Although Borderline Personality Disorder (BPD) continues to present practicing psychologists with difficult challenges, progress is being made in its treatment. Part of the progress stems from increased awareness by the therapeutic community of the intense level of commitment required to make inroads into this disorder. Assisting BPD clients places a longterm, nurturing responsibility on the therapist that can strain the emotional resources of even the most experienced professional.
The diagnostic features of BPD are outlined in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) also known as DSM-IV. According to DSM-IV the essential feature of BPD is a pattern of difficulty in maintaining interpersonal relationships, self-concept and affects, and marked impulsivity. Norcross (1995) describes BPD as "the most angst-producing and recalcitrant of personality disorders," one that produces "feelings of bewilderment, inadequacy, and downright fear in practicing psychologists" (p. 428, p. 426). Arntz (1994) cites Beck et al.'s identification of three characteristic assumptions of borderline patients: fear and mistrust of others, feelings of powerlessness and vulnerability, and negative self-image (p. 421). Norcross (1995) cites Layden et al.'s hypothesis of three subtypes of BPD: "borderline-avoidant/dependent; borderline-histrionic/narcissistic; and borderline-antisocial/paranoid" (p. 428).
The presence of BPD is indicated by five (or more) of nine criterion listed in DSM-IV. The first criterion is avoidance of abandonment. Individuals with BPD become irrational when faced with the prospect of separation or routine change of plans: "The perception of impending separation or rejection, or the loss of external structure, can lead to profound changes in self-image, affect, cognition, and behavior" (DSM-1V, 1994, p. 650). Because BPD individuals link abandonment, either real o...