Paper Session B
10. Integrating Self Psychology,
Neurobiology and Trauma Theories:
Rethinking Good/Bad "Splits" and
Impasses in Treating Borderline Patients
Presenter: |
Barbara Engelman, MFCC |
Discussant: |
Scott M. Davis, MD |
Self Psychology Page | 23rd Conference Program
Overview
How are we to understand moments of significant disruption in the self-sate of both patient and analyst that may be causative in therapeutic impasses? No where are these disruptions more striking than in the treatment of "Borderline" patients. How best can we conceptualize the dynamics of the therapeutic dyad in a way that will facilitate the restoration of a cohesive sense of self to the patient and therapist so that our therapeutic goals can be advanced?
Borderline Personality Disorder has recently been reconceptualized as originating in chronic trauma within the caregiver/child dyad. This paper seeks to integrate contributions from self psychology, trauma research and neurobiology. These theories are then applied to further understanding of how fluctuations in self-state within the intersubjective transference, countertransference matrix, can lead to the appearance of good/bad "splitting" which is a central borderline characteristic. Additionally, this paper illuminates how these fluctuations in patient and therapist self-state can lead to the dramatic and painful impasses that often occur in the course of treatment with patients diagnosed with borderline personality disorder; and, how this understanding can assist in resolving such impasses. A case discussion opens and closes the presentation illustrating the hypotheses and treatment suggestions offered.