THE MASTERSON GROUP, P.C.

Psychoanalytic Psychotherapy
of the Personality Disorders

Descriptions of Books by James F. Masterson, M.D.

FROM BORDERLINE ADOLESCENT TO FUNCTIONING ADULT: THE TEST OF TIME
Edited by James F. Masterson, M.D. and Jacinta Lu Costello, Ph.D.

This volume presents the first long-term follow-up of psychoanalytic psychotherapy of the borderline patient. It culminates Masterson's 25 years of research and clinical work with these severely troubled youngsters and completes a trilogy on the subject.

In reporting the range of effectiveness of psychotherapy of hospitalized borderline adolescents, the author not only confirms the usefulness of his earlier theoretical assumptions and therapeutic approaches, but also offers valuable new formulations about psychopathology of the self in the borderline, which lead to further refinement of clinical techniques.

Through the use of both clinical and statistical methods, this volume describes how well the treatment results obtained with 31 adolescents and their parents, between 1967 and 1974, have stood the test of time. Research evidence is brought to bear on such vital questions as:

How effective is psychotherapy based on a developmental theory with the borderline adolescent?

Can borderline adolescents overcome their development arrest sufficiently to resume normal emotional growth?

What are the clinical guidelines of progress in treatment?

What are the clinical signs of a good prognosis or of a poor prognosis?

Did the parents learn to support their adolescent's emancipation?

Masterson presents compelling evidence supporting the theory that the borderline syndrome is a stable diagnostic entity which is due to a failure of separation-individuation related to the mother's libidinal unavailability.

The results from this follow-up study demonstrate that a therapeutic approach based on this theoretical assumption has a wide range of effectiveness, depending on the patient, from relief of symptoms and improvement in functioning to profound and enduring change in intrapsychic structure.

Four levels of follow-up impairment - minimal, mild, moderate, and severe - are illustrated by detailed case reports which first describe the clinical evaluation of symptoms and functioning and then go deeper to describe changes in ego development and object relations.

Statistical analyses are then employed on a variety of variables, such as patient characteristics, vicissitudes in the hospital psychotherapy, and admission and outcome characteristics, to reveal significant prognostic factors and guidelines for clinical practice.

The volume also describes interviews with parents which not only corroborated the patient's reports, but also revealed the parents' response to casework and the effect on the entire family of the adolescent's treatment. The results of hospital treatment are then compared with the results of outpatient psychotherapy alone.

Without treatment, most borderline adolescents have a poor prognosis. A large number become juvenile delinquents, drug abusers, or dropouts from society; they never develop an autonomous self or satisfying interpersonal relationships.

Now this important volume demonstrates that, even though therapy with these patients is arduous and time-consuming, the effort is well justified - borderline adolescents can become functioning adults.