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Chapter 9.Midphase of Treatment

Movement Toward Integration With Episodes of Regression
https://doi.org/10.1176/appi.books.9781615371006.fy09

Sections

Primary Tasks of the Midphase of Treatment | Range of Sexual Relationships in Patients with BPO | Deepening the Understanding of Splitting and Striving Toward Integration | Following Shifting Projections: Integration and Improvements in Reality Testing | Cycles of Increasing Integration With More Contained and Limited Projection | Expanding the Focus of Therapy in the Midphase | Balancing Attention to the Transference and to the Patient’s Outside Life | Relating Internal Representations, Developmental Identifications, and Projections | Patient Improvement and the Reaction

Excerpt

The patient enters the midphase of treatment when some equilibrium is established, characterized by increased acceptance of the treatment frame and a corresponding decrease in the chaos in the patient’s life and intensification of affects in the sessions. The overt behavioral manifestations of conflict and turmoil that may characterize the beginning phase are contained for the most part. Affects, both positive and negative but usually extreme, become more intense in the sessions. The work of deepening the exploration of the transference themes can progress with a diminished threat of treatment dropout or acting-out behavior (although these may recur at times of regression). Time in the sessions alternates between reexperiencing intense conflicts in the relationship with the therapist and mutual exploration of these conflicts, with the goal of increasing the patient’s capacity to reflect on his or her internal experience and on its impact on his or her relationship with others outside the sessions.

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