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Un tempo di domande: il paziente grave all’interno del trattamento classico
Journal Title: SETTING 
Author/s: Leon Wurmser 
Year:  2012 Issue: 33-34 Language: Italian 
Pages:  24 Pg. 81-104 FullText PDF:  110 KB
DOI:  10.3280/SET2012-033004
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This Lèon Wurmser’s papers represented an important piece of our training almost twenty years ago, but some of its questions and suggestions about the "borderline" patients’ treatment seem to have a big value up to now: - the "borderline" term has no clinical mean, expressing our difficulty to recognize the non absolute discontinuity between "classical" and severe neuroses, if the so-called standard tecnique is an a-priori instrument to define the analysis criteria for patients: no pure standard tecnique has ever existed in psychoanalysis, with its prevalent or exclusive focusing on interpretations; - the conflict and the lack models are complementary and not opposite each other; - the psychoanalytic treatment of severe neuroses shows that working through the super-Ego problems need the analyst not play the role of real super-Ego and use the super-Ego transference, but analyze this as deeply as possible to achieve the patient’s intrasystemic conflicts; - we have to treat aggression not as a drive,but through the defences and Superego analysis; theories of Ego’s or Super-ego’s deficit are not useful in these cases; - complementary therapies are often requested (drugs, behavioural-cognitive interventions, couple or family therapy) to help the patient against his overwhelming affects, instead of tryng to build an impossible therapeutic alliance; - following P. Gray’s approach, the results of severe patients’psychoanalytic treatments are good, revealing the importance of super-Ego affects of shame (referred to dependence) and guilt (referred to separation). Wurmser analyzes the core phantasies about guilt and shame affects and super-Ego conflicts by rich clinical material.

Leon Wurmser, in "SETTING" 33-34/2012, pp. 81-104, DOI:10.3280/SET2012-033004


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