I Hate You--Don't Leave Me - Jerold J. Kreisman [74]
Focusing on current, more practical issues, supportive therapy tries to quash suicidal and other self-destructive behaviors rather than to explore them fully. Impulsive actions and chaotic interpersonal relationships are identified and confronted, without necessarily acquiring insight into the underlying factors that caused them.
Supportive therapy may continue on a regular basis for some time before dwindling to an as-needed frequency. Intermittent contacts may continue indefinitely, and the therapist’s continued availability may be very important. Therapy gradually terminates when other lasting relationships form and gratifying activities become more important in the patient’s life.
In supportive therapy the patient tends to be less dependent on the therapist and to form a less intense transference. Though some clinicians argue that this form of therapy is less likely to institute lasting change in borderline patients, others have induced significant behavioral modifications in borderline patients with this kind of treatment.
Group Therapies
Treating the borderline in a group makes perfect sense. A group allows the borderline patient to dilute the intensity of feelings directed toward one individual (such as the therapist) by recognizing emotions stimulated by others. In a group the borderline can more easily control the constant struggle between emotional closeness and distance; unlike individual therapy, in which the spotlight is always on him, the borderline can attract or avoid attention in a group. Confrontations by other group members may sometimes be more readily accepted than those from the idealized or devalued therapist, because a peer may be perceived as someone “who really understands what I’m going through.” The borderline’s demanding nature, egocentrism, isolating withdrawal, abrasiveness, and social deviance can all be more effectively challenged by group peers. In addition, the borderline may accept more readily the group’s expressions of hope, caring, and altruism.4,5,6
The progress of other group members can serve as a model for growth. When a group patient attains a goal, he serves as an inspiration to others in the group, who have observed his growth and have vicariously shared his successes. The rivalry and competition so characteristic of borderline relationships are vividly demonstrated within the group setting and can be identified and addressed in ways that would be inaccessible in individual therapy. In a mixed group (that is, one containing lower and higher functioning borderlines or non-borderlines), all participants may benefit. Healthier patients can serve as models for more adaptive ways of functioning. And, for those who have difficulty expressing emotion, the borderline can reciprocate by demonstrating greater access to emotion. Finally, a group provides a living, breathing experimental laboratory in which the borderline can attempt different patterns of behavior with other people, without the risk of penalties from the “outside world.”
However, the features that make group therapy a potentially attractive treatment for borderlines are the very reasons many such patients resist group settings. The demand for individual attention, the envy and distrust of others, the contradictory wish for, and fear of, intense closeness all contribute to the reluctance of many borderline patients to enter group treatment. Higher functioning borderlines can tolerate these frustrations of group therapy and use the “in vivo” experiences to address defects in interrelating. Lower functioning borderlines, however, often will not join and, if they do, will not stay.
The borderline patient may experience significant obstacles in psychodynamic group therapy. His