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In a previous monograph, Meissner (1984) proposed that the borderline domain encompasses such a range of functional adaptation and structural integration that it is best conceptualized as a spectrum of pathology rather than as a single diagnosis. Here, he uses the spectrum model to provide a frame of reference for tailoring treatment to the patient's level of pathology. The book combines a scholarly review of the literature on treating borderline patients with specific recommendations informed by the author's clinical experience and theoretical perspective. It draws from and attempts to integrate a diverse set of approaches to the treatment of borderline patients.
Meissner's central thesis is that because of the diversity among borderline patients, treatment approaches will vary widely and need be tailored on the basis of a number of structural features. These include potential for regression, capacity to maintain object constancy, vulnerability to narcissistic injury, and activity of projective mechanisms. Meissner sees a place for treatments ranging from supportive psychotherapy, mixed supportive-expressive psychotherapy, expressive psychotherapy, to psychoanalysis. In fact one of his purposes is "to urge that psychoanalytic technique has a much more important role to play in the treatment of borderline disorders" (p. 97).
The book is organized into sections devoted to (1) a review of the diagnostic category and an argument for the spectrum concept, (2) the therapeutic relationship, (3) the treatment process, (4) a review of adjunctive treatments, and (5) 25 case summaries spanning the continuum.