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Akhtar, S. (1995). Treating The Borderline Patient: A Contract-Based Approach. By Frank E. Yeomans, Michael A. Selzer, and John F. Clarkin. New York: Basic Books, 1992, 210 pp., $35.00.. J. Amer. Psychoanal. Assn., 43:270-275.

(1995). Journal of the American Psychoanalytic Association, 43:270-275

Treating The Borderline Patient: A Contract-Based Approach. By Frank E. Yeomans, Michael A. Selzer, and John F. Clarkin. New York: Basic Books, 1992, 210 pp., $35.00.

Review by:
Salman Akhtar, M.D.

Freud (1905) emphasized that an individual must possess “a fairly reliable character” (p. 263) in order to be suitable for psychoanalysis. However, many of his early pupils and subsequent “second generation” psychoanalysts sidestepped this reminder. Motivated by therapeutic good will and idealization of their discipline, they attempted to treat severe character deformations by means of the usual psychoanalytic method. The results were disappointing. Such patients (with their excessive narcissism, hypersensitivity, masochism, affective instability, fragile object relations, pervasive projective mechanisms, and tenuous grip on reality) did not respond favorably to psychoanalysis. Clearly, the “widening scope of indications for psychoanalysis(Stone, 1954) demanded a reconsideration not only of the psychoanalytic theory of development and psychopathology but also of the potential resilience of the analytic technique.

Two paths emerged as a consequence of such reconsideration. The first is represented by the psychoanalysts of the British Middle Group (Winnicott, Balint, Guntrip, and their exponents Casement, Wright, Bollas, et al.) and, in this country, by Kohut, Modell, and Adler. The second path, embodying a synthesis of certain Kleinian notions with contemporary ego psychology, is exemplified by Kernberg and those who have extended his work. These two conceptual approaches can be seen as representing, respectively, the “romantic” and the “classic” visions of psychoanalysis (Strenger, 1989).

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