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TitleA Developmental Model of Borderline Personality Disorder: Understanding Variations in Course and Outcome
LanguageEnglish
File Size1.6 MB
Total Pages246
Table of Contents
                            Contents
Introduction
Acknowledgments
I: Etiology
	1 An Integrated Developmental Model
II: Variations in Course and Outcome: Case Histories
	2 The Chestnut Lodge Follow-Up Study
	3 When She Was Good...Lillian
	4 Love Having No Geography...Susan
	5 Kindness of Strangers...Sylvia
	6 Wild at Heart...Wendy
III: Treatment
	7 Universal Features of Treatment
	8 Recurrent Themes and Issues
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
	L
	M
	N
	O
	P
	R
	S
	T
	V
	W
	Y
                        
Document Text Contents
Page 2

A Developmental Model of
Borderline Personality
Disorder

Understanding Variations in
Course and Outcome

Page 123

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Page 124

109

5

Kindness of Strangers...Sylvia

Whoever you are—I have always depended on the kindness of
strangers.

Tennessee Williams, A Streetcar Named Desire

The Chestnut Lodge admitting doctor described Sylvia, a
former actress, as an “attractive woman who is quite composed.” Noth-
ing in her manner suggested that she had spent most of her adult life in
psychiatric hospitals. A veteran of 15 hospitalizations, treatment with
electroconvulsive therapy (ECT), and numerous medications and psy-
chotherapies, Sylvia began her odyssey as a professional inpatient at
the age of 27. Over the next 9 years, Sylvia settled into a classic pattern
of stable instability. Her admission to Chestnut Lodge was viewed as a
last-chance effort to alter the downward spiral of her life.

HISTORY OF DISORDER

Sylvia’s problems emerged most clearly when she left home to attend
college. She was unable to adjust to college and changed schools twice
during her first 2 years. In her third year and at her fourth school, Sylvia
became despondent over a failed romance and overdosed for the first
time. She dropped out of college and moved cross-country in search of
an acting career.

At the age of 21, Sylvia met her husband-to-be, Billy, a moderately
successful painter, 16 years her senior, who suffered from episodic de-
pressions, binge drinking, and psychotic states. Sylvia dreamed he
would make her famous. Billy, described as dapper and charming, left

Page 245

230 A Developmental Model of Borderline Personality Disorder

Substance abuse (continued)
drug therapy, 181
self-help groups, 209
tolerating, 127
treating, 208–209

Suicidal behavior
case studies

Sylvia, 124
Wendy, 141

Suicide
attempts, 210–212
completed, 209–210
preoccupation with, 204–205
prevention, 210

Temperament
attachment affected by, 19–20
of BPD patients, 6
contradictory, 14
defined, 7

Therapist-administrator team
(T-A split), 53–54

Therapists
anger tolerance, 202
challenges for, 152–153
countertransference, 78, 140,

190
empathy of, 186–187
idealized, 187
initial work with, 175–176
overestimation of

effectiveness, 128–129
physician relationships, 179
qualities for effective, 172–173
relationships with

in general, 173–175
intense and unstable,

187–189
Lillian’s, 74–75, 77, 88–90
Susan’s, 95–96, 100, 106–107
Sylvia’s, 113
Wendy’s, 136–140

sexualized, 188
as team members, 165–166
trainees, 169

Toddlers, attachment
classification, 21–23

Transference focused psycho-
therapy, 25, 171

Treatment. See also specific aspects
and disorders

anxiety over, 191–192
complementary and

alternative, 180–181
day, 169
goals, 164
hospitalization, 169–170
initiation, 175–176
integrated, 208
maintenance, 177
parallel, 208
planning, 166–170
team, 165–166, 174. See also

Goal-corrected
partnerships

splitting among, 189–190
termination, 177

Violence
assessing potential for, 163
case studies

Wendy, 134–136, 145–146
toward therapist, 214–216
in workplace, 217

Vulnerabilities, neurobehavioral,
4

Vygotsky, Lev S.
on higher mental functions, 19
on language, 26

Wealth
as protective factor, 121,

143–144
as therapeutic, 128

Page 246

Index 231

Wechsler Adult Intelligence Scale
(WAIS)

BPD patients and, 15
case studies

Lillian, 71
Susan, 102
Wendy, 135

Wechsler Memory Scale, 161

Wechsler Preschool and Primary
Scale of Intelligence (WPPSI),
18

Witnessing, 36
Women, in Chestnut Lodge

cohort, 59–61
Work. See Occupational stability

Young, J. E., BPD schema, 34–35
9

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