Group psychotherapy with borderline patients is an activity that is fraught with ominous apprehension and it is perhaps for this reason that little research has been done in the field. The aim of the present studies was to map out the area and to test some basic hypotheses about patient and therapist behaviour during the therapy process. Two therapy groups of carefully diagnosed clinical borderline patients were studied by means of video-technique during a therapy process of 20 months. Special technical arrangements and ethical agreements were elaborated for the research. Outcome data was collected concerning the patients’ self-image, symptom-level and personality structure. A follow-up was done 2-3 years after therapy on functional level, capacity for work, medication and need of further treatment. As expected a high drop-out rate occurred. Within a year 40% of the patients had left, and within 20 months 60%. Drop-out was not found possible to predict before the period of therapy commenced but early drop-outs were generally younger and in a more acute state of distress than late drop-outs. In order to study the therapy process two major perspectives were elaborated and operationalized: 1) classification of focus and depth of therapists’ interventions and 2) relational capacity of the patient (Borderline Relatedness). In contrast to remainers, late drop-outs were found most sensitive to disturbances in the frame of therapy (group instability) and were considered prone to interact malignantly with the therapists, eventually leading to drop-out. As to outcome and follow-up, late drop-outs were characterized by the poorest outcome all over, while early drop-outs and remainers were generally more stabilized although the early drop-outs seemed more dependent on medication for their functioning. By means of a principal components analysis the large amount of outcome data was condensed to two important factors: 1) symptom and functional level and 2) direction of anger. Thus, it was found that an important feature of a positive outcome was the ability to function at work and in social life and to direct anger outwards, not just towards oneself, thus protecting and idealizing important others, as was often the case with these patients before treatment. Taken together, the results point to the need for more precise and sensitive diagnostic methods and outcome criteria both to predict and to evaluate therapeutic outcome. To minimize drop-out and negative therapeutic reaction the research speaks in favor of further studying the therapist-patient interaction during the group therapy process and to evaluate the relative importance of therapist interventions and non-specific curative factors. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1989, härtill 4 uppsatser.</p> / digitalisering@umu.se

[pt] Este trabalho consiste numa discussão sobre o destino do objeto nos casoslimite diante das dificuldades envolvidas nas relações primárias com o objeto absolutamente necessário no início da vida psíquica. Quando este objeto falha sucessivamente em desempenhar suas funções adequadamente, em um momento muito primitivo de despreparo subjetivo, a constituição psíquica é marcada por traumatismos primários que impedem o luto e o trabalho do negativo estruturante, ocasionando negativizações que desorganizam o interior do aparelho psíquico e impedem a construção de um espaço de ausência fecundo para o surgimento de representações que estruturam o pensamento. Ao fracassar em sua ação constitutiva, o trabalho do negativo vai operar de forma patológica, impossibilitando o apagamento do objeto primário que é insistentemente mantido no campo psíquico por meio de sucessivas clivagens e idealizações que cristalizam e purificam o objeto. Enquanto a clivagem consiste em uma saída negativizante mal-sucedida que visa afastar as partes não representáveis da vivência traumática que ameaçam retornar desorganizando a frágil delimitação intrapsíquica e intersubjetiva, a idealização excessiva, por sua vez, é uma estratégia defensiva que confere ao objeto uma posição inacessível, rígida e fixa, ação que entrava o trabalho de luto, resultando, assim, no entupimento do espaço pessoal e na obstrução do pensamento. / [en] This dissertation intends to discuss the vicissitudes of the object in borderline patients faced with difficulties involved in relationships with the object absolutely necessary at the beginning of psychic life. When this object successively fails to perform its functions adequately, in a very primitive moment of subjective unpreparedness, the psychic constitution is marked by primary traumatisms that prevent mourning and the structuring work of the negative, causing negative actions that disrupt the interior of the psychic apparatus and prevent the building up of an empty space that could make possible the emergence of representations that structure thought. By failing in its constitutive act, the work of the negative operates in a pathological way, preventing the effacement of the primary object that is consistently maintained in the psychic sphere as a result of hrough successive splittings and idealizations that crystallize and purify the object. Thus splitting consists in an unsuccessful negative action which attempts to get rid of the unrepresentable aspects linked to the traumatic experience, which threaten to return, disorganizing the fragiles intrapsychic and intersubjective boundaries. Excessive idealization, on the other hand, is a defensive strategy that gives the object an inaccessible rigid and fixed position that interferes with the work of mourning, thus resulting in the clogging of personal space and the obstruction of thought.

[pt] A dissertação consiste numa pesquisa teórica que propõe o argumento de os ataques ao enquadre, frequentemente empreendidos pelos casos-limite, constituírem a tentativa clínica de passagem para o campo do uso do objeto. A agressividade não bem manejada pelo ambiente prejudica o reconhecimento da externalidade, resultando numa tendência à destruição que se torna característica central da clínica com estes casos. O trabalho do negativo malsucedido impossibilita a construção do espaço da ausência no psiquismo, fundamental à construção de representações, à instauração das fronteiras intrapsíquicas e intersubjetivas e ao investimento em objetos substitutos. Os prejuízos relativos à agressividade e ao trabalho do negativo redundam na precariedade das fronteiras entre o eu e o outro, sugerindo a prevalência de uma relação pautada na vertente subjetiva do objeto, logo não reconhecido em sua natureza externa. As contribuições de Winnicott e Green fundamentam nossa hipótese de que a destrutividade – expressa na clínica dos casos-limite através dos ataques ao enquadre – consiste numa tentativa atuada de passagem para o campo do uso do objeto, que consolida a unidade do self ao mesmo tempo que possibilita o reconhecimento do objeto na realidade compartilhada. / [en] The dissertation consists of theoretical research proposing the argument that the attacks on the setting, often undertaken by borderline patients, consists on a clinical way of reaching the use of an object. The aggressiveness not well handled by the environment affects the recognition of the externality, resulting in a tendency towards destruction which becomes the central feature in the borderline clinic. The unsuccessful work of the negative precludes the construction of an absence space in the psyche, fundamental to the construction of representations, the introduction of intrapsychic and intersubjective borders, as the investment in substitute objects. Losses related to aggressiveness and the work of the negative result in precarious boundaries between self and other, suggesting the prevalence of a relationship based in the subjective aspect of the object, not just recognized in his external nature. The contributions of Winnicott and Green underlie our hypothesis that the destructiveness – expressed in borderline clinic through the attacks on the setting – consists in an actuated way to reach the use of the object, which consolidates the unity of self while enables the recognition of the object in shared reality.