The book takes the reader "into the trenches" with the author as he
describes his psychoanalytic work with a variety of patients with
difficult and complex conditions. The reader becomes familiar with the
clinical and theoretical difficulties psychoanalysts encounter in their
day to day practice with such patients, especially the
counter-transference reactions so common with patients who rely on rigid
defense systems. While presented from a Kleinian viewpoint, the book is
written in a very inclusive and flexible manner that brings together a
variety of analytic thought and provides easy access to the reader
unfamiliar with Kleinian theory. The book provides a wealth of in-depth
clinical material including severe personality disorders, chronic
depressive conditions, pathological phantasies of grief and loss, and
destructive states of narcissism. Each chapter provides a vivid look
into the workings of psychoanalytic treatment in the context of the
contemporary focus on understanding projective identification,
enactment, acting out, and the careful and thoughtful interpretive
working through of these complex clinical situations. Much of the book
also addresses how to notice, learn from, and utilize these volatile
moments. Indeed, once properly understood, what once was fertile ground
for the analyst's acting out can become a bridge to better translating
and interpreting the patient's core anxieties and providing a
therapeutic experience of change and growth. This volume shows the
therapeutic power the modern Kleinian approach can have with patients
throughout the diagnostic spectrum. By attending to the interpersonal,
transactional, and intra-psychic levels of transference,
counter-transference and unconscious phantasy with consistent
here-and-now and in-the-moment interpretation, the Kleinian method can
be therapeutically successful with severely neurotic, borderline, and
narcissistic patients. By making the goal of psychoanalytic treatment
the gradual establishment of analyst contact, a broader range of
patients can be helped and understood.
