For much of the time during my work with Mr A, a borderline patient whom I saw for twice-weekly psychotherapy over a period of one year. I had difficulty understanding and communicating with him. I felt despairing and impotent and that therapy was not progressing at all. A few weeks prior to termination a shift occurred and I realised that there had been some improvement in Mr A's functioning. Although I was aware that behind the polite façade was an angry, disturbed man, I felt that he was a little more in touch with reality than he had been at the beginning of the treatment.

In this paper I will focus on the factors that contributed to my difficulty in understanding and communicating with Mr A. I will also attempt to account for his apparent improvement.