Vägen till terapeutisk allians -konfrontationens roll vid psykoterapi med borderlinepatienter

Abstract

The “borderline” disturbance of mental functioning is considered as a developmental malfunction of the ability to create and hold on to a genuine relationship with other persons. developmental disturbance is described in terms of development of object relations according to Mahler's theoretical work.

The development of object relations is based on the “dialogue of development” between mother and child. The author's concept of this dialogue is one of a feed-back model of ongoing emotional mother-child dialogue. As a result of this “dialogue of development” comes the evolution of an instrument of inner reference, whereby the psychic representations of self and objects permit judgement of the world, forming of relationships etc.

The borderline patient with his split object and self representations has great difficulty in relating to other persons. His split object representations of either hostile or rewarding qualities will be alternatively projected and accordingly will distort the representational world of any relationship. In the paper the difficulties in forming a therapeutic relationship are demonstrated in terms of the “dialogue”, especially the risks from not confronting the borderline patient early in the therapeutic process. The transference acting out and the countertransferential counterpart in this acting out are discussed. A confrontive and non-interpretive technique ought to be used as a means to re-establish a “dialogue of development” in the psychotherapeutic setting, thus paving the road for a genuine therapeutic alliance to be formed. □ Borderline, character disorder, psychotherapy, Therapeutic Alliance.