Discussion Following Dr. Shulman's Address

Audience: Did you indicate that there is some age distinction in the borderline patient? Is age a factor?

Shulman: Yes, in the sense that with increasing age a good many people are going to learn some of the social skills that they do not yet have. Learning social skills will allow them to start getting positive feedback from the group. Age is a factor also in seeing the borderline as a developmental phase rather than an eventual diagnostic category. When we begin to see the symptoms of a psychosis or some other chronic illness, we generally make that diagnosis rather than the diagnosis of borderline personality.

Audience: Are different kinds of interventions used with the borderline patient than with other patients in Adlerian technique?

Shulman: There are some modifications of the usual interventions. The amount of encouragement, of positive feedback from the therapist, is exceedingly important. I cannot use irony with the borderline the way I might with the more mature neurotic patient because the borderline will take it as a hostile rather than as a humorous comment. On the other hand, just plain encouragement and acceptance without bringing some very important aspects of reality into the therapeutic picture will simply permit the therapist to go on being the idealized external image-object and no problem solving will take place. It is important, as Kernberg points out, to interpret the defensive behavior when the patient gets angry, I often treat it as if the patient is frightened rather than angry, and I will say directly to the patient, What's upsetting you, what's frightening you? instead of, What's making you angry? I feel that sometimes you pass by the anger and get right to the fear that way. I won't let the borderline do something impulsive if I can help it. I will say directly, Don't do that. Why shouldn't I do that? Because you haven't thought it through. The proper way to approach a task is to think it through. Let's talk about

it before you do that. S