Treatment of the Borderline Patient, Relationship Management

The author suggests that not the borderline syndrome itself but many of the worst behaviours of borderline patients are essentially iatrogenic, leading to a reframing or new interpretation of borderline symptoms and therapists’ reactions.

Abstract

The author suggests that not the borderline syndrome itself but many of the worst behaviours of borderline patients are essentially iatrogenic. To do no harm should be the primary goal of any therapist encountering a patient exhibiting borderline features. Management of the patient-therapist relationship is paramount and may be in itself the most effective and safe treatment for both crisis situations and longer therapy. A conceptual model borrowing from and bridging self psychology and interpersonal theory is described. This model leads to a reframing or new interpretation of borderline symptoms and therapists' reactions. Realtionship management guidelines and specific interventions are suggested.