You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This book is a thoughtful, lucid contribution to the analytic literature on the psychological development and treatment of borderline patients. Volkan is a gifted analyst, and his contributions are a significant addition to the long list of analytic practitioners who work with very disturbed patients. Furthermore, he is an engaging writer who makes his points clearly and punctuates them with engrossing clinical examples. I heartily recommend this book to all analysts and therapists who work with severely disturbed patients.
The book centers around two axes. The first encompasses Volkan's observations on the developmental conflicts and the fixation points of nine psychosis-prone patients and his sequential treatment plan for good analytic results with these patients. The second is a detailed case history of the fascinating treatment of one such severely disturbed young woman. Unfortunately, I do not believe that Volkan's generalizations represent an easy recipe for most therapists to follow, because he has unique gifts of timing and interpretation, as well as an exceptional ability to regress along with his patients that may not be available to many practitioners. As with so many other treatment recommendations for the successful approach to disturbed patients, technique becomes, in large part, an extension of one's character. As Volkan himself indicates, if one is unfamiliar with treating such patients, then it is necessary to have supervision with an experienced therapist before proceeding.
Volkan's ideas are firmly rooted in object relations theory. He believes that the conflicts in his patients are the result of "splitting" mechanisms, as described by Kernberg. He agrees with Buie that the development of ambivalence, accompanied by pain and discomfort, is an essential step in the treatment of these patients. He contrasts these conflicts with those centering around guilt and repression that are seen in neurotic patients. However, he does agree with Abend