• A detailed case report of the long-term intensive psychotherapy of a borderline patient illustrates my approach to such patients. It also raises questions about the value of interpretations in the early phases of therapy of such patients, regardless of which conflicting theories are chosen as the basis of these interpretations. Stress is placed on the value of empathic attunement to the patient, staying with the patient through the many vicissitudes of long-term treatment, and the developmental use the patient made of a long treatment, reliving certain phases of development in the transference. Acquisition of internalized controls may need to occur in this way before the patient is ready to utilize interpretations. Also illustrated are the difficulties in convincing insurance companies and other third parties to support long-term psychotherapy and the effects of such intensive interaction over the years on the psychotherapist.