Prognostic indicators in the psychotherapy of borderline patients.

Although diagnostic and therapeutic difficulties, including countertransference problems, in borderline patients make prognostic estimates hazardous, practical necessity often requires a prognostic judgment regarding treatability. This paper proposes a list of prognostic indicators in borderline patients which may be useful to the psychotherapist in the evaluation of treatability. Unfavorable prognostic indicators include history of brutalized early environment, severe behavior problems in childhood, antisocial behavior, addictions, egosyntonicity, superficial or highly disturbed relationships, marked narcissistic features, injurious social environment; and, in the course of therapy, strong negative reaction of the therapist toward the patient, and antisocial acting out. Suggesting a more favorable prognosis for psychotherapy are: nonspecific personality traits which may promote the therapeutic relationship (likeableness, warmth, reliability, or interest in people), and intact sublimatory outlets (talents, skills). In general, the quality of object relations, especially the therapist-patient relationship, including the countertransference, is crucial to prognosis. The unfavorable prognostic implications of certain atypical forms of anxiety, depression, and dependency, as well as anhedonia and abulia, are discussed. Borderline patients with infantile features probably have better prognosis than is generally recognized; with narcissistic features, a worse prognosis than generally recognized.