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Whewell, P., Lingam, R., Chilton, R. (2004). Reflective Borderline Group Therapy: The Patients' Experience of Being Borderline. Psychoanal. Psychother., 18:324-345.

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(2004). Psychoanalytic Psychotherapy, 18(3):324-345

Reflective Borderline Group Therapy: The Patients' Experience of Being Borderline

Dr Peter Whewell, Ravi Lingam and Roy Chilton

This paper describes a novel 20-week psycho-educational group therapy for borderline patients. The therapy aims to stabilize the disorganized and chaotic presenting behaviours of the patients when they enter the borderline treatment service by providing a group psycho-educational programme based upon a psychodynamic appreciation of symptoms, causes, defences and affects. We think that borderline patients will only take in such understandings if they feel listened to and understood in a way that may not have been available to them as children. To do this, the therapists need to create a reflective space underpinned by psychodynamic thought and respecting the patient's experience of being borderline. The paper illustrates the difficulties encountered and discusses the importance of containing or modifying the counter-transference stresses felt by the therapists.

The authors also report on some recent outcome data collected from the running of the group programme over the last 4 years. Twenty borderline patients were able to complete the pre- and post-treatment self-report questionnaires. The results indicate some positive signs in extra-punitive symptom control and levels of impulsivity. Significant levels of improvement were noted in the BSI total scores (p = 0.048) with particular reduction in interpersonal sensitivity (p = 0.007) and the hostility (p = 0.008) sub scores. Patients also reported a reduction in ‘feeling like’ scores on the Multi Impulsivity Scale — reflecting an improvement in internal affect triggers that might result in impulsive behaviours.

The authors discuss the potential value of this pragmatic model of care that is underpinned by psychoanalytic thinking, and its application to managing long waiting lists in psychotherapy services for borderline patients.

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