Combined group and individual treatment for the borderline patient

Abstract

Treatment of the borderline patient has been a significant issue in the literature and in clinical practice in recent years. The advantages and constraints of mental health systems pose a particular challenge in the treatment of these patients whose needs are highly complex. The focus of this article is one response to this challenge: combined group and individual psychotherapy in a community mental health setting. This article discusses transference and countertransference issues as they presented in a group case study, the method and design of the group case study, and a proposed model for treating borderline patients in a community setting. The group case study allowed observation of the effectiveness and viability of a multidimensional community-based treatment approach. This article discusses only a few of the special qualities of the transference/countertransference experience which are highlighted by this treatment approach.The treatment issues of the borderline patient selected for observation in the group case study were: (a) the intensity and manifestations of the transference and countertransference; (b) the expression of primitive impulses in regressive states; and (c) the preponderance of lower level defenses such as splitting, projective identification, devaluation and idealization. Within a group setting, how these borderline features would present, be managed and modified formed the underlying questions to be addressed.

Homogeneous group therapy of borderline personality disorder

“…The defensive use of splitting regarding the treating therapists occurred and fluctuated in this group as anticipated. At times, as others have pointed out (Bernard & Drob, 1985;Horwitz, 1977;Lofton et al, 1983;Ormont, 1981;Roth & Stiglitz, 1971), group appeared to allow more room for the expression of anger toward both individual and group therapists without threatening either modality. Also, the questionnaires which members completed after each group session, although not designed for this purpose, seemed to provide a safer format for members to express hostile feelings toward both therapists and members.…”

Homogeneous group therapy of borderline personality disorder

“…The defensive use of splitting regarding the treating therapists occurred and fluctuated in this group as anticipated. At times, as others have pointed out (Bernard & Drob, 1985;Horwitz, 1977;Lofton et al, 1983;Ormont, 1981;Roth & Stiglitz, 1971), group appeared to allow more room for the expression of anger toward both individual and group therapists without threatening either modality. Also, the questionnaires which members completed after each group session, although not designed for this purpose, seemed to provide a safer format for members to express hostile feelings toward both therapists and members.…”

Evidence-based group therapy for severe mental illness (SMI): Treatment for schizophrenia and borderline personality disorder.

“…Dysfunctional cognitive schemas (e.g., fear of abandonment) were viewed as pertinent to the borderline condition. Combining group and individual treatment gained recognition as best practice for targeting both intrapsychic and interpersonal difficulties of borderline patients (Lofton et al, 1983). Linehan (1987) then developed dialectical behavioral therapy (DBT) to treat suicidality and self-harming tendencies in women diagnosed with BPD.…”

Homogeneous group therapy of borderline personality disorder

“…The defensive use of splitting regarding the treating therapists occurred and fluctuated in this group as anticipated. At times, as others have pointed out (Bernard & Drob, 1985;Horwitz, 1977;Lofton et al, 1983;Ormont, 1981;Roth & Stiglitz, 1971), group appeared to allow more room for the expression of anger toward both individual and group therapists without threatening either modality. Also, the questionnaires which members completed after each group session, although not designed for this purpose, seemed to provide a safer format for members to express hostile feelings toward both therapists and members.…”

Evidence-based group therapy for severe mental illness (SMI): Treatment for schizophrenia and borderline personality disorder.

“…Dysfunctional cognitive schemas (e.g., fear of abandonment) were viewed as pertinent to the borderline condition. Combining group and individual treatment gained recognition as best practice for targeting both intrapsychic and interpersonal difficulties of borderline patients (Lofton et al, 1983). Linehan (1987) then developed dialectical behavioral therapy (DBT) to treat suicidality and self-harming tendencies in women diagnosed with BPD.…”

Homogeneous group therapy of borderline personality disorder

“…The defensive use of splitting regarding the treating therapists occurred and fluctuated in this group as anticipated. At times, as others have pointed out (Bernard & Drob, 1985;Horwitz, 1977;Lofton et al, 1983;Ormont, 1981;Roth & Stiglitz, 1971), group appeared to allow more room for the expression of anger toward both individual and group therapists without threatening either modality. Also, the questionnaires which members completed after each group session, although not designed for this purpose, seemed to provide a safer format for members to express hostile feelings toward both therapists and members.…”

Evidence-based group therapy for severe mental illness (SMI): Treatment for schizophrenia and borderline personality disorder.

“…Dysfunctional cognitive schemas (e.g., fear of abandonment) were viewed as pertinent to the borderline condition. Combining group and individual treatment gained recognition as best practice for targeting both intrapsychic and interpersonal difficulties of borderline patients (Lofton et al, 1983). Linehan (1987) then developed dialectical behavioral therapy (DBT) to treat suicidality and self-harming tendencies in women diagnosed with BPD.…”