Self-Organizing Therapeutic Systems in Outpatient Therapy of Borderline Patients with Substance Use Disorders



Using a clinical case of three brothers, we discuss a spontaneous, self-organizing family system framework that prevents withdrawal from therapy and acting-out of the borderline clients diagnosed with alcohol dependence. This multi-family framework includes several family members and rests on the symbiotic and co-dependent relational patterns between the clients and their mothers. We discuss the positive and negative aspects of this framework and options for changing it.

General Information

Keywords: alcohol dependence, borderline personality disorder, psychotherapy, family system, genogram

Journal rubric: Case study

Article type: scientific article


For citation: Shustov A.D., Shustov D.I., Tuchina O.D., Shustova S.A. Self-Organizing Therapeutic Systems in Outpatient Therapy of Borderline Patients with Substance Use Disorders. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2019. Vol. 27, no. 4, pp. 165–174. DOI: 10.17759/cpp.2019270411. (In Russ., аbstr. in Engl.)



1.        Greenberg E. Lechenie pogranichnykh rasstroistv [Healing the borderline]. Moscow: KTTs Geshtal’t-Analiza, 2011. 52 p. (In Russ.).

2.        Linehan M. Kognitivno-povedencheskaya terapiya pogranichnogo rasstroistva lichnosti [Cognitive-behavioral treatment of borderline personality disorder]. M.: Vil’yams, 2015. 592 p. (In Russ.).

3.        Merinov A.V. Rol’ i mesto fenomena autoagressii v sem’yakh bol’nykh alkogol’noi zavisimost’yu. Saint Petersburg: Ekspertnye resheniya, 2017. 192 p.

4.        Shitov E.A., Merinov A.V., Shustov D.I., et al. Klinicheskaya i suitsidologicheskaya kharakteristika bol’nykh alkogol’noi zavisimost’yu s soputstvuyushchim pogranichnym rasstroistvom lichnosti [Clinical and suicidological description of alcohol dependent patients with comorbid borderline personality disorder]. Rossiiskii mediko-biologicheskii vestnik im. akademika I.P. Pavlova [I.P. Pavlov Russian medical & biological bulletin], 2015, no. 4, pp. 87—90.

5.        Shustov D.I. Autoagressiya i samoubiistvo pri alkogol’noi zavisimosti: klinika i psikhoterapiya [Self-destruction and suicide in alcohol addiction: clinical picture and psychotherapy]. Saint Petersburg: Spetslit, 2016. 207 p.

6.        Shustov A.D., Klimenko T.V. Strategiya i taktika pri terapii pogranichnykh klientov [Strategy and tactics of treating clients with borderline disorders]. Voprosy narkologii [Journal of Addiction Problems], 2017, no. 6, pp. 117—119.

7.        Shustov D.I., Fedotov I.A., Yurchenko L.N. Kliniko-psikhologicheskaya statika i dinamika terapevticheskikh remissii pri alkogol’noi zavisimosti [Clinical and psychological stato-dynamical characteristics of therapeutic remission of alcohol dependence (review and own findings)]. Narkologiya [Narcology], 2014, no. 9, pp. 57—61.

8.        Shustov D.I., Tuchina O.D. Psikhoterapiya alkogol’noi zavisimosti [Psychotherapy of alcohol dependence]. Saint Petersburg: SpetsLit, 2016. 415 p.

9.        Entin G.M. Letal’nye iskhody pri narusheniyakh rezhima trezvosti posle oposredovannoi stressopsikhoterapii bol’nykh alkogolizmom [Mortality relating to violation of in alcohol-dependent patients who underwent mediated stress-psychotherapy. Sotsial’naya i klinicheskaya psikhiatriya [Social and clinical psychiatry], 2001, no. 4, pp. 88—89.

10.     Masterson J. Psychotherapy of the borderline adult: a developmental approach. New York: Brunner/Mazel, 1976. 377 p.

11.     Miller W.R., Meyers R.J., Hiller-Sturmhofel S. Community-reinforcement approach. Alcohol Research and Health, 1999. Vol. 23 (2), pp. 116—121.

12.     Nowinski J. Facilitating 12-Step recovery from substance abuse and addiction. In Rotgers F., Morgenstern J., Walters S.T. (eds.). Treating substance abuse: theory and technique. New York: The Guilford Press, 2003, pp. 31—66.

13.     O’Farrell T.J. Review or outcome research on marital and family therapy in treatment of alcoholism. Journal of Marital and Family Therapy, 2012. Vol. 38 (1), pp. 122—144. doi:10.1111/j.1752-0606.2011.00242.x

14.     Schiff J.L., Schiff A.W., Mellor K., et al. Cathexis reader: Transactional analysis treatment of psychosis. New York: Harper and Row, 1975. 113 p.

15.     Stoffers J.M., Lieb K. Pharmacotherapy for Borderline Personality Disorder — Current Evidence and Recent Trends. Current Psychiatry Reports, 2015. Vol. 17 (1), p. 534. doi:10.1007/S11920-014-0534-0

Information About the Authors

Alexander D. Shustov, Postgraduate Student, V. Serbsky Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russia, e-mail:

Dmitri I. Shustov, Doctor of Medicine, Professor, Professor, Head of Psychiatry Department, I.P. Pavlov Ryazan State Medical University, Ryazan, Russia, ORCID:, e-mail:

Olga D. Tuchina, Researcher, Moscow Research and Practical Centre for Narcology of the Department of Public Health, Moscow, Russia, ORCID:, e-mail:

Svetlana A. Shustova, PhD in Medicine, Docent, Associate Professor, Psychophysiology Department, I. P. Pavlov Ryazan State Medical University, Ryazan, Russia, e-mail:



Total: 1016
Previous month: 11
Current month: 7


Total: 361
Previous month: 4
Current month: 6