The Treatment of Borderline Personality Disorder Within a Distressed Relationship*

Abstract

An integrated systemic‐psychodynamic approach to the treatment of characterological disorders within conjoint marital therapy is suggested. Spouses' personality disorders may serve a homeostatic function within the marital relationship. Thus, any effort to effect change on either the marital or individual system level must address both the individual and relationship distress. Borderline personality disorder, an extreme characterological impairment, has been considered intractible, although object relations therapists have experienced success in treating such clients. The present paper draws from object relations and systemic therapies in developing a treatment approach to marriages which include at least one borderline spouse. A case example illustrates the conceptualizations and interventions which are proposed.

The Borderline/Schizoid Marriage: The Holding Environment as an Essential Treatment Construct

“…With the proposed treatment approach and a long-term treatment orientation, seemingly hopeless cases can improve.This article describes a treatment approach which evolved over a 6-year period, on a long-term psychiatric inpatient unit in which the borderline/schizoid marriage was the prominent marital constellation among borderline patients. This observation stands in contrast to the literature which describes the spouses of borderline patients as borderline or narcissistic, themselves (Lansky, 1981;Koch & Ingram, 1985). Although the majority of the borderline patients were female, the described dynamics held true when the borderline patient was male.The proposed treatment approach emphasizes the holding environment as an essential treatment construct that informs the treatment throughout its course.…”

Dyadic splitting in partner relational disorders.

“…The effect of borderline dynamics on intimate relationships has also been explored. Koch and Ingram (1985) spoke of clients' lack of tolerance for the “separateness” of the spouse. They also described the chaotic shifts between threats to dissolve the relationship, panic at the threat of loss, and reversals to infantile dependence.…”