OBJECTIVE: This article describes the clinical and theoretical
significance of intolerance of aloneness for patients with borderline
personality disorder. It is intended to make their treatment more effective
and less burdensome. METHOD: Clinical observations from the author's more
than 9,000 hours of psychotherapeutic work and 500 psychotherapy
consultations with borderline patients are synthesized with findings of
relevant empirical studies and attachment theory. RESULTS: Intolerance of
aloneness is a deficit that is associated with the borderline patient's
typical clinging and attention-seeking or detached forms of attachment.
Suggestions are given for ways in which clinicians can respond to these
dysfunctional attachment behaviors to diminish the patient's feared
aloneness without encouraging unnecessary regressions. A framework for
understanding the long-term attachment processes required to correct this
deficit is offered. CONCLUSIONS: Intolerance of aloneness is a core deficit
in borderline patients that can become less handicapping with reliable, but
not excessive, responsiveness of the therapist.