The borderline patient: Theoretical and treatment considerations from a developmental approach

In recent years, there has been growing awareness and concern about the number of patients who do not fit the standard diagnostic criteria for neurosis or psychosis. As the state of knowledge about borderline personality disorders has grown, its enlarging literature has become filled with metapsychological abstractions which attempt to clarify subtle and complex data. In general, research on borderline phenomena differentiates this syndrome from other diagnostic groups according to its special characteristics of transference and countertransference, difficulties in treatment, patients' problems in intimate relationships, and patients' uses of primitive defense mechanisms including splitting and projective identification.This paper will explore a particular theoretical perspective on the borderline phenomenon, as well as a specific treatment modality, both developed by James Masterson, M.D. It will also discuss major developmental issues which contribute to the difficulties experienced by the borderline patient population, including issues of early mother-child interaction, arrests in the rapproachment stage, and the failure of empathic responses. Finally, the author will present a case to illustrate how the use of a developmental approach can facilitate treatment.