Session 2

Question 1

What is the therapeutic split?

Answer 1

A capacity of the patient to distinguish between the observing and experiencing parts of the self.
e.g. paranoid man who is neurotic vs. borderline/psychotic

Question 2

Neurotic organization (characteristics)

Answer 2

High level of capacity to function despite emotional suffering.

• Integrated sense of identity
• Continuous inner experience
• In solid touch with “reality”
• Patient and therapist are on the same side from the start

Question 3

Psychotic organization (characteristics)

Answer 3

• Much more internally desperate and disorganized
• Easy to diagnose when in a state of psychosis (hallucinations, delusions, ideas of reference, illogical thinking)
• Struggle with identity on an existential level (Do I exist?)
• No continuity of identity
• Not anchored in reality
• Lack reflective functioning (difficulties with abstraction)
• Experience mortal fear and dire confusion
• May induce a positive countertransference (but can get too consuming in their needs)

Question 4

Borderline organization (characteristics)

Answer 4

• Rely heavily on primitive defense mechanisms (like psychotic organization)
• When confronted on using a primitive mode of experiencing, they will at least show temporary responsiveness (psychotic: become more agitated)
• Lack theory of mind, mentalization
• Self is likely to be full of inconsistency and discontinuity (still, they know they exist)
• Have trouble with affect tolerance and regulation
• Reality testing is usually intact
• Lack capacity to observe their own pathology
• React with hostility when given intervention ideas by therapist
• Transference tends to be strong (either all good or all bad)
• Countertransference tends to be strong and upsetting (even when positive - may be consuming)