Transference, Incorporation and Synthesis

Formulations about psycho-analytic treatment have evolved mainly from the study of the development of the transference neurosis. In this paper, I will study regression and other changes in the ego state that occur in analysis and will focus upon a clinical group that has often been referred to as borderline states and character disorders. In cases with characterological problems, there is an opportunity to view ego processes and transference more clearly than in cases where ego defects are not prominent. However, I will also consider the psychoneuroses, emphasizing features that are common to all patients who can participate in a psycho-analytic relationship.

As noted in a recent panel discussion (Waelder et al., 1958) of the International Psycho-analytical Association, a comprehensive definition of the character disorders is a difficult and controversial task. In this paper I am referring to a clinical group that is familiar to all analysts because of the special and characteristic difficulties they present in analysis. I use the term character disorder to refer to patients who have reality testing sufficient to distinguish them from a psychotic and yet who find it difficult to relate to objects in an affectively significant fashion. These patients, instead of suffering from circumscribed symptoms, find the task of ordinary living and relating to others difficult and frustrating. Many variables have been considered in order to make such a nosological distinction meaningful. Modell (1963), for example, feels that these patients form an object relation in the transference that is similar to Winnicott's (1953) concept of the transitional object. The conclusions of the recent panel concerning arrested ego development and ego defects are also pertinent both to the understanding of this clinical group and to the thesis of this paper.

Some analysts believe that patients with ego defects present special difficulties in developing a transference neurosis. They make