Drs. Lewin and Schulz present a therapeutic approach to borderline syndromes, which they view as disorders of affective instability. The borderline patient is in constant struggle with two threats to the integrity of the self. For fear of losing the other, the borderline patient needs to cling, but the clinging brings on the danger of getting too close and fusing with the other, thus losing the self. The other is both essential and toxic, in equal measures a promise and a threat.
\nBorderline patients have a difficult time coping with losing and fusing dangers because of constricted relations to their inner experiences. Any step forward seems too much like a step back into early developmental chaos. Negativism, rigidity, concreteness, and all-or-none thinking are used to try to provide a modicum of security. Using clinical examples drawn from extended and intensive treatments, both inpatient and outpatient, Drs. Lewin and Schulz show the claims of conflicting feelings on borderline patients, who are struggling to retain enough sense of inner coherence and stability to go on functioning.
\nHolding is crucial to any growth in the borderline self. The authors use detailed clinical examples to show how holding helps borderline patients become more capable of managing the losing and fusing dangers.
\nJust as borderline patients struggle with the losing and fusing dangers, so too must therapists struggle with finding ways to be neither too close nor too aloof. Lewin and Schulz describe how the therapists' active and involved use of themselves is carried out in the treatment of borderline patients. To help the patients make sense of their own affective experiences, therapists need to monitor their countertransference, which oscillates between too involved and too aloof.
\nThe authors discuss such topics as borderline emptiness, loneliness, and chronic suicidality. Their clinical examples touch the whole range of borderline symptomatology, including cutting, burning, eating disorders, substance abuse, and so forth. They also take up the dangers and atrractions of work with these patients, examining such topics as self-disclosure, therapists' dependence, and therapists' discoveries of access to new parts of their own experience. This preeminent and pivotal book transforms current views of what is involved in the treatment of borderline patients.