Combined Therapy with Borderline Patients

This paper is an account of a programme of combined individual and group psychotherapy offered to borderline patients in an NHS setting. It is written from the perspective of an individual therapist and describes how he came to think of this therapy structure, which offers the patient two different therapy settings and a relationship with two different therapists, as a representation of the patient's entry into and negotiation of the Oedipus situation. The way each patient accommodates to this oedipal structure can be tracked by the therapists, and used in their thinking about and work with each patient. A case illustration is given of how one patient in the programme responded to the provision of two therapy modalities by massively and violently splitting her experience, denigrating and attacking one modality while appearing to value the other. The patient made no real progress until this splitting could be contained by the therapists. This allowed the patient to discover that there could be a generative link between the two settings. It is argued that it was this experience which played a crucial part in enabling the patient by the end of the programme to derive some benefit from the therapy as a whole.