Borderline states: prognosis and psychotherapy.

In the authors' opinion the borderline concept covers a group of patients difficult to define and to delineate but nevertheless a group different from the conventional diagnostic groups of neurosis and psychosis. During work with a follow-up study of borderline patients it occurred to the authors that the classification of Grinker et al., which makes it possible to divide borderline patients into four groups, can fruitfully be combined with the object relation theory of "the English school" of psychoanalysis. A patient's belonging to one of Grinker's groups is shown to be informative as to how this patient has "solved" what Fairbairn calls "the schizoid dilemma". The conceptual framework thus set up is useful in planning the treatment of borderline patients: each subgroup of borderline patients as described by the authors can be given its own indications and contra-indications as far as working alliance and treatment plan are concerned.