Why short-term psychotherapy for borderlines?

This paper outlines general concepts for the utilization of short-term integrative psychotherapy for borderline personalities. It attempts to understand the rationale underlying the application of this therapeutic technique. In arriving at this understanding, consideration should be given to: (1) the technical aspects specific to the briefer procedures such as: time, acceptability, expectations, therapist's activity, focused approach, therapist as a real person, emphasis on patient's determination, withdrawal and regression, and (2) the particular symptomatic and characterological manifestations of this patient population such as: autonomy, relationships, structure and controls, choice, engulfment drives, fantasied universe, reality and ego functions.

Short-term psychotherapy for the borderline personality disorder.

This paper presents concepts of short-term therapy as utilized with borderline personality disorder. Criteria for patient selection as well as contraindications for its use are presented. Many clinical symptoms are rubricated under borderline disorders. One major consideration in diagnosis is based on the discernment of when developmental arrests have occurred. The author's opinion is that short-term integrative psychotherapeutic procedures can be beneficial for patients struggling with any of the developmental subphases. The concepts expressed in this paper are mostly applicable to more developed individuals, who have progressed in differentiating themselves from others, but who still present primitive characteristics and relationships.

Borderlines: problems of self and object separation.

The borderline has deficiencies in the capacity to maintain stable self and object representations and in establishing 'emotional separateness' from others. In order to create and maintain a 'propitious treatment situation' and a 'therapeutic alliance' the therapist must work with unusual sensitivity and repetitiveness on the ground rules of the therapeutic environment. Explicit clarifications of the therapist's usual constructive attitudes, as a caring, responsive, neutral and real person must be continuously emphasized. The intense psychotic transference potential that leads to therapeutic complications and disruptions can be worked through, if recognized early, through countertransference clues, acceptance of positive aspects of the countertransference and technical moves that enhance the patient's capacity for individuation and separation, all this within the framework of a structured and consistent therapeutic situation. These assertions are illustrated by specific instances from treatment processes.

Politics of psychiatry.

In the letter "Politics of psychiatry" (23 Mar., p. 1184), the first signature should have been Paul L. Watson, not Peter L. Watson.