The psychotherapeutic management of a patient presenting with brief psychotic episodes

The aim of this article is to illustrate: (i) the advantages of a psychodynamically informed management of patients with a borderline personality organisation who require inpatient treatment; and (ii) the principles of a 'therapeutic community' approach in practice.

The 18-month residential therapeutic community treatment of a patient presenting with a history of brief psychotic episodes is described. An attempt is made to analyse the relationships between treatment variables and the patient's clinical progress over the treatment period.

By the end of treatment significant improvement in the patient's clinical state had occurred. Evidence is presented to support the conclusion that the treatment was an important factor in this outcome.

Clinical management based upon a psychodynamic understanding of the borderline patient's presentation is likely to best fit the individual patient's needs. Such a treatment approach, as embodied in a well-functioning therapeutic community, may help create the possibility of a 'new beginning' for the patient.