Borderline patient’s quest for empathy: four female patients in a therapeutic community

One of the main diagnostic criteria of Borderline Personality Disorder (BPD) is an absence of empathy. The concept of empathy does not feature greatly in the literature of the British Psychoanalytic Object Relations Schools. However, the work of both Klein and Bion suggests that there is a normal development of empathy: from ‘part-object’ to ‘whole-object’ relationship. Given this, the development of empathy should be central to the treatment of those with BPD. The communal structure of the Therapeutic Community (TC) would appear to offer an ideal environment in which to foster the development of empathy. This study explored the development of empathy in individuals who have a diagnosis of BPD and had completed a year in a TC. Three women, drawn from one TC, were interviewed in a pilot study. The textual analysis of these interviews suggested an increased appreciation of their thoughts and feelings and an empathic understanding of themselves and others. The interviews of four female, from a different TC, were analysed in the main study. No increase in empathy was identified. These participants reported being taught to manage their symptoms through repression of destructive thoughts and behaviours rather than through the development of empathy. Tentative conclusions and future research: 1. At least in some circumstances people with BPD can increase in empathy: insight, self-reflection, and changes in self-experience; 2. The fact that some participants showed no increase in empathy while others did may reflect individual differences in response to the intervention; and/or 3. There may be critical elements of the TC experience which promote the development of empathy; these elements need to be identified to make interventions more effective.