Superego pathology in borderline conditions: Impediments to establishing a therapeutic alliance

Recent advances in the diagnosis and treatment of borderline conditions have imposed upon the clinician not only the task of a clearer differential diagnosis, but the finer job of diagnosing those factors which may speak for the patient's capacity to build up a growth-inducing working alliance. Among such factors, considerations regarding superego functioning have a crucial importance. In this work, a brief exploration of structural defects in borderline conditions, particularly superego-related defects or malfunctioning, is illustrated with three clinical vignettes. Some treatment considerations conclude this work, namely, considerations related to: the therapeutic frame; the facilitation of superego growth; and some notes on sectors of therapeutic mis-alliances and interactional symptoms and syndromes.