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The pathology of the holding environment in families of borderline, schizoid, and narcissistic adolescents is reviewed. A model for family therapy is described in which this pathological family environment can be examined. In this model, the family therapists function to contain displaced, projected, and acted-out affects and impulses. A clinical example illustrates how a therapist's capacity to acknowledge, bear, work through, and redirect these impulses in the family treatment offers family members an opportunity to reestablish previously severed communications, allowing for continued family support at a critical period in the adolescent's development.

This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations-including transference reactions-have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed.

This paper explores two marital constructs set forth by Peter Giovacchini. The first is based on a symbiotic reenactment in which the investment of both partners is tenacious and reciprocal, an attachment which Giovacchini refers to as a "character object" relationship. It represents intrapsychic homogramy. In the second construct, this deep form of attraction is absent and the dyadic bond is superficial, frequently transitory. The latter couples do not require an elementary, intrapsychic bond but do share particular defensive traits or symptoms. Thus these unions are termed "symptom object" relationships and are characterologically heterogamous. By means of a group case study approach, this distinction was statistically supported. Furthermore, it was found that homogamous marriages stay in treatment longer, maintain a lower divorce rate, and respond best to individual psychoanalytic psychotherapy. Heterogamous marriages, by contrast, show a higher divorce rate and tend to leave therapy prior to termination. The research also suggests that the initial treatment of choice for this type of marriage may well be conjoint or group psychotherapy.

This paper discusses and compares Freudian and Kleinian conceptions of the development of early mental life from the vertices of the genetic hypothesis (and reconstruction), the infantile neurosis, the conception of the evolution of the infant, the issue of reality, and the oedipus complex. In so doing, some of the newer findings of infant development are considered. We can now correlate Kleinian conceptions of early infantile reconstruction in light of these new developments; this paper seeks further to demonstrate that the classical notion of primary narcissism, which is laterally known as the conception of the self-object representation, is incompatible with notions of infantile psychology and therefore leaves the classical conception of early mental life in an ambiguous state. An attempt is made to redress this by reconciling the classical and Kleinian notions via a "dual-tract" theory.

It is argued that the borderline personality organization as now conceived embraces a spectrum of differentiable diagnostic groupings. Lumping these diagnostic clusters under a single descriptive heading contributes to continuing conceptual ambiguities and theoretical confusion in the understanding of borderline psychopathology. A potential differentiation of borderline entities on clinical grounds is suggested. The bases for discrimination of higher-order borderline conditions versus lower-order conditions are explored. Current accounts of borderline pathology tend to focus on lower-order pathology as characteristic, but do not account for the full range of the borderline spectrum. Other potential discriminations between an hysterical continuum and an obsessional-schizoid continuum are explored. Differential diagnoses suggested include pseudoschizophrenia, psychotic character, borderline personality, and primitive hysteric in the hysterical continuum; schizoid personality, false-self organization, and as-if personality in the schizoid continuum. The syndrome of identity diffusion is also suggested as part of the borderline spectrum.

In this paper the primitive defenses first described by Melanie Klein under the label of "schizoid mechanisms" are examined. The defenses considered are splitting the pathological uses of identification and projective identification, and the psychotic forms of denial. This examination is twofold: (1) the cognitive aspects of these defenses as described in terms of concepts developed by Jean Piaget; (2) concrete examples of the operation of these defenses during the treatment of schizophrenic patients are given and the effects of interventions based on the cognitive analysis are described. It is stressed that at times interventions, such as interpretation and confrontation, based on cognitive analysis, can temporarily and in some instances even permanently stop the operation of these defenses, allowing emotionally meaningful material to emerge which expedites the therapeutic process.