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The concept of a borderline personality disorder grew out of clinical experience with a variety of affect-laden patients whose intensity of response to interpersonal relations in life was further expressed in the nature of their transference response to analytic psychotherapy. During the 1950's and 1960's the influence of psychoanalysis as a therapy and the availability of both publicly and privately funded long-term hospitalization led to a seemingly unlimited amount of experience with and writing about cases that came to be known as borderline personality disorders. The contributions of psychoanalysts who worked with these patients could not be drawn from anything resembling a full psychoanalytic exploration. Since the nature of their behavior often resulted in hospitalization, the conditions for conducting a full psychoanalysis were simply not met. Almost all contributors to the literature on the treatment of the borderline patient were in agreement that some limits on the extent of the negative transference had to be set, and that these patients did not do well with the absence of visual contact with the therapist. Typically, borderline patients were described as extremely difficult to treat even in a more structured, modified psychoanalytic psychotherapy. It was expected that the patient's response to the therapist would be intense, often ranging to the chaotic and dangerous. The therapist was overly idealized, with accompanying extreme dependence and an explosive response to any threatened interruption of the therapist's availability. Since most inpatient intensive psychotherapy of borderline patients was performed by psychiatric residents, these patients became legendary for their difficult, demanding, infantile, primitive responses. Many psychiatric residents became overinvolved in the treatment of a few borderline patients only to become avoidant of such patients after completing their training.
This is a book about borderline patients that departs