A Hateful Borderline Patient and the Holding Environment

2002

The International Journal of Psychoanalysis, 2008

The present paper discusses situations in which patient and analyst are involved in obstructive collusions, non-dreams-for-two, shaping enactments. Specifically, it describes explosions in the analytical field, acute enactments, which the analyst assigns, at first sight, to his faulty conduct. The subsequent amplification of the analytical dyad's capacity of symbolization makes the analyst investigate his presumed fault. The present work shows how acute enactments revive traumatic situations that were concealed by previous obstructive collusions, or chronic enactments. During chronic enactments unconscious exchanges occur between the dyad, in which the analyst provides implicit a-function to the patient, little by little recovering the traumatized parts. When there is enough recovery, the protective collusion is undone and the trauma is revived as acute enactment. This revival will not be traumatic because there are mental resources ready at hand to symbolize it. These situations are articulated with borderline patients. The patient clings to the analyst, using him as a protective shield against reality traumas. The implicit and explicit a-function exerted by the analyst contributes to the processing and symbolization of this reality, recovering the injured mind and elaborating the trauma. So the patient creates a triangular space to dream and think.

2020

This paper aims to understand the processes of rupture of the Therapeutic Alliance (TA) of a case of interrupted psychoanalytic psychotherapy (PP) with a patient with Borderline Personality Disorder (BPD). This is a systematic case study that comprises 15 sessions of PP, one patient with complaints of impulsiveness and difficulties in interpersonal relationships, and his female therapist. The sessions were videotaped and transcribed. The identification of ruptures was made by the Rupture Resolution Rating System (3R's). There were 100 ruptures of AT, of these 69% were withdrawal ruptures and 31% of confrontation. We found 30 contributions from therapist to ruptures. The withdrawal ruptures are more subtle and difficult to identify, occurring more frequently than those of confrontation in the treatment. In the case of patients with BPD, therapists should develop skills to make interventions focused on TA. The need for other studies that seek to replicate the research in other cas...

A comparison of the splitting mechanism we see among borderline patients with the psychological gap we notice between ethnic, national, or religious groups in conflict. I will try to illustrate that what we learn in the clinical setting about mending the internal splitting of a borderline patient, tells us a great deal about our understanding of peaceful efforts to create “co-existence” between enemy groups.

The Canadian Journal of Psychiatry, 1984

This single case study illustrates a methodology for identifying recurrent pathological emotional states in a hospitalized, borderline patient. Parallel therapeutic inputs are delineated and examined in terms of patient-specific responses. The results indicate that ratings of nursing notes recorded across three periods of hospitalization can reliably isolate the patient's most salient and debilitating emotional states. State-specific therapeutic interventions are extracted and their effectiveness noted. The analyses illustrate clinical phenomena which are congruent with what is known about borderline symptomatology. In addition, the study locates therapeutic errors which often occur when working with difficult patients.

2020

The reflective capacity needed to mindfully organize and integrate information is under fire from information overload and the trend towards simplistic ‘solutions’ to complex dilemmas threatens that further entrench social problems. Truth, as an inherent value guiding civilized societies, is itself under fire, making the psychoanalytic lens an invaluable tool for creative, respectful engagement with problems in living. Posing the dilemma in that way takes a stand against the language of diagnosis that obscures social problems and makes them even more intransigent. I will discuss how social injustice invites readings of distress in ways that affirm the social order and undermine individual development, and point to how current societal pressures oppose the development of the reflective capacities needed to work towards more effective and human solutions to social problems. I will also suggest how the psychoanalytic lens can aid our efforts towards alleviating human suffering, using c...

Issues in Religion and Psychotherapy, 1981

The physician's dictum is "primum non nocere" first, do no harm. Dr. Allen Bergin is noted for his research showing that psychotherapy in some instances harms the patient or worsens his condition. Dr. Bergin's concern in assigning me this presentation is that we as therapists need to know something of how to recognize and understand the prime candidates for getting worse in improper therapy. Little about the therapy of these patients will be discussed since it can't be learned from a lecture. Those not familiar with it should refer to the most experienced therapist they know. Even he will be challenged. Let us clarify which patients we are talking about. Most therapists have been baffled by certain patients who ;eem to show symptoms of several neuroses, sometimes all at once, and at times psychosis as well. For patients hovering on these borders between categories, various diagnostic terms have been used, the most enduring of which has been, not surprisingly, &...

Comprehensive Psychiatry, 1978

Archives of General Psychiatry, 1981