Diagnostic Status of the Patient
This chapter considers the personality structure, personality style and psychopathology of the patient as these factors bear on the patient's reactions to the therapist's pregnancy. The incapacity of the psychotic person to establish boundaries between feelings and actions makes the exploration of the former at best a challenging activity for the patient and therapist. A primary tool that the psychodynamic therapist can use is interpretation, helping the patient to recognize one or more elements of a conflict. Just as the personality styles of the histrionic and obsessive patients contrast greatly, so too must the therapist's style vary with each type of patient in order for that style to be effective. The borderline-level of ego organization represents an advance over the psychotic level in that individuals in the former category have a greater capacity to recognize boundaries between systems. Some research suggests that borderline-level patients recognize the therapist's pregnancy earlier than do either psychotic or neurotic patients.