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This brings together a number of seminal papers on psychoanalytic approaches to working with the borderline patient. Each paper is accompanied by an Internet discussion. This discussion happened following the papers being made available to the IJPA Internet discussion group prior to publication. This format was an attempt to provide a debating forum for analysts. Whilst I believe this format will be an enduring part of future debate and will, I am sure, open up the dialogue around psychoanalytic theory, I think it will be important in the future to avoid the tendency for different groups representing diverse approaches to become entrenched in defending their various theoretical positions. This may be an inevitable development but one hopes that, as the Internet medium opens up and becomes more accessible to a wider membership, the contributors are able to develop a greater level of interactive discourse.
The papers in this book also represent very different theoretical ideas from a diverse group of clinicians with a wide range of patients who span borderline pathology from suicidal enactment to attacks on thinking and delusional beliefs about the mind and body. All the papers seek to find ways of overcoming the perennial problem of trying to reach the borderline patient. Fonagy, in his Introduction, defines the term borderline as a combination of profound relationship disturbance, following a chronic fluctuating course, covering a wide range of psychiatric problems that frequently occur together and following a relatively slow and tumultuous treatment process with often quite limited responses to treatment. This definition highlights the difficulty of bringing such a wide spectrum of clinical problems under one diagnostic category and even challenges, in my view, the need to have one over-arching clinical label.
As we see in this book, this exploration of the so-called borderline ranges from dramatic changes in technique with suicidal or violent patients (Bateman), to