Q. First question: What is your thinking in working with a Borderline? What is your primary goal when working with this type of individual?

Second question? Not sure if you will be able to assist me with this one. What is your thinking in working with Narcissistic? what are your primary goal when working with them?

Third question: Explain the dynamic issues involved in the Narcissistic/Borderline couple. What specific areas would you be particularly concerned with? and can you explain these concepts with your transference and defensive issues,

I am currently working with this population and have no idea what to expect at this moment.

A. As with any medical disorder, there are limits to how well a person with a disease can get. As a physician I hope for 100% wellness, but usually do not get this far along because the disease is only so amenable to treatment. Secondly, when dealing with personality disorders, each type has a certain way of viewing the world. This does not tend to change. Borderlines are black-white and rejection sensitive, narcissists are unable to see things other ways besides their own. Thus, any therapy has to allow for these phenomena.

Borderlines need to be medically stabilized so they can think better and be amenable to therapy. Otherwise, it is like talking to a diabetic to get their blood sugar down. Impossible. Borderlines are very logical in what they do, since their symptoms flow from their biochemistry. To change the aberrant behaviors, you need to change the chemistry, and then do therapy.

Narcissists are close to impossible to do therapy with. They believe they are always right, and are not willing to change their behaviors. Why change if you are already right? And they do not. They only way to get them to change is to have an angle that suggests to them it is in their interest to change.

I do not do couples therapy, so some other member of this panel may be a better person to ask about issues. Positive transference is necessary if you hope to have any therapy work. Counter-transference is irrelevant if you can ignore it. If not, you will be biased. I would recommend not doing therapy with folks you do not like.