chapter  21
16 Pages

The Development in the Patient of an Internalized Image of the Therapist

I DISCUSS HERE some of the difficulties the therapist and the borderline patient have in enabling the patient to develop a stable, internalized image of the therapist (see also Searles, 1978, 1979a).

It seems widely agreed that the borderline patient, until he is relatively far along in therapy, has difficulty in maintaining a stable, internalized image of the therapist between sessions. LeBoit (1979) makes a statement that, although perhaps considerably oversimplified, is relevant here:

On the one hand, the borderline patient is spared, by his lack of wellestablished internal images, from normal grieving. As one man still said, after several years of treatment, "I don't miss anybody ... I never miss people ... 1don't feel unhappy when I'm away from anyone." On the other hand, the lack of a firm internalized image of the therapist makes the patient prone to feelings of panic lest the absent therapist go out of existence entirely. Such patients typically tend to make between-sessions telephone calls to the

therapist, for needed external feedback affirming that the therapist still exists in the patient's external, if not internal, world. Similarly, when the patient arrives for a session after a brief interruption in the therapy, he has difficulty in shaking off a sense that the situation and the therapist are strangers to him.