Making Sense of Chronic Relationship Instability

Key points

Chronic interpersonal instability is a hallmark of severe personality disorder.

Patients may select bad objects but characteristically spoil good ones.

Treatment must address paradox and contradiction, not just encourage better object choice.

A significant minority of patients seen in consultation for psychotherapy present with chronic relational instability: a longstanding pattern of chaotic, tumultuous interpersonal relationships. Many of these patients meet criteria for a Cluster B personality disorder, such as borderline personality disorder, or report a diagnosis of complex posttraumatic stress disorder.

Often, the relational histories of these patients are so dramatic that the therapist has a sense that the patient is the unluckiest person alive for having bee