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The questions, of whether the concept of Borderline Personality Disorder (BPD) is ‘real’, how it develops, whether it is treatable and by what methods, are becoming defining features of many psychotherapies. While accepting the problems with the DSM-IV diagnosis, Ryle argues that ‘there is no diagnostic system which offers an alternative and more satisfactory method’ (p. 4). He powerfully summarizes the social causes of BPD while at the same time identifying how those with BPD maintain their past experiences:
The predominant source of borderline patients' difficulties is the experience of cruelty and neglect; in most cases they have had little or no trustworthy, predictable care and they have usually suffered physical or sexual abuse from at least one parent. The result is that they tend to repeat what they know, accepting and inflicting on self and others the neglect and abuse which was their constant experience. (p. 35)
He argues for a relatively short-term treatment (about 24 sessions with follow-ups) as a good first offer to patients who are often regarded as beyond treatment or as requiring an impractically long and intensive therapy. His book provides an intellectually rigorous overview of the concept of BPD with a critical analysis of the competing accounts of this diagnosis and therapies addressing it.
As a Cognitive Analytic Therapist (CAT) myself I have to confess to a partisan view. The offer of the review elicited within me the desire to read the book intensively rather than focusing on chapters. I was surprised to find I struggled to follow my ‘cover to cover’ purpose. As I reflected on this difficulty, I felt it was centrally tied up with a reaction to the pain contained in the stories given in the book. The list of DSMIV's nine traits, including unstable interpersonal relationships, frantic efforts to avoid abandonment, suicidal and self-mutilating behaviour, indicate clearly the forms of distress this group experience. What the list cannot adequately co