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the resulting affects, and defensive operations (not deficits). Multiple compromise formations arise during each developmental era (Blackman, 2013). Sometimes material from an earlier developmental phase shields against consciousness of later conflicts (‘libidinal regression’ [Freud, S., 1905]); at other times, conflicts from later development defend against unconscious conflicts from earlier developmental phase (handled by ‘reconstruction upward’ [Loewenstein, 1957]; also called ‘reaching up’ [Volkan, 2014]). III. Beb. Treatment and Technique Selection To asses analyzability , Elizabeth Zetzel ’s (1956) concept of therapeutic alliance and Ralph Greeson ’s working alliance (1965), with components of mutuality of purpose, trust and ethics (Meissner 1992) may carry a special significance. These clinical/technical concepts, in line with Hartmann’s (1939/1958) conceptualization of ‘relatively conflict-free ego functioning’, seem to have evolved from Freud’s idea that the analyst and analysand “form a pact with each other” (Freud 1940 [1938], p. 173), unobjectionable positive transference (Freud 1912, 1915d), and, especially where Greenson’s working alliance is concerned, from Fenichel’s ‘rational’ transference’ (1941). Greenson (1965) enumerates a list of the patient’s ego functions, that play an important part, in addition to a role of object relations that are needed to ‘do the analytic work’. These include, but are not limited to communication in words , with feelings; partial regression, free association; listening to the analyst, comprehending, reflecting, and introspection, memory, self-observation and fantasy; ability to develop transference and the capacity to maintain contact with the reality of the analytic situation. It is the oscillation between these two positions that is essential for analytic work. As psychoanalysts began to consider how to modify technique for other-than-typical neuroses, so called ‘ widened scope ’ patients, Leo Stone (1961), Jacobson (1964), Kernberg (2008, 2016) and others described their approach with patients with preoedipal pathologies. Although ego strengths and object relations show damage in both psychoses and “near- psychoses” (E. Marcus, 2012), analytically informed ego-fortifying interventions (Frosch, 1988), together with the building of more adaptive defenses (Blackman, 2003), and safe and stable object relations (Fromm-Reichmann, 1947; Alpert, 1959; Kernberg, 2008, 2015, 2016), in addition to psychotropic medication, have been recommended. Severe damage to ego and/or superego functions represents one end of the diagnostic spectrum (Willick, 2001). Some patients, whose functions are somewhat less damaged, may be helped through analytically-based relational (Mitchell, 2000) approaches, self and intersubjective approaches (Atwood, Orange, & Stolorow, 2002), which utilize concepts of reality testing, wish, and defensive activity in addressing pathology and treatment of patients with disturbances in self-image. Some severely ill patients with a somewhat less disturbed integrative or reality testing functions – so-called “near psychotic” (Doidge, 2007) may benefit from “reconstruction upward” (Loewenstein, 1957) or ‘Transference Focused Psychotherapy’ (Kernberg, 2008), both of which utilise specifically modified dynamic interpretative approach. Others, who view psychosis as the result of pathogenic projective-introjective mechanisms,
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