Patient-Centered and Analyst-Centered Interpretations: Some Implications of Containment and Countertransference

The treatment of psychotic and borderline patients presents formidable technical problems for the psychoanalyst, and many of these arise from the uncomfortable countertransference feelings these patients evoke. They are usually aware of the disturbance around them to which they react but are unable to recognize their role in the creation of the situation and are unaware or unconcerned with their own internal problems. In analysis, the patient in this state of mind is not interested in discovering things about himself, and uses the analysis for a variety of purposes other than that of gaining insight into his problems.

Joseph (1983), who pointed out that many such patients are not interested in understanding, saw this as related to the fact that they are functioning at a paranoid-schizoid level. In these circumstances the patient's main concern is to obtain relief and security by establishing a mental equilibrium, and consequently he is unable to direct his interest toward understanding. The priority for the patient is to get rid of unwanted mental contents, which he projects into the analyst. In these states he is able to take very little back into his mind. He does not have the time or the space to think, and he is afraid to examine his own mental processes. Words are used, not primarily to convey