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THIS PANEL, THE SECOND IN A SERIES, was designed to demonstrate the application of object relations theory to psychoanalytic technique with a patient who had a neurotic personality organization. In contrast to borderline patients, where an object-relations approach may result in a novel technique, Kernberg pointed out, neurotic patients can be psychoanalyzed utilizing a similar object-relations framework, in a way that deviates little from the traditional approach of ego psychology.
The patient, Mr. B., was a married businessman in his thirties, father of two, who came for help because of persistent anxiety two months after a serious automobile accident. Prior to the accident, he had been chronically depressed. Mr. B. feared criticism and feared being assertive. His perfectionistic and procrastinating style interfered with his work effectiveness. His marriage was one of mutual affection, though he had difficulty expressing warmth to his wife, and their sexual relationship had become routinized and perfunctory. Mr. B. was concerned about his frequent homosexual dreams and masturbation fantasies, although he did not want nor had he ever had actual homosexual experiences.
Mr. B. was the only child of rigid, pious, hard-working parents who expected him to work, cooperate, and comply with the orderliness of the household. His mother was the dominant figure, insisting that Mr. B. study art, which he did with a combination of resentment and some success. He was a good student, and though somewhat reserved, he had a few friends and dated occasionally in high school. His homosexual fantasies began in adolescence. He met his wife in college, and he hoped his marriage would resolve his secret homosexual preoccupations.