The difficulty of understanding a borderline patient

SUMMARY

For much of the time during my work with Mr A, a borderline patient whom I saw for twice-weekly psychotherapy over a period of one year. I had difficulty understanding and communicating with him. I felt despairing and impotent and that therapy was not progressing at all. A few weeks prior to termination a shift occurred and I realised that there had been some improvement in Mr A's functioning. Although I was aware that behind the polite façade was an angry, disturbed man, I felt that he was a little more in touch with reality than he had been at the beginning of the treatment.

In this paper I will focus on the factors that contributed to my difficulty in understanding and communicating with Mr A. I will also attempt to account for his apparent improvement.     

The rorschach assessment of borderline defenses: a concurrent validity study

This study assesses the concurrent validity of two Rorschach defense scales designed to identify borderline defensive structure. A Rorschach scale designed by Cooper and his colleagues was systematically compared to a defense scale constructed by Lerner and Lerner. Despite considerable overlap on a conceptual and operational level, the scales are based on divergent theoretical models (developmental arrest and fixation) and Rorschach units of analysis (all responses and human responses). Our results are based on the capacity of each scale to discriminate between independently diagnosed samples (neurotic, outpatient borderline, inpatient borderline, schizophrenic) and the relative discriminatory power of particular defenses within each scale to differentiate between groups.     

The ethics of funding embryonic stem cell research: a Catholic viewpoint

Stem cell research that requires the destruction of human embryos is incompatible with Catholic moral principles, and with any ethic that gives serious weight to the moral status of the human embryo. Moreover, because there are promising and morally acceptable alternative approaches to the repair and regeneration of human tissues, and because treatments that rely on destruction of human embryos would be morally offensive to many patients, embryonic stem cell research may play a far less significant role in medical progress than proponents believe.     

The covariation of trait anger and borderline personality: a bivariate twin-siblings study

Anger can be defined as an emotion consisting of feelings of variable intensity, from mild irritation or annoyance to intense fury and rage. Borderline personality disorder (BPD) is characterized by impulsivity and instability of interpersonal relationships, of self-image, and of negative affects. Borderline personality and trait anger are often observed together. The present study examined the extent to which a genetic association explains the covariation between a trait measure of borderline personality and trait anger. To this end, self-report data of 5,457 twins and 1,487 of their siblings registered with the Netherlands Twin Register and the East Flanders Prospective Twin Survey were analyzed using genetic structural equation modeling. A significant phenotypic correlation was observed between the two traits (rP = .52). This correlation was explained by genetic (54%) and by environmental influences (46%). A shared genetic risk factor is thus one of the explanations for the covariation of borderline personality and trait anger.     

Comparing borderline definitions: DSM-III borderline and schizotypal personality disorders

Compared the two types of borderline disorder formally defined by DSM-III, borderline personality disorder and schizotypal personality disorder, at the diagnostic category and individual criterion level. Unlike previous research in this area, which has focused on inpatient and outpatient populations, the sample was a psychometrically defined, nonpatient sample including Ss meeting DSM-III criteria for each disorder. The results indicated that the two diagnostic categories each define a type of borderline with distinctive combinations of features. Perceptual and cognitive distortion, however, seem to be present in both and define an area of overlap between the two disorders. The implications of these findings for the revision of the SPD diagnostic criteria in DSM-III-R are discussed, and the theoretical separation of two subtypes of borderline personality is affirmed.     

Counselling, support and advice: The adolescent viewpoint

Few discussions on counselling pay more than lip service to what adolescents actually want. Data presented on the preferences of adolescents with regard to helping services show that no one method of providing help would be adequate. An indication of the number of relatively Isolated and unsupported adolescents is given, suggesting that 20-40% of young people lack a regular source of advice or understanding. Professional and official sources of advice are rarely used, and are not likely to be until they improve both their accessibility and image in the eyes of youth.     

The borderline syndrome in adolescents

The borderline adolescent is discussed in terms of diagnostic perspectives, characteristic features based on disturbed object relations, and treatment. The disorder is not fully manifest in adolescence but gradually emerges into a definable personality type, the various features of which express the unsatisfactory outcome of a complex psychodynamic struggle related to developmental arrests in psychic structure. Based on clinical observations, the diagnosis of borderline personality, like the schizoid personality, is considered to be compatible with a past, present or future schizophrenic disorder. Finally, therapeutic approaches in a day-treatment program, and individual therapy is considered from a developmental object relations viewpoint.     

The borderline hypertensive rat: a model for studying the mechanisms of environmentally induced hypertension

The borderline hypertensive rat (BHR) is a first-generation cross between the spontaneously hypertensive rat and the normotensive Wistar-Kyoto rat. The BHR develops frank hypertension when chronically stressed or when fed a high-sodium diet. Stress-induced hypertension can be blocked by exercise. The role of the central nervous system and kidney in hypertension development in this model is discussed.     

The BPQ: a scale for the assessment of borderline personality based on DSM-IV criteria

The aim of the study was to develop a self-report measure that assesses borderline personality traits as defined by DSM-IV criteria, including separate subscales for each criterion. A sample of normal subjects from community colleges in the midwestern region of the United States was used to develop the scale. The psychometric properties of the scale were examined using an additional United States sample and student samples from England and Australia. The scale was compared with existing measures of borderline and schizotypal personality. Evidence for the internal consistency and convergent and divergent validity of the new scale is presented. The results of several analyses of variance comparing males and females in the three national groups are reported. A Principal Components Analysis of the subscales suggested either a single factor or two correlated factors. Oblique rotation yielded a structure that distinguished identity/interpersonal and impulsivity borderline personality traits. It is concluded that the new scale provides a useful tool for clinicians and researchers interested in screening for borderline personality traits in both general and clinical populations. Suggestions for further research are indicated.     

The position of school psychologists in negotiations: One viewpoint

Teachers' associations are becoming increasingly militant. They tend not to represent psychologists in negotiations. School psychologists need both representation and to take a position in relation to work stoppages. He has the following options: (a) identify completely with the teachers' association and its methods and goals and refuse to report during work stoppages; (b) identify with management and perform management duties during the stoppage; or (c) negotiate separately with boards of education, but neither take part in the work stoppage nor assume duties beyond his normal role and function. The last appears to be the better alternative provided the psychologist makes his position clear to both labor and management organizations prior to a work stoppage.