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Harriet Gordon Machtiger, Ph.D., is a jungian analyst practicing in Pittsburgh, Pennsylvania. A diplomats of the University of London Child Development Center, she received her Ph.D. in psychology from the University of London. An associate trainee in child psychotherapy at the Tavistock Clinic who completed jungian training at the British Association of Psychotherapists, she is a member of the New York Association of Analytical Psychologists and o the Inter-Regional Society of Jungian Analysts. She is the author of "Countertransference/Transference" in Jungian Analysis (M. Stein, ed., 1982).

This reading, originally selected for the Chiron Journal by Murray Stein and Nathan Schwartz-Salant, sometimes calls a familiarity with the terminology of Jungian Psychology (e.g., inferior function) but does not require this familiarity for the most part. It invites the reader to consider the  the symbolic meanings (in myth, for instance) within the clinical processes. If you would like more information feel free to e-mail mstaples@sbcglobal.net

For more information about the Borderline Personality disorder I strongly recommend a visit to Patty Johnson's award-winning web site:  Borderline Personality Disorder Sanctuary.

                                                                       And the end of all our exploring
                                                                       Will be to arrive wbere we started
                                                                       And know the place for the first time.

                                                                                               T. S. Eliot, "Little Gidding"
 

The practice of analytical psychology is still in its formative stages. Jung himself espoused an empirical openness to new ideas, accepted and encouraged change, and stressed the importance of one's own experience in arriving at a particular theoretical stance. As jungians, we need to constantly evaluate and reevaluate our mode of therapeutic interaction and be willing to absorb and implement theoretical changes.

My thoughts for this paper arose out of clinical work with a number of patients who showed many features of the borderline disorder. Jungian analysis holds a great attraction for individuals in this particular plight, as they see in Jung a legitimization of their personal psychology. The patients who gave rise to the thoughts expressed in this paper contributed greatly to my growth as a person and as an analyst.

The creative encounter of the analytic process, by its interaction with another human being, can facilitate the corrective emotional experience that is a prerequisite for the growth and development necessary for the movement from borderline to higher level functioning. In the borderline there was a primary environmental failure because of chronic and repetitive parental failures to meet the particular constellation of maturational needs presented by the patient in infancy and early childhood. These early pathological relationships are likely to be superimposed, sooner or later, on all subsequent emotionally significant relationships. This leads to further failure and intrapsychic and interpersonal warping. Persons coming to treatment bring their different ways of experiencing themselves and others, or their subjective phenomenological frames of reference, to the analytic situation. This subjective experience is reenacted in the relational process of the transference/countertransference. Borderline patients have already had a maturational failure in childhood. Since they have such difficulty with interpersonal relatedness, they run a distinct danger of experiencing a second maturational failure in therapy, unless the analyst is able to respond in a developmentally appropriate way.

The term borderline is not a clear diagnostic condition or entity. There is no such thing as a unitary borderline condition. it is a descriptive title for a rather broad category of individuals with arrested psychological development. The syndrome has been perceived as a deficiency illness (Balint 1968; Harding 1965). According to Kohut (1971), the borderline patient has specific disturbances in the realm of the self. Objects are not experienced as being separate and independent from the self. The fixation points are located at a rather early point in psychic development. There is a defect in ego functioning. Grinker and Dry (1968) cite the clinical manifestations and characteristics of the patients and note the fears of aggression in themselves and others, the fear of loving and of being close, of tenuous interpersonal relationships, and of deficient reality orientation. There is a greater than usual use of denial and projection, a proneness to acting out, becoming promiscuous, and using drugs to excess. In the view of Knight (1954), the borderline case is one in which the normal ego functions and defenses against primitive unconscious impulses are severely weakened.

Jung (1946) approaches the borderline state from the perspective of Janet's notion of an abaissement du niveau mental. There is a disintegration and lowering of the threshold of consciousness and the intrusion of archaic contents that are not sufficiently inhibited. When consciousness disintegrates, the complexes are simultaneously freed from restraint and break through into ego consciousness. The abaissement denotes the loss of supremacy of the ego, after a struggle with unconscious contents and forces. Jung's formulation is useful in that it cuts across the problems of nosological classification. The abaissement is found in the neuroses as well as in the psychoses. It is a difference in degree, a qualitative and quantitative state, rather than the crossing of a hypothetical line. It is a continuum in which in the neuroses, the unity of the personality is at least potentially preserved.

The patient's problem arises from the lack of integration and adaptation to reality. There is an inability to tolerate anxiety, impulses, fears, and guilt feelings. The central conflict in distinguishing between the self and the outside world is fraught with ambivalence and permeated by the fear that hate may prove stronger than love. This could result in being harmed or in harming the loved object. Many of these patients need to reality test the fear that their destructiveness is omnipotent. Borderlines have difficulties in maintaining a relationship once it is invaded by conflicts or frustrations. Many of the intensely destructive impulses cannot be expressed. In addition to instability of relationships there are mood fluctuations and identity problems. Common complaints are boredom and intense loneliness. There can be great and pervasive anger, and an overall vulnerability or fragility. Substance abuse, depressive episodes, and transient psychoses may be manifest. There are concerns with power, massive splitting, defenses against disintegration, and feelings of not being entitled to exist. Early maternal deprivation leads to a lack of Eros. Power themes play an important role in therapy with borderlines because of the lack of Eros. The overwhelming fears are of separation, abandonment, and annihilation. Borderlines mistrust and lack the capacity to trust. In some individuals the compensatory sense of entitlement, grandiosity, and the notion that the world owes them a living can be exorbitant.

With some borderline cases there is a transgression of the hypothetical line from the neuroses to the psychoses. With others there is a relatively stable clinical picture in which there are simultaneous signs of psychosis, neurosis, and adequate ego functioning. The wide spectrum of borderline states possesses a varying psychology. Jung's description of the abaissement coincides with these patterns of borderline behavior.

As the borderline is close to or lost in the archetypal world, he may experience the archetypal content bursting through easily, as, for example, in the Compulsive behavior of the Don Juan. Jung attributes this tendency to a disturbance of the primal relationship at the stage of development when the ego is not yet consolidated. The weakening of the ego makes possible a direct inundation of unconscious contents, which has a restrictive influence on the personality as a whole. Later, the disturbance is reflected in feelings of being forsaken, inferior, uninvolved, and in sadomasochistic reactions. In essence, the primary preoccupation of the borderline is with problems centering on symbiosis and object relatedness.

As archetypes are released and activated by an actual personal encounter with a human being, an adverse emotional experience in relation to the parents, or initially the mother, is a trauma that is responded to with fear, anxiety, aggression, or despair. The child feels overwhelmed by internal forces, unconscious material, and a loss of connection to the totality of the Self. The Self is initially experienced by projection onto the parents. The loss of the mother is experienced as the loss of the ideal state of the Self. The process of development during the first three years is centered on the evocation and differentiation of the archetypes that determine the various components of the child's personality.

The Self is the central archetype and surrounds and contains all the other archetypal elements. Since the Self containing these
components of the personality develops within the context of the maternal matrix, and the primary mothering person is viewed as the mediator of the organization of the psyche, the consistent and predictable presence of the good-enough mother throughout the early months of life serves to tie the infant's universe of experience in a particular way. The interrelation between infant and caring mother as a unit becomes the first and most important object relationship. First of all, she prevents traumatic states that overwhelm the infant and impede psychic organization. Then it is through the mother and her body that impulse, feeling, action, and eventually thought become organized as a part of the self and integrated not only with each other but also with the external reality that the mother represents. When early development within this maternal matrix goes well, the outcome is the achievement of a cohesive, reality-related and object-related self.

Disturbances like separation from the mother, hunger, or illness lead to a disturbance in the evocation of the maternal archetype. These early problems damage the ego-Self axis and result in the psychological problems of the borderline. M. Fordham (1957) concludes that borderlines have a defective process of deintegration in which the Self nuclei are not stably cohesive. With the experience of trauma and unmet needs, the child's original state of inflation begins to dissolve and a state of alienation results. The child who had good physical care but did not experience positive warmth and the child who had too much attention can both suffer injury to the archetypal image of the parent. According to Neumann (1973):

Jung (1953, par. 81) stresses the importance of remembering and reexperiencing the events of childhood, since fragments of childhood need to be integrated into adult consciousness: "The journey with father and mother up and down many ladders represents the making conscious of infantile contents that have not yet been integrated."

The healing of the self can only take place after both analyst and analysand accept the heroic and divine aspects of the child archetype. This leads to a more unified and stable sense of identity. Until this transpires, the analysands cannot really be themselves, or, to paraphrase Winnicott (1965), their true selves. Winnicott regards feeling real as an essential manifestation of the "true self," whereas feeling unreal is a typical propensity of the "false self." Khan (I 974) notes that the self is protected from annihilation by staying dissociated and hidden.

Therapy provides an opportunity to repair or reconstruct the injury in the borderline's disorder between ego and self and self and other. According to Lambert (1981), early childhood can be analyzed "both for the repair of damage with a subsequent release of held up development, and to enable the patient to link up emotionally both with his childhood, and ... in a more realistic way with the Divine Child Archetype" (p. I 1). The personal parents need to be differentiated from the archetypal parents. The borderline can be caught up in hate and rebellion toward the parents while at the same idealizing them. The holding environment of the transference/countertransference creates the necessary inner space for the delusion of oneness between analyst and analysand" (Lambert 1981,p.12).

The transference/countertransference, as the sine qua non for analytic work, is the vital ingredient in repairing arrests in development and completing the unfinished business of childhood. It also ushers in the newly unfolding or developing aspects of the psyche and furthers the searches for new beginnings and new solutions in the inborn striving for wholeness. Through the use of the transference/countertransference we gain an increased understanding of the interaction between the personal history of the individual and his archetypal development. The transference/countertransference provides the arena for the resolution of the borderline state by reconstituting the transitional space of a participation mystique or more symbiotic way of being that allows this healing to take place. The analyst carries the projection of the Self and is identified with the symbol of a transcendent aim or goal. The painful inner problems of the patient are introjected through the syntonic countertransference. The analyst helps the patient to understand and integrate the material in a new way. This new integration eventually results in the growth that allows for the patient's independence. There has been a restoration of contact with the inner sources of strength and acceptance. The injured image is replaced by an image of wholeness through the projection of the parental image on the analyst. According to Jung (1955, par. 232), "What has been spoiled by the father can only be made good by a father, and what has been spoiled by the mother can only be repaired by a mother." Only when an individual has had the experience of a positive relation to a parental figure can he be released from the negative and destructive aspect holding him in bondage.

Since borderline patients exhibit shaky interpersonal relationships, inability to love, deficiencies in empathy, egocentric perceptions of reality, and solipsistic claims for attention, their behaviors can erode the therapist's sense of self, making it hard to be a "goodenough therapist." A good-enough therapist is a sort of combination of Winnicott's "good-enough mother" and the jungian ideal of being in touch with the positive mother complex. The therapist needs to be empathically in touch with the patient in a way that offers the opportunity to repair the early damage.

Of course one cannot change the patient's world or undo the prior unfortunate events. One does not redo the whole person in therapy. We cannot reconstruct the earlier period of life in the course of treatment. What we can do is to try and see the elements of its influence and offer the opportunity for a different kind of experience. The origins of the problem are secondary to what we can do about failures in nurturance or development. The basic questions are what is the person now, how did he or she get that way, and what can I do in the here and now to help him or her grow optimally?

One might question the elevation of the concept of transference/countertransference to such developmental preeminence. Some of the questions we can ask are the following:

1. Do we limit the transference/countertransference to distortions or projections that require correction, or can we view it as  an articulation of a perception of an inner perspective or view?

2. Is the transference/countertransference in the past or in the present?

3. Is the transference/countertransference to be relinquished or is it a part of the individuation process and, as such, part of the life cycle?

4. Is the transference/countertransference an intrapsychic phenomenon, or is it also an external or interpersonal phenomenon?

Jung (1946) answers these questions in "The Psychology of the Transference" when he refers to the crucial experience of the transference in every analysis. He makes the following significant qualifying comments: "The psychotherapist has to acquaint himself not only with the personal biography of his patient, but also with the mental and spiritual assumptions prevalent in his milieu, both present and past, where traditional and cultural influences play a part and often a decisive one" (p. viii). "The transference phenomenon is without doubt one of the most important syndromes in the process of individuation; its wealth of meanings goes far beyond mere personal likes and dislikes. By virtue of its collective contents and symbols, it transcends the individual personality and extends into the social sphere" (par. 539).

I would like to postulate that transference/countertransference, with its basis in projection and introjection, is a universal phenomenon present in early life experiences. Its value for the treatment of the borderline lies therein. Analytic treatment does not create transference/countertransference but only brings it to life, for it is shaped by contemporary external reality in conjunction with inner phenomena. There is no interpersonal life that is separate from intrapsychic life. All transference responses are responses to contemporary events and may be realistic or nonrealistic, adaptive or maladaptive. All of life is transferentially determined by unconscious factors. Any human interaction involves the intrapsychic. The words intrapsychic
and interpersonal have unfortunately degenerated into slogans or buzz words, and the adherents of each approach attack the other. But like the nature versus nurture controversy, both are important. In fact, there are three states of being: (a) an inner psychic reality that is the personal experience of each individual, (b) an external reality, and (c) an intermediate area combining the experience of the individual and his environment. Inner reality basically contains all of the experiences that we have undergone or have the potential for undergoing, colored by the immature cognitive processes of childhood and by later distortions of the personality. Some are remembered directly, others become inaccessible to recall, and yet others shape the way experiences are processed. The human psyche is an internal world of a personal nature that partly realistically and partly in highly distorted ways reproduces internal relationships in the external world.

The space of the transference/countertransference is similar to the area of illusion. What is objectively perceived and subjectively conceived takes place here. It is the transitional space in between, neither inside nor outside, where we recreate what was originally the facilitating environment for the infant. The essential feature of this space is its illusory character. Given adequate opportunity to participate in the illusion of symbiosis in therapy, the individual can renegotiate separation-individuation and be well on the road to further individuation.

A lack of the capacity to form a therapeutic alliance can reflect an impairment in transference capacity. Sometimes the borderline aspect only becomes manifest after a period of treatment during which the transference/countertransference phenomenon reveals evidence of splitting and denial. or one notices that the patient has a capacity for slipping in and out of psychotic states or uses psychotic defenses. Simultaneously, there is a fear of the unconscious, o states of fragmentation, and of depersonalization. Borderlines have often not reached the stage of mirroring or idealizing relationships. The transference shows us how personal reality is constructed. It is not in contrast to reality but is a part of it. it provides the opportunity to go into the symptom or sickness and transform the massa confuse by connecting with the symbolic meaning of the symptom.

One of the shortcomings of the jungian approach, except for the contributions of Neumann (1973), Edinger (1972), and M. Fordham (1957), is the lack of an adequate cohesive developmental theory. The analytical process is in itself a developmental process. The application of the findings of infant and child observation, along with object relations theory, to the clinical understanding of adults has contributed to our understanding of stages of transference/countertransference phenomena. The developmental approach to the treatment of the borderline patient allows for the evaluation of changes in intrapsychic structure and psychodynamic functioning. Winnicott (1965) states that he had the unique opportunity to observe infants by noting the specific transference relationships of his severely disturbed patients. F. Fordham (1969, p. 3) noted that "by paying attention to a patient's infancy, one can discover the flaws in his environment which distorted his later development, led to a weak ego structure, and consequent excessive influence of the archetypes." There is something to be said for recommending that all therapists have some experience working with infants and young children and a knowledge of phase-specific development. We need to incorporate knowledge of growth and development in childhood to further our knowledge of normal and pathological developmental processes. In general, the higher the developmental phase attained, the more likely experiences will be expressed in verbal introspections. The lower the developmental phase, the greater likelihood of enactions involving the therapist. Persons emotionally stuck communicate in ways that differ from persons who can differentiate self and other. The borderline has difficulty with symbolizing and basically remains in a world of concrete thinking.

In a previous article (Machtiger 1982), I discussed the role of the transference/countertransference in the healing process. The unio mysticaof the transitional space allows for the merging and fusing of the harmonious penetrating mix-up that is part of the borderline state. in the blurring of boundaries the gulf is bridged, and the analyst can incarnate earlier parental figures. The therapeutic field facilitates the emergence of a symbiotic situation that is necessary for the release of the archetypal images, and the emergence of the helpful mother imago brings about a new orientation. These experiences have nothing to do with role playing on the part of the analyst but represent an authentic responsiveness to the patient. The projective identification serves a necessary function as it lies at the root of psychic transformation. It is the analyst's ability to eventually show the patient the role that the latter has assigned to him in the transference, and the genesis of this assignment, that carries the potentiality for change. What we construct in clinical work is a myth of genesis, which is not identical to the data of historical development. Therapeutic growth results from the therapist's ability to understand and respond to the patient in a developmentally appropriate way. In other words, how one listens and responds is more important than what one does. Growth is not dependent upon clever interpretations but upon the analyst's constellating and mediating the image of the good parent or healer, or Self, and containing it within the transference/countertransference. Borderlines require a compelling interpersonal involvement.

While each transference/countertransference is unique, certain realities of the analytic situation can be used to build up the psychic unity between analyst and analysand. The temenos, or maturationally facilitative matrix, is created by the room, the hour, and being part of each other's lives. It is a shared interaction. The analyst makes a commitment to feel for, about, and with the patient while maintaining the necessary separateness. Jung (1946) notes that the success or failure of treatment is bound up with the transference in a very fundamental way.

Borderline patients can become hypercritical about their treatment and their therapists. They are constantly seeking ammunition for their rage and are marvelous at ferreting out the therapist's Achilles' heel in their need to provoke and manipulate. There is a need to experience the therapist as hostile and controlling; the patient's paranoia and bitterness can thus be justified. While distrusting and fearing the therapist, borderlines simultaneously try to appease and placate. Any perceived deficiency in empathy becomes a cause celebre and is reacted to with disappointment and rage.

In the literature on borderline syndromes, it is recognized that one of the difficulties with borderlines is their ability to create a confused state in the analyst. By projecting their self-hatred onto the analyst, they can succeed in paralyzing him or her. Since the transferences can be more chaotic and archaic and are fraught with projective identification, many borderlines require more of a here and now handling and sometimes a more confrontative mode.

In the early stages of the transference/countertransference the therapist is not experienced as a separate person but as a transitional object. The patient cannot begin new growth until the therapist finds a way to replicate the original form of symbiotic relatedness. Loss or separation from the symbiotic partner remains the key in borderline personality disorders. if the process is allowed to develop, eventually an internalization of the images can take place and there is a greater differentiation of self and object. Misperceptions and misconstructions of self/object relations can take place and be explored in the constancy of the dynamic process of the analytic relationship. The fragmented self of the patient merges with the "Rock of Gibraltar" therapist and borrows from the therapist what could not be obtained in childhood. There are some patients who need to do this in a surreptitious way, and any evidence of progress or feeling better is hidden. This can engender self-doubt, incompetence, impotence, and defeat in the analyst, feelings often related to the feelings of emptiness inside the patient. The analyst's boredom might point out an affective absence on the part of the patient.

The transference/countertransference keeps changing during the course of therapy. At the outset of treatment, the symbiosis is allowed to develop, since the transference reactions of borderlineshave their roots in the developmental state prior to the interpersonal experience of whole objects. The interaction in this cocoonlike participation mystique, in this symbiotic state of the transference/countertransference, is therapeutic since oneness facilitates the elicitation of affects and archetypal images surrounding unconscious fantasies, memories, and images that can be held, differentiated, and ultimately integrated into a symbolic form.

The two patients I discuss in this paper have failed to achieve a high level of differentiating self from other, although differentiation in its earlier and more primitive stages had been accomplished. There was a failure to integrate good and bad aspects of experience in accordance with the increasing perceptual and cognitive abilities of the child. This resulted in a persistent proneness to identity disorganization.

As the borderline is unable to appreciate the other as psychically independent of his own needs and interests, there is a tendency to anticipate a consistent attitude of maternal preoccupation from important relationships. Merger fantasies in the transference often reflect primitive fusions from the deepest levels of symbiosis. The patients with better reality testing find this an intolerable state of being and equate the loss of identity with going crazy. In this state, there is a tendency to withdraw interest from the other person by denigrating the other.

In actual relationships, the borderline patient oscillates between painful detachment and frightening overinvolvement. Some may find separateness frightening on the basis of their excessive idealization of the analyst, with consequent excessive dependence not threatening to their psychic existence. The fear of possible abandonment is the threat. In the treatment situation, the transference reflects the failure of full differentiation. The terror at separation is particularly evident at the times before vacations and holidays. Some of these patients need to be seen by somebody else, while others come down with bodily illness, decompensate, or act out various kinds of self-injury. They may take up dangerous personal relationships or use drugs and alcohol to excess. There may be an increased number of cancellations before or after a long holiday. Patients who utilize denial are more apt to show this reaction. Some may actually act out manic behavior. With these patients, the achievement of missing the analyst or grieving for the loss is often a major breakthrough. There is a realization that separation can occur without aggression, retaliation, or being abandoned by the other person. One can relinquish a measure of control and allow the other
person an independent existence. it does not lead to a complete loss of control, chaos, or finding oneself in the other person's power.

The transference of the borderline bears similarities to the narcissistic transference in which the analyst is not experienced as a whole, separate person but rather as an extension of the needs of the patient. The analyst is needed to maintain the patient's selfesteem. There is excessive projection and a distorted evaluation of the external world. Empathy is shallow, anxiety tolerance impaired, and the capacity for concern and mourning limited and impoverished. There is a greater likelihood of an abaissement d niveaumentalunderstress.

The therapy of the patients I discuss here fits the descriptive material previously presented. There were boundary problems, questions of sexual identity, and initial issues of substance abuse. Although the primary focus of attention was on transference/countertransference, initially the patients' communications of developmental and transferential expressions were not interpreted. The patients' problems with the self started with maladaptive environmental care. Premature confrontations and interpretations would be maladaptive too and are therefore to be avoided while one is holding the patient in the area of illusion. Certain experiences can then become actualized, and transformations can take place. The main task is to learn how to function in such a way with the patient as to correct or reverse some of the earlier experiences. Jung (1946) believed that "the patient needs you in order to unite his dissociated personality in your unity, calm and security."

The first phase of treatment was similar to the treatment of any serious personality disorder. The basic aim was to create the empathic environment in which trust could grow and affect be ventilated. With the replication of the symbiosis, differentiation of affects such as rage and envy could emerge. The analyst's task is to mediate between the opposites and keep the patient from falling apart. During this phase there is often regressive behavior. Episodes of confusion, fragmenting, and emotional flooding often usher in new levels of integration. The conflict was rooted in the giving up of the symbiotic partnership or earlier state for a more differentiated one. This reorganizing process could then move the person forward.
 
 

Mr. C. was a 34-year-old man in the early stages of a professional scientific career who began twice-weekly treatment shortly after finishing a doctorate and moving away from the geographic location of his family of origin. In outward appearance C seemed fairly well integrated. He had done well academically, professionally, and, it seemed from externals, socially. Under the surface there was a limited range of absolutely fixed ideas belonging to a very early level of development. C was a man who feared and hated his own immaturity and weakness in the face of everyday living and in comparison with other people. His marriage had been stressful from the beginning and involved sexual problems and episodes of wife beating. His wife, in an effort to extricate herself from the marriage of 10 years, accepted a job in another city.

There were also work-related problems with peers and feelings of being overwhelmed by the new job. C described himself as being on the thin edge of exhaustion, drinking too much, using drugs, and feeling he was on trial in the work situation and being crucified by his superiors. Suicidal ideation and hypochondriacal concerns were present. A weak psychosomatic integration made him liable to psychosomatic illness. C insisted that illness is either entirely somatic or entirely psychogenic. Psyche and soma had to be kept apart. In his early history, there was a pronounced lack of early bodily closeness that would have enriched the buildup of psychosomatic unity. Concerns with sexual adequacy led him to overcompensate in the realm of educational and intellectual endeavor. He could achieve this by getting into a martyr complex. The Adlerian concept of organ inferiority is an apt description of his modus operandi.

In our first meeting I was informed that C was an Aristotelian who did not like to look at motives or get involved in "psychobabble." The religious function was repressed and he was an atheist. After sharing an initial dream of trying to tend to a young man with a hole in his head, he expressed fear that I would be like lace, too fragile and needing his protection, or that I'd be taken in by his,bullshit.

When I was with him early in therapy, it felt as if he never lived far from the edge of explosive physical violence. There was a virtual reservoir of repressed and suppressed rage. Sessions were punctuated by abusive, angry outbursts. The first few times that this rage erupted in a session, he got very upset. After the first occasion, he presented me with a bouquet of flowers, saying he felt stupid and embarrassed, yet he knew that he really did not have to apologize to me. After the second episode, he wrote a note of apology, not so much as an act of reparation but as an insurance policy to forestall rejection. Some of these outbursts felt like brief paranoidal experiences. These mini-psychotic episodes were short lived and continued to appear at times of temporary intense anxiety and stress.

In the initial sessions there was nothing but positive regard for his mother. As things progressed, he mentioned in passing that she had been hospitalized with severe depression for the nine months following his birth. He felt that his birth had damaged her. His mother returned to work as a child librarian at the local school before he was three years of age. Despite her career, she had fixed notions about men's and women's work in the home. Men did not participate in household chores. His father would return from work and drink himself into semi-oblivion while his mother prepared dinner. His father was depicted as short tempered, often crude, and frequently drunk. At times he would stagger in the door, reeking of alcohol, and sprawl out on the livingroom floor. Several times he lost his balance and, in a bloody state of unconsciousness, urinated on the floor. C would clean his father's wounds and drag him off to bed. In the morning it was as though the incident had never occurred. Early on in therapy he could not recall having felt anything, nor could he remember his mother's reaction. It was only midway through therapy that he was able to feel the terror and pain and could weep when talking a'bout his early life.

His mother was portrayed as a quiet, unassuming, and gentle woman who espoused the myth that women were too weak to cope with the rigors of life. Simultaneously, she was strong willed, quite tough, and much shrewder financially than her husband. C viewed her as the queen bee who dispenses with the male once she is impregnated. Early on in dream therapy he dreamed of a man tearing a rear wall out of a building in order to rescue a queen bee and place it in an enclosure in the front of his childhood home. In another dream he was protecting this home from a 14-foot tiger lurking outside. He had a small pistol which was useless against the tiger. The dream of the 14-foot tiger was followed by a dream of a little dog eating the tail of a big cat. The associations were to early memories of believing that his mother had a phallus.

There was a recollection of an incident at age eight when he felt his parents were not in touch with his feelings. After injuring a foot playing outdoors he came in the door trailing blood. He was scolded and punished for making a fuss and mess. The blood had to be cleaned up before medical attention was sought.

The relationship with a sister three years his senior was highly ambivalent. They had engaged in exploratory sex play, and he later used her bed for masturbation. There was jealousy, as he saw her as the more favored and gifted child. Several years ago he purchased brother and sister kittens and allowed them to have a litter before having them neutered. This material paved the way for an exploration of his sexuality. There were dreams of homosexual encounters under heterosexual cover-up and a dream of his sister turning into a demonic-faced man while in bed with him. in another dream, a male was swimming on the surface of the water while a female was making porpoiselike movements underneath.

The archetypal constellation was of someone caught in the grips of homosexuality. C was like one of Gaia's children: a child trapped in the earth. As long as his masculinity was embedded in the maternal matrix, he was unable to genuinely utilize his ego in an assertive way. In his regressive pull toward the unconscious, C could not contact the masculine qualities that would result in the assumption of more assertive behavior. Until this was possible, C had to seek it out in other people and incorporate it in a magical way.

As therapy continued, he complained of feeling increasingly isolated, lonely, and distrustful and he found it hard to tolerate other people. He would find himself denigrating others so as to feel superior. It soon became clear that there were chronic feelings of anger, deprivation, and disappointment at what was experienced as a lack of concern and attention on my part. Failure to attend to him was experienced as not only done to him, but because of him. There were also difficulties in impulse control.

When homosexual and transsexual themes came up, he experienced vertigo, tremor, and nausea. During the work day and on business trips, he was terrified of becoming sexually aroused toward male colleagues. Colleagues at work were perceived as making obvious but unconscious homosexual displays toward him. in addition to dealing with his homosexual feelings through projective identification, C would periodically resort to masturbation accompanied by primitive merger themes and sadomasochistic activity. Business trips were particularly traumatic, especially when he was expected to share a room with a colleague. There were numerous panic attacks, and he decompensated. At those times he would ask the men to hold him and comfort him. The desire was to be held, cared for, and nurtured. What was needed was not a particular person but a state of being, of unhurtness, and containment.

With an overall restlessness, incapacity for relaxation, and agitation, a strong sense of tension was ever present. Desperate feelings surfaced when there was no one to offer a sustaining relationship. There were fears of separation, clinging states, and a terror of being invaded and possessed. Since survival was bound up in and dependent upon another person, the threat of annihilation was ever present. Eventually, my task was to help him piece together by genetic reconstruction all the bits and pieces of his early life and relate them to his feelings for me. It was as though he were hearing it for the first time. This part of the work helped him differentiate between the real mother and the archetypal mother. It was only after I had become a new object of identification by carrying the incarnation of the mother archetype and constellating an alternate parental image in the unconscious that C was able to tolerate criticism of the symbiotic parent. Previously, when he would bestow upon me the numinious power of the Great Mother, there was a tremendous pull to remain in the world of fantasy. When ego and consciousness were more developed, I became the bad mother on whom he could courageously unleash all his negative feelings as he struggled to separate the objective reality of the personal mother from the archetype of the Great Mother. Sometimes I was the critical mother who could never be satisfied. At other times I was a kind of Circe, who magically knew what was going on inside him and was out to enchant and capture him.

C saw me as having two personalities. My predominant mode was a mean and calculating one. The reason for my becoming an analyst was that it gave me an opportunity to indulge to the utmost all of my sadistic fantiasies. I knew how to frustrate him by determining precisely what he wanted from me, and then by not acceding to these desires I could torture him with great glee. Manipulation was also my forte. Sometimes I commented that these qualities resembled some of his own and amplified my comments with descriptions of our interactions. He would then be reflective. At other times I would not confront him with reasonableness or reality. On rare occasions I was seen as helpful and caring. The problem was that what he perceived of as my alternating personalities made me totally unpredictable.

An ever-present and prominent theme in the transference/ countertransference was his attempt to inveigle me into his sadomasochistic life pattern. He could not openly ask for help because he was not able to tolerate the thought of a possible refusal without being consumed by hostile fantasies or fears of abandonment. This transferential aspect was rooted in the earlier experience of parental rejection. C had learned that it was futile to have expectations of others. In this masochistic pattern, the transference feeling is that the therapist will be rejecting too. My countertransference was of being in a tenuous position, with feelings of frustration and impotence. At times my inability to comprehend the dynamics of what might be going on left me discouraged and depressed. At other times, he would goad me and try to provoke an angry reaction. When intensely angry he would tell me that the "Jack the Ripper" aspect was coming close to the surface. it was described as fiery underneath with water dashing against the rocks and creating steam.

On numerous occasions he would accuse me of not responding to his need for help. This need surfaced in somatic complaints or in requests to do something for him that would help him get his wife back. I was the mother who was indifferent to his pain, and even if I took note of it, I was too incompetent to do anything about it.

In the transference, we went from my being an impersonal, inhuman, computer-technician-type of professional whom he experienced as virtually nonexistent, to my being a seductive siren. There was a badgering to meet with him outside of sessions. If I refused to do so, he said he was doomed to bachelorhood. In the midst of these pleas, he said he could not get involved with another woman 11 until he finished with" me. When he expressed warm, erotic feelings toward me, he would appear ashamed and embarrassed. I assented to his difficulty and allowed him to continue. When he looked away I would say, "you look uncomfortable," but would not make any premature interpretations that would analyze the feelings away. At the time, he dreamed of some men who were trying to stem the flow of red-hot lava in the basement. The lava started to emerge out of the opening and he was helping to plug the flow by throwing whatever he could get his hands on into the opening.

The anger at my not always being there when he wanted me to be, as well as my not having a sexual relationship with him, abated somewhat after he had an image of running over a short wooden bridge. "I'm running toward a woman dressed in a loose white gown. She has black hair tumbling down to her shoulders. Her arms may be slightly raised toward me. She is disturbingly familiar, but I cannot place the resemblance. Certainly, none of the obvious people I can think of. That's all I get, but it's compelling somehow." The woman turned out to resemble his youthful mother. As he grieved for what he had missed in childhood, C realized that what he wanted was not physical closeness with me in the here and now but the closeness of the infant with the mother's body.

The rage-filled baby occupied a large part of the therapy. We needed to bring this traumatized infant into communication with C. He worked through much psychic pain. The fact that I was a separate individual with needs and wishes not coinciding with his was excruciatingly painful. Until the rage was recognized and integrated he would feel unlovable. The terror of the rage, and the pain, needed to be heard.

It was difficult to remain in a state of syntonic countertransference. Positive responses were experienced as gratifications; negative responses were my wanting him to suffer. His responses were that of the young child whose elated and depleted states are connected to feeding experiences and awareness of its own body.

C complained about my inadequacies as a therapist, the inequality of the treatment situation, the demeaning of the patient, and how this therapy was going nowhere. My response to all this was to ask questions and to listen. Mr. C was externalizing his own difficulties and disappointments and making me the deficient child self. He could then be the critical, sadistic parent and attack me. It was crucial for me to survive the psychonoxious effects in good health. In this way, C was better able to gain acceptance of his own needy child. When feeling dominated by this child, I would need to resist reacting by blaming, attacking, or appeasing C. This would lead to feelings of fatigue, depression, and at times even detachment. When I could feel pain again, it was an alternative to feeling nothing. At those times, C would say I was useless.

Sometimes in the transference there was anger at my underestimating his ability. Particularly when he was experiencing grandiosity, my role was to be a one-person combination of mirror, pep squad, and admiration society to cheer him on to even greater feats. If I did not do this, I became the mother who wanted to keep him nonfunctional. At other times he complained that I was pushing too hard. Then I was rated as the kind of therapist who needed to put people down in order to feel more important. Anything I said was denied, derided, or destroyed. C would get impaled and wallow in the role of the suffering victim. The pressure for rescue was unrelenting; after all, I was responsible for his welfare. After a period of immersion in this theme, he had a dream of getting in the driver's seat of a car and refusing to use his mother's road map. This was followed by a dream in which his mother abandoned him. I was there telling his mother that she didn't understand how C really felt. in the sessions, he expressed anger at me for not allowing his functional part to come out. He was not accomplishing anything because I did not have expectations.

In the transference he was struggling with two images of the self: an omnipotent, grandiose one, which was equated with being functional, and a contemptible one, which was nonfunctional. Where there was a push to be dependent, C would say he was falling apart and needed to be hospitalized. The idea that there was no one to offer him a sustaining relationship panicked him, and he felt then that I should care for him. He dreamed that he could not get a job promotion until he had finished nursery school.

There was a shift in the transference/countertransference from hating himself for not achieving to hating me for holding him back. This switch, ironically, provided the impetus for growth. The issue of what is therapeutically useful is enormously important, complicated, and controversial. At times it was tempting to confront C with the contradictory nature of his transference reactions. On the rare occasion when this happened, we ended up in a confusing morass. When I attempted to clarify my original formulation, I ended up forgetting my original point.

If I talked about his difficulties, he felt criticized. Everything said was a painful reminder of my superior creative power, which then needed to be nullified. What seemed to help him most was for me to accept all that he had to say about me, particularly the negative things. In doing so, the analytic setting provided a safe place, or temenos, for both the positive and negative feelings. The image of me as both good and bad, strong and weak, began to come together.

Another area of important work was the gradual acceptance of my not making decisions for him or pushing him to get better. There were many complaints of my being a cold, uninvolved, unfeeling bitch. Ultimately he realized that this coldness meant that I was not going to control him. This led to fewer fears of loss of identity and autonomy. Eventually there was an awareness that his concern about being taken over was rooted in his own wish to do so to others. C was more aware of the infantile part of himself that undermined his more adult side by remaining in the grips of the puer aeternus archetype.
 
 

Ms. S, a 26-year-old divorced woman, began four-times-a-week therapy after being referred by the local mental health facility. Her illness became manifest during adolescence; her first hospitalization was when she was 16, although there were numerous hospitalizations for illness in early childhood. She was the youngest of six children, two of whom died before she was born. The family constellation was a rather complicated one. The patient's mother was the result of a casual liaison and had been sent to live in foster homes for 14 years. She was then brought back to live with her own mother and her mother's common-law husband in a m6nage A trois. This man fathered S and the other five children. When S was threeand-a-half, her 64-year-old father died of a malignancy of the larynx. S found him dead on the lavatory floor.

S looked much younger than her actual years and had an aura of fragility about her. in our early sessions, she denied having any major problems, past or present, and described herself as being too detached and - unable to get close to people to form relationships, even with "friends." Pervasive feelings of emptiness and depression were ever present, along with a sense of unreality.

The initial transference was a negative one. The night before our first meeting she dreamed that she went to see a stern therapist who made her feel trapped. That feeling stayed with her all day. As she saw it, therapists were in it for the money, or because of their own problems, which included needing to be in a position of power over others. She did not want a mad jungian who was more messed up than she was. She was afraid that if she became involved with me, I would take over and she would cease to exist. She viewed her analysis as brain washing, and if she did not fight my attempts at brainwashing, I could take over. She felt that it was abnormal to trust people, and she asked me to confirm this view of life. She did of not like me and would make sure that she did not need me. Her motivation for continuing to see me was that she could not understand the intensity of her anger toward me.

S was quite gifted in being able to portray accurately her inner and state, and the typical problems of the borderline can be well illustrated in the content of her material. For the first few months she kept me uninformed about the circumstances of her everyday life, as well as her past history, but they came tumbling out as she began to trust me. There was a need to maintain a dissociation between external life and fantasy life. The message conveyed was "keep away." There was an interesting combination of arrogance and inferiority with a suggestion of having to defend herself against any external supplier of self-esteem and any dependency feelings. S described herself as having two opposite parts: One, which she named her Irish part, was a megalomaniac who thought she could do anything and everything and could talk to anyone; the other, inferior part was the recipient of contempt for her weakness, helplessness, and dependence.

Some of the time S would be in a typical depressive state, complaining of insomnia, anorexia, withdrawal from social contacts, bombarding herself with accusations, particularly with respect to irritability and hostility toward her children. At other times she appeared disconnected, confused, and nonresponsive, and showed signs of depersonalization. She would describe herself as being dead, not here, encapsulated in a bubble, covered with cotton, or separated from me by a sheet of glass. During these disturbances in sensation, self-perception, and communication, S would often ask if I could see her. At times I would hold her hand. It was important for me to be there and to share her terrified state with her.

A persistent problem was her inability to handle envious and destructive feelings toward me. When she was absorbed with anxiety and guilt over these feelings, it was difficult for her to maintain contact with me. At the same time there was the inability to tolerate the feeling of separateness from me. She would shut me out and then feel cut ofF, and she would panic. Periodically S had to make sure her angry feelings had not damaged me and would ask, "Are you all right?" or "Are you there?"

In our relationship, S was trying to achieve union with the idealized object. She had to avoid the feelings of separateness as she used our relationship to work out the problems rooted in her early life. Our relationship represented the fusion between self and object images based on primitive mechanisms of projection and introjection. My role was to be Winnicott's "good-enough mother" and to allow her to communicate her sense of anger toward her mother and her feelings of desolation about her father's death and her grandmother's deliberate withdrawal from the family. As our relationship deepened and we established more trust, S began to let me into her inner world, which was populated with voices. it took two years of meeting from four to seven times a week before she could share that she lived in two worlds and did not belong to the real world. There were auditory and visual hallucinations. The blurred-faced people included a wise and frightening old man, an ogre type, a snivelling child, and a black man. She labeled the figures "The Mafia" and had known since childhood that she belonged to them and that they would eventually claim her. Meanwhile she struggled not to be taken over. The clash of the two realities was seen as ending in her annihilation. The more she trusted me, the more prominent the voices became. We shared the struggle with the voices who were telling her that therapy was useless. Periodically she would go through a phase of accusing me of being the smartest con of all, the chief agent of this Mafia, her biggest enemy.

She took to hiding under a blanket. One day, when I said she must be very lonesome, a hand came out from under the blanket. I grasped the hand and she started to sob. Before she left she asked if she could take the blanket with her. It became her transitional object. She told me that she had loved a blanket as a small child. Her mother had taken the blanket and washed it; S had tried to reach the wet blanket but could not. She never saw the blanket again.

For a long time she could not accept the Mafia as split-off parts of herself, but as she became able to accept her own rage and angry feelings, the power of the voices abated.

There was one hospitalization during the therapy. Prior to the admission, S had a series of dreams centering around hospitals; this was in contradiction to her conscious attitude where she denied being ill. There were also dreams of water coming up through floorboards, babies with hydrocephalic heads, bombed-out buildings, crashed airplanes, and children smearing themselves with feces. Shortly after her hospital admission she had two dreams conveying her psychic state. In the first she was in a canoe and saw a big tidal wave coming. It was August 6th, the day of Hiroshima, and she could not get out of the way. She knew that in radiation sickness her skin would come off and she would be on fire with her skin bursting. In the second dream she was in a pond full of crocodiles at night. Terrified, she saw a ladder leading up into a tree but was not sure she could make it up to safety.

Although the hospitalization looked like an alarming regression, it was more of a reculer pour mieux sauter or what Jung (1946) describes as an amassing and integration of powers that will develop into a new order. S was swamped by the emergence of strong, infantile, rageful feelings. She projected this infant onto me and experienced a psychological rebirth by identifying with this infant. My presence provided the containment and continuity that she needed to experience.

After the hospital stay, S was able to mobilize some positive feelings toward her mother. Two thoughts dominated: either "comehere" or "go away. " This was identical to what I experienced in the transference/countertransference. She expressed much anger toward her father for having a family late in life and then dying. There was more ability to tolerate painful feelings about the unmet needs of her childhood. There were many sessions when I had to rely on the use of body language, gestures, and actions as analytic material. In the occasions when S felt persecuted by me, she would say that I already knew her thoughts, so they did not have to be verbalized. At other times, when her thinking was inhibited, she would panic at feeling cut off and isolated from me. There was a constant need to be alert to events that would precipitate the regressional and confusional states and, at appropriate times, to use detailed transference interpretations to facilitate the confrontations with the inner psychic contents expressed in her projections.

The grand theme was S's need to damage me and to destroy our relationship and the therapy. In this way she could substantiate her self-hatred, her sense of being evil and unlovable. At the same time it enabled her to triumph over me. It appeared in the fear that one of us must die or commit suicide. S was an expert at manipulation and would try hard to make me feel guilty, depressed, upset, fed-up, or responsible for her welfare. At times it was extremely difficult to differentiate between her hysterical manipulation and the symptoms of her distress and deep disturbance.

S's poor contact with reality led to my being more open about my feelings. This helped her sort out her feelings from mine. The mode of our relationship and the style of therapy varied with the state of mind of the patient. I found that I had to be very flexible in approach and needed to ascertain what S's capacity for tolerance of anxiety was at a particular time. There were occasions when I had to slip in and out of her psychotic episodes to try to understand what was happening. Together we had to maintain the delicate balance in the fluid relationship between the inner and outer worlds contained in jung's concept of the abaissement.

As therapy progressed with both of these patients, changes from borderline to higher level functioning took place along the following highly interrelated dimensions. There was greater cohesiveness of self and object representations, with movement from a more narcissistic to a more interpersonal relatedness. There was more capacity for self-reflection and containment of conflict without acting out. Interaction with people was less fragmented and was no longer of the need-fulfilling part object variety that had made for obvious difficulties in the more adult world. There was less massive projection of unconscious contents and a concurrent greater ability to assume responsibility for contents of the psyche. These patients no longer experienced themselves as weaklings, forever being pushed around. They fought more successfully for the things they felt entitled to. For a while they were afraid of the consequences of being successful and competent.

There were progressive developmental swings between the poles of merger and detachment of the ego-self axis. They described entering relationships with less wish for, less experience of and less defense against merger. They consciously and deliberately tried to limit the frequency of contact, or the speed with which they would be involved, with others and activities. At the same time there was more of a need for others. C used to say, "I don't need anyone. I can be alone as long as I want. I have things to keep me content." Eventually he realized his need for real people and could not be satisfied with evoking images in his mind.

Another milestone in treatment was the ability to share details about decisions and everyday problems. initially, due to the need to merge, sharing these problems was equated with a loss of ownership of them, which meant I could take credit for them.

The capacity for self-reflection was ushered in by deep depressive reactions to the realization that it was the deepest wishes that made it impossible to maintain relationships with any lastin,- worth and led to profound loneliness. it was the desire to merge that led to withdrawal in relationships. The depressive reaction corresponded to what Balint (1968) described as the patient's awareness of his or her basic fault-the realization that the difficulties are caused by something wrong in the patient. There is a need to mourn what has been missed and will never transpire. It is the internalization of the positive symbiosis in the transference/countertransference that permits this reaction to take place. These depressive episodes need to be accepted without interference. The old wishes cannot be met; the old ways of coping do not work. This acceptance can result in a move toward more adult functioning. To release themselves from the transference, patients must understand that they no longer need the gratification they once desired and that they must abandon the wish to rectify the old traumatic situation or event. Predominant transference/countertransference patterns of treatment included the all-powerful good mother of early infancy, the mother with whom one longs to merge. Then there was the mother of later infancy and childhood-controlling and intrusive. There was also a hostile and abandoning mother who would abandon them prematurely. Sometimes a powerful, idealized father image would get constellated. At other times, a fused mother-father image arose. To all of these powerful constellations there was a wish to submit, but this wish could be tempered by fear. There were requests for advice and positive guidance. The analyst was requested to be tougher, more confrontive, more demanding, and even to set limits.

There was also a transference through projective identification of an extremely contemptible, useless, helpless, ineffectual part. The contrasting projective identification of the capacity to hope and to improve would also make its presence known. All these transferences were accompanied by intense affect.

The most conspicuous and profound countertransference reaction to all of this was in response to the transference of the denigrated self. It was only after these feelings lessened in the patients and there was less need for me to carry these projections that I was able to experience a tremendous sense of relief. I had come closer to being a whole person because of these patients, and they were more aware of my having been helpful to them at times. They are now strong enough to be able to provide for themselves from their own inner resources.
 
 

Balint, M. 1968. The basic fault. London: Tavistock.
Edinger, E. 1972. Ego and archetype. New York: G. P. Putnam's Sons.
Fordham, F. 1969. Some views on individuation. Journal of Analytical Psycbology 14/1:1-12.
Fordham, M. 1957. Origins of the ego in childhood. In New developments in analyticalpsychology, pp. 104-30. London: Routledge & Kegan Paul.
Franz, M. L. von. 1970. Puer aeternus. New York: Spring Publications.
Grinker, R. R., and Dry, R. D. 1968. The borderline syndrome. New York: Basic Books.
Harding, E. M. 1965. Tbeparental image. New York: G. P. Putnam's Sons.
Jung, C. G. 1912. The battle for deliverance from the mother. in Collected u@orks,5:274-305. Princeton: Princeton University Press, 1956..1946.
The psychology of the transference. In Collected u,orks, 16:163 323.
Princeton: Princeton University Press, 1966.. 1953. Psychology and alchemy. In Collected u orks, vol. 12. Princeton:Princeton University Press, 1968.
Mysteriumm coniunctionis. In Collected Works, vol. 14. Princeton: Princeton University Press, 1970.
Khan, M. 1974. The primacy of the self London: Hogarth.
Knight, R. P. 1954. Borderline states. In Psycboanalysis, psychiatry and psychology, pp. 97_ 109, R. P. Knight and C. R. Friedman, eds. New York: International Universities Press.
Kohut, H. 1971. Analysis of the self New York: International Universities Press.
Lambert, K. 1981. Analysis, repair and initiation. London: Academic Press.
Machtiger, H. G. 1982. Countertransference/transference. In Jungian analysis, pp. 86-110, M. Stein, ed. La Salle, Ill., and London: Open Court.
Neumann, E. 1973. The child. New York: G. P. Putnam's Sons.
Winnicott, D. W. 1965. The maturational processes and tbe facilitating environment. London: Hogarth.