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If one takes for granted that the 'borderline' patient exists, then what are the basic dynamic stances from which to attempt to understand and treat him? Andrew Druck lists four: (1) Kernberg's model (2) the representational-deficit/self-deficit models (3) the ego-deficit model and (4) the modifications of classical technique model.
It was a curious process to review a book about 'the borderline patient' because there has been so much material produced on the subject in the recent past. Was this going to be another 'borderline' book which would be an incomprehensible rehash of the many psychoanalytic contributions on the subject? Would it be idiosyncratic and lack a comprehensive perspective or simply 'grind another axe'? Would it conclude that 'borderline patients' are unanalysable because of their diagnosis?
Basically, I found that it cut through the borderline maze adeptly. Furthermore, I found it useful. It clearly states that psychoanalytic psychotherapy with the 'borderline patient' is more difficult than with others and why this group of patients is difficult. The author's main thesis asserts the close connexion between theory and technique in each therapist/patient interaction, i.e. that theoretical assumptions are important determinants of therapists' responses to patients. The therapist's awareness of these assumptions enables consistency with the patient and broadens his treatment options. Druck also emphasizes that the ultimate and most important determinant of the success of an 'analytic treatment' is the therapist's character, especially with those patients who are severely disturbed.
Therapists differ in their capacity to allow for regressive states, in their capacity to hold the patient through such states without major modifications in the treatment situation, and in their capacity to respond therapeutically to these states (p. 396).
I would recommend that each reader of Four Therapeutic Approaches to the Borderline Patient approach this work