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Andrew Druck has written a book that attempts to present four different approaches to the treatment of borderline patients, and to provide the therapist with an understanding of the value of each approach for a specific patient. In many ways he succeeds admirably, outlining a series of useful frameworks and their clinical applications, and relating them to a literature that expands our understanding of work with these patients. Although he describes the four approaches in sufficient detail, a major emphasis of his book is the explication of Kernberg's theoretical and clinical work, since Kernberg has been the major contributor to the borderline personality disorder literature in over the past two decades.
Druck views these models from the vantage point of the primary etiology of the borderline patient's psychopathology as well as of the kind of patient treated, the role of interpretation and confrontation in the treatment, the stance of the therapist, how resistance is understood, and a description of the course of treatment. The four models defined (using Druck's labels) are: (1) Kernberg's model; (2) the representational-deficit, self-deficit model, utilizing the contributions of Buie and Adler, Kohut, and Stolorow; (3) the ego-deficit model, illustrated by the work of Blanck and Blanck; and (4) modifications of classical technique, largely from the writings of Abend, Porder, and Willick.
There are also thoughtful discussions about the use and misuse of transitional objects, from both a theoretical and a clinical vantage point. Particularly valuable are Druck's explorations of the differences in psychoanalytic stances in working with borderline patients in contrast to neurotic patients, in which he synthesizes the work of Eissler, Langs, and Stone. As part of this discussion, Druck elaborates the role of insight and interpretation in work with borderline