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Every author seems to have his or her own method for the treatment of borderline patients as well as differing diagnostic criteria to determine whether or not a patient is to be labeled “borderline.” The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; APA, ) defines the essential feature of borderline personality disorder as a pervasive pattern of instability of interpersonal relationships, self-image, and affects, along with marked impulsivity that begins by early adulthood and is present in a variety of contexts. This pattern is observable in many kinds of DSM-IV personality disorders, and as a result the borderline personality diagnosis overlaps with many other types of DSM-IV disorders. Unfortunately, a substantial segment of psychotherapeutic practice is made up of difficult, usually female, patients who fall more or less under this DSM-IV rubric.
Of the making of books about borderline patients there seems to be no end. Techniques range from those of Abend et al. (1983), who recommend a more or less standard psychoanalytic treatment without parameters, to the cognitive therapy methods of Young (1996), and the recently presented “dialectical behavior therapy” of Linehan (1993). Somewhere in between lie the techniques of Kernberg (1975; Kernberg et al., 1989) and Masterson (1981), which are a bit idiosyncratic and are each based on an extremely specific developmental theory, as well as pragmatic techniques such as my own (Chessick, 1977, 1993).
The issue of whether borderline patients can form stable therapeutic alliances remains controversial. Although Adler (1985) claims they cannot, there is evidence presented by Linehan (1993) that seems to indicate that Adler is wrong. In my experience