Definitive treatment of the borderline personality

A discussion of "Notes on the Potential Differentiation of Borderline Conditions," by W.W. Meissner, M.D. Through psychotherapy, borderline personalities can develop a mature level of emotional autonomy. Their fundamental psychopathology involves annihilation anxiety consequent on inadequacy and instability of holding-soothing introjects. Psychological corollaries of this deficit render them unable to effect the internalization of real caring relationships that is necessary for development of effective holding introjects. Ideally, psychotherapy proceeds in three phases. Phase I is devoted to amelioration of the pathological impediments to using relationships with the therapist and others as resources for a holding-soothing form of emotional security. The outcome is development of a relatively stable idealized self-object transference in terms of holding-soothing, along with formation of relatively stable idealized holding-soothing introjects. Phase II of treatment involves optimal disillusionment in relation to idealization of the therapist as holding-soother; this results in gradual acceptance of the realistic use of external objects along with modification of holding-soothing introjects to correspond more nearly with reality. Stable autonomy in the area of self-security is fully attained in Phase III, in which the relationship with the therapist provides the context for the patient's developing capacities by means of identification to care for, esteem, love, and trust himself or herself. Psychotherapy of narcissistic issues is also important, but special precautions must be observed.