Notes on countertransference in borderline conditions

"When dealing with borderline or severely regressed patients, as contrasted to those presenting symptomatic neuroses and many character disorders," Kernberg (1975) observed, "the therapist tends to experience rather soon in the treatment, intensive emotional reactions having more to do with the patient's premature, intense and chaotic transference and with the therapist's capacity to withstand psychological stress and anxiety, than with any specific problem in the therapist's past" (pp. 16-17). The argument in the present paper contends that Kernberg's description of countertransference reactions to borderline patients is a caricature that applies only within a limited range of borderline conditions, specifically the most primitive or poorly organized level of borderline functioning or regressive borderline states. The description does not apply to the full range of borderline psychopathology, and in many cases can be misleading. It has generally been recognized that countertransference vicissitudes play an extremely important role in the therapy of borderline patients at one or another phase of the treatment. At critical points in the development of transference (TR) and countertransference (CT) and their interaction, the therapist's recognition of and capacity to deal with CT issues become crucial to the treatment progression. The present paper explores the dimensions of CT experience and provides a tentative model for the understanding of transference-countertransference (TR/CT) interactions. The central points emphasized are: (1) that borderline disorders form a spectrum of character pathology falling between the psychoses on one side and the narcissistic personality disorders on the other; (2) that these conditions reflect varying degrees of pathological disruption and varying levels of personality integration; (3) that, depending on the form of pathological organization, these conditions manifest a variety of types and degrees of intensity of TR involvement and elicit corresponding CT reactions; and, finally (4) that these forms and degrees of TR/CT call for corresponding modifications in therapeutic response.