non-

judgementally (Department of Health, 2003), tolerate intense affect and understand my
role alongside transference responses and countertransference (Gabbard & Wilkinson,
2000; Searles, 1994) with the support of weekly supervision and personal therapy.

Attachment
Deprivation of a reliable, attuned caregiver to provide a safe base for feelings being
contained and fed back to the child (Fonagy & Bateman, 2004; Kernberg, 2004) can
result in what Adshead (1997) describes as an increased tendency to dissociate, an
impaired capacity to put emotions into words and dysregulation of affect control.
Feelings can be split off in order to cope with the need for care from the mother,
despite the awareness of not having ones needs met. Loss, separation and trauma can
also lead to insecure attachment formation, the failure of developing a ‘protective
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shield’ (Freud, 1920/2001, p. 27) being the result of cumulative trauma (Khan,
1963). Bowlby (1988) saw attachment behaviour as continuing throughout life,
during anxiety and stressful times. In adulthood, ambivalent attachment, as seen in
BPD clients, can lead to over responsiveness in close relationships, jealousy and
consequently rejection. The relational framework of attachment theory provides a
social and developmental perspective for understanding patterns of interpersonal
and intergenerational pathology (Fonagy & Bateman, 2004).
Dance movement psychotherapy (DMP) seeks to engage patients through a
therapeutic relationship. The therapist can provide containment through kinaesthetic
empathy, attunement and awareness of ones own countertransference experiences
(Warnecke, 2009). Homann (2010) presents how DMP interventions foster
embodied, attuned connections using physical and emotional aspects of the self.
Research on neurological functioning of mirror neurons provides insight to the
underpinning of body– mind domains. Mirror neurons become activated not only
through witnessing movement but also through voice, touch, proprioception and
other sensory modalities (Sherwood, 2011). This brain research suggests that one
can experience activation of equivalent neurons by observing movement of another.
Mirror neurons are a source of inter-subjective empathy (Gallese, 2003) and help to
explain how mirroring and embodiment in DMP therapeutically benefit patients
(Berrol, 2006). Empirical research is needed in this area for further evidence of
effectiveness (McGarry & Russo, 2011).

BPD and DMP

The ‘personality disorder’ construct is described by Bourne (2011), highlighting the
issue of personal responsibility prescribed from the diagnosis. Historically,
symptoms associated with BPD were linked to character, and patients were seen to
be ‘bad’ rather than ‘mad’, and as ‘being, rather than having the disease’ (Bourne,
2011, p. 78). Bourne suggests that shame is the ‘conceptual underbelly’ of the
construct (p. 81). He argues that symptoms of BPD could be best understood as
adaptive reactions to relational traumas.
According to the Diagnostic and Statistical Manual of Mental Disorders, BPD is
defined as a severe, pervasive personality dysfunction characterised by features such
 Body, Movement and Dance in Psychotherapy 95

as impulsivity, identity disturbance, self-harm behaviour and intense unstable

relationships (DSM-IV-TR; American Psychiatric Association [APA] 2000).
Aetiology of BPD is quite varied; however, the psychoanalytic perspective of
personality development emphasises the developmental failures and conflict in the
infant’s first two years (Kernberg, Selzer, Koenigsberg, Carr, & Appelbaum, 1989).
A failure of tolerating anxiety and aggression in the infant by the caregiver can lead
to failure of integration of good and bad objects and ‘emotional object constancy’,
therefore largely influencing the infant’s identity formation. Defence mechanisms
such as ‘splitting’, ‘dissociation’ and ‘projective identification’ are utilised in order
for the infant to cope with conflicting thoughts of self and others (Bloom, 2006;
Gabbard, 1989; Klein, 1975; Sidoli, 2000). Winnicott (1971) describes the absence
of ‘good enough’ mothering especially in the separation-individuation stage of
development (Materson, 1976). This is supported by the theory describing the
‘failure of the holding environment’ (Orbach, 2004; Winnicott, 1971) and the
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detrimental impact on the infant as a consequence of poor containment.

Research indicates that clients with BPD commonly use primitive defence
mechanisms such as projection, as described by Minne (2003). Consequently,
therapists should be prepared to face and contain split-off parts that the client cannot
yet own as theirs. Fear of rejection, unpredictable emotional responses, unstable
relationships, dissociation and low self-worth may be experienced (Lavender &
Sobelman, 1995). According to Warnecke (2009), the borderline ‘disorder of self’
lacks integration of psyche and soma leaving an individual to experience merging or
dissociation. ‘Motor and sensory functions are split in order to numb and reduce the
emotional intensity of trauma and make conflicts less overwhelming’ (Warnecke,
2009, p. 197). Furthermore, the autonomic nervous system is dysregulated in BPD,
with sympathetic overstimulation. Therefore, the fight-flight instinct and experience
of fear or panic is heightened. Difficulties mediating emotional regulation may
explain increased impulsivity, rage and aggression (Austin, Riniolo, & Porges,
2007). According to Blatt (1996), DMP provides a way for patients to defeat long-
held defences and access emotions. The symbolic process, use of movement and
creative unconscious in the therapy relationship offer understanding of personality.
Lavender and Sobelman (1995) describe how patients with BPD enter therapy with
strong dissociative feelings towards their bodies, fearing emotional and physical
proximity, having extreme discomfort with angry feelings and a sense of being
unable to move. An emphasis is made to support client’s development for tolerating
inner conflicts through flexible improvisation, structure and timing. DMP can
support integration of split-off parts of the self, bringing them into consciousness
(Wyman-McGinty, 2007).

Violence and aggression

Zuletta (2006) explores the link between pain and violence, describing the
relationship of insecure attachments with patterns of anger and violence. Where
feelings of anger remain disproportionate and uncontrollable, they are acted upon
impulsively and not processed constructively. Pines (1994) suggests that unbearable
feelings are expressed through the body, and that somatising is a way of expressing
psychic pain in an extreme manner. Patients communicate somatically what they
 96 B. Manford

cannot verbally express as it is not yet available as mentalised information (Wyman-

McGinty, 2007).
DMP is based on moving with the aim of making available feelings to think
about; there is an opportunity for working through impulse control, regulation of
aggression and tension alongside the development of the therapeutic relationship
(Batcup, 2013; Smeijsters & Cleven, 2006). Wethered (1993) describes how
movement is used when working with violent clients who often live in fear of being
overwhelmed by inner feelings. Furthermore, she explains how those who have
suffered trauma and have poor ego strength consequently have difficulties meeting
external demands, seeing them as threatening. DMP can provide a space for
exploring alternative methods, as opposed to aggressive ‘acting out’ (Smeijsters &
Cleven, 2006). The use of play and selected movements in the therapy process can
help patients look at their behaviours, feelings and bodily experiences to gain
understanding of these differing aspects of the self without hurting others. A crucial
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aspect is the therapist’s role is redirecting impulsive or violent outbursts in order to

provide a channel for containing the aggressive impulses. Another important task for
a therapist working with and thinking about forensic clients is how to work through
truth and deception. Patients cannot always face shared reality or recall it. Jones
(2004) draws focus on the need to pay attention to the transference and
countertransference in terms of establishing shared realities in the relationship.

Self-inflicted injuries
Adshead (1997) argues that self-harm is a symptom of distress. Gordon and
Kirtchuk (2008) propose that body mutilation is an attack on the body boundary of
the self, providing the feeling of being in control. Bick (1968) develops the concept
of ‘second skin’, developed as a defensive layer during the struggle for containment.
Krueger (2002) argues that cutting establishes an experience of existing as a
contained being, separating ‘me’ from ‘not-me’. Attacks on the self are described as
a coping mechanism when a situation is overwhelming and the patient cannot think.
In BPD, self-harm has a mood regulatory function in that patients describe
significant mood elevation and decreased dissociation following an act
(Kemperman, Russ, & Shearin, 1997). A gesture replaces verbal language,
communicating feelings that cannot be thought about (Motz, 2008), much like my
client’s offence of firesetting. Self-harm externalises feelings, ‘providing relief from
intolerable internal tension’ and enabling dissociation (p. 157).

The client, context and referral

My client, I call her Sharon,1 experienced highly disorganised parenting, with both
parents being absent for long periods due to imprisonment or mental illness. Sharon
witnessed domestic violence and found her mother emotionally unavailable. She
had a number of significant romantic attachments in her adult life; often beginning
with an emergency and ending tragically through illness, death or abuse. She began
to self-harm after discovering one of her two children attempted suicide following
familial abuse. Sharon cut and scratched her arms when distressed, her body
becoming a vehicle for bearing psychic pain (Adshead, 1997; Motz, 2008). Leading
 Body, Movement and Dance in Psychotherapy 97

up to her index offence, she experienced a lack of support from friends and family.
Sharon sought respite in psychiatric hospital but was discharged. On returning
home, she set her home alight and was rescued by the fire service.
Sharon was admitted to a more secure hospital environment and diagnosed with
BPD (DSM-IV-TR; APA, 2000). She was referred for individual DMP through the
psychology and psychotherapy team with a view to increasing her ability to
understand and manage her emotional distress. She expressed interest in the arts
therapies and was deemed suitable for DMP due to a tendency to somatise, self-harm
behaviours, difficulties with boundaries and fraught interpersonal relationships.
Sharon seemed to evoke strong countertransference feelings of fear and anxiety in
staff; relating to staff as attachment figures, there was a parallel process seen in the
transference (Norton & Dolan, 1995).
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Assessment process
During my first meeting with Sharon, she spoke about her anxiety and how she
would scratch her skin until blood was drawn, finding this ‘self-soothing’. She
described an altercation with a fellow patient, which resulted in her punching the
wall. She showed me her knuckles, saying it was not painful and described feeling
frustrated being unable to resolve the disagreement through verbal dialogue. When
questions addressed how she became ill, she voiced that she did not want to repeat
herself and had already spoken with a psychologist. She then stated, ‘You can leave
anytime you want, I can’t’. Her body posture narrowed and took on a retreated form.
Kestenberg Amighi, Loman, Lewis and Sossin (1999) relate such body shape
changes as terminating contact; I thought she was keeping a distance. She seemed
tearful but then punched her hand strongly, verbally emphasising a desire to dive
into the work and frustration at being held back by the pace her team had set. She
spoke of her stomach being churned around whilst making gestures with her hands,
using weight in effort and bound flow, explaining how she ‘bottles things up’ and
‘keeps things in’ but wants to find a way to let them out. I discussed with Sharon that
we would use movement at our next meeting. She did not attend our second
appointment and I heard that she had become a grandmother and also that she had
self-diagnosed a syndrome related to her scratching and psychosomatic expression
(McDougall, 1989). I was curious as to whether one of her anxieties could be that
movement is often revealing.
When we met to complete the assessment, Sharon held her posture in a hollowed
position (Bartenieff & Lewis, 1980). She showed interest in working individually, so
I explained the boundaries and process of therapy. We started movement sitting in
chairs. I lead the warm-up starting with the feet but Sharon closed her eyes, ignored
me and began stretching her neck. I thought that she had shut me out and I felt
rejected. Her body was stiff and cracked as her bones moved; I mentioned how
things may be starting to open up. After preparing other areas of the body for
motion, Sharon re-enacted her morning routine, guiding me through it. Her hands
and arms were active with gestures and she talked throughout with her eyes closed.
I felt confused and sought ways to connect. I joined her in movement, making
sounds with my hands and feet to inform her I was alongside her in the journey but
held a strong sensation that she could have been alone. As she neared the end of the
 98 B. Manford

routine, she opened her eyes briefly and jumped back. I felt afraid as she looked at
me wide eyed directly. She asked if I had closed my eyes so I informed her that
I kept them open but had joined her in movement. She stated having noticed my
presence and said, ‘It was like you were my shadow’. On reflection, I could have
used my voice further to attune with her fear of being shut out, rather than
empathically reflecting. I thought Sharon was anxious and the pressure in her speech
together with the sudden and continuous movements meant that she could control
the interaction. Providing more details of the session’s structure could have been a
containing function for Sharon and I wondered if she was unable to ask for this.
Towards the end of the session, Sharon talked of a butterfly that landed on her
hand, weaving between her fingers whilst smoking one morning and how she
carefully removed the cigarette to her other hand, trying not to harm the butterfly.
I thought of the butterfly representing her anxiety, being symbolic of the modes
flight, fight and freeze (Rothschild, 2000). This image made me think of her offence,
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the use of fire and her awareness of the damage that could be caused to life; I was
reminded of the life and death instincts (Klein, 1975). I felt the need to
tread carefully with Sharon and also a will to tolerate her as the staff team ‘could not
stand her’.

Absent-minded
During the first session in the New Year, I acknowledged the break and our stop start
journey thus far. I shared some thoughts about the assessment session where she
disclosed details about her routine and I voiced how it seemed she was
communicating a need for information of our sessions and I elaborated on them. She
responded that our sessions got her out of the locked environment of the inpatient
ward.
We prepared to move, focusing on grounding movements to establish a sense of
yielding (Cohen, 1994) and stability to create a ‘safe base’ to move from. Her body
cracked and seemed stiff, I commented that things were moving and releasing.
I introduced a ball prop to enable further connection between us (Payne, 1990); she
squeezed it and stated how good it was. We threw the ball to each other, a simple
throw and catch to connect us; she had strong, direct and sudden effort qualities. She
recalled a game from her childhood where players name associating words.
I suggested accompanying words with gestures and was pleased she was engaged
but mindful that she resorted to verbalising throughout and needed the support of
movement for communication. I used a stretch cloth prop to maintain the movement
and connectedness. We took an end of the material each and a wide stance. Sharon
wrapped the material tightly around her wrists and pulled hard which made me jolt
forwards towards her. I then held tight to my end and remained on two feet and her
material flung in my direction; she seemed surprised. ‘That felt so good, it is better
than punching a wall’. I wanted to let her know that I could withstand her, whilst
physically encouraging movement related to feeling and flow.
These movements enabled Sharon to speak about a close family member’s life-
threatening illness and the severity of this. She disclosed that there had been an
absence of family contact over the festive period; I mentioned how we had not seen
each other during that time and asked whether she felt I had held her in mind?
 Body, Movement and Dance in Psychotherapy 99

Spontaneously, she changed the subject, telling me her birthday was approaching.
‘You had better not leave before then, and if you do, that would be it, no more
movement therapy, it wouldn’t be as good without you’. Communication in
movement led to verbal communication of her thoughts and feelings. However, I felt
that she had idealised me and had placed me as a ‘good object’.

Wrapped up
Sharon was still in bed at the time of our scheduled session. I noticed that I felt like
the mother of a teenager, hoping she would get up. We began sharing movement
focused on leading and following, I described how to pass on movement without
words and she realised that this involved eye contact. What struck me was how
Sharon impulsively moved between turns. My supervisor advised me to focus on
pauses in movement, providing punctuation to help her digest the process.
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Furthermore, she advised me to adhere to the Chace (1975) model of ‘talk, move,
talk’, to make time for verbal reflections for the end of sessions, encouraging
impulse control and the capacity to recall and think about the movement.
I asked Sharon to choose a prop from the selection and she picked a large sheet,
which I associated with access to symbolism and active imagination (Jung,
1961/2010). We held one side each and played with different ways of holding it
together and she verbalised images that took us metaphorically on a journey
together. As the session neared the end, we sat to reflect and Sharon seemed
disappointed. ‘I don’t like endings do I? All good things get started and then have to
end’. The following week Sharon did not attend, she was in bed complaining of back
pain.

Rock the boat

When I next saw Sharon, she apologised for her non-attendance, emphasising her
desire to continue therapy. She thought I would have been angry that she did not
attend. I wondered whether she might have been angry with me? The predominant
transference relationship seemed to be one of parent and child. I explained to Sharon
that she could choose not to come but that I would always attend, hold the space and
think about what she was communicating. I asked whether she only felt able to come
when she was feeling good? I welcomed her to attend no matter how she felt at the
time and these words seemed to touch Sharon. She talked about avoiding others
when feeling anxious, fearing there would be conflict.
We began moving together and Sharon forced eye contact and moved
impulsively as if she was fully prepared without warming up. I wondered whether
she was impatient with preparing to move, wanting to dive in? I reflected on the
butterfly image she raised during the assessment and her desire for instantaneous
transformation which she had talked previously about. Sharon found a stretch cloth
and wrapped it around her body before curling in a ball on the floor. She described
her shape as a cocoon and said, ‘it’s safe in here’. She moved to the edge of the room
and tried to cover the parts of her body she found exposed. As she struggled with
this, she had a shooting pain in her abdomen and sat upright, the cloth opening
widely. She re-covered her body with the cloth and paused. I watched her tense
 100 B. Manford

breathing under the cloth, seeing the shape pulsating rapidly. Suddenly she burst out
and looked at me. Sharon was tearful and stated she did not want to hide away
anymore. I encouraged her to tell me more and she placed the stretch cloth on the
floor and gestured for us both to sit on it. She began to row, explaining through
movement that we were in a boat. She expressed worry that the boat may capsize and
would be a rocky ride. She sat rubbing her legs, rocking backwards and forwards,
becoming tearful again. I attuned to her movements, squeezing my legs and hands
with a similar rhythm. She voiced how she was afraid of letting me get ‘in the boat’
with her.
Movement enabled Sharon to notice that she was always ‘doing’ and may have
found a space where she could ‘be’. I thought of how she had taken off her shoes
for the first time, peeling off a layer, and reflected on the theme of protection
alongside exposure in the session. I mentioned this to her and she spoke of a time
when she ran down the street partly dressed in front of her daughters, sharing
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embarrassment at their having seen her unwell. She also recalled having been
beaten until she haemorrhaged, needing hospitalisation. I wondered about how she
felt being in hospital currently as she went on to complain about not being
understood by the staff. I reminded her that I was also staff, being mindful not to
collude with possible splitting. After the session I thought about how Sharon
lacked protection during her childhood and how she failed to protect her children.
The metaphor of the cocoon and protective shell spoke to me of vulnerability,
whilst the boat made me think about how she had jumped aboard relationships
without checking first to see if she was safe. As I left, she called down the corridor,
‘don’t forget your life jacket’. During supervision, I reflected on whether Sharon
was projecting feelings of anxiety. The following week Sharon would leave the
secure environment where her movements were heavily restricted to an unlocked
building for sessions.

New holding environment

Sharon attended the clinic for therapy and began a dialogue of how the ward staff
wished she would keep her feelings to herself. I encouraged thinking around staff
comments and decisions, which enabled Sharon to recognise that staff did think of
her safety. She made a link with her father’s negative assumptions as if she had
internalised this way of thinking from him. During the session, she expressed
wanting therapy twice a week. After discussing this, she acknowledged her
impulsivity. I reflected back the importance of taking things slowly and first being
able to consistently come once a week. Sharon voiced a willingness to work on her
index offence also; I reassured her to bring whatever she needed to therapy.
The ward staff were late collecting Sharon, therefore we had additional time
together. I felt the weight of holding responsibility for her beyond our session time
boundaries. After she left, I felt exhausted and reflected on her verbal
dialogue absent of pauses, recognising anxiety in the countertransference. I felt
that I had to breathe on her behalf. On another occasion, I noticed that I felt relief if
she was late for sessions, the space allowed to me to gather a sense of myself which
was difficult to feel in her presence, as if there were some merging in the
relationship.
 Body, Movement and Dance in Psychotherapy 101

Toxic internal relationships

One session, Sharon arrived late and immediately stated that she felt nauseous.
I asked if she was well enough for therapy and wanted to stay. I encouraged her to
consider her physical needs. Movement highlighted how Sharon felt unsteady on her
feet and uncomfortable in her body even after a gentle body preparation. I suggested
the use of a buddy band prop and gave her part of it to hold as I took the other side.
We sat for stability and I slowly encouraged sustained movements, focusing on the
use of breath and sensing the body. I showed her how we could move together,
rocking forwards and backwards, which seemed to give her comfort. I suggested a
movement where we both stood inside the buddy band, holding each other’s weight
whilst the prop provided external support. She closed her eyes and leaned back
giving her weight to the prop. This enabled her to talk about trust and a curiosity of
how the body can express psychological and emotional changes.
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Processing the work with Sharon led me to come into touch with my somatic
countertransference (Warnecke, 2009). I found myself scratching my skin when
thinking of her, as she does when anxious. Seeing the body as a container for
unconscious feelings (McDougall, 1989), I understood how she physically withheld
inner emotions, unable to communicate clearly with words (Morgan & Ruszczynski,
2007).
Towards the end of therapy, Sharon presented as if experiencing a manic state of
mind. She rapidly talked, walking around the room collecting objects and building a
mound. She then placed her trainers on top and said they were her daughters. Sharon
had created a bonfire, which enabled her to explore feelings of guilt in her parenting
and anger towards her own parents. I questioned her about whether the feelings
aroused were similar to those present when she committed her index offence.
I endeavoured to welcome negative feelings towards me and encouraged that she
may be feeling angry with me for leaving her. On reflection, I was struck by how
she broached her offending indirectly through movement and wondered whether she
could have arrived here through words alone.

Reflections
I felt that Sharon began to trust me once she allowed me to support her
psychologically and physically. Movement therapy provided access to meaningful
metaphors encouraging thinking with Sharon, for words alone acted as a defence
against relating authentically. DMP enabled Sharon to explore thoughts, behaviours
and emotions through the use of props, music and movement. She was able to
connect with her body feelings, traumatic life experiences and complex family
relationships. The creative, action-orientated focus of DMP provides a space to
experience the body, make sense of feelings and behaviours in a less destructive
manner. DMP supported Sharon in accessing and expressing her thoughts and
feelings through the therapeutic relationship, improving her capacity to think and
check in with her emotional state (Meekums & Daniel, 2011). From my experience
in the therapy with Sharon and reflection on suitability of treatment, I strongly
support that DMP is an effective way of working with this client group.
Initially Sharon found ways of creating distance from emotional distress using
both psychodynamic and movement defence mechanisms. Fear of abandonment and
 102 B. Manford

sensitivity to rejection are core features of BPD (Zuletta, 2006). Patients often find a
lack of containment in relationships and difficulties self-soothing due to empathic
failures and toxic experiences (Schore, 2002). Sharon showed conflict between a
will to delve into therapy or flee, much like her butterfly metaphor. Sharon’s
absences served to prevent me from making psychological links with her. Bion
(1972) states that attacks are made upon the therapist’s thoughts of the patient.
As the therapy progressed, I thought more about the shadow image she raised
and how her anger was kept out of sessions. I felt anxious about this in terms of
transference as I seemed to represent the good object, and bad feelings were split off
and projected elsewhere. I thought of Jung’s (1961/2010) concept of the shadow
holding the negative aspects of the self and realised I was holding onto intolerable
anxiety and aggression that she feared to bring into the relationship. I understood the
process occurring through projective identification (Klein, 1975). Jung (1961/2010)
stresses the importance of integrating the shadow for transformation and wholeness.
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I was mindful of Sharon’s history of relationship endings and the impact of

support withdrawal. Similar antecedents led to a fragile state of mind and enactment
through her index offence. Sharon produced clear movements that showed potential
for us being in conflict; I acknowledged that something important was just starting to
happen in the therapy and that she may angry that I was leaving. I aimed to provide
opportunities where she could address split-off feelings, hoping she could better
manage this ending healthily. Building trust alone can take a considerable amount of
time with BPD clients; in terms of limitations, I would advise consideration of brief
therapy for this client group.

Acknowledgements
I wish to thank Dawn Batcup who supervised me with this work and helped me to work
through and understand DMP with patients diagnosed with BPD. Thanks to Sue Curtis and
Caroline Frizell who helped me further my own transformation as a movement therapist. I
also wish to thank Sarah Smith and Mairi Tsiatsoulli for their honesty and friendship through
this journey.

Note
1. Personal details have been changed and some additional details have been altered in order
to protect the identity of the patient.

Notes on contributor
Bethan Manford has a BSc psychology degree and an MA in dance/movement psychotherapy.
She has four years post-qualification experience. Bethan gained extensive experience working
within a therapeutic community for male offenders in a National Health Service forensic
medium secure unit working with adult mental health conditions and personality disorders.
She has provided therapy within a specialist education setting for children diagnosed with
autism spectrum condition also. Currently she is working with a Children and Adolescent
Mental Health Disability service in East London.

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