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It is difficult to locate, understand, and interpret the transference state of some patients In the course of psychoanalytic treatment. This paper examines the use of the countertransference to assist in making "analytic contact," the analyst's attempt to engage the patient in an exploration of unconscious phantasies, transference patterns, defenses, and internal experience of the world. The goal of analytic contact is the identifying, understanding, and working through of core object relational phantasy states. Countertransference can be valuable in helping analysts find their way to the transference, especially when projective identification processes exclusively shape it. Case material, examined from a Kleinian perspective, is used to show work with patients exhibiting difficult to access transference states primarily determined by projective identification based phantasies. [ABSTRACT FROM AUTHOR]

People with borderline personality disorder (BPD) often describe a longstanding depression or dysphoria central to the disorder. The dimension of chronic inner dysphoria is reflected in the DSM criterion of "emptiness" and is demonstrated on self-report measures of depression. In this paper, we report on outcomes for patients with BPD treated with outpatient psychodynamic psychotherapy based on the Conversational Model. Data were collected using the Zung depression scale and the Westmead severity scale at 1 year and at 2 years from two groups of patients. One group had 1 year in psychotherapy, the other had 2 years in therapy. While general symptom scores improved steadily over time in the two-year group, gains for the one-year group tapered off in the second year. Change in depression scores continued at an unchanged rate in the second year for the two-year group compared to a leveling out of gains in the group treated for one year. Gains in general symptom scores were more substantial, suggesting that change in affect occurs more slowly than other symptomatic changes. Drawing upon our findings and those of others in the field, it appears that this slowness of affective change may reflect that patients with BPD have an inner world where predominant negative affectivity became established early in life in the context of disturbances of relatedness. This has implications for the appropriate duration of psychotherapeutic engagement with this group. We argue for more prolonged psychotherapy in this group, which is consistent with current understanding of processes of attachment and development. [ABSTRACT FROM AUTHOR]