Supportive containment in the hospital care of treatment-resistant borderline adolescents

Psychotherapeutic treatment of borderline patients is characterized by threats to maintenance of the therapeutic alliance during periods of regression. Hospitalization provides ego support and limits to help sustain the alliance, but for some patients traditional hospital approaches are not adequate. This paper describes a specialized treatment approach for managing treatment-resistant borderline adolescents in a hospital setting. The approach provides supportive containment through a restricted environment and enforcement of patient dependency on treatment staff. Patients gradually gain freedoms as their self-regulation increases. Success rates with this approach are raised to a level comparable to that attained with less difficult patients.