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In 1981 I presented a paper which stated in summary that
The borderline patient's personality-organization renders ever-present, for him, the danger of separation and loss. He is continually faced with the threat of loss, either of his tenuously established individual identity, through fusion with the other person, or of his fragile interpersonal relatedness, through uncontrollable flight into autism of psychotic degree….
In that paper I discussed various aspects of the patient's personality functioning in this regard; but presentation time and publication space allowed me to include only half of my originally written theoretical points and illustrative clinical vignettes. The present paper is intended, while including a minimum of repetition of the first one, to convey most of my additional contributions to this subject.
A basic theme in one's work with these individuals is that of unconscious, fantasied omnipotence, variously an aspect of the patient's unconscious self-image, or projected into the therapist. This theme appears much more subtly than one finds it in overtly psychotic patients and requires one, therefore, to be attentive to its presence.
Typically, the therapist is assumed to be omnipotent and not himself subject, therefore, to any uncontrollable losses. Thus if the treatment is interrupted by some loss on the therapist's part, this is assumed by the patient to be something calculated by the therapist to tyrannize, or otherwise seriously discommode, him. He reacts analogously when he, himself, experiences significant loss. First of all, such an experience is usually long in