Editorial

In the recent debate around Otto Kernberg's paper published on the IJPA website and laying out the differences between psychoanalytic psychotherapy, standard psychoanalysis and supportive analytically-based psychotherapy, most of the email respondents were critical of his three divisions, stating that no such clear-cut differences can be made in practice. All analysts are engaged in all three modalities in the course of an analysis, and several thought that the distinctions made by Kernberg were for political purposes and ‘identity politics’. He called for psychoanalytic training institutions to offer psychoanalytic psychotherapy courses, as this is the modality best suited for more disturbed borderline and other personality disordered patients. Kernberg's paper suggests that psychoanalytic psychotherapy, to the extent it deals with severe identity disturbances, has a special expertise to offer, with wider parameters of technique that differ from standard psychoanalysis. However, I appreciated Quinodoz's comment that all candidates should be trained to recognize, understand and deal with primitive/psychotic organizations as well as neurotic organizations. Since many patients presenting for treatment now, including training patients on psychotherapy courses, have severe personality disorders, trainers and supervisors need to be aware of and prepared for patients with primitive/psychotic areas and perhaps, another frequent comment in the emails, require a diagnosis from the assessors or referrers.

Therapeutic change comes about through modifying the patient's internal objects or object relations, although the extent to which different therapists rely on the transference in their work varies. Some analysts more actively pursue the transference, constantly presenting themselves as transference figures, real or wished for, reworking and working through, while others are more shadowy, letting the patient get on with it, hanging back until, like the blacksmith, s(he) can st