By most accounts, people with a borderline personality disorder prove exceptionally difficult to treat. Divergent opinions abound about what, if anything, contributes to a positive outcome. Is it the quality of the relationship with the psychotherapist that is curative, in that the careful attunement of therapist to patient enables the development of a more secure attachment experience? Or is it the technical and structural parameters of the therapy-i.e., therapist neutrality, frame issues, and defensive operations combined with skillfully formulated and timely interventions? Taken together, the findings of attachment research and object relations theory offer an integrated understanding of borderline personality disorder as an attachment disorder that relies on a pervasive false self for adaptation and personal connections. A particular corrective relationship experience, therefore, is necessary if positive personality changes and improved adaptive capacities are to result.
In Another Chance to Be Real, Donald and Deanda Roberts propose a treatment approach, specific to those suffering from borderline personality disorder, that emphasizes both relational and technical variables as necessary in eliciting a positive treatment outcome.