chapter  20
20 Pages

Six Constellations of Psychoanalytic Psychotherapy of Borderline Patients

AN ATTEMPT TO systematize my observations on my psychoanalytic outpatient psychotherapy with low-level borderline patients has led me to conclude that such therapy moves through six constellations.

After Kernberg (1966) systematized the evolution of internalized object relations and described the borderline personality organization both phenomenologically and metapsychologically (Kernberg, 1975), I began a series of analytic treatments with patients who lacked an integrated identity, who had object relations conflicts rather than structural conflicts, and whose treatment was necessarily designed initially to mend the splitting of their self-and object representations. I tried to examine the course of treatment with these patients systematically and offered nine of them an undiluted version of psychoanalytic psychotherapy on the couch that was designed to effect lasting structural change. This process used the maximum potential of both patient and therapist.