A Theoretical Approach to the Treatment of Work Difficulties in Borderline Personalities

This paper reviews the psychodynamic basis of borderline personality disorder with special reference to work difficulties. The model of human occupation is reviewed, and its use as a theoretical framework model for a formulation of borderline occupational functioning is proposed. A hypothetical model is conceptualized and the expected deficits in the volitional, habituation, and performance subsystems described. The primary occupational dysfunction of the borderline patient is shown to occur at the level of exploratory behavior, or play, and to manifest itself in the inability to perform autonomous adult roles. A treatment approach derived from this formulation is delineated, emphasizing the need for a context of exploration and curiosity. A specific treatment program is described and the therapeutic change process is illustrated through clinical case examples.