The “Holding Function” of the Therapist in the Treatment of Borderline Patients

It is well known that an important difficulty in the treatment of borderlines stems from these patients' intense object hunger and extreme vulnerability to narcissistic injuries in their relationships and in their professional endeavors. This object hunger and vulnerability often precipitate crises in their lives that are dealt with through extremes of withdrawal or promiscuity and repeated emotional discharge in outbursts of rage and in physical outlets including self-mutilation and suicide attempts.

The object of this paper is not to explore the genetic roots and dynamic complexities of these problems, but to expose and clarify some of the technical difficulties that they entail for therapy. I will discuss why the working alliance is particularly difficult to establish in the therapy of borderlines and I will elaborate on the importance of the holding function of the therapist as a support to maintain and enhance the observing, anxiety-containing, and integrative capacity of the ego in these patients.

As the object-seeking of the borderline patient is quickly transfered to the therapist, with both a sense of entitlement and an expectation of rebuff, it often makes for a stormy initial phase of therapy. The therapist can then be misled into early interpretation of primitive instinctual strivings in the transference. This, however, will intensify the already-too-great propensity to regression in these patients; it will make the establishment of a working alliance particularly problematic and it may precipitate acting out.

With borderline patients an important and long period of therapy is concerned with the consolidation of a working alliance resting on an observing ego; for this it is essential that the therapist refrains from doing much more than performing a holding function that, to quote Modell (1976), entails that the therapist “does at times have a better grasp of the patient's inner psychic reality than