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Tuttman, S. (1990). Exploring an Object Relations Perspective on Borderline Conditions. J. Amer. Acad. Psychoanal., 18(4):539-553.

(1990). Journal of American Academy of Psychoanalysis, 18(4):539-553

Exploring an Object Relations Perspective on Borderline Conditions

Saul Tuttman, M.D., Ph.D.

For more than 30 years, I have worked with difficult-to-treat patients sometimes called “borderline.” Over this period, I have derived concepts based on clinical experiences, the reports and reactions of patients and colleagues, and an ongoing review of the literature. I have conferred with Kleinians in England and have organized seminars in New York with several object relations analysts who are interested in these patients. When Otto Kernberg arrived in New York in the 1970s, six other psychoanalysts and I were invited to join him in a two-year seminar. Among us were members of the Kris Study Group, which has since published their findings on borderline patients (Abend et al., 1983).

The purpose of this article is to seek perspective for today about object relations in borderline patients, first, by examining the evolution of the borderline concept in psychoanalytic thought, and, second, by considering some of the different object relations approaches in psychoanalytic theory as applied to practice.

The Evolution of Psychoanalytic Theories about Borderline States

Adolph Stern, in 1938, was probably the first psychoanalyst to use the term “borderline” in a paper. He wrote,

It is well known that a large group of patients fit frankly neither into the psychotic nor into the psychoneurotic group, and that the borderline group of patients is extremely difficult to handle effectively by any psychotherapeutic method. (p.

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