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Fonagy, P. (1991). Thinking about Thinking: Some Clinical and Theoretical Considerations in the Treatment of a Borderline Patient. Int. J. Psycho-Anal., 72:639-656.

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(1991). International Journal of Psycho-Analysis, 72:639-656

Thinking about Thinking: Some Clinical and Theoretical Considerations in the Treatment of a Borderline Patient

Peter Fonagy

INTRODUCTION

The borderline concept

Psychoanalysis and modern psychiatry take opposing approaches to the definition of borderline patients. In the North American clinical literature borderline pathology is seen as a distinct clinical syndrome characterized by impulsivity, pattern of unstable but intense relationships, inappropriate and intense anger, identity disturbance, affective instability, frantic efforts to avoid abandonment, suicidal threats, self-mutilating behaviour and chronic feelings of emptiness and boredom (APA, 1987); (Gunderson, 1984); (Gunderson et al., 1981). Clinicians, working within various psychoanalytic and psychotherapeutic frameworks, who are frequently confronted by pathology typical of borderline patients in so-called neurotic individuals are understandably reluctant to draw sharp distinctions on the basis of concepts and categories which are primarily descriptive (Bion, 1957); (Guntrip, 1968); (Klein, 1946); (Knight, 1953)(Rosenfeld, 1978). Kernberg (1967), (1975), (1985)(1988) takes an intermediate position between a purely phenomenological and a classical psychoanalytic position, preferring to conceive of borderline as a level of psychic functioning characterized by non-specific manifestations of ego weakness, shift towards primary-process thinking, identity diffusion and specific defence operations. Within this framework, borderline denotes a particular type of psychic organization which may be found in quite a broad range of personality

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