Psychotherapy of borderline patients is often approached with pessimism. Various psychotherapeutical modalities are used, including psychodynamic psychotherapy, supportive psychotherapy, and dialectical-cognitive psychotherapy.
Classical psychoanalysis has been considered to be contraindicated. Long-term individual psychotherapy can be helpful to patients with borderline personality disorder. Kernberg(62) recommended a more structured form, expressive psychotherapy (a modified psychoanalytical procedure), involving an active technique focusing on confrontation of maladaptive defences and interpretation of transference, focusing on the 'here and now', without attempting the achievement of a full genetic reconstruction.
Short-term psychotherapy is useful for managing crises or introducing long-term forms of therapy. Supportive psychotherapy is suggested for more fragile borderline patients, who are prone to serious regression in treatment. In practice, supportive therapy, with a psychoeducational component, has been the most frequently used form of treatment for borderline personality disorder. It is also possible to combine elements of intensive dynamic therapy with supportive therapy, depending on the ego strength of the patients. (56)
Some authors consider long-term intermittent treatment to be the standard method for borderline personality disorder. (63> Another variant of intermittent therapy is crisis intervention. An increasing number of experts see combined individual and group treatment, preferably by the same therapist, as a promising development in the treatment of borderline patients. Dialectical behavioural therapy(64> can be useful for parasuicidal borderline patients. Intermittent hospitalization, usually for short periods, together with adjunctive treatment may help in crises.
Psychiatrists who intend to treat borderline patients need special training and sensitivity. Countertransference problems are frequent, and regular supervision is necessary.
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