Q. I am presently working with a client diagnosed with BPD who is currently being treated by her psychiatrist using Electro Convulsive Therapy. She began getting the ECT treatments about a year ago on a weekly basis - she is now on a maintenance program of every other week. As ECT is a fairly controversial and invasive treatment (client must be fully under anesthesia for each treatment), I am searching for more information on this treatment. Was wondering what your thoughts were on ECT treatment for borderline personality? Could you refer me to some reference material? Would appreciate any help you could offer me. Q. There is scant data on the topic. Only one article mentions it, and it suggests that most, but not all patients, lose the beneficial effects of ECT after 15-20 treatments. Some continue to benefit. It is an open trial to boot.

  A. ECT is a controversial treatment, but as long as it is working, it is hard to complain. I am a proponent of medications, as is abundantly evident from my letters. I would always like to see a patient on medications. Particularly with BPD, since the ECT often interferes with therapy. I think therapy is very necessary after getting a patient medically stable.

I would discuss any concerns you have with the doctor doing the ECT, not the patient. This prevents splitting (putting the patient in the middle) and counter transference by the patient to the ECT performer, you, or the doctor doing the ECT toward the patient.