Q. Can you give me some information on splitting? I mean when a person with borderline personality splits staff, therapists, family members.

  A. Splitting in the simplest sense is playing one person off against another. For example, a patient comes to see me and might say, "I wish my therapist was as good as you," or "You are the best doctor I have ever seen. My last doctor was an idiot." I know I am in trouble when I hear this. It may be considered part of the black-white thinking that comes with BPD. It is important to keep on a clear course of treatment with a clear goal at the beginning. Splitting introduces conflict and two ideas into treatment, where it is tough enough to deal with only one. In the therapist example, the split may occur because the therapist actually was wrong, or had canceled a session that the patient really wanted, or did not agree with the patient's response to a situation under discussion in therapy, or many other things. In the case of a person with BPD, you are either good or bad. No mid-ground. All care providers need to be careful to stay away from the splits, and move toward a common ground of wellness for the patient.

Psychologically, many clinicians immediately discuss the split and point it out to the patient.