Psychotherapy in the residential treatment of the borderline child

Residential versus day treatment for children: a long-term follow-up study

Adults and adolescents, who as children, received day or residential treatment were followed up ten years after treatment completion. No differences were found between the two treatment modalities on follow-up ratings of personal and social adjustment. This pattern was not influenced by gender, IQ, or presenting problem. Overall, about two-thirds of the children demonstrated improvement at follow-up. As expected, individuals demonstrating higher levels of personal and social adjustment at initial assessment were functioning better at outcome. However, the magnitude of therapeutic gain was not significantly different for mild versus moderate-to-severe presenting problems. Suggestions for future research are included.

Borderline disorders of childhood: an overview

This selected review considers children classified as "borderline" and focuses on two broad categories: Borderline personality disorder/borderline spectrum and schizotypal personality disorder/autism/schizophrenia spectrum classifications. Clinical descriptions, biological correlated, delimitation from other disorders, outcome, family studies, hypothesized etiologies, therapeutic considerations, and response to treatment are presented for each. Data support the subclassification of the heterogeneous groupings of borderline children into at least the two categories, and their differentiation from each other and from other clinical disorders in the population. Overlap across the borderline categories exists for individual children. The nature and shortcomings of relevant studies are described, the need for scientifically based research championed, and a differential approach to directive treatment of borderline children advocated. Further subclassification of borderline disorders should result in more cost-effective diagnosis and treatment.

Supportive containment in the hospital care of treatment-resistant borderline adolescents

Psychotherapeutic treatment of borderline patients is characterized by threats to maintenance of the therapeutic alliance during periods of regression. Hospitalization provides ego support and limits to help sustain the alliance, but for some patients traditional hospital approaches are not adequate. This paper describes a specialized treatment approach for managing treatment-resistant borderline adolescents in a hospital setting. The approach provides supportive containment through a restricted environment and enforcement of patient dependency on treatment staff. Patients gradually gain freedoms as their self-regulation increases. Success rates with this approach are raised to a level comparable to that attained with less difficult patients.