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PubMed1980

Staff countertransference reactions in the hospital treatment of borderline patients.

The aim of this paper is to elucidate a systematic framework for understanding the nature of the borderline patient's reactions to the hospital milieu and for comprehending the responses of hospital staff to such patients. The theory and principles of the therapeutic milieu or milieu therapy are not the focus of this paper; rather, the unique ways in which borderline patients create their own reality and interact with that reality are examined. The borderline patients considered here constitute a group who present severe character pathology, including pronounced distortions in reality testing, marked paranoid trends, minimal distinction between self and others, and multiple hospitalizations that have proven ineffectual. Overall, these patients are functioning at a level more regressed than most borderline patients and their histories often reveal many psychotic episodes. Because of their severe psychopathology, long-term intensive treatment in a hospital setting, termed "reconstructive hospital treatment" by Zee (1975), is indicated. The goal of such treatment is to augment the patient's failing ego functioning, to help the patient develop constructive alternatives for dealing with conflict, and to aid the patient develop constructive alternatives for dealing with conflict, and to aid the patient in embarking upon a psychoanalytically oriented exploration of his highly conflicted object relations. Without the use of the hospital as a treatment modality these patients tend to continue in a downward spiral of destructive relationships. These remarks, therefore, are addressed to the effect severely ill borderline patients have upon the hospital milieu and to the impact of the milieu upon them.

Adult↗
PubMed1986

Borderline defenses and countertransference: research findings and implications.

Among Main's (1957) several cogent insights about the nature of defensive and countertransferential reactions to those so-called "special" patients who ungraciously refuse to improve - patients who in today's parlance would most assuredly be diagnosed as borderline - is his hypothesis that some of us may flee some of the time into research activities to avoid the frustrations and disappointments of clinical work. Writing from the dual perspectives of researchers and psychotherapists, and with the interest of furthering the integration of these often split-off enterprises, we offer some observations on the amassing body of empirical data about the borderline patient, observations which bear upon and lend support for Main's speculation regarding the detachment of researchers from the emotionally charged dilemmas facing the therapist in working with the borderline patient. We also present some findings from our ongoing investigations of borderline dynamics in groups and organizations, which underscore the role of defensive and countertransferential processes in the psychotherapeutic treatment of borderlines. Finally, based upon our observations of the extant data as well as our own findings, we offer a suggestion about the direction of future research on borderline pathology, proposing a shift away from the largely descriptive-level diagnostic studies and toward the investigation of the therapeutic relationship, with a particular focus on countertransferential dynamics.

Acting Out↗