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In this article I will discuss a group of patients, in my opinion a fairly sizeable group, who present special difficulties if we attempt to treat them psychoanalytically. These are clinical situations that can be best understood in terms of ego pathology and have been extensively explored under the rubric of borderline states. Kernberg (1975) and Masterson (1976) have outlined general patterns characteristic of borderline patients, whereas Giovacchini (1975, 1979) and Menaker (1979) have emphasized specific character traits as well as general developmental vicissitudes.
Some patients suffering from structural defects can be treated by using standard psychoanalytic technique. What characterological factors hamper or determine treatability is a topic that has not been extensively explored. Understanding the specific developmental constellations that are the foundations of psychopathology will enable the clinician to make connections and distinctions between treatment impasses and the repetition of infantile traumas in the current transference setting.
I will focus upon a specific type of patient suffering from a character defect which I will later distinguish from the typical borderline state. These patients present themselves in a fashion that would seem to preclude analysis. Still there is something about them that is appealing and which indicates that they are capable of using insights. In spite of their concreteness and neediness, they also reveal aspects of their personality that are sensitive, intuitive, and creative, qualities that are considered favorable for analysis. It is this mixture of a concrete, stubborn, resistive patient and a person who possesses subtle understanding and the capacity for insight that is especially puzzling to the analyst who has to decide whether he will pursue analysis or