Am J Psychiatry 1987; 144:927-930
Copyright © 1987 by American Psychiatric Association
The initial contract in the treatment of borderline patients
MA Selzer, HW Koenigsberg and OF Kernberg
The initial treatment contract with a borderline patient recognizes the
patient's potential for destructiveness and builds in safeguards. The
therapist's effort to protect the treatment mobilizes the patient's
primitive defenses. The therapist must be prepared to respond to resistance
to the contract by clarification, confrontation, and occasionally
interpretation. Although countertransference reactions evoked by the
patient's use of primitive defenses complicate the therapist's task of
defining the necessary treatment frame, the therapist's recognition of
countertransference responses can enable him to establish and enforce an
appropriate contract.
