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This is a well-developed presentation of various approaches to “self development,” “object relations,” the “psychology of the self,” and “short-term dynamic treatment.” The above-mentioned authors, as well as Shelley Barlas Nagel, Ph.D., Ralph Klein, M.D., and Karla Clark Ph.D., present cases illustrating “lower-level borderline personality disorder,” “narcissistic personality disorder,” and “borderline personality disorder” syndromes. These are the varieties of pathology used by the various authors to compare and contrast their diverse approaches to therapy and theory.
The authors make very clear the differences in approach that require new varieties of theory and treatment. It is these varieties that yield a most enlivening discussion. Tolpin differs with Masterson, for example, as to the management of the self-object transference formations. She offers a “helping hand” in contrast to approaches that are more confrontational. You do not order the patient “to pull himself together.” Thus, she discerns not simply a neurotic defense such as attachment but a global devitalization process that calls for direct assistance in all ways possible. She recognizes the power of self-hatred and thus the urgency of such intervention.
Sifneos responds indicating that his mode of relating to the therapeutic process cannot be self-involving enough for he uses his own feelings as the measure of what his patients are experiencing. “Dr. Tolpin, when you say the patient might feel the shame I also would feel ashamed if I descended from the moon and all of you were speaking in a different language. I would feel completely alienated.”
By contrast, Masterson views Tolpin's approach as running “into serious risks because it drastically diminishes the patient's reality perception and draws her into the world of fantasy and emotion.” Masterson describes a difference between transference and the therapeutic alliance. It is from the latter that self-activation evolves as the therapist provides co