ABSTRACT
The patients being considered in this chapter rely on projective identification as a way to maintain certain rigid and archaic object-relational patterns and defensive organizations. Some of the individuals are borderline and narcissistic, mired in the realm of paranoid phantasies and conflicts. Other individuals exhibit a predepressive, primitive foothold into more whole-object functioning while still needing to use splitting and manic control to avoid internal fragmentation and severe states of psychic loss and emotional collapse. In discussing Betty Joseph's unique approach to working with such difficult patients, Feldman and Spillius describes how Joseph puts an emphasis on the patient's need to maintain his psychic equilibrium. With patients working so intensely to maintain their psychic equilibrium, the analytic process is very difficult to keep alive without succumbing to the urge to force it onto life support. It is also very difficult to accept the relational loss with these hard-to-reach patients without wanting to slam the door shut in grim defeat.
