L5  - “Why should he listen to my voice?” An illustrated account of some of the difficulties in establishing and maintaining a therapeutic alliance

Abstract for TAoAT 2002 by Deena Northover

The paper will discuss the benefits as well as the limitations of working in the negative transference with an individual with a severe borderline personality disorder.

It was the breakdown of this therapeutic relationship that has led to me to consider the limits to a successful outcome, which are placed upon the therapy by the nature and extent of the causes of the patient’s self-destructive behaviour.

Through the use of art materials and working in the transference we were both able to see and hear glimpses of C’s abusive past and of his hallucinated, persecutory and perverse inner world. I will show and discuss how we also were able to understand how he both sought as well as defended against any benefit or pleasure from my attention in the therapeutic relationship. In C’s mind pain and pleasure were inseparable. My voice could only be heard as seductive and my attentions a sadistic and attempting to lure him away from the more familiar and always available voice of his dead father. Between some sessions and during therapeutic breaks his father’s voice could become louder and more persistent in urging C to harm or kill himself.

The imagery-8 slides-conveys why and how C attempted to fill the gap between fantasy and reality. Although the process of having his negative thoughts and feelings taken up and worked through in the transference enabled C to become more able to take back some of his projected sadism, the therapy could not survive his addictive and masochistic pull towards destructiveness.

Key Words:

  • “Acting out”
  • Borderline personality disorder
  • Negative transference

Patient Group: Adult Mental Health


Biography of Deena Northover

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