Variations in the analytic holding environment.

The concept of the holding environment has been used previously to characterize the treatment needs of severely regressed patients (Winnicott, 1963b). This holding of dependence is contrasted with the holding needs of narcissistic, apparently disengaged patients (Modell, 1976). The present paper considers the type of holding required by difficult, borderline patients. It is suggested that these borderline patients need a holding of their ruthlessness and rage, and also of analytic self blame. Clinical vignettes describe the holding of an anxiously demanding and of an overtly hateful borderline patient. The patient in a holding environment evokes widely divergent countertransference reactions. These range from maternal nurturing feelings with extremely dependent patients (usually those emerging from profoundly schizoid states), to feelings of annihilation with narcissistic patients and of deep self doubt, anger and destructive wishes with demanding or hateful borderline patients. In the treatment of narcissistic and borderline patients, the holding environment metaphor may help the analyst tolerate these difficult countertransference feelings. Clinical examples of each type of countertransference reaction are presented.