ABSTRACT
This chapter discusses some general problems of research into personality disorder (PD), outlines some of the difficulties faced in organizing research into borderline personality disorder (BPD), and summarizes the results of the first randomized controlled trial of outcome of treatment of BPD in Britain. The modified individual psychoanalytic approach adopted by Kernberg is based on clarification, confrontation, and interpretation within a developing transference relationship between patient and therapist. Initially there is a focus and clarification of self-destructive behaviours both within and outside therapy sessions. Gaps in mentalization in BPD engender impulsivity, and during treatment the intensification of the therapeutic relationship highlights the patient’s difficulties and further exposes the rift between internal and external reality. One of the most complicated challenges arising from treating BPD relates to externalizations of unbearable self-states. Splitting the transference by creating alternative foci for the patient’s feelings is important.
