A study of the relationship between theory and technique in clinical work with the more seriously disturbed patient (borderline, severe character disorder, narcissistic, and psychotic).

This is a study of the relationship between theory and technique in clinical work with the more seriously disturbed patient (borderline, severe character disorder, narcissistic, and psychotic). Despite the polemics between various psychoanalytic theorists, there is much to learn from all of them. The appropriate question is not "Which theory is right?" but "To what clinical issues can the therapist become more sensitive by understanding a given model?"

Part 1 Four models and their clinical implications: four models of therapy - Kernberg's model
- the representational-deficit
- self-deficit models
- the ego-deficit model
modifications of classical technique
different understandings lead to different clinical interventions
supportive and expressive therapy traditional definitions - difficulties with traditional definitions
- alternate conceptions of supportive and expressive psychotherapy
- further difficulties with traditional definitions
- what is supportive and what is expressive?
- therapeutic potential. Part 2 Variations in the therapist's stance: use of transitional objects - rationale
- role in development
- criteria for use
- clinical use and misuse
the psychoanalytic position - contextual aspects of the therapist's stance. Part 3 Critical inquiry into Kernberg's technique: borderline defenses and their development - neutralization
- achievement of reality testing
- development of the capacity for ambivalence
- structural consequences of splitting
- splittings
- splitting and repression
- examples of splitting
- primitive idealization and devaluation
- denial and projective identification
Kernberg's treatment approach. Part 4 Expansion possibilities within classical technique: the changing conception of the therapist's role
the right and left wings of classical technique
clinical applications - difficulties in working with the disturbed patient in psychoanalytic psychotherapy
- the diagnostic importance of signal and panic anxiety
- reality and the disturbed patient
- the issue of support and gratification
- dangers in reliance on support and gratification
- uses of support and gratification
- planning a supportive psychotherapy
- structural versus dynamic issues
- are conflict and deficit approaches irreconcilable?
- preliminary considerations in clinical work
- the therapeutic relationship
- adjustments
- variations in interpretive focus
- increasing the patient's activity and control
- advice. Part contents.