In this discussion of Carsky's paper, Meissner writes of the inner turmoil of borderline and psychotic patients. He notes how aggression and narcissism are particularly disturbed. Thus the rapid shifts in the projection and introjection of the aggression and the alternation between narcissistic superiority and inferiority lead to chaos and confusion in patient and therapist. Meissner questions some aspects of the treatment as described by Carsky, especially the apparent non-use of medication and the seeming lack of work on the therapeutic alliance. He cites the value in the collaboration between staff and therapist in resolving the transference-countertransference difficulties, as well as Carsky's inherent capacity to deal with the problems involved.