Psychoanalytic Therapy in the Borderline Neuroses

The patients who fall in the so-called borderline group constitute a large percentage of those who seek treatment for neurotic illness. Many of them are desperately sick people. Many have been ill for a long time and have gone from doctor to doctor in their effort to obtain relief. These patients present problems difficult for all of us to solve: problems that demand all our ingenuity, knowledge, skill and patience. In my experience we often fell far short of good therapeutic results. I say 'fell' advisedly because the results of my therapeutic efforts, based on better insight into some of the fundamental etiological factors involved in the borderline neuroses, have encouraged me materially. It is not that the time required has been markedly lessened (it is still imposingly long) but that the therapeutic results themselves, because of an increased assurance and ability in handling the clinical picture and in controlling the transference by keeping at a minimum its negative or disturbing aspects, have been increasingly gratifying.

Some of these patients remained in treatment long enough to have served, as it were, as an experiment so that in the course of the last few years I have from time to time been able to modify my technique from that of the classical psychoanalytic manner. These modifications were initiated as the etiological factors in the illness revealed themselves.

Experience has impressed upon me the importance of what might be called the 'traumatic' origin of the pathological development of the warped ego, an ego so characteristic in borderline cases. Such people are born into an environment where traumata are practically continuous, giving credence in this sense to Freud's early theory of the traumatic origin of the neuroses. It is not that these patients are exposed to specific experiences, sexual or otherwise, which are in themselves of a necessarily traumatic nature, but that their environment