In 2013 the Italian Region Emilia-Romagna has produced "Suggested guidelines for the treatment of severe personality disorders" that recognize the need of specific "psychotherapeutic" approaches for these particular patients, and only occasional use of medication. However, clinical practice in Mental Health Centers is characterized by the opposite: more medication and less psychotherapy. It is difficult to work psychotherapeutically with these patients because they induce in the therapists a countertransference characterized by rejecting acting-out and by the psychiatrist’s fear of legal responsibility. The aim of these "Suggested guidelines" is to improve clinical practice, but they are too "prudent" since do not succeed in overcoming the psychiatrist’s fear of legal responsibility and the unfortunate current trend of a "psychiatry subdued to the judiciary system", which reasserts a "technological paradigm".
Keywords: Severe personality disorders, treatment guidelines, psychiatrist’s legal responsibility, psychotherapy, countertransference