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This succinct and clearly written book is a welcome addition to the understanding and treatment of borderline patients. The authors have provided an articulate statement of Kernberg's theoretical and treatment framework, and have used their wisdom both to add to it and to make it understandable for a wide audience. Although they caution the reader that this primer may present ideas and treatment implications in a way that is too much in outline form, they do provide a thoughtful and well-balanced account of Kernberg's and The New York Hospital-Cornell Medical Center, Westchester Division's, view of the expressive psychotherapy of borderline personality disorder patients.
The authors emphasize that their treatment approach is based on a view of borderline patients as individuals who have a stable, pathological internal world in which the major ways of coping with significant childhood frustration and/or excessive, pathological aggression is through the use of the major defenses of splitting, projective identification, primitive idealization, and denial. They contrast their view of borderline patients with those in the neurotic spectrum and outline the treatment implications of these distinctions. They define the core of their approach as the analysis of splitting, which requires clarification and confrontation in order to prepare the patient for the interpretation of splitting, an essential ingredient of the expressive psychotherapy they elaborate. They also emphasize the use of countertransference to help the therapist understand the process of splitting and projective identification that has occurred, now involving the therapist.
Especially useful for the clinician are the rich clinical illustrations which make their theoretical formulations and clinical advice come alive. These vignettes, often presented as verbatim interactions between patient and therapist, are vivid examples of therapists in action, processing countertransference awareness of projective ide