Transference and the vicissitudes of medication use by borderline patients

This paper discusses the psychodynamics of medication use by borderline patients who are involved in ongoing psychotherapy. Particular attention must be paid to the transference reactions that these patients have to the therapist and to the medication, and to countertransference responses as well. Shifts in the transference must be monitored, as rapidly fluctuating views of self and other may hamper borderline patients' abilities to use medication responsibly at certain points in treatment. Case examples are used to illustrate the complexities of the prescribing process in such situations. The implications for prescribing strategies are considered.