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This is a long-awaited guide to the psychotherapy of borderline patients by one of the world's outstanding experts on dynamic therapy
and by his team of long-term associates. They have worked together for years perfecting their theory and its related technical practices. The book they produced makes three kinds of contributions: to knowledge of the nature of the borderline personality, to a treatment guide that fits with this borderline personality, and to psychotherapy research practice through a manual that is close to the state of the art in format.
As everyone who has tried to work with these patients knows, "borderline" connotes "difficult." Borderline had referred roughly to a borderline between neurotic and psychotic. Now an official, more precise definition of borderline has been supplied by the American Psychiatric Association (1987) in its Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). But Kernberg (1984) had already considered that the profile that became part of the DSM did not adequately distinguish the usual features of severe personality disorders from those that are less severe, and that the DSM-III-R criteria overlap too much with the other severe personality disorders. Furthermore, Kernberg considers that the DSM-III-R profile has too little to say about etiology, treatment, or prognosis. With regard to the etiology of the disorder, as well as to its treatment, Kernberg proposes the concept of "borderline personality organization" which adds to it a structural dimension with three facets: identity diffusion, low level of defensive operations, and restricted capacity for reality testing.
Identify diffusion appears in the patients' experience of chronic emptiness and contradictory self-perceptions and behavior, so that the therapist has difficulty in empathizing with them.
The defensive operations make heavy use of repression and more primitive defenses that protec