Psychodynamic group psychotherapy in the treatment of borderline personality disorder

Abstract

Borderline personality disorder (BPD) is characterized by pervasive symptoms of instability in interpersonal relations, self-image, and affect, accompanied by impulsive behavior and major identity issues. Social behavior of such patients is unstable, chaotic, and contradictory. The treatment of BPD is a challenge from the therapeutic point of view since the patient personality traits mentioned above affect the relationship with both the psychotherapist and the group, if treated in such setting. At the time when the diagnostic criteria were being set, BPD was considered to be an incurable disorder. In the meantime, there have been changes made to the concept of BPD, to the attitudes toward it, as well as to the therapeutic approach. Evaluations of psychotherapeutic methods showed that many were effective, including group psychodynamic psychotherapy, for BPD treatment. In contrast to the classical psychoanalytic approach, greater psychotherapist involvement is advised, as well as encouragement, validation, and counseling. The BPD patients are being motivated to use intersubjectivity and enactment, especially in the initial sessions when anxiety can be overwhelming and there is a risk of premature termination of the therapy. After the group cohesion has been achieved and the group matrix developed, expressive or interpretative interventions can be employed. Due to the risk of strong countertransference, regular supervision must be practiced. The aim of this paper is to present some theoretical considerations and deepen the understanding of the role of psychodynamic group psychotherapy in the treatment of BPD patients.