Notes on the Psychopathology and Psychoanalytic Treatment of Some Borderline Patients

In this paper I intend to describe aspects of the psychopathology and treatment of borderline states in general, but with particular emphasis on the severely traumatized borderline patient. I shall first discuss briefly some recent work on borderline personality disorders and will single out the writings of Otto Kernberg as some of his findings come very close to my own observations of borderline patients. Secondly, I shall discuss states of confusion as an aspect of the psychopathology of borderline states. Thirdly, I shall discuss in some detail the significance of the appearance of a transference psychosis for the understanding of the basic psychopathology and treatment of borderline patients. I shall use clinical material of one severely traumatized borderline patient to illustrate these ideas which come from working with a number of borderline states which I have treated myself or had the opportunity to observe in my supervisory work of other analysts.

In discussing the borderline personality organization, Kernberg (1967), (1968), (1971), (1976) has described in great detail the character structure of these patients and the importance of primitive mechanisms of splitting of the self and objects into good and bad; primitive idealization; denial; omnipotence and, particularly, primitive projective identification, which constitute characteristic defence constellations of these patients. He suggests that there is an excessive development of pregenital and especially oral aggression which tends to induce premature development of oedipal strivings and, as a consequence, there is a particular concentration of pregenital and genital aims under the overriding influence of the aggressive needs. He found that these instinctual conflicts determine the peculiar characteristics of the transference situation of these patients. He stresses their 'excessive aggression which may stem both from constitutionally determined intensity of aggressive drives or from severe early