Ego and superego alterations in borderline structures: their effect on the process and outcome of treatment

The intermediate variable establishing the link between pathological structural alterations and aetiopathogenic factors, whether constitutional or acquired, might correspond to mental substructures derived from defensively altered and pathologically internalized object relations. Some basic postulates, connected to this central thesis, guided a brief, introductory critical review of two controversial areas in the treatment of borderline structures: (a) the relationship between mental models and developmental theories and (b) the relationship between mental models and therapeutic approaches. Since the axis of this paper centred around the limitations determined by structural alterations produced by defences, I then outlined some aspects of the treatment of a patient with severe character pathology, laying particular stress on: (a) the clinical manifestations of ego and superego alterations and their influence on the process and outcome of treatment; (b) the impediments and complications stemming from early superego precursors, with reference, in particular, to the therapeutic frame and psychoanalytic tactics; and, finally (c) the limitations and vicissitudes of the interplay of specific and diatrophic (non-specific) aspects of the analytic work in the task of promoting emotional growth.