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Blechner, M.J. (1996). Comments On The Theory And Therapy Of Borderline Personality Disorder. Contemp. Psychoanal., 32:68.

(1996). Contemporary Psychoanalysis, 32:68

Comments On The Theory And Therapy Of Borderline Personality Disorder

Mark J. Blechner, Ph.D.

THE DIAGNOSIS AND TREATMENT of borderline personality disorder has been complicated by differing views concerning the nature of the psychopathology involved and the consequent assumptions about the best approaches to treatment. This paper discusses my own approach to conceptualizing and treating the borderline patient, based on the principles of interpersonal and relational psychoanalysis, and clarifies it through contrast with Kernberg's views. When I approach any clinical situation, I always have in mind the fundamental question raised by William Alanson White (Sullivan, 1962): "What is the patient trying to do?" When White asked this question, he was implying a central principle—that much of a patient's behavior and experience has meaning, and that his psychopathology needs to be seen not only as a disruption of function, but as an attempt to work constructively to better his life under a given set of circumstances.

Borderline pathology, in my view, can be best understood in its relation to schizophrenia. The borderline patient presents the picture of a severely maladjusted personality, but without many types of chronic, formal thought disorder. Such a patient is fixed in a state similar to the preschizophrenic anxiety so well described by Sullivan (1956pp. 304–360). The borderline patient experiences a paralyzing level of dread, a tremendous sense of urgency to do something without a clear sense of what to do, and a painful lack of mutuality in relations with others. The patient avoids intimacy and dependency, through what Sullivan called "the malevolent transformation." He experiences a fear of annihilation and an arousal of aggression in both himself and others. The borderline patient's overwhelming sense of loneliness and fragmentation drives him toward impulsive attempts at making interpersonal contact, through all sorts of actions that may be criminal, self-destructive, exhibitionist, or otherwise self-defeating. But the borderline differs from the schizophrenic in that, in the midst of this crisis in his sense of self and interpersonal relations, he cannot or does not escape into psychosis. The solution of interpersonal difficulties and psychic pain through autistic, magical, psychotic ideation—what Arieti (1974) calls "psychotic insight"—is rejected

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