Meetings of the New York Psychoanalytic Society

DISCUSSION: Dr. Joseph Krimsley opened the discussion, stating that his own clinical experience confirmed Dr. Stewart's remarks. He had noted the frequent early seduction and prolonged intimacies to which these borderline patients are subjected. He suggested that some auxiliary 'good parent', frequently a grandparent, was an important object in the early life of these patients, saving them from more serious illness. He agreed that whereas in the neurotic we can assume the patient has a capacity for object relations and transference, achieving this with the borderline case is more than half the battle. He saw the borderline patient as exhibiting a preoedipal ego, fluctuating between early fusion fantasies and later structural differentiation. The therapeutic alliance as viewed by Dr. Stewart emphasizes the need to split and fuse two images of the same person, and in this way underlines the problem of the synthetic function so frequently impaired in the borderline case.

Dr. Victor Rosen focused his comments on the disturbed object relations, as seen in the transitional object phase and as appearing in the therapeutic alliance. He defined the therapeutic alliance, in the broad sense, as the implied contract which lies behind all the specific agreements between patient and physician, and which is prerequisite for analysis of intrapsychic conflict in general and the transference in particular. The therapeutic alliance rests on an implicit agreement to accept a controlled illusion, in which psychic reality and external reality are both acceptable. It is the type of arrangement essential to 'playing together' and involves the temporary abandonment of that axiom of logic termed the exclusion of contradiction. When either the therapist or patient treats transference manifestations as totally real or totally illusory, the analytic process can be pacity for controlled illusion. If the doll is seen as inert and illusory, there is disappointment; if it is seen as a rea