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Treatment of the borderline patient has been a significant issue in the literature and in clinical practice in recent years. The advantages and constraints of mental health systems pose a particular challenge in the treatment of these patients whose needs are highly complex. The focus of this article is one response to this challenge: combined group and individual psychotherapy in a community mental health setting. This article discusses transference and countertransference issues as they presented in a group case study, the method and design of the group case study, and a proposed model for treating borderline patients in a community setting. The group case study allowed observation of the effectiveness and viability of a multidimensional community-based treatment approach. This article discusses only a few of the special qualities of the transference/countertransference experience which are highlighted by this treatment approach.The treatment issues of the borderline patient selected for observation in the group case study were: (a) the intensity and manifestations of the transference and countertransference; (b) the expression of primitive impulses in regressive states; and (c) the preponderance of lower level defenses such as splitting, projective identification, devaluation and idealization. Within a group setting, how these borderline features would present, be managed and modified formed the underlying questions to be addressed.

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The individual who talks of killing others, but then kills himself, has received little attention in the psychiatric literature. This paper describes four young men who shared a number of features, including the initial threat of homicide, which the authors feel represent a serious suicidal syndrome. A striking aspect of these cases is the denial of violent potential by all concerned, including the evaluator. The latter's need to deny his own aggressive and hostile impulses may prevent his acknowledging them in others. The paper concludes with recommendations for evaluation of such patients.