The Patient and the Analyst: The Basis Of The Psychoanalytic Process By Joseph Sandler, Christopher Dare, and Alex Holder.  International Universities Press, Inc., New York, 1973,  150 pages.

The authors assert in their preface that they are embarking on a research study of basic psychoanalytic concepts because of the “difficulty they encountered in teaching psychoanalytic theory to intelligent post-graduate students of psychiatry.” They realize “the difficulty was due, in no small part, to a lack of clarity in the concepts themselves.” The concepts are revealed in the introduction as “not well defined theories” which developed multiple meanings through the varying biases of different psychoanalytic schools. The authors attempt clearer communication by clarifying and redefining the psychoanalytic concepts in terms of the varied biases and their historical settings.

Four phases of psychoanalytic conceptual development are described. The first phase was from 1881 to 1897. Freud in his early work with Breuer indicated that repressed real traumatic events were converted into symptoms because of their need of expression. This is named the traumatic theory of neurosis. In the second phase, from about 1900 to 1923, the topographical model of psychoanalysis replaced the traumatic model. According to this model, the unconscious and instinctual drives, particularly the sexual drive, become attached to important figures in early childhood. When these become conflicting or opposing wishes they produce a source of conflict of ambivalent attachments. These conflicts repeat in adult life the infantile attachment and conflicts of love and hate, usually through the unresolved Oedipus conflict.

In the third phase, from 1923 to 1939, the structural division of the mental apparatus was developed into the id, ego, and superego. Sandler indicates that Freud did not change previous concepts to a “further point of view by replacing prior concepts with the new, but maintain[ed] the new aside the old.” This resulted in a lack of consistency, coherence, and integration of the classical psychoanalytic model. The fourth phase represents contributions by other psychoanalysts since Freu