Narcissistic Disorder is clinically marked by grandiosity and a sense of unwarranted entitlement. Borderline Disorder is marked by a disabling fear of abandonment, suicidality and splitting. Clinical experience, supported by factor research, indicates a strong overlap of these conditions. The psychotherapist may experience some of the clinical features of Borderline Disorder as narcissistic in themselves, and might find that some of the clinical features of Narcissistic Disorder have a Borderline quality, or a patient might clearly present both full DSM-V Personality Disorders at once. The Conversational Model (Hobson 2003; Meares, 2005, 2012) has continued to integrate clinical experience, theoretical models, and empirical research into various expressions of trauma-based personality disorder and its psychotherapy. Other major figures such as Kernberg (1975) and Kohut (1984) held contrasting views of these conditions and their relationships (Consolini, 1999). Current research findings on subtypes of Narcissistic Personality Disorder, Borderline Personality Disorder and their associations with psychopathy and Machiavellianism (Paulhus and Williams, 2002; Miller et al, 2010) may offer useful clarification for the treating psychotherapist.
In therapeutic conversation there is a co-construction of text by therapist and patient. The language of this therapeutic conversation is crucial: it is both the mode and evidence of intervention. This paper explores the language of the poetic in this context, which is associated with the non-linear, analogical, right-hemispheric form of language outlined in the Conversational Model (cf. Meares et al, 2012:27). This style of conversation is associated with a change in the form of consciousness and cohesion of self (Meares, 2012; Meares et al, 2012).
This paper examines a clinical case in which Heidegger’s work took a central role, where a confluence of Conversational Model and Heideggarian ideas assisted in a current engagement in psychotherapy. In this case, Heidegger’s work functioned in two modes. Firstly, as a shared play-space between my patient and I where analogical relatedness could develop. Secondly, Heidegger’s work also functioned as a literal model for being-in-the-world that over time became integrated into the conversation. This is an example of fit, intersubjectivity and fellow-feeling. Heidegger’s concept of existential authenticity (Eigentlichkeit) derives from that which is owned. If affect is innate, then it is arguable that this is the essence of that which is owned. By engaging with the affect of our patients we are engaging on a fundamentally authentic level.
While verbal art has been regarded as the quintessential expression of what a community shares in a “collective consciousness”, equally it has been studied as the harbinger of experiential innovation. Language affords the chief source of interpersonal solidarity AND a semantic laboratory for what is incipient or even weird (outside the ken of ‘normal folk’). This polarisation of functions can in some cases be explained by changes of artistic taste – mediaeval poetry in Europe was appreciated in terms of its ensemble of standard cultural motifs – e.g. roses, blood, courtesy… Other eras, like our own (in English, at least), have given value to novelty and invention, as well as to highly marked linguistic constructions.