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Three Phases of Treatment with Borderline and Psychotic Patients

  • Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid~schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.

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Metadaten
Author:R. T. Waska
Parent Title (English):International Forum of Psychoanalysis, Oslo (Scandinavian University Press) Vol. 11 (No. . 4, December 2002), pp. 286-295.
Document Type:Articles
Language:English
Year of first Publication:2002
Release Date:2012/12/13
Format:PDF-scan upon request / PDF-Scan auf Anfrage
IdNo:Waska_R_T_2002
Erich Fromm's Library and Erich Fromm Archive:Articles / Artikel
Licence (German):
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