ABSTRACT
This chapter explores several approaches to treatment planning for hospitalized patients with severe borderline pathology during the early or resistant phase of treatment. It recommends an open or team formulation of the patient's psychopathology, particularly utilizing staff counter transference feelings as one method of developing an initial hypothesis about the patient's self-system. In addition, the possible harmful effects of aggressive confrontation and interpretation are stressed and suggestions made to minimize the possibility that such interventions are experienced by the patients as staff assaults. The chapter focuses on limited segment of treatment planning for hospitalized patients with severe borderline pathology: several activities found useful during the initial, or resistance, phase of hospitalization. Severe borderline pathology is considered in a restricted sense, that is, as a certain part of a continuum of personality organization. The chapter describes several clinical processes that address these concerns, an 'open' clinical formulation and involvement of the patient in self-monitoring.
