Skip to main content
SpringerLink
Log in

Psychoanalytic Treatment of Borderline Patients in a Day Hospital Setting

  • Chapter
  • First Online:
Neuropsychodynamic Psychiatry

  • 880 Accesses

Abstract

The authors present the relevance of day hospital settings for the psychoanalytic treatment of borderline patients. Referring to specific areas of conflict which are central to borderline pathology (identity problems, dealing with separation and dependency, claustro-agoraphobic anxieties, taking refuge to ‘psychic retreats ’), they argue that the specific elements of a day hospital setting may be more favourable in dealing with these problems than a classical psychiatric inpatient treatment. Using clinical vignettes, the significance of focusing on the emotional experiences in the here and now of the interactions, maintaining the borders of the setting and the thorough working through of the transference and countertransference is emphasised. Possibilities and limits of day hospital care are discussed with reference to the existing literature and future research strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Agarwalla P, Küchenhoff J. Teilstationäre Psychotherapie. Ergebnisse, Katamnese, Einflussfaktoren. Psychotherapeut. 2004;49:261–71.

    Google Scholar 

  • American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders DSM-5. Washington DC: American Psychiatric Association; 2013. p. 2013.

    Book  Google Scholar 

  • Bateman A, Fonagy P. Effectiveness of partial hospitalization in the treatment of Borderline personality disorder: a randomized controlled trial. Am J Psychiatry. 1999;156:1563–9.

    Article  CAS  Google Scholar 

  • Bateman A, Fonagy P. Treatment of borderline personlity disorder with psychoanalytically oriented partial hospitalization: an 18th month follow-up. Am J Psychiatry. 2001;158:36–42.

    Article  CAS  Google Scholar 

  • Bateman A, Fonagy P. Borderline-Persönlichkeitsstörung und Mentalisierungsbasierte Therapie (MBT). In: Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 566–75.

    Google Scholar 

  • Bion WR. Learning from experience. London: Heinemann; 1962.

    Google Scholar 

  • Bohus M. Dialektisch-Behaviorale Therapie für Borderline-Störungen. In: Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 619–39.

    Google Scholar 

  • Buchheim A. Borderline-Persönlichkeitsstörungen und Bindungserfahrungen. In: Dulz B, Herpertz SC, Kenberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 158–67.

    Google Scholar 

  • Chiesa M, Fonagy P. Cassel personality disorder study. Br J Psychiatry. 2000;176:485–91.

    Article  CAS  Google Scholar 

  • Chiesa M, Fonagy P. Psychosocial treatment for severe personality disorder. 36-month follow-up. Br J Psychiatry. 2003;183:356–62.

    Article  Google Scholar 

  • Chiesa M, Fonagy P, Holmes J, Drahorad C. Residential versus community treatment for severe personality disorders: a comparative study of three treatment programs. Am J Psychiatry. 2004;161:1463–70.

    Article  Google Scholar 

  • Clarkin JF, Levy KN, Schiavi JM. Transference focused psychotherapy: development of a psychodynamic treatment for severe personality disorders. Clin Neurosci Res. 2005;4:379–85.

    Article  Google Scholar 

  • Clarkin JF, Yeomans FE, Kernberg OF. Psychotherapy for borderline personality: focusing on object relations. Washington DC: American Psychiatry Publishing; 2006.

    Google Scholar 

  • Dammann G, Buchheim P, Clarkin JF, Kernberg OF. Einführung in eine übertragungsfokussierte, manualisierte psychodynamische Therapie der Borderline-Störung. In: Kerberg OF, Dulz B, Sachsse U, editors. Handbuch der Borderline-Störungen. Stuttgart: Schattauer; 2000. p. 461–81.

    Google Scholar 

  • Domsalla M, Koppe G, Niedtfeld I, Vollstädt-Klein S, Schmahl C, Bohus M, Lis S. Cerebral processing of social rejection in patients with borderline personality disorder. Soc Cogn Affect Neurosci. 2014;9(11):1789–97.

    Article  Google Scholar 

  • Ducasse D, Courtet P, Olié E. Physical and social pains in borderline disorder and neuroanatomical correlates: a systematic review. Curr Psychiatry Rep. 2014;16(5):1–12.

    Article  Google Scholar 

  • Dulz B, Jensen M. Aspekte einer Traumaätiologie der Borderline-Persönlichkeitsstörung – psychoanalytisch-psychodynamische Überlegungen und empirische Daten. In: Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 203–24.

    Google Scholar 

  • Fonagy P, Gergely G, Jurist EL, Target M. Affektregulierung, Mentalisierung und die Entwicklung des Selbst, vol. 2004. Stuttgart: Klett-Cotta; 2002.

    Google Scholar 

  • Gergely G, Watson J. The social biofeedback model of parental mirroring. Int J Psychoanal. 1996;77:1181–212.

    PubMed  Google Scholar 

  • Green A. Geheime Verrücktheit. Grenzfälle der psychoanalytischen Praxis, vol. 2000. Gießen: Psychosozial-Verlag; 1990.

    Google Scholar 

  • Jacobs TJ. On countertransference enactments. J Am Psychoanal Assoc. 1986;34:289–307.

    Article  CAS  Google Scholar 

  • Joseph B. A clinical contribution to the analysis of a perversion. Int J Psychoanal. 1971;52:441–9.

    CAS  PubMed  Google Scholar 

  • Joseph B. Transference: the total situation. Int J Psychoanal. 1985;66:447–54.

    Google Scholar 

  • Joseph B. In: Feldman M, Bott Spillius E, editors. Psychic equilibrium and psychic change: selected papers of Betty Joseph. London: Routledge; 1989.

    Google Scholar 

  • Kamphausen S, Schröder P, Maier S, Bader K, Feige B, Kaller CP, Tüscher O. Medial prefrontal dysfunction and prolonged amygdala response during instructed fear processing in borderline personality disorder. Curr Psychiatry Rep. 2013;14(4):307–18.

    Google Scholar 

  • Kernberg OF. Borderline conditions and pathological narcissism. New York: Jason Aronson; 1975.

    Google Scholar 

  • Kernberg OF. Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: contemporary controversies. Int J Psychoanal. 1999;80:1075–91.

    Article  Google Scholar 

  • Krause-Utz A, Winter D, Niedtfeld I, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2014;16(3):1–13.

    Article  Google Scholar 

  • Küchenhoff J. Teilstationäre Psychotherapie. Theorie und Praxis. Stuttgart: Schattauer; 1998.

    Google Scholar 

  • Lang S, Kotchoubey B, Frick C, Spitzer C, Grabe HJ, Barnow S. Cognitive reappraisal in trauma-exposed women with borderline disorder. NeuroImage. 2012;59(2):1727–34.

    Article  Google Scholar 

  • Lieb K, Stoffers J, Dulz B. Pharmakologische Behandlung von Borderline-Persönlichkeitsstörungen. Nervenheilkunde. 2014;10:720–2.

    Article  Google Scholar 

  • Linehan MM. Dialektisch-Behaviorale Therapie der Borderline-Persönlichkeitsstörung. München: CIP Medien; 1996.

    Google Scholar 

  • Mahler MS, Pine F, Bergman A. The Psychological birth of the human infant. New York: Hutchinson; 1975.

    Google Scholar 

  • Maier W, Hawellek B. Genetik. In: Dulz B, Herpertz SC, Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 69–74.

    Google Scholar 

  • Mauchnik J, Schmahl C. The latest neuroimaging findings in borderline personality disorder. Curr Psychiatry Rep. 2010;12(1):46–55.

    Article  Google Scholar 

  • Meltzer D. Terror, persecation and dread. Int J Psychoanal. 1968;49:396–401.

    CAS  PubMed  Google Scholar 

  • Money-Kyrle R. Cognitive development. In: Meltzer D, O’Shaughnessy E, editors. The collected papers of Roger Money-Kyrle. Perthshire: Clunie Press; 1968. p. 416–33.

    Google Scholar 

  • Osofsky JD. Aspekte der frühen Entwicklung als Verständnisgrundlage der Borderline-Persönlchkeitsorganisation. In: Dulz B, Herpertz SC, Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 148–57.

    Google Scholar 

  • Rey H. Schizoid phenomena in the borderline. In: Le Boit C, editor. Advances in the psychotherapy of the borderline patient. New York: Jason Aronson; 1979.

    Google Scholar 

  • Rey H. Universals of psychoanalysis in the treatment of psychotic and borderline states. London: Free Association Books; 1994.

    Google Scholar 

  • Rosenfeld HA. A clinical approach to the psychoanalytic theory of the life and death instincts: an investigation into the aggressive aspects of narcissism. Int J Psychoanal. 1971;52:169–78.

    CAS  PubMed  Google Scholar 

  • Rosenfeld HA. Zur Psychopathologie und psychoanalytischen Behandlung einiger Borderline-Patienten. Psyche – Z Psychoanal. 1981;35:338–52.

    CAS  Google Scholar 

  • Rosenfeld HA. Impasse and interpretation. London: Tavistock; 1987.

    Google Scholar 

  • Rosenfeld HA. The relationship between psychosomatic symptoms and latent psychotic states. In: De Masi F, editor. Herbert Rosenfeld at work. The Italian seminars. London: Karnac; 1997. p. 24–44.

    Google Scholar 

  • Rudolf G. Strukturbezogene Psychotherapie. Stuttgart: Schattauer; 2004.

    Google Scholar 

  • Rudolf G. Psychoanalytische Therapie struktureller Störungen. Behandlung ‘as usual’ oder strukturbezogene Modifikation. In: Springer A, Gerlach A, Schlösser A-M, editors. Störungen der Persönlichkeit. Gießen: Psychosozial-Verlag; 2006. p. 93–112.

    Google Scholar 

  • Ruocco AC, Amirthavasagam S, Choi-kain LW, Mcmain SF. Neural correlates of negative emotionality in borderline personality disorder: an actionlikeklihood-estimation meta-analysis. Biol Psychiatry. 2013;73:153–60.

    Article  Google Scholar 

  • Schmahl C, Bohus M, Esposito F, Treede RD, Di Salle F, Greffrath W, Seifritz E. Neural correlates of antinoception in borderline personality disorder. Arch Gen Psychiatry. 2006;63(6):659–66.

    Article  Google Scholar 

  • Segal H. Dream, phantasy and art. London: Routledge; 1991.

    Google Scholar 

  • Simons LE, Moulton EA, Linnman C, Carpino E, Becerra L, Borsook D. The human amygdala and pain: evidence from neuroimaging. Hum Brain Mapp. 2014;35(2):527–38.

    Article  Google Scholar 

  • Steiner J. Psychic retreats. Pathological organizations in psychotic, neurotic and borderline patients. London: Routledge; 1993.

    Google Scholar 

  • Steiner J. Narzißtische Einbrüche: Sehen und Gesehenwerden. In: Weiß H, Frank C, editors. Scham und Verlegenheit bei pathologischen Persönlichkeitsorganisationen. Stuttgart: Klett-Cotta; 2006.

    Google Scholar 

  • Steiner J. Seelische Rückzugsorte verlassen. In: Weiß H, Frank C, editors. Therapeutische Schritte zur Aufgabe der borderline-position. Stuttgart: Klett-Cotta; 2014.

    Google Scholar 

  • Stoffers J, Lieb K. Pharmakotherapie der Borderline-Persönlichkeitsstörung. In: Dulz B, Herpertz SC, Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 854–64.

    Google Scholar 

  • Weiß H. Das Labyrinth der Borderline-Kommunikation. Klinische Zugänge zum Erleben von Raum und Zeit. Stuttgart: Klett-Cotta; 2009.

    Google Scholar 

  • Weiß H. Wiedergutmachung beim Borderline-Patienten. Jahrb Psychoanal. 2012;65:59–80.

    Google Scholar 

  • Weiß H. Überlegungen zum agora-klaustrophoben Dilemma des Borderline-Patienten. Psyche – Z Psychoanal. 2015;69:916–35.

    Google Scholar 

  • Weiß H, Horn E, Kidess A, Roman A, Winkler R. Das mobbende innere Objekt – der kleinianische Ansatz in einem teilstationären psychotherapeutischen Setting. In: Dreyer A, Schmidt MG, editors. Niederfrequente psychoanalytische Psychotherapie. Stuttgart: Klett-Cotta; 2008. p. 246–65.

    Google Scholar 

  • Winnicott DW. Transitional objects and transitional phenomena: a study of the first not-me possession. Int J Psychoanal. 1953;34:89–97.

    CAS  PubMed  Google Scholar 

  • Yeomans FE, Diamond D. Übertragungsfokussierte Psychotherapie (Transference-focused Psychotherapy, TFP) und Borderline-Persönlichkeitsstörung. In: Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 543–58.

    Google Scholar 

  • Zanarini MC, Hörz S. Epidemiologie und Langzeitverlauf der Borderline-Persönlichkeitsstörung. In: Dulz B, Herpertz SC, Kernberg OF, Sachsse U, editors. Handbuch der Borderline-Störungen. 2nd ed. Stuttgart: Schattauer; 2011. p. 44–56.

    Google Scholar 

  • Zeeck A, Hartmann A, Küchenhoff J, Weiß H, Sammet I, Gaus E, Semm E, Harms D, Eisenberg A, Rahm R, Wietersheim JV. Differentielle Indikationsstellung stationärer und tagesklinischer psychotherapie: die DINSTAP-Studie. Psychother Psych Med. 2009;59:354–63.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Robert-Bosch-Krankenhaus, Abt. Psychosomatische Medizin, Stuttgart, Germany

    Heinz Weiss

  2. Sigmund-Freud-Institut, Frankfurt, Germany

    Heinz Weiss & Margerete Schött

Authors
  1. Heinz Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margerete Schött
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heinz Weiss .

Editor information

Editors and Affiliations

  1. Psychiatric University Hospital Zurich, Zurich, Switzerland

    Heinz Boeker

  2. Hospital of Psychiatry-Psychotherapy-Psychosomatic, General Hospital Frankfurt, Teaching Hospital of the University, Frankfurt, Germany

    Peter Hartwich

  3. Mind, Brain Imaging, and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada

    Georg Northoff

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Weiss, H., Schött, M. (2018). Psychoanalytic Treatment of Borderline Patients in a Day Hospital Setting. In: Boeker, H., Hartwich, P., Northoff, G. (eds) Neuropsychodynamic Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-75112-2_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-75112-2_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-75111-5

  • Online ISBN: 978-3-319-75112-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation