This year marks 50 years since John Gunderson and Margaret Singer identified borderline personality disorder as a distinct psychiatric disorder, yet the history of the syndrome predates this pioneering work by several decades. Undoubtedly, the evolution of the borderline personality disorder construct occupies a position of great importance in the history of psychiatry; debates surrounding its nature, etiology, and diagnosis continue to fill the pages of psychiatric and psychotherapy journals around the world. This article seeks to provide a brief overview of the history of borderline psychopathology, from early descriptions of "borderline schizophrenia" to Gunderson's identification of borderline personality disorder and beyond. It focuses mainly on the evolution of psychoanalytic models of borderline personality disorder, including work by theorists such as Kernberg, Masterson, and Adler, but also covers Linehan's development of dialectical behavior therapy and more recent discussions regarding the relationship between borderline personality disorder and complex trauma. We argue that understanding the history of borderline personality disorder can enrich contemporary practice and inform current discussions regarding the disorder's nosological status.

In 2021, in the wake of rising anti-Asian violence in the United States and abroad, we piloted a group psychotherapy intervention for Asian American and Pacific Islander (AAPI) patients in the outpatient services department of McLean Hospital. The group, which lasted 12 weeks and took place virtually, included five group members and combined an interpersonal process group psychotherapy approach with the multicultural orientation framework. In this article, we discuss the intervention design as well as three key clinical vignettes from the group that challenged fundamental assumptions about ourselves as Asian American therapists and about the creation of a group that centers race, culture, and mental health. In particular, through discussion of the vignettes, we explore three scenarios that group therapists may face when facilitating similar multicultural groups: (1) drawing on notions of racial melancholia and racial dissociation, how to manage intragroup conflict between individuals with starkly different relationships to race and racial identity; (2) how to respond to intersectional microaggressions occurring between group members within a multicultural framework; and (3) where to draw the limits of psychodynamic approaches to psychotherapy in multicultural settings. Ultimately, we find that clinical encounters cannot be divorced from the histories and institutions that frame those encounters. Failure to recognize the impacts of such historical and institutional forces on clinical work risks perpetuating the inequities seen in mental health outcomes for AAPI individuals and communities.

Introduction: Intensive short-term dynamic psychotherapy (ISTDP) focuses on emotional processing and the resolution of internal conflicts. This randomized pilot and feasibility study evaluated the implementation of a novel 12-week group program based on ISTDP model, and compared clinical outcomes in reducing symptoms associated with personality vulnerabilities (e.g., emotion regulation, self-harm). The setting of the study was an Australian Public Hospital Service. Methods: Participants were referred to a brief intervention service for personality disorders and were randomly assigned to either the ISTDP group or the dialectical behavior therapy (DBT) group. Outcome measures included questionnaires assessing mood and distress, emotion dysregulation, disassociation, and DBT skill use. Feasibility outcomes, such as recruitment, attrition, and potential participants' experiences of the therapy, were also evaluated. Results: A total of 15 participants were recruited, with nine randomly allocated to the ISTDP group and six to the DBT group. Both groups showed improvements in clinical symptoms, including reductions in depression, emotion dysregulation, and dissociation. The ISTDP group also demonstrated a reduction in anxiety and stress. Follow-up surveys indicated that participants found both group interventions relevant, useful, and beneficial for managing their thoughts and emotions. Conclusion: Both the ISTDP and DBT interventions were well received by participants, and no adverse events were reported, further supporting their potential for implementation in public hospital settings and feasibility.

Some patients, especially those encountered early in one's career, become emblazoned in memory. Such was the case for this author with Rudy. His is a moving story by virtue of who he was and what happened to him. From him, I learned of the potential for deeply mutative work with medically ill patients, even in the context of infrequent meetings. I learned how and why in supportive, dynamically oriented therapy, there are times when bending the frame is essential. Rudy taught me-and my students-how important the "art" of medicine is and about the potential for "healing" even in the absence of cure. His story conveys the deep psychological impact of childhood illness and demonstrates the potential to reverse some of that impact when illness is encountered once again in adulthood. The theme of the "music" of the consulting room provides an organizing metaphor for the dialectic of spontaneous, emotionally engaged responsiveness and disciplined restraint that optimally characterizes dynamic psychotherapeutic work.

Transcranial magnetic stimulation (TMS) is an established treatment for mood disorders, yet its relevance to psychodynamic psychotherapy remains underexplored. This conceptual article integrates neuroscience and psychoanalytic theory to examine how TMS may influence insight and affect regulation and the therapeutic relationship. By enhancing neuroplasticity, TMS may reduce resistance and support deeper emotional processing, potentially increasing receptivity to psychodynamic work. At the same time, neuromodulation may alter transference dynamics and perceptions of the therapeutic alliance. The article also explores how the treatment environment, including sensory input, relational context, and the symbolic role of the TMS provider, shapes psychodynamic engagement. A dedicated section outlines what a psychodynamically informed TMS setting may look like. Rather than viewing TMS as solely biological, the article proposes an integrative model in which neuromodulation and psychodynamic therapy are mutually reinforcing, emphasizing the importance of setting, psychoeducation, and relational attunement in maximizing therapeutic impact.

The meaning of being adopted is a process that needs to be reworked throughout the life cycle. Therapists ought to be familiar with the concerns that are pertinent to patients who are adopted but must be careful not to place adoption at the center of the therapy if this is not why patients are seeking help. The object relations of the adopted person will play an important role in therapy, given that the person has two sets of parents, one real and another that may exist only in fantasy. The most commonly reported negative self-representations of patients in treatment who are adopted include feelings of being unwanted and therefore undesirable. In patients in which adoption plays a central role, there are seven core issues that can be used as a guideline in psychotherapy with an individual affected by adoption: loss, rejection, guilt and shame, grief, identity, intimacy, and control. It is very difficult to predict the risk for psychopathology and long-term outcomes of adoptees because of the many variables and their complex interplay, yet research findings reveal that the majority of adoptees are functioning well. Research studies support the advantage of adoption over placement in foster care, in institutions, or with uncaring, abusive, or neglectful biological parents.

Mentalization-based therapy (MBT) formulates eating disorders as disorders of the self. This article examines the meaning of self-hatred and self-directed negativity as manifestations of self-alienation and vulnerable mentalizing. Relevant concepts are examined to substantiate MBT as a clinical approach to negative self-representations and epistemic mistrust. In this context, MBT states that a clinician's not-knowing stance is crucial to help elucidate underlying states of mind. Additionally, representing the patient as possessing an agentic-self is seen as crucial to the generation of curiosity about rigidified definitions of the self. Clinical vignettes are provided, and guidelines relevant to clinical practice are proposed.

A survey of 20 older psychodynamic psychiatrists was conducted to determine practice metrics, venues of clinical care, and clinician's subjective observations. The post-pandemic normalization of teletherapy, societal acceptance of psychoactive medication into the practice of psychotherapy, significant advances in medical care for older persons, and increased utility of computer technology have enabled clinicians to work into their later years. The integration of supportive therapeutic techniques with psychoanalytic principles coupled with long-term weekly or biweekly treatment has largely replaced intensive formal psychoanalytic therapy of an earlier era. How aging may impact the therapeutic relationship and matters of health and mortality may need to enter the therapeutic dialogue. Minor deficits in cognitive function may be offset by note-taking and session reviews. The benefits of wisdom and experience often unburdened by the demands of earning a livelihood or furthering professional ambitions may render care by secure older psychodynamic psychiatrists effective.

This article immerses the reader in the psychoanalytically oriented psychotherapy of an adult patient suffering from extreme loneliness. It describes healing that occurs slowly and involves the psychotherapist's active searching-through historical research, dreaming, and countertransference-to locate and recognize the patient. It demonstrates how the confluence of personal history with larger sociohistorical forces can be revealed through enactment in the transference and countertransference.

In transference-focused psychotherapy (TFP), an evidence-based treatment for patients with borderline personality disorder (BPD), the attention paid to establishing and tracking goals is both organizing and distinctive. The objective of this article is to describe TFP's unusual emphasis on first elucidating and then focusing on a patient's concrete, measurable personal goals. We review the critical distinction between the patient's goals and the therapist's goals. We also provide pertinent examples of material related to goals in TFP. The examination of the role of goals in the treatment of patients with BPD has significant salience given accumulating data that suggests that symptom remission does not reliably lead to enhanced functioning (sustained work/study performance, stable relations with a partner or parents) in this patient population.