ABSTRACT
This chapter discusses how a psychoanalytic approach can complement other treatment methods and provides a helpful model for thinking about these complex clinical presentations. Indeed, professionals’ feelings about their patients can provide an invaluable source of information about the nature of the clinical problem. The chapter argues that “frontline” mental health professionals need appropriate clinical training as well as ongoing supervision to increase and maintain their psychological mindedness in the face of their patients’ concrete communications. It describes the patients a mixture of strong feelings, including sympathy, confusion, anger, hopelessness, and guilt. Patients with borderline features function on the edge of the depressive position. However, when faced with disappointment and loss associated with a failure to reach ideals, they can feel persecuted and retreat into paranoid-schizoid states of mind. Patients with longstanding psychological difficulties can fear that they are damaged and cannot be returned to a healthy state without the help of some magical and superhuman solution.
