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This volume makes for excellent reading in that it demonstrates what may be viewed as the ideal route for the further development of psychoanalysis and indeed of all psychotherapy. Its author displays no slavish devotion to any theoretical formulations previously postulated, but adheres instead to his own originality and the conceptions that emanate from his observations. He does not disregard earlier views and gives us informative evaluations of them. He employs selective usage of the concepts of others, notably Winnicott, and, I think, Freud, although he constantly refers to the differences between his work and classical psychoanalysis.
Giovacchini feels that the evolution of psychoanalysis revolves around the treatment of seriously ill patients, commonly referred to as borderline cases. One admires both his courage and his ingenuity in working with some of these very difficult patients. Numerous features of such cases have been emphasized in recent years by many observers, but this reviewer was a little surprised to find no reference to the book of John Frosch, The Psychotic Process (Int. U. Press, N.Y. 1983), and his work on the psychotic character. This reviewer feels that the best definition of the borderline patient is the oldest one, namely, a severely ill patient likely to lapse into psychotic states from time to time.
The author departs from the familiar Freudian route of studying libidinal development, the resolution of instinctual conflict, and the rendering into conscious form of unconscious material. He feels that borderline patients suffer from structural defects of personality, with deficiencies of ego capabilities in dealing with reality, and a resultant faulty picture of the self and of identity. The correction of these problems takes place in the transitional space promulgated by Winnicott; the patient can play and work with new object relations in this space. All of this is elaborated in great detail by Giovacchini and illustrated with many clinica