Customer Reviews

Management of Countertransference with Borderline Patients

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This book represents the end result of a collaboration between two of the clearest thinking clinical minds in our field today. Drs. Gabbard and Wilkinson bring, to this book, a wealth of clinical and teaching experience, deep and comprehensive understanding of the human mind and condition, and an enviable ability to spell out and explain it all. These traits, which the authors share, is evident throughout their book. From the first page to the last, the reader is not only taken into the "consulting room", but into the therapist's inner experience, as well. In a 3-dimensional fashion, the reader is exposed to, and informed about the experience of countertransference. Admittedly, the focus of the book is on countertransference with Borderline patients, but the book goes beyond that, and gives the reader a better understanding about countertransference in general. Specifically, the reader is taken through a process of looking at countertransference as a useful, and natural part of the therapeutic process, and, through the use of vivid and detailed clinical examples, shown how to make use of this phenomenon in treatment.

The book systematically takes the reader from a general overview of the topic, into specific clinical paradigms and situations which frequently occur in the treatment of patients with Borderline disorders. In each situation (or for each paradigm) theoretical explanations are interspersed with clinical examples. In this way, the material "comes to life" and the reader is more easily able to relate to and put himself/herself into the situations described in the book. I have been teaching and supervising psychotherapy for the past 12 years, and can say without hesitation that this is one of the best books available for practicioners and students alike. I highly recommend this book to anyone engaed in or training in the practice of psychotherapy. I also anxiously await the next collaboration from these two authors.

This is the most helpful paper or book I have read on working with "borderline" clients. I am not fond of DSM lablels. While the authors are writing from a theoretical orientation different from my own, the information is clear and theory independent.

They appear to have a magnificent command of the literature on this subject and make complex concepts clear. Most importantly they describe practical ways for the therapist not to lose themselves when dealing with clients most likely to hook the therapist.

This text offered immediate relief to me when I was feeling utterly trapped in the transference/countertransference web created with a highly challenging patient. Gabbard's writing style is accessible and practical, with case examples that are realistic, rather than overly simplistic, as is often the case in other texts. From the first chapter, Gabbard creates a sense of having an ally and regaining the lost analytic space that has been collapsed by the intense dynamic with the patient. Highly useful. Highly recommended.

It seems fair to me to say that Glen Gabbard's body of work is "the bomb" for the therapist whose found himself hopping around the Karpman Drama Triangle with a particularly capable "dramatist," which pretty much is, of course, what one tends to find in the hysteric borderline. One may argue that he treads the same ground again and again, but I find that he does so with different boots on every time he takes us for a hike.

In -Management...-, Gabbard's view is either informed by those who grasp "codependence" more or less as Beattie, Mellody, Schaef, Cermak and others describe it in their mass market texts, or co-dependence is itself simply the larger-world version of transference and counter-transference. Codependence is, after all, a notion of temporary or permanent enmeshment between any combination of people who lose their sense of autonomy owning to interpersonal seductions that appear to offer supplies for their unconscious, narcissistic needs. If that's not a neat description of transference and countertransference, we may need to rethink the two concepts.

Gabbard's and Wilkinson's notions about therapist containment being something like "taking reactivity off the table for the time being, considering the interpersonal and intrapsychic circumstances, metabolizing the affects, detoxifying from impulsivity and responding after due process" describe a staged process one might do as well to teach the patients as well as utilize oneself. (I now have a memonic on a sheet above my desk that reads "Contain. Digest. Detoxify. Consider. Respond.")

Fans of Lorna Benjamin's -Interpersonal Reconstructive Therapy-, and Harry Stack Sullivan's school of thought in general, will find safe harbor here, as will existentialists and gestaltists. Gabbard's always been about marrying up the unconsidered baggage from the past to "the present moment." That said, I don't think this thing is going to insult any psychodynamic or psychoanalytic people, save for a possible lack of terminological density. (-Management...- is not a "hard read," however much the authors may rely on Winnicott, Kernberg, Kohut, Fonagy, Bion, Klein and the rest of object relations gang.)

If that weren't sufficient to make the book worth owning (and reading, highlighting, peppering with notes and flag tags, and then re-reading), the chapter on splitting would have closed the deal for me in a second. We've all read about it 'til our eyes are bloodshot, but the authors' descriptions and extension of the concept into the workaday world of treatment center society is something every mental health professional from psych tech to MD should be required to read at least annually.

I know it's hard to get through school without having to read Gabbard now, but one does him- or herself a favor to look forward to digesting this remarkable volume as an explanation of interpersonal dynamics well beyond, as well as deeply within, that thing we call the "boxing match with the borderline."