A social system approach to the psychoanalytic treatment of personality disorders

I present a social system conception of psychoanalytic psychotherapy and describe its uses in the treatment of individuals with personality disorders. By analyzing the divisions of labor and authority in treatment, I try to show that there exist fundamental role requirements upon the therapist to create and maintain structure, and upon the patient to respect it. I identify the treatment system's external and internal boundaries. Doing so makes it possible to distinguish two classes of resistance, system-threatening extramural resistance and intramural resistance. The first class of resistance is common in individuals with personality disorders, since they tend to act out against the structure of the treatment itself. In the matter of extramural resistance, the therapist needs not only to make interpretations, but also to manage the treatment enterprise effectively lest it be destroyed. A social system understanding of psychotherapy helps the clinician manage the boundaries without becoming authoritarian or parental.