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Jackson discusses the current conceptual confusion about the diagnosis of borderline personality organization and its relationship to Klein's concept of the paranoid-schizoid position. Although acknowledging the reality of the early chaotic and provocative environment, he speculates that the cause of Mrs. X's problems is her own difficulty in containing destructive feelings of envy and jealousy in the early relationship with mother. This caused an early split in her personality and failure of the split-off part to progress beyond a paranoid-schizoid position. In spite of significant pathology, he sees in Mrs. X evidence of a strong reparative drive. Jackson clarifies the importance of her Roman Catholic background in providing her with structure in the midst of an otherwise chaotic life. He traces the "self-destructive behavior" throughout her development, pointing out its preoedipal origins and its usefulness in dealing with separation-individuation anxiety. He then examines the oedipal meanings of the behavior, her identification with the suffering Christ, and her persistent sadomasochistic fantasies. He points out the necessity of dealing with the fundamental distrust in the transference relationship because of the split-off part of the personality that is fixated in the paranoid-schizoid position. He uses that Kleinian concept to explain the relationship with Dr. Z, the transference relationship to Dr. Pearson, the dreams, and the artwork. However, he is careful to point out that he would not attempt direct interpretation of any primitive content; rather, he would patiently work through Mrs. X's defenses with an empathic awareness of her condition at the time.