The borderline patient's intolerance of aloneness: insecure attachments and therapist availability.
OBJECTIVE
This article describes the clinical and theoretical significance of intolerance of aloneness for patients with borderline personality disorder. It is intended to make their treatment more effective and less burdensome.


METHODS
Clinical observations from the author's more than 9,000 hours of psychotherapeutic work and 500 psychotherapy consultations with borderline patients are synthesized with findings of relevant empirical studies and attachment theory.


RESULTS
Intolerance of aloneness is a deficit that is associated with the borderline patient's typical clinging and attention-seeking or detached forms of attachment. Suggestions are given for ways in which clinicians can respond to these dysfunctional attachment behaviors to diminish the patient's feared aloneness without encouraging unnecessary regressions. A framework for understanding the long-term attachment processes required to correct this deficit is offered.


CONCLUSIONS
Intolerance of aloneness is a core deficit in borderline patients that can become less handicapping with reliable, but not excessive, responsiveness of the therapist.
Gunderson
J G
JG
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
D001010:Anxiety, Separation / Q000517:prevention & control / Q000523:psychology; D001294:Attitude to Health; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D003674:Defense Mechanisms; D005239:Fear; D006801:Humans; D008132:Loneliness; D009769:Object Attachment; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011613:Psychotherapy / Q000379:methods; D012043:Regression, Psychology