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In this clearly written, well-documented presentation, Giovacchini discusses patients with severe characterological problems and primitive mental states as well as those categorized as having borderline psychopathology. He feels that since there is no consensus as to the clinical characteristics of the borderline patinet, rigid definitions are inappropriate. He prefers to think of a borderline spectrum which he identifies from three frames of reference: phenomenological observations, developmental levels, and structural defects. He expresses the need to emphasize and study intrapsychic factors rather than symptomatology. He believes that the stress on biological concepts and pharmacological treatement tends to minimize intrapsychic factors and claims that the aim of such treatment is symptom relief, not the integrity of the patient as an autonomous and worthwhile person. His goal is to convert the borderline patient into a sensitive introspective human instead of a constricted person. He demonstrates his methods for doing this with numerous detailed clinical examples.
He describes patients in the borderline spectrum as being concrete and mechanistic in their thinking. Many can move into a psychotic state and can reintegrate. He ascribes this orientation as resulting from structural discontinuities which prevent such patients from getting in touch with their inner worlds, which contain unconscious