1.  Ed Kaufman, MSW.    "Development; Film Discussion"

Ed Kaufman, MSW, clinician, educator, and film discussion leader, discusses some of the developmental issues leading to the Borderline Personality, especially as these are portrayed in the film, "You Can Count on Me."

In our program, Volume 7, "Critical Issues in Psychotherapy," two of our speakers spoke about the Borderline Personality, and we have reproduced several moments from those interviews.

2.  Sandy Hotchkiss, MSW.    "Brief Treatment with Borderlines"

Sandy Hotchkiss, MSW, summarizes three levels of Borderline Personality, so that we can have some more nuanced criteria about this disorder. These will help us predict the kinds of treatment and transference issues that may arise in treatment, and thus may help our decision making about what to offer to the patient.

3.  Karla Clark, Ph.D.    "The Masterson Approach "

Karla Clark, Ph.D., clinician, educator, and speaker, discusses understanding patients with disorders of the self based on their attachment styles.

Here, we explore the treatment of individuals with BPD and Borderline couples from the Object Relations perspective.

A primary task of object relations treatment is to interpret modes of relating through the current relationship that develops between patient and therapist, rather than making conscious the unconscious elements of any conflict. The therapeutic goal is not insight per se but the facilitation of new relationships. Through the relationship with the therapist, the patient is helped to relinquish pathological relational patterns and replace them with others based on the patient's authentic experience.

4.  Frank Summers, Ph.D.     "An Object Relations Approach" 

Frank Summers, Ph.D., author of Transcending the Self: An Object Relations Model of Psychoanalytic Therapy, provides case discussions demonstrating how psychoanalytic therapy informed by an object relations model can effect radical personality change.

5.  Charles McCormack, MSW.    "Borderline Marriages" 

Anyone doing marital therapy knows that there are couples, and then there are couples! The normal/neurotic couple rapidly incorporates the therapist's suggestions help with communication and conflict resolution issues. On the other hand the personality-disordered marriage seems impervious to change and often seems to get worse in treatment.

Charles McCormack, MSW, authority of Treating Borderline States in Marriage: Dealing with Ruthless Aggression, Severe Resistance and Oppositionalism, describes marriage as containing both the dream and the nightmare of the couple's way of being in relationship. The couple presents a tangle which all three in the room must work to sort-out.

A history of self-mutilating behavior is one of the 9 indicators of Borderline Personality Disorder. Self-injury is one of our society's fastest-growing and most disturbing problems. Alarming and horrifying, self-abuse is a widely misunderstood and dangerously mistreated psychiatric disorder. What motivates self-injury? And most puzzling: how is it that things like cutting, gouging, and burning one's body actually make the injurer feel better? That being the case, what possible therapeutic intervention can compete?.

6.  Karen Conterio & Wendy Lader, Ph.D.   "Self-Injurious Behavior"

Karen Conterio & Wendy Lader, Ph.D., co-authors of the book, Bodily Harm, founded the first treatment program in the nation specifically for people who harm themselves. In this interview, they describe a course of treatment based on years of experience and extensive clinical research, as well as compassion, advice, hope, and humor. Treating patients with respect and empathy, they place the responsibility for recovery squarely on the patients' shoulders. They use innovative techniques, including cognitive analytic therapy, to look at the underlying dynamics driving the behavior.

7.  Paul Mason, MS.    "Impact on Families "

Paul Mason, MS, is the co-author of the best-selling book entitled, Stop Walking on Eggshells: Taking Your Life Back When Someone You Care about Has Borderline Personality Disorder. In this book he manages the delicate tasks of appreciating the dilemmas that families and friends of persons with Borderline Personality face each day, while at the same time not simply blaming the person with BPD in a simplistic fashion. In this interview he describes how family and friends can learn what they can do to cope with Borderline behavior and take care of themselves.

Dialectical Behavior Therapy (DBT) is a comprehensive, cognitive-behavioral treatment for individuals meeting criteria for borderline personality.  Devised by Marsha Linehan at the University of Washington in Seattle, it consists of a unique balance of behavioral change and acceptance strategies.  DBT is one of only two treatments for BPD that has been supported by a ramdonized clinical trial.  This research has shown that DBT has reduced suicidal episodes, hospitalizations, and dropout for treatment, while reducing anger and improving social adjustment.

8.  Valerie Porr, M.A.      "Educations; crisis intervention

Valerie Porr, MA, is the founder and director of TARA, the only national nonprofit, educational and advocacy organization for BPD.  In this interview, she discusses how she uses DBT in crisis intervention on the telephone, and in her educational groups for family and friends of people with BPD.

9.  Charles Swenson, MD      "Dialectical Behavior Therapy"

Dr. Swenson gives an overview of DBT, its base on a bio-social theory of BPD, its synthesis of principles and strategies from behaviorism, from Zen, and from Dialectical philosophy, and how DBT actually works.

While understanding of BPD has been traditionally grounded in psychodynamic formulations, it has been become increasingly clear that BPD emerges from vulnerabilities in brain function around the regulation of affect and impulse control. Research is beginning to show that the development of BPD depends on an interaction of constitutional biologic vulnerabilities with often adverse environmental circumstances during development.

10.  Christine Lawson, Ph.D.       "Borderline Mothers"

The neurological functioning of children of borderline mothers is impacted by deficits in early parenting, by the projection of massive states of confusion and terror onto the children by borderline mothers.

11.  Larry Siever, MD        "Medication; Neuropsychology"

A study in the Journal of Clinical Psychiatry, 2002, indicates that the use of Risperidone at low to moderate doses can improve borderline personality disorder symptomatology.  This is only one of many studies underway and in the recent past that begin to arrive at pharmacological interventions toease the suffering of the patient with the Borderline Personality.

Dr. Siever believes that knowledge of the biology of the borderline personality disorder can help us better understand and treat it.  Even though BPD has important neurobiologic underpinnings that call for pharmacologic intervention, this population tends to be either over or under medicated and poses problems with compliance and suicide.