Some comments on the treatment of the borderline personality

A discussion of "Some Clinical Manifestations of Structural Defects in a Borderline Personality," by Alan Krohn, M. D. Because the borderline patient presents the gamut of symptomatology and therapeutic responses, diagnosis and treatment have been problems since the beginning of psychoanalysis. With her key conceptualization of the "as if" personality, Helene Deutsch, in the 1930s (1942), stimulated the clarification of both the diagnostic and therapeutic problems. The primitive ego defenses were delineated by Klein (1946), and Mahler's studies (1968) of symbiosis, separation, and individuation provided the developmental framework for the growing understanding of these conditions. Since then, many have contributed, none more than Kernberg (1975). He has proposed limiting the term borderline to a relatively specific, more or less stable personality with typical symptom constellations, defensive operations, pathology of internal object relations, and instinctual vicissitudes. These conditions dictate a modification of therapeutic technique practiced by many but formulated by Kernberg, Masterson (1972, 1976), Boyer (1977), and others. Essential to the implementation of this modified technique is the understanding of the defensive operations and the pathology of the internal object relations. Particular emphasis is given to two defensive operations, splitting and projective identification, and to aspects of the other concepts especially pertinent to the therapy of the borderline. The work of Kernberg has been drawn on extensively.