Treatment issues with borderline patients and the psychosomatic focus.

I have discussed a group of borderline patients who can be conceptualized as having defects in character structure. There is no smooth, hierarchically arranged continuum from lower id-oriented to higher ego, secondary-process organized psychic levels. They suffer from psychic discontinuity, characterized by psychic lacunae, empty spaces devoid of psychological content. These lacunae are often the locus of somatic disruptions, a psychosomatic focus, which are manifested as psychosomatic symptoms. Though the treatment of these patients can be stormy, and, in some instances impossible, providing a setting in which these patients can comfortably regress and eventually get in touch with split-off parts of the self can lead to a manageable therapeutic interaction. On occasion, this might be life-saving.