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The author's atheoretical approach that relies on the specifics of the clinical data will be most useful for the relative beginner who can benefit from detailed instruction in a way of listening and guidance on how to intervene. The book will be of less interest to the psychoanalytic reader or to the more sophisticated practitioner. The author says quite directly, “In this book, emphasis is placed on supportive psychotherapy leading to control of maladaptive defenses, rather than the repair of psychological deficiencies…. The readers of this book, as well as their patients, are likely to have more modest goals, and achievement of these goals will necessitate the modification of defenses.” From his own perspective, the title of the book is very misleading, promising as it does a psychoanalytic, structural, object relations approach.
Although the author makes clear this is not psychoanalytic therapy, he is obviously “analytically informed.” He compares the approaches of Masterson and Kohut, attempting to find a comfortable place between the two.
Manfield approaches treatment with the defenses as his focus. They are described and elucidated with generous clinical material, as is the book overall. The extensive verbatims are juxtaposed with the author's thoughts about the interaction and his clinical rationale for responding as he did. The book will be very valuable to the beginner who most often is confused by too much theory and who needs more of the nuts and bolts of listening and responding. The author relies on his own obviously fine clinical intuition in this process.
Manfield divides the personality disorders into three distinct categories: borderline, narcissistic, and schizoid. Of these the author says, “All three categories have in common the patient's difficulty in connecting to his inner self, impairing his ability to reference his own values, preferences, thoughts and feelings in order to make life choices, develop intimate relationships, and resolve tensions