Short term psychotherapy in borderline personality disorders

Abstract

The treatment of Borderline personality disorders continues to be a challenge for psychotherapists, because it is difficult to predict the successful clinical outcomes.

Scientific evidence about the efficacy of the long term psychodynamic oriented psychotherapy in Borderline personality disorders is now available. Nevertheless, it is necessary to look for effective types of psychodynamic psychotherapy which could be delivered in a limited or short time. The reason is that the long term psychotherapies are not accessible for the majority of borderline patients. The scientific literature about short term dynamic psychotherapy in borderline personality disorders is scarce.

The short term dynamic psychotherapy for this kind of patients sets out some practical and theoretical controversies:

1. • It is difficult to establish a therapeutic attachment, which has to be solved in a limited time avoiding an iatrogenic proceeding. It is due to the difficulty of this patients to have an enough symbolic representation of the therapist and the therapeutic relationship.

2. • It is difficult to establish the treatment objectives around a focus in the psychotherapy.

3. • The management of temporality, both in the own past time and in the future is difficult for this patients.

Nevertheless, we support the possibility to put into practice short term psychodynamic psychotherapy in a number of selected patients. We discuss the technical adaptations that would be necessary: to include supportive elements, to limit the interpretation, to increase the mentalization capacity with an active position of the therapist or to focus in the difficulties with the object relationships.