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Jacobson discusses analysis of depressed patients diagnosed as 'borderline', manic-depressive, or schizophrenic. Their defenses find expression in ego distortions, superego defects, disturbances in object relations, and severe pathology in affects, and require much analytic work in these areas. The analyst becomes
the central love object and the center of the depressive conflict, and as treatment progresses the patient may develop more serious depressive states with periods of deeper ego and id regression,—an apparent negative therapeutic reaction.
Treatment characteristically has several phases: an initial spurious transference success, an ensuing period of hidden negative transference with corresponding negative therapeutic reactions (more severe states of depression), a state of dangerous introjective defenses and narcissistic retreat, and a final phase of gradual constructive solution of conflict. Analysis is most successful in those patients who, when not depressed, show mild hypomanic and compulsive attitudes. Jacobson illustrates the technical problem of how to allow the intensely ambivalent transference to develop and yet prevent the patient from ending his treatment in resistance, with severe depression or retreat from the analyst. The analyst must be aware of the emotional quality of his own responses (this is more important than the frequency of sessions), his empathic tie to the patient (warmth, understanding, and respect but not overkindness and sympathy), and the necessity, at times when narcissistic withdrawal threatens, that he show a more active interest in the patient's daily activities. Often even the careful analyst's interpretations and attitudes will be taken as a seductive promise, as a severe rejection and lack of understanding, and as a sadistic punishment, all of which may increase the insatiable demands, the frustration, ambivalence, and ultimately the depression. Most lasting therapeutic results are obtained if the analysis progr