Long-term psychotherapy in borderline and narcissistic disorders: when is it necessary?
OBJECTIVE
This paper explores the barriers and impediments to psychological change in those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment.


METHODS
Examination of the relevant literature was made and the author's clinical experience included.


RESULTS
Those patients with borderline and narcissistic character pathology requiring long-term psychotherapeutic treatment to achieve lasting psychological change are characterised by their experience of severe early developmental trauma. This has resulted in the formation of entrenched adverse relational patterns which are unconscious, difficult to bring into consciousness and slow to change. These patients have failed to establish security of attachment patterns in the course of a depriving and/or traumatic childhood, often in the care of parents with similar character pathology. Such patients will often require a therapeutic relationship with an emotionally responsive therapist sustained over time within a secure therapy frame to achieve lasting psychological change.


CONCLUSIONS
Patients with borderline and narcissistic pathology who have sustained severe early developmental trauma will often require long-term psychotherapeutic treatment to achieve lasting psychological change. Such treatment is necessary for the relief of suffering in the patients, and may contribute to the alleviation or prevention of the intergenerational transmission of these disorders.
Beatson
J A
JA
D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D016241:Child of Impaired Parents / Q000523:psychology; D006801:Humans; D008134:Long-Term Care; D009289:Narcissism; D009769:Object Attachment; D010553:Personality Development; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome