The Therapeutic use of Writing in the Service of the Ego

The recent intense interest in object-relations theory has illuminated some of the difficulties in treating patients with borderline structures, including narcissistic personality disorders, schizoid, or borderline personalities. These patients have deficits in object relations relating to the early separation-individuation phase of development as described by Mahler (1968). Her stages include normal autism at birth, the developing attachment bond which leads to symbiosis at four to five months, and then the separation-individuation phase ending with object constancy at approximately the fourth year of life. The separation-individuation period is divided into three subphases: differentiation, practicing, rapproachment. It is the failure to achieve object constancy and a well defined sense of self as a separate person that are the core problems in borderline states. Recently, Horner (1975) has suggested that specific failure at any of these stages results in particular pathology later in life. For instance, the patient who becomes fixated at the beginning of the separation-individuation period just as he enters the differentiation subphase may develop into a narcissistic personality disorder. Just as the infant at the beginning of this subphase still sees his mother and himself as one unit, so this type of patient sees important others as extensions of the self. Infantile rage emerges when the other asserts his separateness. The schizoid and borderline personalities are seen to be more advanced, and are disorders of the practicing and rapproachment periods. The borderline does at times experience full differentiation only to retreat from it (Horner, in press), while the schizoid represses the attachment