The revival of "Dora": advances in psychoanalytic theory and technique

For nearly six decades after its publication in 1905, Freud's remarkable case of Dora remained untouched by critical comment. However, beginning in the early 1970's, an abundance of articles began to appear, which focused exclusively on the Dora case. The present paper reviews the literature of this so-called "Dora revival" in order to explain the historical and theoretical reasons leading to this extraordinary burst of research. Above all, two vital developments in the psychoanalytic discipline created the climate that fostered the Dora revival. First, there was a revolutionary change in attitude toward the phenomenon of countertransference: in contrast to the classical view of countertransference as a disruptive interference in treatment, analysts increasingly regarded countertransference as a pervasive and natural process, which could be potentially utilized to enhance understanding of the patient's unconscious conflicts and defenses. Second, there was enormous and rapid growth of a comprehensive psychoanalytic theory of adolescence and its treatment. Thus, based on a more favorable attitude toward countertransference, and a much improved understanding of the unique problems of adolescence, psychoanalysts could reexamine and better understand the decisive events that contributed to Freud's abortive analytic treatment of Dora.     

A preliminary report on defenses and conflicts associated with borderline personality disorder

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.