Giovacchini believes that in the literature too much emphasis is placed upon description and definition of the borderline conditions and too little upon improving and understanding therapeutic interactions. The term "borderline," he feels, is used to describe very heterogeneous conditions which have in common: 1) structural defects, and 2) early developmental fixations resulting in a "primitive" mental state. He postulates an analogy between the borderline states and adolescence. In both there is an identity diffusion, a diffuseness of the inner self-representation. He views borderline states as pathological exaggerations of the borderline qualities of adolescence. He illustrates his hypothesis with the case history of a borderline adolescent, currently in treatment. The case demonstrates the difficulty of establishing a "therapeutic foothold" with borderline patients, as well as the common feeling of inadequacy engendered in the therapist by such patients who "use" their ego defects as defenses to control and manipulate.