ABSTRACT
For many years psychoanalysts working with adult as well as with child patients had been discussing how to widen the scope of psychoanalysis to help patients with non-neurotic disturbances. The early discussions about technique had tended to focus around the broad issue of whether psychoanalysis was an appropriate form of treatment for any but neurotic illnesses in which current conflicts could be analysed. Patients needed a sufficiently strong ego and superego to contain impulses and feelings in thought, and a good enough capacity for object relationships to form a transference to the analyst which could be interpreted so as to give the patient an insight into conflicts. Patients with weak ego and superego functioning often could not contain their feelings and impulses in thought, but acted on them; and if they formed a transference it was often infantile and demanding, even delusional. Interpretation to such patients often seemed not to produce insight and greater control, but to provoke acting out because of their poor defences. Hence ego-supportive therapy was usually advocated for such patients. This helped them to manage themselves better but did not alter underlying defects. Increasing understanding of object relations and narcissistic development led to attempts to work with damage deriving from deficient or malignant aspects of early parent-child relationships, i.e. to find ways of reconstructing and interpreting these early experiences and their effects on the patient’s expectations of himself and his objects, as well as on his internalised conflicts.
