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The authors present preliminary psychodynamic findings from a naturalistic study of borderline personality disorder compared to antisocial personality disorder and bipolar type II (depression with hypomania) affective disorder. An independent psychodynamic interview of each subject was videotaped from which ratings were made of the presence of 22 defense mechanisms and 11 psychodynamic conflicts. A factor analysis of ratings from 81 subjects supported the separation of borderline (splitting, projective identification) from narcissistic defenses (devaluation, omnipotence, idealization, mood-incongruent denial). While certain groups of defenses were associated with each diagnosis, defense ratings did not significantly discriminate the three diagnostic groups, suggesting a limit to their diagnostic value. Among 27 subjects rated, borderline personality was strongly associated with two conflicts: separation-abandonment, and a global conflict over the experience and expression of emotional needs and anger. Antisocial personality was psychodynamically distinct and more heterogeneous. Bipolar type II was associated with two hypothesized depressive conflicts: dominant other and dominant goal. Chronic depression, which was more common in both personality disorder groups than in bipolar type II, was associated with a third depressive conflict, overall gratification inhibition. Overall, conflicts were powerful discriminators of the three diagnostic groups. The heuristic value of these findings is discussed.

Psychoanalysis began with a focus on how the "intrapsychic" defense mechanisms of the individual helped to reduce and control conflict. More specifically, defenses were seen as helpful in managing the intensity of needs, desires, and affects that inevitably lead to conflict as the individual encounters the needs and desires of others around him. While the earliest theory of defenses focused more on maintaining internal equilibrium, contemporary theories of defense are seen as part of a set of relational and cognitive patterns that develop in the context of close relationships with important others. In the more contemporary psychodynamic approach to defense, many defenses are seen as protecting the self-esteem of an individual rather than axiomatically protecting an individual from becoming conscious of thoughts or ideas that would cause anxiety were they to be remembered or recognized. The shift to more object relational and interpersonal approaches for the understanding of defense has had major implications for clinical treatment, which are examined in this article.There is a paradox at the center of psychoanalytic theory, one centered on the issues of continuity and change. Psychoanalytic theory attempts to explain why people repeat patterns and are driven to stay the same. Psychoanalytic therapy as a method of treatment also tries to explain how people can change. Indeed, psychoanalytic therapists believe that it is through the process of repeating patterns with the therapist that change comes about. As Philip Bromberg (1995, p.176) put it, "The human

Most discussions of countertransference disclosure have focused on points of impasse. Here, I will discuss countertransference disclosure in which the analyst attempts to make explicit to the patient how the analyst experiences something during an analytic session that differs from the way the patient experiences the same moment. The analyst presents his observation as something for the patient and analyst to work on together, with the aim of arriving at further understanding. In a clinical example, I suggest a way of comparing uses of countertransference that relate to other approaches in analytic technique. Since the analyst's disclosure evokes questions regarding asymmetry and anonymity in the analytic process, I will briefly elaborate these dimensions.