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It is interesting to witness the current shifts in theory, research, and practice in psychoanalysis. From its Freudian beginnings and instinct theory to the present focus on the integration of neurobiology and psychoanalysis, models of psychopathology are reflecting the complex interplay of intrapsychic, relational, and neurobiological factors. We may wonder how theories can be used to inform how to intervene with patients displaying disturbances that are often profound in nature, such as borderline personality disorder (BPD). This book on the dissociation model of borderline personality disorder aptly and succinctly notes that, at its core, borderline personality disorder represents a disturbance of the experience of the self, with its central feature being feelings of disconnection in multiple life areas. Isolation and disengagement in the social sphere mirror the inner sense of fragmentation—resembling dissociation—that the individual experiences. Meares aptly quotes one of his patients who uttered, “When I look in the mirror, I don't see me.”
This book is very timely in that much of the current thrust in terms of therapeutic approaches for BPD tend to emphasize skill building related to affect regulation and distress tolerance. Linehan (1993, 2014), who outlines a cognitive-behavioral model for BPD, emphasizes affective skill building and mindfulness but deemphasizes the attachment and developmental issues that are associated with BPD. In this author's view, manuals that are mainly behavioral in focus are typically highly effective in modifying the manifest symptoms of BPD (affective dysregulation, harming behaviors) but often neglect to address the underlying core issues of BPD, like dissociation, which Meares explores. His argument is persuasive because he draws from recent neurobiological research that demonstrates that the pathologically large amplitude of P3a, which is found to be a biological marker of self, is associated with BPD. Research data are also pr