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Das agora-klaustrophobe Dilemma des Borderline- Patienten – behandlungstechnische Herausforderungen


The claustro-agoraphobic dilemma: Technical challenges in the treatment of Borderline patients

The paper focusses on the clinical manifestations of the agora-claustrophobic dilemma of some Borderline patients as described by Henri Rey. For those patients external and internal space are clued together with the consequence that neither closeness nor separateness can be tolerated. In the clinical situation the analyst is confronted with the problem, that the patient is putting raw, non-symbolized elements into him, which he has to contain, gradually transform and finally return to the patient in a less indigestible form. Referring to detailed clinical sequences the author argues that in this process the analyst’s internal space becomes temporarily deformed and that it is the onset of reparative mechanisms that gradually enable him to re-gain a capacity for symbolic thinking. In this case he may lend his internal space as a »marsupial space« (Rey) to the patient. Theoretically, the tensions that arise from the projection of highly condensed, nonsymbolised part-object relations can be conceptualised as »intrapsychic gravitation waves« to gain a better understanding of the explosive pressure and the implosive pull to which patient and analyst feel exposed to in the transference and counter-transference.