A short-term hospital program preparing borderline and schizophrenic patients for intensive psychotherapy

Psychotherapy in borderline and narcissistic personality disorder

Psychodynamic concepts about borderline personality disorder are reviewed and the literature concerning psychotherapeutic treatment of this group is examined. The treatment contexts considered include: psychoanalysis and intensive (expressive) psychoanalytic psychotherapy, supportive psychotherapy, group psychotherapy, family therapy, in-patient treatment, the therapeutic community, cognitive-behavioural approaches, and combinations of drugs and psychotherapy. The practical implications of recent follow-up studies for intervention strategies are considered.

The inpatient treatment of the borderline personality disorder: a critical review and discussion of aftercare implications

The literature on inpatient treatment of adult borderline personality disorder is reviewed. The controversy regarding the use or avoidance of the regression which can accompany hospitalization is discussed. It is suggested that this literature is not specific enough. There is insufficient attention to definition of terms, clinical heterogeneity and the longitudinal course of the illness. As well, the ahistoric approach to the hospitalization of these patients serves to reinforce characteristic ego deficits. Recommendations regarding the use of long or short-term length of hospital stay are not substantiated by formal research. It is suggested that greater emphasis be placed on aftercare issues. The stabilization of the patient, outpatient therapist, and aftercare system are described as important goals of inhospital care.

The shared field: a precursor stage in the development of a psychotherapeutic alliance with the hospitalized chronic schizophrenic patient

Psychotherapeutic work with chronic schizophrenic patients is difficult for both patient and therapist. Such patients lack many of the capacities necessary to participate in psychotherapy: motivation, observing ego, the ability to communicate verbally about thoughts and feelings, the capacity to sustain a relationship. Treatment of such patients may require phases in which such capacities are nurtured until the patient is able to form a therapeutic alliance of the ordinary kind. This paper discusses the ways in which hospitalization can be helpful during pre-alliance phases of psychotherapeutic work, through the provision of a protected setting and a team approach, in conjunction with individual psychotherapy. A perspective is offered for conceptualizing the early relationship between patient and hospital staff as a stage in the development of an alliance.