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We seem to be making some headway in the treatment of "borderlines." For the more disturbed segment of this population, programs of individual, group, and family therapy in residential or transitional settings (i.e., group homes) offer some hope of a life that may be productive and during which only periodic hospitalization is
necessary. If these patients live in the right "catchment area" or if they have enough money, the various treatment approaches are coordinated, focused, and informed by a continuing relationship with an empathic, trained professional. In spite of the fact that in both public and private organizations the least experienced individuals tend to see the most difficult cases, some psychoanalysts do work with this kind of patient. In addition, they supervise and train many of the other professionals who do this work, and through such teachers many of the recent reformulations of narcissism, object relations theory, and psychoanalytic research on early development have infused the training programs.
Developing a capacity for accurate empathic perception and response is the core task for trainees in the mental health field. Contributors to the psychoanalytic literature on borderlines and the narcissistic disorders have provided a theoretical substructure that has helped to refine empathic skills. Many in the field suggest that if therapists can tune in to patients' perceptions and to their affective responses to the world, a relationship is possible which can provide a foundation for progressive personal development through the reopening of the developmental dialogue and later through interpretive work.
The theoretical contributions referred to have provided some rudimentary conceptual tools to those who struggle with the management of very disturbed patients, tools that are mainly effective in the understanding and control of countertransference hate, and they have enriched our understanding of the "more or less analyzable" patient whose preoed