Long-term psychotherapy in borderline and narcissistic disorders: when is it necessary?

This paper explores the barriers and impediments to psychological change in those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment.

Examination of the relevant literature was made and the author's clinical experience included.

Those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment to achieve lasting psychological change are characterised by their experience of severe early developmental trauma. This has resulted in the formation of entrenched adverse relational patterns which are unconscious, difficult to bring into consciousness and slow to change. These patients have failed to establish security of attachment patterns in the course of a depriving and/or traumatic childhood, often in the care of parents with similar character pathology. Such patients will often require a therapeutic relationship with an emotionally responsive therapist sustained over time within a secure therapy frame to achieve lasting psychological change.

Patients with borderline and narcissistic pathology who have sustained severe early developmental trauma will often require long-term psychotherapeutic treatment to achieve lasting psychological change. Such treatment is necessary for the relief of suffering in the patients, and may contribute to the alleviation or prevention of the intergenerational transmission of these disorders.