From Borderline Adolescent to Functioning Adult: The Test of Time by James F. Masterson & Jacinta Lu Costello

From Borderline Adolescent to Functioning Adult: The Test of Time by James F. Masterson & Jacinta Lu Costello

Author:James F. Masterson & Jacinta Lu Costello
Language: eng
Format: epub
ISBN: 978-1-317-83938-5
Publisher: Routledge


8

Mild Impairment (Group B)

Four of these seven patients are described in this chapter. All seven were rated mild impairment because, although their surface functioning was adequate, when one looked beneath that surface at the psychodynamic basis responsible for that functioning, it became apparent that there was less improvement in self-representation than the subgroup A patients and a more intense need for defense against separation anxiety and abandonment depression. Although they felt better about themselves and were somewhat better able to assert themselves, this change was mild compared with the subgroup A patients. They could not take direction of their lives. They could not identify what they wanted and activate and pursue their interest in reality. There was moderate pathology in the self-representations as well as in object relations.

ELLEN

FOLLOW-UP SIX YEARS AFTER DISCHARGE

History of Present Ilness

The case of Ellen, 16, is a good example of the clinical and developmental aspects of the splitting defense mechanism. Eighteen months prior to admission, Ellen, at age 14½, came into intense conflict with her father who disapproved of her socializing with a girlfriend who wore low-cut dresses. He called the friend, Amy, a whore. Fights between Ellen and her father increased in frequency and intensity because she continued to associate with friends her father disapproved of, broke curfews, and dressed in a manner to which he objected. If her father forbade her to wear dungarees, she would sneak them out of the house in her purse. Ellen began to smoke marijuana and occasionally to act out sexually. During this period, Ellen and Amy were sent home from school for smoking.

There were increasing confrontations between Ellen and her father, during which he accused her of being a slut and a whore, and at times slapped her. He objected particularly to her association with Amy, whom Ellen described as being “all screwed up and taking all kinds of drugs.”

On one occasion, two weeks prior to her admission, Ellen’s father picked up the phone extension and could hear that Amy was talking to his daughter. He told Amy to stop talking to his daughter and not to call again. The next morning Ellen sneaked out of the house and ran away to Chicago with Amy, where both girls stayed with a friend. Ellen’s father traced them, got in touch with the Chicago police and arrived there himself six hours later. After this episode, Ellen was hospitalized.

The history of present illness, as well as the initial interview, was inundated by Ellen’s rage at her father and by unremitting conflict with him. Her mother was portrayed at that time as a positive, supportive figure: “My mother is the opposite of my father, very giving and understanding. I could see nothing good in my father—my mother and I had a good relationship. I know I could go to her and talk. With my father, I’d go berserk—yelling, screaming and talking about killing him.”

Ellen dealt with her anxiety about her rage at the frustrating mother—the negative WORU—by splitting and projection: She retained



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