Through Bowlby and Mahler towards Masterson: from child study to adult healing

The focus on human personality and its disorders—extending beyond symptom-atology and inner fantasy to concern with the whole self and relationship—has created a paradigm shift in psychoanalysis. Detailed observation and study of growing children and their mothers lent impetus to this change, and gave increased relevance to the object relational concept of the infant’s psychic internalisation of external perception. A leading figure in the treatment of personality disorder, James F. Masterson drew much from Margaret Mahler’s developmental constructs and John Bowlby’s conceptualisations of attachment. In particular, Masterson’s work built upon Mahler’s subphases of separation–individuation in order to define the progression of unmet psychic needs underlying the schizoid, narcissistic, and borderline personality disorders. Relatedly, Masterson’s approach implemented Bowlby’s formulations of secure mother–child attachment in shaping an effective therapeutic alliance. Following Bowlby, Masterson emphasised the patient’s developmental need for a steadfast therapeutic frame and therapeutic respect for the despair suffered by patients coming to grips with the early trauma of insecure attachment. Extensive illustrations of Masterson’s specific interventions with the different personality disorder types are included.