First Do No Harm: Short-Term Inpatient Psychotherapy of the Borderline Patient

Patients with borderline personality disorder typically are hospitalized in the midst of a crisis and in a state of acute regression. After a few days in which the patient is provided with containment and support, the therapist can assess whether the patient has the capacity for exploratory psychotherapy that may help in ego development or whether such psychotherapy may prompt further regression and dangerous acting out. For exploratory therapy certain conditions, such as an observing ego, a therapeutic alliance, and the therapist's ability to contain countertransference feelings and deal with the patient's projections, are essential. The therapist must be alert to common treatment errors that can undermine the patient's capacity to recompensate; they are likely to occur in the areas of empathy, confrontation, transference, interpretation and management, and the patient's attachment to pain.