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We discuss consciousness from evolutionary and developmental perspectives. The expansion of communicative abilities was a necessary step for the emergence of a new type of cooperation based on equality that probably appeared for the first time among nomadic hunter gatherers during the upper Paleolithic era. In turn, this new level of cooperation gave raise to an expanded form of consciousness. From a developmental perspective an expansion of intersubjective abilities and consciousness go together. Three basic levels of intersubjectivity are present in humans. A primary form of intersubjective communication is accompanied by a primary form of consciousness that is not easily accessible for conscious scrutiny. During the second year of human life secondary forms of intersubjectivity expand consciousness from the immediacy of one-to-one interactions, to include a shared understanding of intentions and goals with caregivers. Secondary forms of intersubjectivity give raise to the type of consciousness characterized by preverbal symbols and images-a primordial form of conceptual knowledge. A further step in intersubjective communication uses the meanings and concepts that have emerged earlier in development and transforms them into words. The leap into language allows our species to conceive past, present, and future simultaneously. The cultural transmission of knowledge and social mores depends on these abilities. This further expands the scope of consciousness and creates conditions for self reflection, a type of consciousness that is uniquely human. [ABSTRACT FROM AUTHOR]

The clinical management of borderline personality disorder (BPD) commonly employs treatments administered in different settings by different clinicians (e.g., individual psychotherapy and drug prescriptions, or individual and group psychotherapies). The general consensus of clinicians on the importance of using different therapists and different settings simultaneously in treating borderline patients is acknowledged by the guidelines for the treatment of BPD provided by the American Psychiatric Association. This widespread type of clinical practice is not supported, however, by a unifying theoretical model explaining the specific effects of a multiple therapist, multi-setting approach in treating BPD. [ABSTRACT FROM AUTHOR]