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There is expanding agreement among psychoanalytic clinicians that borderline psychopathology is comprised of a continuum or spectrum of interrelated narcissistic syndromes, common to whose pathogenesis is a developmental fault that renders their victims highly vulnerable to real or fantasized abandonment. There is also growing awareness that narcissistic personalities represent “higher-level” borderline personalities, as it were, in that both share similar internalized object relations, abandonment-related anxiety and depression, identity impairment, various degrees of regressionproneness and impairment of the sense of reality, and notable impairment of the capacity to mourn. Impaired object constancy (or, more accurately, impaired object permanency [Rinsley, 1984, 1985]), that is, dysfunctional evocative memory, typifies borderline personalities and contributes to the storminess of their interpersonal, including psychotherapeutic, relationships. What is missing from these patients' inner lives and worlds is a dependable source of self-coherence and meaningfulness—the proverbial good object—to put to rest the affectomotor instability, with its resultant feelings of emptiness and aloneness, to which borderline personalities are ever-prone.
Not many clinicians understand this as well as Gerald Adler. An immensely sensitive and caring man, Adler combines within himself the accomplished psychoanalytic clinician, the careful and integrative theorizer, and the effective writer, and his book reflects these qualities. It is, in his own prefatory words, a synthesis of work accomplished over 15 years, sometimes in collaboration with his colleague, Dan Buie. It consists of 13 chapters organized under 3 Parts: Part I consists of 3 chapters devoted to development and dynamics; Part II consists of 7 chapters devoted to psychotherapy, including one chapter adapted from Adler's important earlier paper on the borderline-narcissistic personality disorder continuum; Part III consists o