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The array of therapeutic techniques available to analysts is so broad as to be downright alarming. Like our experienced patients who are in their second analysis, or who are simultaneously in group, individual, and couples treatment, we have a potpourri of at times interrelated, at times mutually exclusive techniques to draw upon.
This paper will focus on a specific psychotherapeutic technique, called paradigmatic, with a particular type of patient—a borderline man with schizoid, paranoid, depressive and masochistic features— and will present the therapeutic process during three sessions with the patient. Dr. Otto Kernberg's descriptions of the internal phenomenology of the “borderline mind” and the treatment process with such patients is relevant here.
Perhaps the most striking characteristic of the transference manifestations of patients with borderline personality organization is the premature activation in the transference of very early conflict-laden object relationships in the context of ego states that are dissociated from each other. It is as if each of these ego states represents a full-fledged transference paradigm, a highly developed, regressive transference reaction within which a specific internalized object relationship is activated in the transference. Thus the premature activation of such regressed ego states represents the pathological persistence of
Page 101nonmetabolized internalized object relations of a primitive and conflict-laden kind (1).
Within this theoretical framework I want to discuss my understanding of the primitive self-representations and related object representations which are part of Mr. R's psychology. In particular, I would like to demonstrate how paradigmatic techniques elucidate these representations and how the simultaneous focus on my initial feelings and fantasies evoked by the patient provided a more crystallized set of representations to be understood in relation to the transference.
Mr. R. was described as a