The authors contrast two paradigms for long-term treatment of borderline
patients: 1) modified psychoanalytic psychotherapy, which attempts to bring
about structural intrapsychic change, and 2) psychotherapy that strives
only to improve adaptation. They demonstrate the divergent uses of the
psychiatric hospital for these two treatments and the potential for
regression and hospital failure when conceptual conflict arises between
inpatient and outpatient clinicians or when the hospital mixes aspects of
these often antithetical treatment models.