Split Self/ Split Object: Understanding and Treating Borderline, Narcissistic, and Schizoid Disorders

Split Self/Split Object helps clinicians to diagnose personality disorders, understand patients’ experiences of these disorders, and provide effective psychotherapy. It is written from the perspective of clinical practice with a minimum of theory. The capacity to be empathic with a patient’s inner feeling states depends on the ability to understand the meaning of the patient’s comments and behavior. This is difficult with patients who have personality disorders because their perception of reality is distorted by their propensity for splitting. The task for the therapist is complicated with them by their sudden swings in attitude toward the therapist and by their tendency to view those attitudes as reality based. Patients with personality disorders speak a foreign language; they use familiar words but in some instances with meanings uniquely shaped by the way they experience the world. This book will improve the therapist’s fluency in the language of personality-disordered patients.

The protective mechanisms used by these patients are relatively primitive and maladaptive, interfering with their function and sometimes making their lives and their therapy sessions chaotic. Split Self/Split Object presents an understanding of the inner dynamics of these patients that explains many otherwise confusing clinical phenomena, details a way of tracking clinical events that make them understandable, and offers a variety of useful forms of intervention.

The first chapter discusses some of the differences in characteristics and treatment between neurotic and personality-disordered patients. The second focuses on common maladaptive defenses used by these patients, giving clinical examples of each and offering useful therapeutic responses. Chapters Three through Five focus in turn on borderline, narcissistic, and schizoid disorders, and include transcript material to provide clear examples of how these patients appear in treatment and how they can and cannot be treated. Chapter Six describes a practical approach to differential diagnosis, presenting it as an ongoing process for deepening one’s understanding of a patient. This chapter addresses the clinician’s actual experience with patients, describing specific points the therapist must consider in evaluating an apparent discrepancy between a patients probable diagnosis and an inconsistent attitude the patient may exhibit. Chapter Seven, the final chapter, focuses on interventions, including the difficult process of intervening in cases involving substance abuse. It provides discussion and illustration of the therapeutic use of a variety of interventions, including an extensive discussion of the use of confrontation in psychotherapy.