ABSTRACT
A therapist baffled by a therapeutic impasse with a "borderline" patient asks for a consultation and gives a good description of the patient's clinical picture. Separation stresses commonly precipitate a clinical syndrome. The diversity of the clinical picture—difficulties with self-image, with affect, with relationships with others, with overt symptoms, with impulse control, workaholism and alcoholism—seem to defy organization, and, therefore, the development of a carefully thought-through and considered therapeutic approach. The clinical picture, like a chameleon, can take on the colors of other disorders. There are a number of symptomatic themes that reflect the patient's complaints rather than the aspects of the problem that the patient denies—for example, grandiosity, sense of entitlement, or lack of empathy. A real, healthy close relationship would interrupt the patient's narcissistic defenses and expose the patient to his or her impaired self and abandonment depression, and so the patient must form relationships based on narcissistic defense.
