Transference in Borderline Neuroses

The childhood of patients in borderline states reveals that one or both parents had gross psychopathology ranging from distorted characters to psychosis. The parents quarrel, and an anxious, insecure atmosphere pervades the household more or less constantly over long periods of time. Separation of the parents, desertion by one or the other parent, cruelty or brutality, deprive these children of normal affective support for their naturally dependent needs. The 'hunger for love',1 understanding, support, reassurance, respect and a sense of belonging being ungratified, the effect is severely traumatic.

It is therefore not surprising that, from the very beginning of psychoanalytic treatment, these patients react in the transference as traumatized, preoedipal children. Experience has shown that sitting face to face with the patient obviates some difficulties that ensue if the patient lies on a couch (except occasionally and for specific, limited objectives). It is less liable to produce anxiety at the beginning of treatment. Any tendency to withdraw from reality is made less likely by seeing and watching the analyst directly. The patient is also less apt to lapse into a detached state of reverie; moreover, the analyst has the advantage of being in a position to note the patient's reactions to what is said. But be they rigid, affectless or overtly anxious, each one conveys vividly a spoken or a mute plea for help and support (parental).

From the start there is a high degree of unreality in the transference until the patient has become convinced that the analyst's affective support is constant and dependable, in contrast with his experience in this respect during his childhood. The degree to which this succeeds enables the patient to gain effective insight with a minimum of anxiety.

Because of the preoedipal nature of the dependent transference, it is essential that the analyst be more active than is customary in psychoanalytic therapy. This encourages, as it should