The author discusses the treatment needs of the young, self-destructive, unstable borderline client. A practice approach reformulated on the basis of recent research findings on borderline developmental history and course of illness is presented. This approach employs strategies derived from trauma recovery and brief treatment to address self-destructveness and high rates of attrition in this clinic population as well as the demands of managed mental health care for briefer, more effective treatment. Pragmatic goals and structured, focused interventions for initial contacts or the early stage of treatment are outlined and illustrated.
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