Ruptures or Disruption: Identity Diffusion and the Therapeutic Relationship

Abstract

In the psychotherapy of personality disorders, the limitations of the self and of interpersonal functioning that underlie all personality pathology are both a main treatment focus and a major obstacle in doing so. These limitations are most intensely manifested within the primary aspect of the psychotherapeutic relationship. The core of personality disorders–identity diffusion–refers to a self, tormented by insignificance and annihilation, and by disconnectedness and mistrust. The infant will have internalized a mental state called the alien self that persists alongside an agentive self. This split leads to two domains of primitive dyadic object relations: one dominated by projection of epistemic yearning onto an idealized object, the other by projection of self-rejection onto a demonized object. The therapist remains an alien object in this way, making cooperation within therapy momentarily or even structurally impossible, with a negative impact on the working relationship, and a greater role of the realistic relationship.

Keywords:

• therapeutic relationship
• identity diffusion
• splitting
• object relations theory
• transference-focused psychotherapy
• mentalization-based treatment

Acknowledgements

I thank Victor Kense and Laura Paquette for their insightful comments on earlier drafts of this manuscript.

Notes

1 Schema therapy’s “limited reparenting” (Arntz & van Genderen, 2009) refers to a technique designed to provide support to a patient that the parents failed to provide. This is said to enable patients to internalize the therapist and eventually provide their own support.

Additional information

Notes on contributors

Michel F. M. Boyer

Michel F.M. Boyer, Psy.D., is a clinical psychologist and psychotherapist in private practice in Amsterdam, The Netherlands. He has worked at various institutes treating personality disorders in recent years, including the Netherlands Institute for Psychoanalysis, from which he is recently retired. He is a graduate of the University of Amsterdam.