LONG-TERM PSYCHOTHERAPY IN BORDERLINE AND NARCISSISTIC DISORDERS - WHEN IS IT NECESSARY

Objectives: This paper explores the barriers and impediments to psycho logical change in those patients with borderline and narcissistic char acter pathology requiring long-term psychotherapeutic treatment. Metho d: Examination of the relevant literature was made and the author's cl inical experience included. Results: Those patients with borderline an d narcissistic character pathology requiring long-term psychotherapeut ic treatment to achieve lasting psychological change are characterised by their experience of severe early developmental trauma. This has re sulted in the formation of entrenched adverse relational patterns whic h are unconscious, difficult to bring into consciousness and slow to c hange. These patients have failed to establish security of attachment patterns in the course of a depriving and/or traumatic childhood, ofte n in the care of parents with similar character pathology. Such patien ts will often require a therapeutic relationship with an emotionally r esponsive therapist sustained over time within a secure therapy frame to achieve tasting psychological change. Conclusions: Patients with bo rderline and narcissistic pathology who have sustained severe early de velopmental trauma will often require long-term psychotherapeutic trea tment to achieve lasting psychological change. Such treatment is neces sary for the relief of suffering in the patients, and may contribute t o the alleviation or prevention of the intergenerational transmission of these disorders.