Maintaining a balanced treatment approach with the borderline patient

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Abstract
There has been an ongoing controversy in the nature of the recommended treatment for the borderline personality disorder early in therapy. Kernberg emphasizes the negative features of the transference early in therapy and recommends dealing with it primarily by interpretation, confrontation, and limit setting. Adler views the transference early in therapy as primarily reflecting subjectively perceived breakdowns in needed self‐object merger, and recommends creating a symbolic holding environment through empathy and support. Gunderson devotes more equal emphasis to empathizing with and challenging the patient's point of view. The balance between empathy and confrontation is difficult to maintain because of the counter‐transference pull of the borderline. In order to avoid bias toward empathic or confrontive treatment strategies, it is argued that one must pay special attention to the extent to which the therapist understands the plausibility and adaptiveness of the borderline patient's experience and behaviour as readily as the implausibility and maladaptiveness.

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