Victim, victimizer: interaction in the psychotherapy of borderline patients

Borderline and narcissistic patients suffuse relationships with intense pregenital aggression to which the therapist, despite his level of training or self-understanding, is not totally immune. Aggression is considered an energetic expression of the narcissistic defense against vulnerability. The therapist is subject to a continuing siege of projections and projective identifications. Vigilance against repetitive sadomasochistic interactions is a necessary and often wearying extension of therapeutic concern. Most necessary, too, is the willingness to make second efforts at understanding the patient's vulnerability. Such understanding comes from attentiveness to countertransference feelings.