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Harold Searles has the reputation of being a therapeutic virtuoso with difficult patients; a collection of his sometimes hard-to-find
papers on his work in this area is therefore very welcome. The present volume consists of twelve articles, originally published between 1969 and 1986, and lightly revised in the interest of coherence. Although the choice of material leads to more and more repetitiveness as one reads on, the inclusion of ample clinical excerpts avoids the danger of tedium. The heart of the matter is contained in the eight chapters in the sections on Basic Principles, Disturbances in Ego Functioning, and Countertransference.
Throughout the book, Searles writes about "borderline patients" as though he were an adherent of the popular view that these persons suffer from a condition that constitutes a discrete nosological entity. Only his preface, written expressly for this volume, sets forth the idea that he conceives of "borderline pathology" as a ubiquitous aspect of the human condition, evoked by any psychological treatment that goes deep enough. Searles finds it in each of the numerous analysands he mentions; even persons securely within the "neurotic" category develop autistic states in Searles's analyses. Hence, he sometimes properly refers only to "borderline transferences" or a "transference borderline-psychosis," and he is explicit about the fact that these regressive states are evoked in analysis by the analyst's willingness to comply with the patient's pressure for a symbiosis. Searles assumes that such a regression goes back to the autistic phase of separation-individuation in Mahler's developmental schema and that some analysts forestall such regressions because of a need to defend themselves against anxieties about separation issues.
Searles vacillates between two incompatible views about his subject matter. These can be designated as the concept of borderline as a pathological entity—as espoused by, among others, Kernberg, Masterson,