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Patient: It helps me know if you care about me I count up the number of times you speak, and when I go home I compare that number to the last session That s how I tell how much you re giving me Therapist: Does it matter what I say Client: Not so much What really counts is how many times you tell me why you think I m doing what I m doing Then I know you re really listening to me and concerned about me Therapist: So it s very important that I care about you, and you ve devised a scheme to answer that question for yourself Can you see you re also treating what I m saying as if it were worthless (Kernberg et al, 1989, p 115, emphasis added) This fragment is an illustration of several key aspects of Kernberg s approach.

E who is a native Salvadoran and psychologist Dr E helps Dr D in securing access to the population of immigrants, translates questionnaires into Spanish, and helps Dr D better understand the Salvadoran culture to improve his research study..

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One is the splitting that occurs: The client simultaneously idealizes and devalues the therapist, without any integration of the two The therapist is simultaneously the longed-for caring nurturer, while he or she is seen, projectively, as devalued and empty Kernberg uses both clarification and confrontation concerning the relationship between the therapist and the client (ie, the transference) to push the client to integrate the split self and object relations implied in the interaction Masterson (1981) has a different perspective Rather than emphasizing the child s internalized aggression, he sees the primary problem as the mother s libidinal withdrawal from the child, frustrating the child s separation-individuation process In the most common pattern, the mother discourages separation, instead encouraging dependency and clinging The mother, according to Masterson, is generally a person with BPD herself, who has her own problems with separation anxiety.

Attempts for the child to individuate provoke extreme anxiety in the mother, which in turn elicits caretaking behavior from the child Another pattern is for the child to regress and cling to the mother, failing to individuate, thus gratifying the mother s emotional needs Alternatively, the mother may withdraw, unable to handle the child s dependency needs For Masterson, like Kernberg, the key to understanding the individual with BPD is understanding the part self and part object relations that compose the psyche The mother is divided into two part objects as a function of splitting There is the rewarding object relations unit (RORU), which is the all-good object, and the withdrawing object relations unit (WORU), which is all bad ( hostile, withdrawing, and rejecting) The child can defend against feelings of abandonment in one of two ways.

110 90 70

The first way is to project the rewarding unit onto others (including the therapist), while internalizing the withdrawing unit This leads to clinging subordination The second path is to project the withdrawing unit onto others, while the rewarding unit is internalized Others are thus seen as hostile, critical, and distancing The client avoids thoughts and feelings that interfere with this defense, primarily through denial, and psychotherapeutic progress once again grinds to a halt Abandonment depression, and the defenses built around it, for Masterson, constitutes the heart of borderline psychopathology Masterson calls this constellation the borderline triad: separation-individuation leads to depression which leads to defense (Masterson, 1981, p 133) Similar to Kernberg, Masterson recommends confrontation as the path through which to break this stalemate The purpose of the confrontation is to render the functioning of the split object relations unit /pathologic ego alliance ego alien (p 136).

That is, clients must experience their perceptions of others as part objects (eg, as entirely hostile, withdrawing, bad, or good) as something foreign and in need of repair, rather than as a necessary and adaptive response to reality According to Masterson:.

P7.1 You are planning to purchase a range and have to make a choice among the following three models: Model 1 Cash cost Estimate life Trade-in value at end of life Cash from sale of old machine Installation of new machine Initial training cost in year 1 Annual maintenance contract Annual cost of supplies Annual wage costs of employees $ 5,000 5 years $ 1,000 $ 200 $ 75 $ 350 $ 300 $ 200 $32,000 Model 2 $ 5,500 5 years $ 1,200 $ 200 $ 100 $ 300 $ 275 $ 200 $32,000 Model 3 $ 5,300 5 years $ 800 $ 200 $ 100 $ 250 $ 200 $ 200 $32,000

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