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Event Series Event Series: Psychopathology II: Borderline

Psychopathology II: Borderline

March 25, 2022 @ 3:30 pm - 5:00 pm, Wyman Classroom

Adult Psychoanalytic Training (APT)
2021-22, 3rd Trimester — Fridays, 3:30-5:00pm

View Whole Syllabus


Hello, and welcome to Psychopathology II: Borderline States.

Early analysts emphasized the fixed character structure of such “primitive” patients. It is our opinion that this fixed view is reductionistic and less clinically useful than a more flexible model whereby structures and defenses and emergent clinical phenomena are thought to be greatly influenced by the framing, containing, and holding capacities of the analytic situation and person of the analyst.

We will approach the affect-laden enveloping quality of the work with a focus on the developmental conditions and clinical manifestations of this psychopathology spectrum. This is rich, intricate, challenging, and at times uncomfortable work. Unbearable discomfort can lead to empathic failure and collapses of the space for thought on both sides of the relationship. We will emphasize how the analyst is affected by such patients, the various means by which disturbing experience is transmitted, and how these processes are a ubiquitous, inevitable, and potentially useful/reparative part of the analytic process.

Immersing oneself in the literature relevant to this psychopathology spectrum can lead to similar disorganizing affective states in the reader, accompanied by a reactive wish for a clearer more durable way of conceptualizing and organizing the material; a wish for more clarity where entropic disorganization often reigns. It is our hope that as a group we can cultivate the space to together metabolize the fragments and integrate the experience into a good-enough whole.

As you read through the articles for this class recall from psychopathology I Sugarman’s model for a neurotically organized mind consisting not of particular mental content but rather certain mental capacities (i.e. self-reflective capacity, capacity for affect regulation, capacity for narcissistic regulation, and internal conflict). We will make use of this to understand the struggles that characterize the phenomena that present in borderline states and states of narcissistic fragmentation / breakdown.  

Considerations For Further Reading:

  • Benjamin, J. (2004). “Beyond Doer and Done To”. Psychoanal. Q., 73:5-46
  • Knafo, D. (2015) Guys and Dolls: Relational Life in the Technological Era. Psychoanalytic Dialogues 25:481-502
  • Mancia, M. (2006) “Implicit Memory and Early Unrepressed Unconscious: Their role in the Therapeutic Process (How Neuroscience Can Contribute to Psychoanalysis)” IJP 87: 83-103
  • Anderson, M.K. (1999) “The Pressure Toward Enactment and the Hatred of Reality” J. Amer. Psychoanal. Assn., 47:503-518.
  • Briggs et al (2012) “Suicide and Trauma: A Case Discussion” Psycho. Psychotherapy, 26:13-33
  • Kernberg, O. (2003) “The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients” JAPA 51/2: 517-545
  • Frosch, Allan (2012) “Absolute Truth and Unbearable Psychic Pain: Psychoanalytic Perspectives on Concrete Experience” London: Karnac. Introduction. Pages xix – xxiv.
  • Britton R (2004) “Subjectivity, Objectivity, and Triangular Space.” Psychoanalytic Quarterly. 2004 Jan; 73(1): 47-61.
  • Anderson, M. (2012) “Concreteness, reflective thought and the emissary function of the dream.” Absolute Truth and Unbearable Psychic Pain: Psychoanalytic Perspectives on Concrete Experience. A Frosch, ed. London: Karnac. Chapter 1, pp.1-16. (Not on PEP Web. Provided upon request).
  • Coen, S.J. (2005) “How to Play with Patients Who Would Rather Remain Remote” J. Amer. Psychoanal. Assn., 53:811-834.
  • Stein, R (2005) “Why perversion? False love and the perverse pact” Int. J Psa, 775-799.
  • McDougall, J. (1980) “A Child is Being Eaten—I: Psychosomatic States, Anxiety Neurosis and Hysteria—a Theoretical Approach II: The Abysmal Mother and the Cork Child – A Clinical Illustration” Contemporary Psychoanalysis, 16: 417-459.
  • Gabbard, G.O. (1991) “Technical Approaches to Transference Hate in the Analysis of Borderline Patients” IJP., 72:625-636.
  • Eaton, JL (2005) “The Obstructive Object” Psycho. Review, 92(3): 355-372
  • Caligor, E., Diamond, D., Yeomans, F.E. and Kernberg, O.F. (2009). The Interpretive Process in the Psychoanalytic Psychotherapy of Borderline Personality Pathology. J. Amer. Psychoanal. Assn., 57(2):271-301
  • Blechner, MJ (2009) “Erotic and Antierotic Transference” Contemp. Psychoanal. 45(1):82-92
  • Geist, RA (2011) “The Forward Edge, Connectedness, and the Therapeutic Process” IJP. Self Psychol., 6(2):235-251
  • Akhtar S (1996) “Someday…” and “If Only…” Fantasies: Pathological Optimism and Inordinate Nostalgia as Related Forms of Idealization” JAPA., 44: 723-753
  • Davies, J.M. and Frawley, M.G. (1992). Dissociative Processes and Transference- Countertransference Paradigms in the Psychoanalytically Oriented Treatment of Adult Survivors of Childhood Sexual Abuse. Psychoanal. Dial., 2(1):5-36
  • Socarides, DD. Stolorow, R.D. (1984) “Affects and Selfobjects” Ann. Psychoanal., 12:105-119
  • Tuch, R.H. (2007) “Thinking with, and About, Patients too Scared to Think” IJP., 88:91-111.
  • Fonagy, P and Target, M. (1995) “Understanding the Violent Patient: The Use of The Body and The Role of The Father” IJP. 76:487-501.
  • Steiner, J. (1994) “Patient-Centered and Analyst-Centered Interpretations: Some Implications of Containment and Countertransference” Psychoanal. Inq., 14:406-422.
  • Kohutis EA (2010) “Concreteness, Metaphor, and Psychosomatic Disorders: Bridging the Gap” Psychoanalytic Inquiry, 30(5)416-429
  • Nos, J.P. (2014) “Collusive Induction in Perverse Relating: Perverse Enactments and Bastions as a Camouflage for Death Anxiety” Int. J. Psycho-Anal., 95:291-311.

Learning Objectives

The clinical associate will:

  1. as a result of gaining greater knowledge of the hypothesized etiologies of borderline-level character disorder, have a greater capacity to understand, empathize, and connect interpersonally with this clinical population, and thereby improve the odds of the treatment retention necessary for a positive clinical outcome
  2. as a result of gaining a greater understanding of and capacity to work with the intense transference-countertransference phenomena that develop when working with this population, have an increased ability to assist their patient in reflecting on these phenomena, and thereby improve the odds of a positive clinical outcome
  3. as a result of gaining a greater capacity to work with collapses in reflective functioning under the weight of unbearable affect, become more capable of assisting this population in such a way that they are better able to tolerate, regulate, and reflect on their affect states and associated triggers, thereby improving their defensive structures, self-understanding, interpersonal relationships, and overall life functioning

March 25, 2022 — Etiology/Conceptualization

[48 pages]

We will begin with Fonagy, Robbins, and Winnicott to highlight the relational – etiological factors contributing to the emergence of these character / self-disorders.

In Attachment and Borderline Personality, Peter Fonagy outlines how the caregivers’ reflective capacity impacts their child’s capacity for mentalization and the development of a secure attachment. He links these concepts with the idea that early trauma may result in a child’s inhibition of mentalization in an effort to avoid the pain of reflecting on their lived experience, thereby resulting in impaired reflective abilities and an impaired sense of self. Per Fonagy, these impairments may explain the link between childhood maltreatment and character pathology.

In The Mental Organization of Primitive Personalities and its Treatment Implications, Michael Robbins encourages us to think of more primitive personalities as differing in qualitative rather than quantitative ways and that assumptive errors along these lines lead to technical approaches that may be regressive or promote what Winnicott described as an analysis with the false self.

Fonagy, P. (2000) Attachment and Borderline Personality Disorder, Journal of the American Psychoanalytic Association. 48:1129-1146.

Robbins, M. (1996) “The Mental Organization of Primitive Personalities and its Treatment Implications”, JAPA, 44(3):755-784


March 25, 2022
3:30 pm - 5:00 pm
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(206) 328-5315
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SPSI on Madison
4020 E Madison St, #230
Seattle, WA 98112
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(206) 328-5315
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