This paper reviews a case treatment of an 18-year-old female seen in psychotherapy on a weekly basis for one year. The young woman presented a range of problems, including night terrors and fantasies of uncontrolled homicidal behavior. Her early history was noteworthy for severe cardiac anomalies at birth resulting in extensive hospitalizations and surgeries.

Treatment focused on three major areas: (1) the development of a sense of psychological and physical mastery anchored in feelings of self-esteem; (2) the growth of object constancy, trust, and differentiation; and (3) recognition, acceptance, and control of powerful feelings of anger over unmet dependency needs. During her therapy, such symptoms as sleeplessness, suicidal ideation, rage fantasies, and depressed affect, were notably reduced. The underlying borderline personality organization remained basically unchanged; what remained noteworthy was the patient's growing ease with her physical condition, specifically, reduced anxiety over sudden death.