Extended state hospital treatment of severely impaired borderline patients

Paradigms abstracted from the literature on hospital treatment of severely disturbed patients with borderline personality disorder are not adequate for extended treatment in state hospital settings. A new paradigm, based on Winnicott's concept of the holding environment, incorporates the development of a therapeutic environment in the hospital with the integrated use of mental health and other support services in the community. Treatment can succeed if three primary therapeutic tasks are accomplished, in three phases: the establishment of an adequate holding environment for the patient in the hospital, the maintenance of the hospital holding environment to foster limited structural change, and the transfer of the holding environment from the hospital to the community.