Truth as a way of developing and preserving the space for thinking in the minds of the patient and the analyst

Abstract

Clinical material from the analysis of a young patient diagnosed with borderline personality disorder and heavily dependent on drugs was examined to identify changes in setting that may be necessary to enable the psychoanalytical treatment of this type of patient. The article describes a lack of truth in the patient’s life and the absence of a good enough space for thinking in her mind. In order to enhance the development of the capacity for symbolization in the patient’s mind, the analyst had to become an object the patient needed. In order to do this the analyst had to manage setting alteration. Theoretical frameworks proposed by Ferenczi, Winnicott and Bion were used to guide the psychoanalyst’s approach to this patient. The survival of the capacity for thinking psychoanalytically inside the analyst’s mind when the setting has been significantly distorted by the disruptive behavior of the patient is guaranteed by the trueness of their link. It is suggested that maybe this is decisive for a successful psychoanalytical treatment of this type of patient.

Key words:

• abstinence
• borderline personality disorder
• borderline transference
• changes in setting
• neutrality
• substance‐related disorder/drug addiction
• truth in the analytic pair