Leonard Horwitz

Borderline Personality Disorder: Tailoring the Psychotherapy to the Patient explores the challenge of treating patients with borderline personality disorder. These patients make up a large segment of the difficult-to-treat population. The instability of their relationships, the intensity of their affective responses, and their proneness to paranoid reactions all contribute to their difficulty in working consistently and constructively in the psychotherapeutic situation. When one adds these difficult patient problems to the therapist's quandary about how expressive or supportive to be, therapists are indeed often confronted with a challenging therapeutic task. The book begins with a review of the clinical and research literature pertaining to the treatment of borderline patients. It presents a unique, empirically based intensive study of three borderline patients, based on transcripts of audiotaped therapy sessions. The research methodology is reviewed, and clinically oriented descriptions of the three patients, their psychotherapy processes, and their outcomes are included. Following an overall summary of results, conclusions regarding the differential indications for supportive versus expressive emphasis in psychotherapy are discussed. In their research, the authors recorded every psychotherapy session and studied a randomly selected group of sessions. Therefore, the reader is provided with increased insight into what is most effective with what kind of patient at a given point in the therapy process.

There are multiple meanings to the term 'group-as-a-whole' and all have a contribution. This book emphasizes that the therapist ideally listens with the fourth ear, not only attending to the latent communication of each individual, but also listening for the shared theme of the whole group. Ferreting out the underlying theme that the entire group is dealing with, the common group tension, provides a valuable opportunity for each individual to change the underlying issues that impair his or her relationships. In addition, the author provides a wide ranging coverage of theoretical, clinical, and training issues. These include a clarification of the confusing, but all-important conception of projective identification as well as a contribution to the understanding of the similarities and differences between group and individual psychotherapy. He presents a special perspective on why groups are particularly indicated in dealing with narcissistic pathology and also explores the effect of the therapist's narcissism on his patients. Finally, he emphasizes that therapists' participation as members of experiential groups is an essential part of their training.