The subacute hospital treatment of the borderline patient. II: An integrated focus on splitting.

A psychiatric inpatient unit with expertise in family treatment has developed an integrated effort to provide a one to three month treatment program for hospitalized borderline patients. Treatment goals are more ambitious than those obtainable by simple crisis intervention. Appreciation of staff splitting is enhanced by an intergenerational family systems approach. Early and sustained focus on splitting is aided by the use of a 15 minute educational tape and a weekly therapy group required for all nonpsychotic patients and recommended for their families. Cases illustrating the family perspective and a group therapy session are presented in detail. The therapy group, run by an interdisciplinary team (the authors) requires active staff initiative and confrontation to avoid responsibility-evading patient coalitions. Diagnostic considerations and impact of the program on patients and on staff are discussed.