Citation

Nathan J. Br. J. Psychother. 2018; 34(1): 61-77.

Copyright

(Copyright © 2018, John Wiley and Sons)

DOI

10.1111/bjp.12344

PMID

unavailable

Abstract

Kernberg has suggested that work with severe borderline psychopathology requires limit-setting interventions to mitigate the possibility of life-threatening enactments. These actions constitute a deviation from the classical analytic stance of technical neutrality. Taking up these modifications, I argue for a re-calibration of the analytic task with severe borderline patients predicated on the use of benign authority. Abandoning therapeutic equidistance, I propose a model based on interventions organized around ?maternal? and ?paternal? functions and the dialectical and generative intercourse between these two poles. Such engagement requires close attention to the countertransference, as enactments are inevitable. In this context I reflect on the way ?action? in psychoanalysis is considered pathological, as a countertransference enactment. Clinical vignettes are presented arguing for ?actions? based on limit setting and active emotional engagement as therapeutic in their own right, which is consistent with psychoanalytic practice. This realignment of the psychoanalytic project embodies the ideas that Gabbard and Westen introduced in ?Rethinking therapeutic action?. They suggest that it is now more accurate to speak of therapeutic actions in psychoanalytic treatment, rather than the ?single-mechanism theories of therapeutic action?, which may have implications for psychoanalytic practice beyond the treatment of the personality disordered patient.

Keywords

Analyst–Patient Relationship; Borderline Personality Disorder; NHS Psychotherapy; Psychic Change; Psychoanalytic Technique; Sadomasochism; Self-Harm; Transference/Counter-Transference