The Management of Affect Storms in the Psychoanalytic Psychotherapy of Borderline Patients

Abstract

Affect storms are a frequent complication in the psychoanalytic approach to borderline patients. The descriptive, psychodynamic, and structural characteristics of these storms are explored, and the verbal, nonverbal, and countertransference manifestations that permit the formulation of interpretations under such conditions are described, as are the interventions required to maintain the treatment frame as a precondition for an analytic approach. The principal theoretical formulations regarding the affect pathology of borderline patients are reviewed and related to a proposed interpretive approach. An apparently opposite development, the utter absence of emotional developments in the sessions, is examined, and its defensive function of avoiding affect storms is explored. Clinical case material illustrates the proposed approach to these storms, and clinical evidence is given to support the approach, which centers on systematic analysis of the primitive internalized object relations of these patients in the transference, the use of countertransference analysis without countertransference communication to the patient, and the repeated restoration of technical neutrality in the service of protecting the treatment frame.

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References

Bion, W.R. (1967). Second Thoughts: Selected Papers on Psychoanalysis . New York: Basic Books.

——— (1970). Attention and Interpretation. London: Heinemann.

Clarkin, J. , Yeomans, F. , & Kernberg, O. (1999). Psychotherapy for Borderline Personality. New York: Wiley.

Fonagy, P. (1999). The development of representation. Paper presented at the Lindauer Psychotherapiewochen, Lindau, April 15, 1999.

——— & Target, M. (2000). Playing with reality III: The persistence of dual psychic reality in borderline patients. Paper presented to the Borderline Symposium, the Munich Institute of the German Psychoanalytical Association, April, 2000.

Green, A. (1993a). Le Travail du Négatif. Paris : Éditions de Minuit.

——— (1993b). On Private Madness. Madison, CT. International Universities Press.

——— (2000). The central phobic position: A new formulation of the free association method. International Journal of Psychoanalysis 81:429—451.

Kernberg, O. (1984). Severe Personality Disorders: Psychotherapeutic Strategies. New Haven: Yale University Press.

10.

——— (1992). Aggression in Personality Disorders and Perversion . New Haven: Yale University Press .

11.

——— (1999). Psychoanalysis, psychoanalytic psychotherapy and supportive psychotherapy: Contemporary controversies. International Journal of Psychoanalysis 80:1075—1091.

12.

——— (2001). Recent developments in the technical approaches of English-language psychoanalytic schools. Psychoanalytic Quarterly 70:519—547.

13.

Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psychoanalysis 27:99—110.

14.

——— (1957). Envy and Gratitude and Other Works 1946—1963 . New York: Basic Books.

15.

Kohon, G. (1986). The British School of Psychoanalysis: The Independent Tradition. London: Free Association Books.

16.

Matte-Blanco, I. (1975). The Unconscious as Infinite Sets. London: Duckworth.

17.

——— (1988). Thinking, Feeling, and Being. London: Routledge.

18.

Rosenfeld, H. (1987). Impasse and Interpretation: Therapeutic and Anti-Therapeutic Factors in the Psychoanalytic Treatment of Psychotic, Borderline and Neurotic Patients. London: Tavistock Publications .

19.

Sandler, J. , & Sandler, A.-M. (1998). Internal Objects Revisited . London: Karnac.

20.

Spillius, E.B. (1988). Melanie Klein Today: Developments in Theory and Practice. 2 vols. London: Routledge.

21.

Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic and Borderline Patients. London: Routledge

22.

Winnicott, D. (1958). Collected Papers: Through Paediatrics to PsychoAnalysis . New York: Basic Books.