Epilogue

The study of borderline patients has become one of the most important arenas for the advancement of psychoanalytic knowledge. It has focused renewed attention on preoedipal drive development (especially aggression), the formation of early object relationships, the development of a unified self, and the vicissitudes of narcissistic libido. The techniques of psychoanalysis and psychoanalytically informed psychotherapy have been expanded by our need to accommodate to the needs of these more disturbed patients. The concepts of parameter, holding environment, transitional phenomena, and therapeutic milieu have evolved from the analytic work with borderline and psychotic individuals. The scope of our understanding and our technical expertise have indeed widened, and this has enriched our field.

The opportunity to work with seriously ill patients in a hospital setting over an extended period of time is an invaluable training experience. At Sheppard Pratt, we require our psychiatric residents-in-training to spend one year on the long-term inpatient services. Expert supervision is clearly instrumental in the successful use of this setting for training. Some of the more difficult and important lessons can be learned here best. Transference and countertransference passions come to life with dramatic intensity. Projective identification and splitting become tangible processes. The concept of the treatment team and the roles of therapist and team leader are brought into high relief, requiring careful definition. In such a crucible, one's identity as a psychoanalytically oriented therapist may be born and reborn.