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The life of the borderline patient has been aptly described as “stable chaos.”1 Severely weakened ego strengths, punitive and archaic superego constellations, and excessive oral-sadistic drives contribute to the borderline personality disorder.2 Psychotherapists who attempt to treat borderline patients soon discover that they must limit what they can provide for or tolerate from these patients. Although limit setting is widely acknowledged as a technique for treating borderline patients,3-12 only one previous publication,13 which is behaviorally oriented, has addressed the details of limit setting with manipulative patients. In general, the specifics of this process have been left largely undefined.
The purpose of this paper is to thoroughly describe the limit-setting process from a psychodynamic perspective. The following case report illustrates the complex issues involved in limit setting and shows how effective limits can enhance therapy. The paper then discusses the specific goals of limit setting, pointing out problems that are frequently encountered in this process, and describes techniques for instituting and maintaining effective limits.
Ms. D, a 26-year-old woman, sought treatment for “feelings of anger and emptiness” that followed her recent breakup with a boyfriend. She described feelings of sadness and thoughts of helplessness and hopelessness but showed no vegetative signs of depression, diurinal variation, or psychomoter changes. She had no history of medical illness and was not taking medications, but she admitted to frequent alcohol binges and abuse of marijuana, cocaine, and methamphetamine. Although she claimed to have considered suicide by overdose both recently and in the past, close questioning