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IN THIS ESSAY, I DO the following: first, I differentiate those characteristics of the borderline and the narcissistic personality organizations which, I believe, contribute to important variations in the transference-countertransference matrices typically established by one and the other type of patient. This will include comments on the Kernberg-Kohut controversy. Secondly, I consider how the countertransference difficulties generated by the massive resistances of the borderline patient might induce psychoanalysts to disqualify such patients as analyzable, or to otherwise mistreat them.1
In responding to an earlier draft of this paper, some colleagues challenged the premise that persons can be meaningfully differentiated into one or another of such personality organizations, raising larger issues concerning the pitfalls of diagnostic labeling.2 Once we pin a label on a person, or accept a label as given—and this can begin, of course, with the label, 'patient'—we may be led easily to think of the person as some-thing-known. And, this may stimulate in our thoughts, a process which begins with depriving the patient of his personhood and ends by negating his therapeutic need to be understood as fully as possible in his own terms.
It is, therefore, necessary always to monitor our diagnostic thinking lest we reify our patients or our psychoanalytic constructs. (Feiner 1970), (Schafer 1979) Still, mindful of such cautions, I find