ABSTRACT

Pathological manifestations in one area have repercussions in any and all other areas, a fact that determines whether or not patients may be treated psychotherapeutically without hospitalization or medication, as when they become suicidal or acutely psychotic. In doing psychotherapy with patients who manifest a severe personality disorder, this chapter follows psychoanalytic clinical theory, being hardly concerns psychoanalytic metapsychology. Psychoanalysts have always stressed the importance of the wish in the neurotic fantasies of patients–the forbidden, conflictual wish in particular. A wish, however, is different from an intention in that the latter involves action, an attempt to make the wish come true by employing a certain mode of behaviour or thinking, which in psychotherapy manifests itself in the attitude of the patients and in the way they express themselves verbally, both of which make for the phenomenon of enactment.