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Borderline Personality Disorder

Tailoring the Psychotherapy to the Patient

Leonard Horwitz, Ph.D., Glen O. Gabbard, M.D., Jon G. Allen, Ph.D., Siebolt H. Frieswyk, Ph.D., Donald B. Colson, Ph.D., Gavin E. Newsom, M.S.W., and Lolafaye Coyne, Ph.D.

  • ISBN 978-0-88048-689-7
  • Item #8689

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Borderline Personality Disorder: Tailoring the Psychotherapy to the Patient explores the challenge of treating patients with borderline personality disorder. These patients make up a large segment of the difficult-to-treat population. The instability of their relationships, the intensity of their affective responses, and their proneness to paranoid reactions all contribute to their difficulty in working consistently and constructively in the psychotherapeutic situation. When one adds these difficult patient problems to the therapist's quandary about how expressive or supportive to be, therapists are indeed often confronted with a challenging therapeutic task.

The book begins with a review of the clinical and research literature pertaining to the treatment of borderline patients. It presents a unique, empirically based intensive study of three borderline patients, based on transcripts of audiotaped therapy sessions. The research methodology is reviewed, and clinically oriented descriptions of the three patients, their psychotherapy processes, and their outcomes are included. Following an overall summary of results, conclusions regarding the differential indications for supportive versus expressive emphasis in psychotherapy are discussed.

In their research, the authors recorded every psychotherapy session and studied a randomly selected group of sessions. Therefore, the reader is provided with increased insight into what is most effective with what kind of patient at a given point in the therapy process.


  • The expressive versus supportive controversy. Effect of interventions on the therapeutic alliance. Mr. Black. Ms. Green. Ms. White. Tailoring the psychotherapy to the patient. Appendix A: Chapter notes. Appendix B: Instruments. Appendix C: Log linear analysis. Appendix D: Quantitative data. Appendix E: Manuals. Index.

About the Authors

Leonard Horwitz, Ph.D., is Training and Supervising Analyst at the Topeka Institute for Psychoanalysis and Director of the Treatment Interventions Project at The Menninger Clinic. He is also Clinical Professor of Psychiatry at the University of Kansas School of Medicine, Wichita.

Glen O. Gabbard, M.D., is Professor and Director of the Baylor Psychiatry Clinic at the Baylor College of Medicine and Training and Supervising Analyst at the Houston-Galveston Psychoanalytic Institute in Houston, Texas. He was previously Director of the Menninger Hospital in Topeka, Kansas. Dr. Gabbard is the author or editor of sixteen books and currently is joint Editor-in-Chief and Editor for North America of the International Journal of Psychoanalysis. His numerous awards include the 2000 Mary Sigourney Award for outstanding contributions to psychoanalysis.

Jon G. Allen, Ph.D., is Senior Staff Psychologist in the Trauma Recovery Program at C. F. Menninger Memorial Hospital and Editor of the Bulletin of the Menninger Clinic.

Siebolt H. Frieswyk, Ph.D., is Coordinator of Psychotherapy Training at Karl Menninger School of Psychiatry and Mental Health Sciences and Faculty Member at the Topeka Institute for Psychoanalysis.

Donald B. Colson, Ph.D., is Chief Psychologist at The Menninger Clinic and Graduate of the Topeka Institute for Psychoanalysis.

Gavin E. Newsom, M.S.W., is Chief Social Worker at The Menninger Clinic.

Lolafaye Coyne, Ph.D., is Director of the Statistical Laboratory and Acting Director in the Research Department of The Menninger Clinic.

Borderline Personality Disorder is an interesting and unique book. . . . Psychoanalysts and psychotherapy researchers are encouraged to take a careful look at this book. . . . [T]his book makes several important contributions. One is that is makes a rigorous clinical-quantitative inroad into the understanding and treatment of some borderline patients—a further documentation of their heterogeneity, the great importance of tailoring treatments to individual needs and capacities, and the value of support and of tolerance for limited outcomes. The book also documents the continued clinical and research value of rigorous individual case studies, and provides a harbinger of future analytic treatment research.—Journal of the American Psychoanalytic Association

All of this material, including a review of the literature, is a gold mine of information for every therapist interested in the borderline patient. It is well organized and well written. The care that these clinicians took with this project shines through on every page.—Bulletin of the Menninger Clinic

This exceptionally clearly written book will be of interest to anyone who attempts psychotherapy with borderline patients. . . this is a stimulating, well-produced book that I highly recommend to anyone involved in the intensive psychotherapy of psychoanalysis of borderline patients. The authors are to be congratulated for producing this fine work and encouraged to enlarge on it with a study of more patients.—Richard D. Chessick, M.D., Ph.D., American Journal of Psychiatry

This book is an important addition to the literature on the treatment of the borderline personality disorders. It combines an intensive clinical study of the psychoanalytic psychotherapy of three patients, at different points along the spectrum of borderline personalities, with the formal research study with a variety of measures, of the attributes of the patients and their therapists, of the interactions between them, and of the consequences in immediate and long-term outcomes. In so doing, considerable light is shed on the imprecation roles of expressive and of supportive interventions, in differing admixtures, in the therapies of these different , but all borderline, patients.—Robert S. Wallerstein, M.D., Past-President of the American Psychoanalytic Association (1971-2), Past-President of International Psychoanalytical Association (1985-89)

The authors' extensive experience with borderline patients assures readers that they will be informed by this book. By joining their clinical strength with empirical methods, the authors explicate previously unknown processes in long-term dynamic psychotherapies. The result is an advance in knowledge and a new and higher standard for future clinical investigations of this subject.—John G. Gunderson, M.D., Professor of Psychiatry, Harvard Medical School, Director, Psychosocial and Personality Research, McLean Hospital, Belmont, Massachusetts

The Menninger Foundation's first team—a group of senior clinical and research psychiatrists and psychologists—have put their heads together to produce a volume that will prove invaluable to clinicians on the front line of the psychotherapeutic treatment of borderline patients. . . . This study is lucid, concise, and comprehensive, approaching the complex field of borderline studies with a breadth of scope and flexibility of clinical perspective that respects both the variability and the variance of borderline syndromes as they confront the practicing psychotherapist.—W. W. Meissner, S.J., M.D., Training and Supervising Analyst, Boston Psychoanalytic Institute, University Professor of Psychoanalysis, Boston College, Chestnut Hill, Massachusetts

The authors are an experienced and talented group of clinical investigators at the Menninger Foundation. Anyone treating borderline patients should profit from their years of clinical experience and investigation. Their focus on enhancing the collaborative process between the borderline patient and the psychotherapist is essential to any psychotherapeutic effort.—John F. Clarkin, Ph.D., Professor of Clinical Psychology in Psychiatry, New York Hospital–Cornell Medical Center, Westchester, New York

Dr. Horwitz and his colleagues provide one of the most comprehensive studies of the interactions between therapists and patients with borderline personality disorder (BPD). Their analyses provide specific directions for the clinical management of these difficult-to-treat patients. The book will be particularly useful for clinical supervisors and their trainees. Experienced clinicians will gain important insights about subjective appraisals of their work with BPD patients.—Elsa Marziali, Ph.D., Department of Psychiatry, University of Toronto, Ontario Canada

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