ABSTRACT
This chapter describes a psychoanalytically orientated day hospital programme for patients with severe borderline personality disorder (BPD) whose difficulties make them impossible to treat within a "classical" psychoanalytic model. The day hospital programme takes into account both conflict and deficit models and emphasizes staff discussion of countertransference responses, in order to avoid excessive enactment. From a psychoanalytic perspective, BPD has evoked intense theorizing among psychoanalysts and, perhaps because of its clinical difficulty and variability, represents a battlefield upon which many of the controversies and schisms of contemporary psychoanalysis have been played out. There are four areas of psychoanalytic theory that are helpful in thinking about a psychoanalytically orientated day hospital treatment programme: the therapeutic alliance; the type of interventions; the triangulation of relationships to encourage the development of a mentalizing capacity; the containment of countertransference responses of staff, to prevent enactments that lead to breakdown in treatment.
