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Fischel, R.E. (1992). Effective Psychotherapy with Borderline Patients. Case Studies: By Robert J. Waldinger, M.D. and John G. Gunderson, M.D. Washington, D.C.: American Psychiatric Press, Inc., 1989. 232 pp.. Psychoanal Q., 61:474-477.
(1992). Psychoanalytic Quarterly, 61:474-477
Effective Psychotherapy with Borderline Patients. Case Studies: By Robert J. Waldinger, M.D. and John G. Gunderson, M.D. Washington, D.C.: American Psychiatric Press, Inc., 1989. 232 pp.
Review by: Robert E. Fischel
Five very disturbed patients were treated by five different therapists in psychoanalytic psychotherapies. The patients improved dramatically over a time span of about five years. The authors, who were two of the five therapists, have written this book to explain why.
The patients were chosen because they had done well, and because the therapists were willing to participate in the study. This included their willingness to contact their patients for permission to be used in the study, and for information about follow-up. The therapists met regularly to discuss the cases over a period of about a year, in preparation for this book.
Before they go into some depth about each of the five cases, the authors give an excellent, useful overview of the literature on intensive psychotherapy with borderline patients. In less than twenty pages, they review, compare, and critically evaluate work by many of the past and present major contributors to the field, including Gunderson, whom I have always thought of as sensible and down-to-earth: the kind of guide one should have available, along with others, on the difficult and often confusing journey that one takes with borderline patients. His theoretical positions have been derived from observable data, data that he shares with his readers. His review of the theoretical positions of others seems even-handed and accurate.
The following section is devoted to an in-depth description of the psychotherapies of the five patients used for this study. I read these case histories with much interest, and I applaud the authors for using this format to illustrate their points of view. I was able to see aspects of my patients in theirs, aspects of myself in the treating therapists. I had a chance to criticize some of the therapists' interventions, and to agree with others. I felt justified in my criticisms when what I felt were uncalled for parameters resulted in transient exacerbations of pathology, or non-productive periods of treatment.
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