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A GREAT DEAL HAS BEEN WRITTEN ABOUT the resistances of borderline patients to ordinary analytic process. These patients present the analyst with a variety of therapeutic dilemmas because their ability to form a true working alliance is too often either fragile or non-existent.
In everyday analytic work, associations and breaks in associations are understood and then interpreted by the analyst. However, severely disturbed patients are not always able to participate in the analysis of the associative process. Instead, they sometimes spend seemingly endless sessions attacking themselves, the analyst, or analysis itself. They may recount bitter complaints about the quality of their lives with apparently no interest in understanding anything new about the cause of their unhappiness. The analyst's attempts to offer help are met with dissatisfaction or rage. Even when these patients appear to receive help with pleasure, they often return to the next session feeling much worse, unable to connect this reaction to the analyst's intervention or to anything else. Borderline patients may react to even tentative interpretations with intense, uncontrolled aggressive outbursts, suicidal gestures or actions, or by abruptly terminating treatment. They often reject attempts by the analyst to remain neutral or to express empathy. The analyst may thus be left feeling as if all analytic tools have been exhausted (cf. Robbins, 1988) ; (Gabbard, 1989).
The patient who maintains an intensely and unremittingly hostile stance toward the analyst inevitably evokes strong countertransference feelings. It is generally agreed that an important aspect of the analyst's task involves identifying and containing these