We will begin with a short historical presentation of the concept of borderline, focusing on the approach taken by psychiatry and psychoanalysis respectively. We will then go on to discuss the two main aetiological models that explain the borderline experience: the mother-child interactional model and the trauma model respectively.

We will explore a phenomenological description of borderline, distinguishing between what I call the logic of despair and the logic of indifference. Finally, I shall introduce a theoretical discussion of the defence mechanisms used by borderline patients - primarily the defence of repudiation (foreclosure).

In this presentation, we will examine the theoretical model underpinning Dialectical Behavioural Therapy (DBT), highlighting the main influences shaping the development of this approach. The evidence base for standard DBT and its many adaptations will be briefly presented. The therapeutic structure and techniques will be reviewed to highlight the applicability of DBT for personality disorder and other disorders of emotional dysregulation and impulsivity.

What is known as the Borderline personality covers a wide sphere of personality tendencies and forms. Its most striking aspects are those of suspicion, instability in relating and poor affect regulation. In this presentation, Franklyn will discuss some of the pioneers in the acknowledgment and exploration of this unstable personality form. He will look at ideas from Ronald Fairbairn, Donald Winnicott and Frank Lake, emphasising the territories of the early relational experience, object relation theory, pre- and perinatal psychology and the early care-giving environment.

By its very nature, trauma or abuse objectify the victim, creating an unbearable sense of shame for the sufferer. This shame contributes to the pattern of behaviour and relationship in which the patient oscillates repeatedly between a kind of adhesive attachment to the therapist and a violent rejection, in which the relationship with the therapist is smashed up or obliterated. Labelling this as BPD can be another way to objectify the patient with a diagnosis. The implications of these issues for our clinical practice will be explored in this presentation.

From its inception psychoanalysis has sought to affect a cure through the therapeutic relationship between analyst and analysand. In this session we will look at what happens when the established framework of the psychoanalytic process is challenged by those with borderline personalities, and how we might understand the analysand who is unable to engage with therapy and how we might bring them to a point where they are able to do so.

The fragmentation characteristic of BPD poses challenges for containment and integration. Working from an attachment based perspective using the Jungian notion of archetypal energies can be a fruitful way of helping to integrate split off aspects of the person, engaging the client in a different relationship with their psyche and its processes. We will explore new approaches for treating the personal archetypical energies of The Victim, The Abuser, The Judge, The Witch, The Saboteur, the Perpetrator and many more of the 'difficult' aspects commonly found in people suffering from BPD in a non-shaming way. Through such treatment it is possible to 'clear' the traumatic patterns and 'personality grids' which constitute BPD. By working simultaneously with the person and their parts (the archetypal energies and internalised object relations) and clearing core traumas which have distorted the person's development, the ego is strengthened through integrating these energies/aspects of the self, thereby reducing the BPD's tendencies to be triggered by PTSD into dis-regulated 'states' of mind.

This presentation will consider the importance of both aetiology and neurobiology in diagnosing and understanding the psychiatric patient who is presenting with severely disorganised moods and behaviour. Using case material we will consider how we can apply an understanding of the neurological organisation of the emotional operating systems in conjunction with an assessment of the patient's unique history to provide the most effective psychiatric/psychotherapy combined treatment.

Borderline structures refer to a disorganisation of mind, characterised by dysfunctional psychological defences, poor reality testing, and dsyregulation of affect and arousal homeostasis. Subjectively, the patient experiences rapid oscillations of attachment emotions - especially love, hate, shame and fear - and cannot maintain an integrated sense of self over time. This type of personality disorganisation is associated with violence to the body in the form of self-harm, and (rarely) violence to others. In this presentation, I will explore how psychological therapies may be helpful in re-organising defences and homeostasis, especially therapeutic techniques that promote mentalisation - the capacity to keep mind in mind.

In 1999 Dr de Zulueta wrote a review on the subject of borderline personality disorder (BPD) as seen from an attachment perspective. Ten years later, having worked with patients suffering from complex Post Traumatic Stress Disorder, she is struck by the similarities and links between their symptoms and those of patients diagnosed as suffering from a BPD. This presentation focuses on the psychobiological basis of their pathology in terms of attachment research and what clinical implications this may have in terms of their diagnosis and treatment.

Using a verbatim session with a patient who had been previously diagnosed as borderline/psychotic, we will discuss how relational self psychologists attempt to engage in healing therapeutic dialogues with these often difficult patients. From a self psychological perspective, borderline patients are often fragmentation-prone and rageful until they are able to develop a sustaining empathic connection with their therapists. What is most difficult for those doing therapy with such people is their boundary challenging behaviour, but I will illustrate how this is always in the service of health rather than pathology. We will look at how differentiating between safety and boundaries facilitates self development, the role of heightened affective moments in strengthening the self, the interactions that catalyze affective regulatory structures in the patient while concurrently strengthening and reorganizing the therapist's self organization.

In this presentation I will review the evidence for effectiveness of a number of modalities of treatment for borderline personality disorder. I will concentrate on studies that evaluated psychodynamically-informed approaches (mentalisation-based treatment, transference focused psychotherapy, group psychotherapy and multi-modal approaches) as well as cognitive-based models (schema-focus therapy, dialectic behaviour therapy and cognitive-analytic therapy). A critical evaluation of what constitutes accepted evidence of effectiveness will be also discussed.

I will initially explore the nature of borderline patients' viscerally disturbing experiences. We will then consider what makes them different from the 'normal-neurotic' via the way this difference is embodied by the psychotherapist, for whom the countertransference reactions cause profound disturbances that resonate with those of the patient. Because losing one's therapeutic equilibrium is axiomatic, I will detail the way in which benign authority, through attunement and limit setting, can support the therapist, especially when confronted by their own idiosyncratic limitations.

In the final session, participants will have an opportunity to draw together those aspects of the summer school which may be of greatest relevance to their work, and to consider new approaches to the conceptualisation and treatment of borderline personality disorder.