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By definition, the treatment of so-called primitive personalities is fraught with turmoil, turbulence, and provocation. Efforts to understand the negativity and volatility of these difficult patients have inspired a growing interest in treatment technique. My purpose in this paper is to focus on the understanding and treatment of rage in the psychoanalytic psychotherapy of a young adult. In the case presented, the treatment was characterized by stony silences, oppositionalism, and persistent rage reactions on the part of the patient. Throughout the four years of the twice-a-week therapy, both the patient and myself were aware of the arduous, wearing, exasperating, seemingly futile and negativistic atmosphere of the treatment.
My initial approach was to attempt to reach the patient through the use of the internal empathic stance of Kohut (1977): that is, the careful pursuit of the patient's internal subjective experience. Since most of the time this approach was met with rage, I was led to try to use the more interpretive approach of Kernberg (1975). The rageful