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Partial Hospitalization

Partial (or day) hospital care is a treatment approach in which the patient attends hospital activities during part or most of the day and then returns home in the evening. Partial hospital programs may also be held in the evening, following work or school, and may allow sleeping accommodations when alternatives are not available.

This approach allows the borderline to continue involvement in the hospital program, benefitting from the intensity and structure of hospital care, while maintaining an independent living situation. Hospital dependency occurs less frequently than in long-term hospitalization. Because partial hospitalization is usually much less expensive than traditional inpatient care, it is usually preferred for cost considerations.

Borderlines who require more intensive care, but not twenty-four-hour supervision, who are in danger of severe regression if hospitalized, who are making a transition out of the hospital to the outside world, who must maintain vocational or academic pursuits while requiring hospital care, or who experience severe financial limitations on care may all benefit from this approach. The hospital milieu and therapy objectives are similar to those of the associated inpatient program.

The Rewards of Treatment

As we shall see in the next two chapters, treatment of BPD usually combines standardized psychotherapeutic approaches and medications targeting specific symptoms. While at one time BPD was thought to be a diagnosis of hopelessness and irritation, we now know that the prognosis is generally much better than previously thought. And we know that most of these patients leave the chaos of their past and go on to productive lives.

The process of treatment may be arduous. But the end of the journey opens up new vistas.

“You always spoke of unconditional acceptance,” said one borderline patient to her therapist, “and somewhere in the recent past I finally began to feel it. It’s wonderful. . . . You gave me a safe place to unravel—to unfold. I was lost somewhere inside my mind. You gave me enough acceptance and freedom to finally let my true self out.”

Chapter Eight

Specific Psychotherapeutic Approaches

There is a Monster in me. . . . It scares me. It makes me go up and down and back and forth, and I hate it. I will die if it doesn’t let me alone.

—From the diary of a borderline patient

True life is lived when tiny changes occur.

—Leo Tolstoy

Borderline Personality Disorder is the only major psychiatric illness for which there are more evidence-based studies demonstrating efficacy from psychosocial therapies than for pharmacological (drug) treatments. Thus, unlike the treatment for most other disorders, medications are viewed as secondary components to psychotherapy. Not only have several psychotherapy approaches been shown to be effective, the arduous and sometimes extensive endeavor of psychotherapy has also been shown to be cost-effective for the treatment of personality disorders.1

Psychotherapy as a treatment for BPD has come a long way since the publication of this book’s first edition. Spurred by rigorous research and constant refinement by clinicians, two primary schools of therapy have emerged—the cognitive-behavioral and psychodynamic approaches. In each category several distinct strategies have been developed, each supported by its own set of theoretical principles and techniques. Several psychotherapy strategies combine group and individual sessions. Though some are more psychodynamic, some more behavioral, most combine elements of both. All embrace communication that reflects SET-UP features that were developed by the primary author and discussed in detail in chapter 5: Support for the patient, Empathy for his struggles, confrontation of Truth or reality issues, together with Understanding of issues and a dedication to Persevere in the treatment.

Proponents of several therapy approaches have attempted to standardize their therapeutic