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People with borderline personality disorder (BPD) often describe a longstanding depression or dysphoria central to the disorder. The dimension of chronic inner dysphoria is reflected in the DSM criterion of 'emptiness' and is demonstrated on self--report measures of depression. In this paper, we report on outcomes for patients with BPD treated with outpatient psychodynamic psychotherapy based on the Conversational Model. Data were collected using the Zung depression scale and the Westmead severity scale at 1 year and at 2 years from two groups of patients. One group had 1 year in psychotherapy, the other had 2 years in therapy. While general symptom scores improved steadily over time in the two--year group, gains for the one-year group tapered off in the second year. Change in depression scores continued at an unchanged rate in the second year for the two--year group compared to a leveling out of gains in the group treated for one year. Gains in general symptom scores were more substantial, suggesting that change in affect occurs more slowly than other symptomatic changes. Drawing upon our findings and those of others in the field, it appears that this slowness of affective change may reflect that patients with BPD have an inner world where predominant negative affectivity became established early in life in the context of disturbances of relatedness. This has implications for the appropriate duration of psychotherapeutic engagement with this group. We argue for more prolonged psychotherapy in this group, which is consistent with current understanding of processes of attachment and development.

This paper gives a brief outline of the Conversational Model which is among the best validated of currently employed psychotherapies. The theory is built around the idea that the central task of psychotherapy is to potentiate the emergence and amplification of that dualistic form of consciousness that William James called self. However, this state of mind cannot he acted upon as if it existed in isolation. Rather, it is part of an ecology that includes the form of relatedness that underpins it. No element of the ecology can change unless the other elements also change. Seen in this way, the form of relatedness is transformational. It is necessarily mediated by conversation consisting of more than its content, the simple transmission of information. The main point of the paper is that the form of the conversation manifests and constitutes not only a form of consciousness but also a form of relatedness. This conception provides a means of testing hypotheses of therapeutic action since it suggests that syntactical structuring, together with the other major elements of language, lexicon, and phonology, allow us to chart the waxings and wanings of personal being in the therapeutic conversation.

This paper suggests that traumatic memories are represented in a way that is qualitatively different from nontraumatic memories. The argument depends upon a concept of self, derived from Hughling Jackson and William James, which is double, involving not only mental life but reflection upon it. Trauma is seen as causing an uncoupling, or dedoubling, of consciousness. The traumatic diminishment of the subject-object distinction in psychic life has several main effects. First, there is a change in the form of consciousness to a state which is focussed on the present and on immediate stimuli. Secondly, the memory system in which the traumatic events are recorded is nonepisodic, lacking the reflective component. In this way, it is unconscious. Thirdly, the traumatized-traumatizer dyad is represented not as two persons in relation but more nearly as a fused monad. This representation is not integrated into the system of self as the stream of consciousness but remains relatively sequestered. This sequestration is 'unstable,' determining rapidly oscillating, and opposite, forms of relatedness, termed 'reversals.' Finally, in an 'uncoupled' state, the interpretation of the 'meaning' of the traumatic event is impaired. Its construction is determined by affect.