Core issues in the treatment of personality-disordered patients.

I have offered my understanding of the primary psychological problem for personality-disordered patients. They lack some or all of the selfmaintenance capacities that are required for basic self-stability and survival. That is, they cannot sufficiently provide themselves the experience of being real, warmly secure, worthy, and self-loving, and of having a genuine identity. To the extent these capacities are lacking, patients must depend on others to provide them. Their primary defense is denial. One key to treatment is the analyst’s knowing in his own feelings the feelings that patients bring to him. I have also discussed the defenses patients use to prevent internalizing others’ experience of them, thus depriving themselves of the resources they need for experiencing their self-qualities. Treatment requires a face-to-face analytic situation. I have also described the difficulties presented to patients when they are making progress. They can become significantly unfamiliar with themselves, and this may induce temporary regressions.