The beginning of wisdom is never calling a patient a borderline; or, the clinical management of immature defenses in the treatment of individuals with personality disorders.
In individual psychotherapy of personality disorders, patients' uses of the less mature ego mechanisms of defense can detrimentally affect the intersubjective field. The diagnostic epithet "borderline" often reflects unconscious countertransference more than it does diagnostic precision. Psychotherapists can avoid the deleterious effects of such countertransference by being attentive to the ways their patients' defensive styles affect the therapeutic dyad and by learning to collaborate with self-help groups. The author discusses strategies for managing in individual psychotherapy seven immature or image-distorting defense mechanisms: splitting, schizoid fantasy, hypochondriasis, projection, turning against the self acting out, and neurotic denial.
Dartmouth Medical School, Hanover, New Hampshire.
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Vaillant