This chapter contains primarily illustrative sessions to which I have referred throughout the book. The cases in point emphasize special problems that arise at different times in treatment. Characteristic resistances will be seen in these sessions. Some instances demonstrate a working-through process to a greater or lesser degree.

In this chapter, we shall review some of the literature in the field of infant development that appears to negate the current psychoanalytic concepts regarding the early phases of infant life. These recent studies have important implications for the understanding of the borderline patient.

It is the environment that forces identification on the individual rather than the innate schedule. The ability to imitate makes it possible to defend through identification. It is possible that this capacity to imitate has a relation to the ability to “give in to the other” and to identify with and appease another, an enduring characteristic defense of the borderline patient.

In psychoanalysis with the borderline patient the problem of feeling demeaned as a child arises constantly and has to be dealt with repeatedly. The feeling of being demeaned is functionally related to the problem of having created an identification with the neurotic patterns of the parents.

In this chapter I shall try to summarize my ideas regarding the dynamics of the borderline condition in the context of the theory that environment plays a decisive role in the etiology of the neuroses and the psychoses.

It is my thought that the dynamics of borderline cases may be more evident if I discuss in this chapter the more resistive types of cases, those that are closer to psychosis, and who may be in treatment for as many as twenty years or more.

Short-term therapy can be effective with the borderline patient even though certain borderlines benefit only from long-term treatment; but the borderline patient, for many reasons, does not get into a long-term treatment regimen readily.

The psychiatric literature reveals that the borderline patient was a focus of interest as far back as 1884 and 1890. The word borderline, however, was not used, although from descriptions, patients that we think of as borderline today seem to have been included in case studies. This chapter will set forth briefly the views of some of these early writers and examine them in reference to current theories.

Between 1937 and 1954 , beginning with Adolph Stern, very few papers were written on the borderline patient (about 25 were published including my own first paper in 1952). One of the major findings relating to the borderline during the late 1930s came from the psychologists who worked in the testing field, particularly Rorschach and others who employed projective testing. They discovered that on structured material the borderline did very well, but with the unstructured material the patient showed anxiety and pathological responses.

The dynamics and treatment of the borderline patient have been examined extensively by Otto Kernberg, James F. Masterson, and Richard D. Chessick as well as the present author. In this chapter their theories will be the focus of the discussion. In addition, we shall consider Heinz Kohut, for although he writes primarily about narcissistic disorders, he assumes that his theory concerning narcissistic personalities and some of his ideas regarding schizophrenia cover the main facets of the borderline syndrome.