Psychodynamic Psychotherapy of Borderline Patients: By Otto F. Kernberg, Michael A. Selzer, Harold W. Koenigsberg, Arthur C. Carr and Ann H. Appelbaum. New York: Basic Books, Inc. 1987. Pp. 210.

Written by colleagues from the Borderline Psychopathology Research Project at Cornell-Westchester, this book grew out of a need for a handbook describing a standardized approach to psychotherapy that would facilitate scientific investigation into the treatment of this group of patients. It is a manual for operationalizing the approach to borderline patients that Otto Kernberg has developed and advocated in his many books, articles, and public presentations for the past two decades (Kernberg, 1968), (1975), (1976). Its focus is thus concrete and its purpose directive. The focus and purpose account for both the major strength of the book, its refreshing clinical accessibility, and its major weakness, the disputable use of directives in teaching or doing psychotherapy. It has clarity, forcefulness and order, but these virtues have their price.

One tension that runs through the many psychotherapeutic approaches to the borderline patient that have been advocated in the last three decades is the polarity that pits a limit-setting, confrontational approach on one side, against an empathic, regression-fostering approach on the other. The first stance has been articulated by a number of authors, including Masterson (1976) and Gunderson (1984), but it's been most persuasively and